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Background We assess the effect of Coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. Materials and Methods From April 1st 2020 until July 31st 2020, OMF Surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information gathered included clinical presentation, mechanism of injury, and how it was managed and whether or not treatment included surgery. Participants were also asked to compare the patient’s care with the treatment, which would have usually been given prior to the crisis. Results Twenty-nine units across the UK contributed with 2229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and mandible fractures (13%) for hard tissues. Of 876 facial fractures, 79 patients had treatment, which differed from that which would be normal pre-COVID and 33 had treatment deferred meaning 112 (14%) patients received care at variance to normal practice because of COVID restrictions. Conclusions The pattern of OMFS injuries changed during the first COVID-19 lockdown period. For the majority, best practice and delivery of quality trauma care continued in spite on-going operational challenges. Changes to treatment affected only a small proportion of patients. The lessons learnt from the first wave combined with adequate resources and pre-operative patient testing should allow those facial injuries in the second wave to receive best practice care.

OMFS training is perceived as a long and expensive pathway although papers have shown it compares favourably with other surgical specialties. Every OMFS clinician has a vested interest and duty continually to improve the quality of training and minimise costs, especially to trainees at junior levels. Any serious proposal to fundamentally change the format of training, must be given due consideration by all stakeholders. In 2016, a British Medical Journal article whose authors included the BAOMS President of that year and OMFS Specialty Advisory Committee (SAC) Chair, posed the question - should the future of OMFS training revert to single dental degree, change to single medical degree - or continue as a dual degree specialty? The BMJ publication was discussed at the British Association of Oral and Maxillofacial Surgeons (BAOMS) Council in March 2016 and all present unanimously supported the dual degree pathway. Later that year a formal proposal was made by the BAOMS immediate past President that training in the UK change to single medical degree ‘Maxillofacial Surgery’ similar to the training in Spain, France or Italy. Evidence around the risks and benefits of making this change to OMFS training was assembled and reviewed by BAOMS Council in March 2017. BAOMS Council once again unanimously supported continuing OMFS as a dual degree specialty with the observation that the quality of patient care which this training provided was the specialty’s Unique Selling Point or USP. The requirement for both degrees to provide care for OMFS patients had been confirmed by external scrutiny on two separate occasions by the responsible regulators. In this paper, we outline the key steps to be considered when making major changes in the OMFS training pathways using this event as an example and the suggestion that those proposing changes should assemble and present evidence to support their proposal using the template provided.

INTRODUCTION: Atrial fibrillation is the most frequently diagnosed cardiac arrhythmia globally and is associated with ischemic stroke and heart failure. Patients with atrial fibrillation are typically prescribed long-term anticoagulants in the form of either vitamin K antagonists or non-vitamin K antagonist oral anticoagulants; however, both carry a potential risk of adverse bleeding.AREAS COVERED: This paper sheds light on emerging anticoagulant agents which target clotting factors XI and XII, or their activated forms - XIa and XIIa, respectively, within the intrinsic coagulation pathway. The authors examined data available on PubMed, Scopus, and the clinical trials registry of the United States National Library of Medicine (www.clinicaltrials.gov).EXPERT OPINION: Therapies targeting factors XI or XII can yield anticoagulant efficacy with the potential to reduce adverse bleeding. Advantages for targeting factor XI or XII include a wider therapeutic window and reduced bleeding. Long-term follow-up studies and a greater understanding of the safety and efficacy are required. Atrial fibrillation is a chronic disease and therefore the development of oral formulations is key.

Our aim was to conduct a sex-disaggregated analysis of pulmonary and systemic vascular function in healthy individuals both at rest and during submaximal exercise. Healthy individuals underwent right-heart catheterization at rest and during submaximal cycling. Hemodynamic data were collected in a control state and with moderate exercise. Pulmonary and systemic vascular variables including: compliance, resistance, and elastance were calculated, indexed to body surface area (BSA), adjusted for age and compared between male and female sex. Thirty-six individuals (18M/18F; 54±7 vs. 58±6 years, p=0.04) were included. When adjusted for age and indexed to BSA, total pulmonary resistance (TPulmR) (516±73 vs. 424±118 WU•m-2, p=0.03) and pulmonary arterial elastance (PEa) (0.41±0.1 vs. 0.32±0.1 mmHg•mL-1•m2, p=0.03) were higher in females vs. males. Both pulmonary (Cpa) and systemic compliance (Csa) were lower in females vs. males however lost significance with adjustment for age. Systemic arterial elastance (SEa) was higher in females (1.65±0.29 vs. 1.31±0.24 mmHg•mL-1, p=0.05). Secondary analyses demonstrated significant correlations between age and PVR (r=0.33, p=0.05), TPulmR (r=0.35, p=0.04), Cpa (r=-0.48, p

WhatsApp (Facebook), which is a popular instant messaging “app” that is available on several platforms globally, allows users to share text, images, and video (and much more) over an end-to-end encrypted connection. We have investigated its use among the oral and maxillofacial surgery junior trainees’ WhatsApp group at King’s College Hospital, a level one trauma centre in London, and reviewed existing studies. On five of the seven days analysed, there were 191 communications. Most (n = 127, 67%) were related to administrative issues and patient care (n = 62, 33%). Only two (1%) related to neither and were classified as “other”. No communications were sent to the group over the weekend. WhatsApp is a popular means of communication among junior trainees within our department, and can be used to send concise information to several people at once, often more quickly than by telephone, pager, or email. The technology, however, should be used carefully, and it raises important questions on confidentiality, which have recently been addressed by the medical director of the NHS in the wake of its use as a “cascade mechanism” during major terrorist incidents. We also discuss the potential value of emerging methods of communication that have been specifically designed for use in healthcare.

The use of exercise right heart catheterisation for the assessment of cardiovascular diseases has regained attention recently. Understanding physiologic haemodynamic exercise responses is key for the identification of abnormal haemodynamic patterns. Exercise total pulmonary resistance >3 Wood units identifies a deranged haemodynamic response and when total pulmonary resistance exceeds 3 Wood units, an exercise pulmonary artery wedge pressures/cardiac output slope >2 mmHg/l/min indicates the presence of underlying exercise-induced pulmonary hypertension related to left heart disease. In the evolving field of transcatheter interventions for valvular heart disease, exercise right heart catheterisation may objectively unmask symptoms and underlying haemodynamic abnormalities. Further studies are needed on the use of the procedure to inform the selection of patients who might receive the most benefit from transcatheter interventions for valvular heart diseases.

Halomonas sp. strain ML-15 is an aerobic, haloalkaliphilic bacterium capable of degrading polycyclic aromatic hydrocarbons (PAHs). The draft genome sequence of the isolate contains 19 contigs encompassing 4.8 Mb and a G+C content of 65.38%. This sequence will provide essential information for future studies of PAH degradation, particularly under haloalkaliphilic conditions.

There is a subgroup of patients with mandibular fractures who could safely and effectively be managed in an outpatient day-care unit. Suitability depends on medical, social, and operative factors, and identification of the correct criteria will govern management after that in the emergency department. Reduced use of beds would lead to less money being spent on emergency treatment, and increased capacity for elective surgery. The aims of this study were to identify a group of patients with mandibular fractures whose duration of operation and period of recovery would be suitable for treatment in the day-care unit, and to evaluate the potential financial benefits. Inpatients were assessed for day surgery using medical, social, and surgical criteria. Each patient’s suitability for discharge was assessed two, three, and five hours postoperatively. A financial feasibility study was made retrospectively on a larger sample of patients with mandibular fractures. The discharge criteria from the day-care unit were fully met by 26/40 patients at five hours postoperatively, mean (range) duration of operation was 145 (40–285) minutes, and mean (SD) Mandibular Injury Severity Score was 13 (3), range 7–20. When all the criteria were combined (n = 100), 12 of the patients were suitable for day care. With 24 bed-day savings/100 patients, potential earnings would increase to around £80 000/year at this hospital. In conclusion, we have identified a group of patients who were suitable for management of mandibular fractures in the day-care unit. Considerable cost savings are anticipated.

Dose-dependent cardiotoxicity is the leading adverse reaction seen in cancer patients treated with doxorubicin. Currently, dexrazoxane is the only approved drug that can partially protect against this toxicity in patients, however, its administration is restricted to those patients receiving a high cumulative dose of anthracyclines. Investigations into the mechanisms of cardiotoxicity and efforts to improve cardioprotective strategies have been hindered by the limited availability of a phenotypically relevant in vitro adult human cardiac model system. Here, we adapted a readily reproducible, functional 3D human multi-cell type cardiac system to emulate patient responses seen with doxorubicin and dexrazoxane. We show that administration of two NRF2 gene inducers namely the semi-synthetic triterpenoid Bardoxolone methyl, and the isothiocyanate sulfurophane, result in cardioprotection against doxorubicin toxicity comparable to dexrazoxane as evidenced by an increase in cell viability and a decrease in the production of reactive oxygen species. We further show a synergistic attenuation of cardiotoxicity when the NRF2 inducers and dexrazoxane are used in tandem. Taken together, our data indicate that the 3D spheroid is a suitable model to investigate drug induced cardiotoxicity and we reveal an essential role of the NRF2 pathway in cardioprotection providing a novel pharmacological mechanism and intervention route towards the alleviation of doxorubicin-induced toxicity.

Full thickness calvarial defects present considerable challenges to reconstructive surgeons. In paediatric cases, the use of biomaterials as a substrate for cranioplasty rather than autologous bone is controversial. Alloplastic cranioplasty in adults is supported by several large case series however long term outcome of biomaterial use in paediatric cases is limited. Retrospective seven year analysis of departmental database and clinical records identified 22 patients aged under 18 who had undergone 23 custom made titanium cranioplasties by a single surgeon using the same technique. Data including patient demographics, reason for craniectomy and complications experienced following surgery was obtained. The mean age at operation was 12 years 9 months. The mean defect size was 44.3 cm(2). No significant complications related to the cranioplasty were recorded in the early post operative period or during long term review (average follow up 4 years 6 months). No cranioplasty implant required removal. This retrospective case series shows that custom made patient specific titanium cranioplasty is a viable alternative to autologous bone as a reconstructive material in paediatric patients under specific circumstances.

A diverse range of techniques is available for reconstruction of full-thickness calvarial defects and the optimum substrate for cranioplasty remains unproven. During a 9-year period, 149 patients underwent insertion of 151 custom-made titanium cranioplasties using the same technique. Data relating to patient demographics, indication for cranioplasty, and site and size of the defect were collected from the clinical records. Patients were followed up in all cases for a mean of 1 year 2 months (range 7 days to 8 years 8 months). Early complications requiring intervention were experienced in 7% and included seroma, haematoma, and continued bleeding necessitating implant removal in one patient. One death occurred at 3 days post-operation due to haemorrhagic stroke. Late self-limiting complications such as seroma were experienced in 19% of patients, however complete failure requiring implant removal was seen in only 4% of cases. Infection was the cause of failure in all cases. A comprehensive literature review was carried out and data abstracted to compare reported failure rates in other techniques of full-thickness cranial reconstruction. This review shows that custom-made patient-specific titanium cranioplasties compare very favourably to the other published techniques and remain a tried and tested option for reconstruction of all sizes of full-thickness calvarial defect.

The behavior of filaments and prominences during the Solar Cycle is a signature of Sun's activity. It is therefore important to follow their evolution during the cycle, in order to be able to associate it with the various phases of the Solar Cycle as well as with other Solar features or events. The virtual observatory HELIO provides information that can be used for such studies, especially its Heliophysics Feature Catalogue gives a unique access to the description of various features during around one cycle. Features available are: filaments, prominences, photospheric and coronal active regions, coronal radio emission, type III radio bursts, coronal holes and sunspots. Web interfaces allow the user to query data for these features. Useful information can also be shared with other HELIO services, such as Heliophysics Event Catalogue, which provides access to dozens of tables of events such as flares, CMEs, . . .

In 2010, King's College Hospital in London was designated as a major trauma centre. To deal with the increasing number of patients, an integrated oral and maxillofacial team of the week was established in 2012 to provide a consultant-led, emergency service dedicated to acute care, and it was anticipated that this would reduce the duration of stay by 0.3 bed-days. To assess the effect of the new system, we compared the duration of stay between 1 October and 31 January 2011-2012 with the same period in 2012-2013. We also assessed the activity and training of registrars, and the department's perception of the post of trauma registrar. The mean total duration of stay had decreased significantly by 0.84 days (p=0.03), the mean delay to operation had decreased by 0.3 days, and the mean postoperative stay had decreased by 0.5 days. During one week, the trauma registrar did 12 operations at various sites in the hospital. The new system was a cost-effective way of improving emergency OMFS care and it can be recommended to other centres with similar profiles.

Decompressive craniectomy is effective in controlling intractable raised intracranial pressure and improves survival and neurological outcome. Significant cranial defects are created by this procedure mandating reconstruction. A case history of cranial reconstruction using a custom-made titanium implant following decompressive craniectomy as a result of middle cerebral artery infarction is presented with commentary from an expert in cranial reconstruction. The evidence and rationale for decompressive craniectomy are discussed followed by an account of current biomaterials in use for cranioplasty and surgical technique. Outcome following cranioplasty is discussed including complications and how these can be minimised. The benefits of cranial reconstruction are discussed particularly cosmesis and neurological improvement.

We present a new method to automatically track filaments over the solar disk. The filaments are first detected on Meudon Spectroheliograph H{\alpha} images of the Sun, applying the technique developed by Fuller, Aboudarham, and Bentley (Solar phys. 227, 61, 2005). This technique combines cleaning processes, image segmentation based on region growing, and morphological parameter ex- traction, including the determination of filament skeletons. The coordinates of the skeleton pixels, given in a heliocentric system, are then converted to a more appropriate reference frame that follows the rotation of the Sun surface. In such a frame, a co-rotating filament is always located around the same position, and its skeletons (extracted from each image) are thus spatially close, forming a group of adjacent features. In a third step, the shape of each skeleton is compared with its neighbours using a curve-matching algorithm. This step will permit us to define the probability [P ] that two close filaments in the co-rotating frame are actually the same one observed on two different images. At the end, the pairs of features, for which the corresponding probability is greater than a threshold value, are associated using tracking identification indexes.On a representative sample of filaments, the good agreement between automated and manual tracking confirms the reliability of the technique to be applied on large data sets. Especially, this code is already used in the framework of the Heliophysics Integrated Observatory (HELIO) to populate a catalogue dedicated to solar and heliospheric features (HFC). An extension of this method to others filament observations, and possibly the sunspots, faculae, and coronal holes tracking can be also envisaged.