Functional outcomes of soft palate free flap reconstruction following oropharyngeal cancer surgery

IntroductionThe objective of this study was to assess the impact of surgical resection and free flap reconstruction of soft palate cancer on speech, swallowing and quality of life, and to identify the factors influencing functional outcomes and quality of life.Material and methodsPatients treated with surgical resection of squamous cell carcinoma and free-flap reconstruction of the soft palate were reviewed at least 12 months after surgery. Speech was assessed using the Hirose intelligibility scoring system, nasalance scoring, GRBAS scoring and the Voice Handicap Index 30 (VHI30) questionnaire. Swallowing was assessed by fiberoptic endoscopy and the Deglutition Handicap Index (DHI). Quality of life was assessed using EORTC QLQ-C30 and QLQ-H&N35 questionnaires.Results29 patients were included. Speech outcomes were satisfactory, demonstrating normal or slightly below normal speech intelligibility in 75.9% of the patients, moderate or no rhinolalia in 72.4% of the patients and mean overall VHI30 scores indicative of slight or no handicap in 86.2% of the patients. Swallowing outcomes were satisfactory, with mean overall DHI scores indicative of slight or no handicap in 82.8% of the patients. Patient quality of life was preserved as demonstrated by mean quality of life and functioning scales scores all superior to 80%.ConclusionThe sequelae arising from surgical resection and free-flap reconstruction of soft palate cancer are tolerable, involving slight handicap in terms of speech and swallowing and relatively little impact on quality of life.     

Thinned-out skin paddle versus collagen matrix as an optimized peri-implant soft tissue following fibula osteoseptocutaneous free flap: 3-year retrospective study

The objective of this study was to compare the implant longevity following two methods of peri-implant soft tissue optimization following free fibula flap (FFF): thinning of skin paddle (SP) and collagen matrix (CM). All patients who underwent rehabilitation with dental implants after mandibular reconstruction with FFF between June 2009 to May 2014 were retrospectively reviewed. Two methods of peri-implant soft tissue optimization were applied: (1) SP group, (2) CM group. Outcome measurements were: modified plaque index (mPI), modified sulcus bleeding index (mSBI), probing depth (PD), marginal bone loss (MBL), implant success rate and complication rates. A total of 24 patients with 69 implants were included in the study, with 8.7% (n = 6) of implants lost in 3 years. No statistically significant difference was found regarding the outcome measurements in both groups. Failed implants presented with statistically significant higher mPI, mSBI, PD and MBL scores during prosthesis delivery and subsequent follow-ups (P<0.03). In the SP group, one patient experienced SP necrosis which later underwent soft tissue optimization using CM. CM is an alternative peri-implant soft tissue, while thinning of SP is feasible if thickness is well controlled.     

50 years of Hepatology: The Royal Free Hospital School of Hepatology

Writing about the history of Hepatology would necessarily imply writing about the history of the Liver Unit and the School of Hepatology created by Dr. Sheila Scherlock at the Royal Free Hospital (London). On the 70th anniversary of the creation of the first liver unit (Hammersmith Hospital) this article presents a brief account of the history, organization, structure, educational program and contributions of perhaps the first and the most influential medical research models created for the study of liver diseases: the Royal Free Hospital Liver Unit.     

健脾疏肝降脂方干预非酒精性脂肪肝病肥胖小鼠肝功能、游离脂肪酸机制探讨

目的:观察健脾疏肝降脂方治疗非酒精性脂肪肝(NAFLD)肥胖小鼠ALT、AST、FFA及光镜下病理组织学改变,并与壳脂胶囊治疗组比较,观察其疗效。方法:将72只小鼠随机分为模型组、健脾疏肝降脂方高、中、低剂量组、壳脂胶囊对照组和空白组。采用饲养高脂饲料及皮下注射5%CCl₄复制NAFLD肥胖小鼠模型,分别以相应药物灌胃6周,检测血清中ALT、AST及FFA的含量,光镜下观察肝组织的脂肪变程度。结果:①各个用药组相比模型组,血清ALT、AST均降低有统计学意义(P<0.01),且中药各浓度组较壳脂胶囊组血清ALT、AST降低,差异有统计学意义(P<0.05); 中药高、中剂量组相比模型组FFA降低,比较有统计学意义(P<0.05); 但与壳脂胶囊组相比,中药各剂量组改善FFA,差异无明显统计学意义(P>0.05)。②光镜可见:各用药组光镜下病理组织改变均较模型组明显,以中、高剂量组较低剂量组小鼠肝细胞脂肪变程度减轻较明显。结论:健脾疏肝降脂方能有效降低NAFLD肥胖小鼠的肝功能、其与浓度无关; 可以降低FFA及改善光镜下肝脏的脂肪变,其有效程度与浓度有一定的关系。     

白及多糖超声提取工艺及其抗氧化活性研究

目的：优化白及多糖的超声提取工艺，比较不同产地白及多糖含量差异，考察白及多糖稳定性和抗氧化活性。方法：以多糖得率为考察指标，料液比、超声温度、超声时间为考察因素设计L9（34）正交试验优化白及多糖超声波提取工艺；以苯酚-硫酸法测定白及多糖含量，考察陕西汉中、云南普洱、湖南洪江及四川绵阳白及多糖含量产地差异；以化学方法考察白及多糖稳定性，并比较白及多糖对1,1-二苯基-2-苦肼基自由基（DPPH·）和羟基自由基（·OH）的清除率以评价其体外抗氧化活性。结果：最佳超声提取工艺条件为：料液比1:25（g/mL）、超声温度80 ℃、超声时间10 min；四川绵阳白及多糖含量最高，达到60.81%，湖南洪江次之，云南普洱最低；白及多糖在柠檬酸及中性溶液中的稳定性较好，在苯甲酸钠、过酸性或过碱性溶液中的稳定性较差；白及多糖能有效地清除DPPH和羟基自由基，具有潜在的体外抗氧化活性。结论：白及多糖超声波提取工艺的优化及其抗氧化活性研究，可为白及多糖提取及综合利用提供借鉴。     

难复性肘关节脱位合并肱动脉损伤的治疗策略

目的探讨难复性肘关节脱位合并肱动脉损伤的治疗策略。方法回顾性分析自2015-03—2018-06行手术切开修复治疗的7例单纯肘关节脱位合并肱动脉损伤,一期行肘关节骨性结构的恢复与软组织稳定的重建,同时行血管移植恢复肱动脉的连续性,二期行游离皮片移植关闭伤口。结果7例均顺利完成手术并获得完整随访,随访时间6~24个月,平均14.5个月。末次随访时肘关节X线片显示7例均获得并维持同心圆复位。1例出现肘关节关节囊及韧带处异位骨化,对症治疗后治愈。无肘关节不稳定、无切口或针道感染发生。末次随访时Mayo肘关节功能评分:优5例,良1例,可1例。结论难复性肘关节脱位合并肱动脉损伤通过一期肘关节骨结构与软组织稳定重建、恢复肱动脉连续性,二期行游离植皮,并结合早期康复锻炼可获得满意疗效。     

Reducing free thyroid hormone testing through multiple Plan-Do-Study-Act cycles

ObjectivesFree thyroid hormones (fT4 and fT3) are one of the most commonly ordered laboratory tests and often ordered when not clinically meaningful. Based on this, many studies have sought to identify strategies to reduce inappropriate fT4 and fT3 testing. The goal of the current study was to implement a quality improvement (QI) framework to identify an optimal approach to reducing inappropriate free thyroid hormone testing through multiple change ideas and Plan-Do-Study-Act (PDSA) cycles. The aim was to reduce fT4 and fT3 30% from baseline at a large tertiary hospital within 12 months.MethodsThe Model for Improvement Framework was used to implement a total of 3 change ideas in the first and second PDSA cycles. Change ideas included implementation and refinement of a free thyroid hormone forced function reflex system, modifications to test requisitions/order-entry interfaces, and a TSH-only option. Process and balancing measures were evaluated to fine-tune the change interventions. Data was continuously monitored pre and post interventions to assess progress, impact and potential errors.ResultsIn the first PDSA cycle, laboratory testing of fT4 was decreased by 24% and fT3 by 18%. Soliciting physician feedback and assessing balancing measures was important in refining the approach. In the second PDSA cycle, fT4 was decreased by an additional 16% and fT3 by 29%. An audit of the process showed that phone calls to the laboratory to add-on free thyroid hormones did not increase after the second PDSA, averaging 2 calls per month.ConclusionsTo achieve optimal reductions in free thyroid hormone testing, multiple PDSA cycles were required alongside assessing process and balancing measures. Overall, fT4 and fT3 testing was decreased by 39% and 47%, respectively.