Jensby Sloth (birchseed4)

In these unprecedented times, OMFS surgeons are faced with dilemmas over the priority of treatment, safety of staff, safety of patients and the most appropriate use of available resources. Efforts should be made to provide the best evidence-based care, which will mean revisiting old techniques, and risk stratifying patients on a case by case basis. Recent experience from colleagues internationally has shown that even the wealthiest health care infrastructure is at best fragile. We hope this paper will add to the debate and hopefully provide a framework for decision making in OMFS trauma care during this difficult time. Crown All rights reserved.The standard of care for head and neck reconstruction is microvascular free-tissue transfer. Various techniques of soft tissue, free-flap design have previously been described. Patient-specific planning and 3D printing have changed practice in bony reconstruction, but are not currently used in soft tissue head and neck reconstruction. We present the first report of Personalised pAtient-specific plaNning of SOFt tissue recOnStruction, the "PANSOFOS" flap, and aim to prove that the technique has a place in soft tissue reconstruction of the head and neck. Using the IDEAL framework for the reporting of surgical innovations (IDEAL stage 1, proof of concept report), we describe the case of a patient with oral cancer who had reconstruction of the tongue after hemiglossectomy. The staging scans, 3D printer and software were used to create a soft silicon resection guide and flap harvesting guide. The 3D guide was then used to design a 2D outline of the perimeter of the flap, and a negative silicone mould used to control its bulk. The procedure was successful and the postoperative period uneventful. The oncological, cosmetic, and functional outcomes were excellent. The patient followed the local enhanced recovery pathway and was discharged home with safe swallowing. This report confirms that patient-specific 3D planning can be used in the reconstruction of soft tissue defects of the head and neck. We aim to develop the technique using the next stages of the IDEAL framework, and anticipate that the PANSOFOS flap will become a standard of care. Crown All rights reserved.Chronic mucocutaneous candidiasis is a rare disorder that is characterised by chronic or recurrent superficial candida infection of skin, nails, and mucous membranes. We describe such a case in a young boy who failed to respond to conventional therapy. It highlights the important role of the dental team in assessment, treatment, and onwards referral. Crown All rights reserved.AIMS Lipoprotein(a)(Lp(a)) has emerged as an independent risk marker for cardiovascular disease (CVD) in the general population and among persons with existing CVD. We investigated associations between serum Lp(a)concentrations and renal function decline, incident CVD and all-cause mortality in individuals with type 2 diabetes (T2D) and microalbuminuria. METHODS Prospective study including 198 individuals with T2D, microalbuminuria and no CVD. Yearly p-creatinine was measured after baseline in 176 of the participants. The renal endpoint was defined as decline in eGFR of >30% from baseline. CVD events and mortality were tracked from national registries. Cox regression analyses were applied both unadjusted and adjusted for traditional risk factors (sex, age, systolic blood pressure, LDL-cholesterol, smoking, HbA1c, creatinine and urinary albumin creatinine ratio (UAER)). RESULTS Baseline mean (SD) age was 59 (9)years, eGFR 89 (17) mL/min/1.73 m2, 77% were male, and median [IQR] UAER was 103 [38-242] mg/24-h. Median Lp(a)was 8.04 [3.42-32.3] mg/dL. Median follow-up was 6.1 years; 38 CVD events, 26 deaths and 43 renal events were recorded. For each doubling of baseline Lp(a), the following hazard ratios (95% confidence intervals) were found before and after adjustment respectively 0.98 (0.84-1.15) and 1.01 (0.87-1.18) for decline in eGFR > 30%, 0.96 (0.81-1