Purpose of this study was to observe if there was any increase in epistaxis admissions to hospital after the introduction of routine population wide nasal swabbing. This study looked at difference in epistaxis admissions from 2020 and 2021 across the 9 NHS Trusts in the Southwest.This study found that there were less hospital admissions in 2021 due to epistaxis. This could be due to the widespread fear amongst the populace at the time of attending hospital due risk of COVID-19 and of overburdening the hospital. Patient's that did present to ED may have received more effective epistaxis management with biodegradable nasal pacs and topical haemostatic matrices. However there are many confounding factors, thus it is important to avoid over interpretation of the data.

Aim Approximately 5% 1 of all mucosal head and neck (H&N) squamous cell cancers (SCC) arise from the hypopharynx. 1 Patients with hypopharyngeal SCC (HPSCC) tend to have a poor prognosis compared with other subsites with reported 5-year survival of 27% in the UK.2 Most patients (80%) have stage III/IV disease at presentation.3 There are very few HPSCC-specific studies and this subsite is not well represented in more general H&N SCC trials. Thus, deciding the best treatment plan is difficult and relies on the expertise of an experienced multi-disciplinary team (MDT).4 Patient fitness for treatment complicates matters further. The incidence of H&N cancer increases with age and is closely correlated with deprivation.1 The aim of this series was to review outcomes of patients with HPSCC in our cancer network. Method This retrospective study included all patients with a histological or radiological diagnosis of HPSCC made from August 2016 to August 2018. They were identified from the cancer network MDT database. Subsites included pyriform fossa, post cricoid and posterior pharyngeal wall. Data including patient demographics, treatment details, toxicity and disease control were extracted from case records. Results 118 patients were evaluable. 8 (6.7%) patients had a radiological diagnosis, the remainder were biopsy proven HPSCC. The probability of survival at 24 months was higher in patients of good performance status (PS 0-1: 41.7%, 95% CI 29.7-53.2% Vs. PS ≥2: 27.5%, 95% CI 13.9-43.0%). Patients aged >70 years had a lower probability of survival at 24 months compared to those <70 (<70yrs 44.5%, 95% CI 27.1 – 55.9% Vs ≥70yrs 24.4%, 95% CI 12.6 – 38.3). 57 (48.3%) of the 118 patients were treated with radical intent, of which 19 (33%) died at time of follow-up. 14 of these deaths were cancer related. The median time from primary surgery to adjuvant RT was 17 weeks. Conclusion Most patients with HPSCC present with locally advanced disease and are unsuitable for active anti-cancer treatment. For those treated radically the pattern of treatment failure is loco-regional. A multimodality approach for locally advanced disease with surgery and radiotherapy appears to be advantageous in terms of survival.

The authors report the case of a young patient, a football player, who presented with a pure, closed dislocation of his ankle following a road accident. Management consisted of immediate reduction, followed by immobilization in plaster for 1 month, The short, clinical and radiological results are excellent

The human body is, by definition, a "corpus". This Latin term emphasises the synergy and interdependence of each of its parts. There is no scientific basis for estimating the number of specialists of various types needed to meet the population's needs of the type of interventions that confer benefit. However, it is virtually certain that the proper functioning of the filter could free up more time for properly deployed specialists to provide services that would significantly improve health and, above all, equity in health.  Recognition of the importance of first contact function in Primary Care as a filter and co-ordinator, should lead us to better clinical outcomes for the most part. The government should recognise, protect, and prioritise, the role of the Primary Care interface. 

Cardiac dysfunction occurs in hypereosinophilic syndromes is a major cause of morbidity and mortality. In patients with high clinical suspicion for acute myocarditis and confirmed peripheral eosinophilia, timely diagnosis and treatment is imperative to avoid the catastrophic consequence of irreversible fibrotic changes to the cardiac tissue.

Chylothorax is a rare but life-threatening condition in neonates. We herein report the successful use of OK-432 for a low-birth-weight infant with trisomy 18 who developed refractory chylothorax after thoracic surgery. Increasing the concentration of OK-432 seems useful in cases with a lot of pleural effusion.

Key Points  Transoral resection for oral cavity and oropharyngeal cancer has become popular.  Transoral conventional interrupt knot tying suturing for oral/oropharyngeal defect often requires time.  Transoral barbed knotless continuous suture could reduce operation time with a comparable complication rate.  Knotless barbed suture provides appropriate tension and secure closure with multiple anchors.  Transoral barbed knotless suture is particularly advantageous in deep and narrow areas.

Data Availability StatementThe data that support the findings of this study are available from the corresponding author upon reasonable request.

Tracheal hemangioma is a rare vascular tumor in adults and children. Recurrent hemoptysis and chronic cough are main symptoms revealing the disease. We report here a case of tracheal hemangioma in an eight-year-old girl. She was admitted to the pediatric department of Habib Bougatfa Hospital of Bizerta in Tunisia because of recurrent hemoptysis. Diagnosis was performed using computed tomography and bronchoscopy. Beta blocker therapy was not efficient. Radical treatment by electrical excision leads to total recovery. Tracheal hemangioma should be considered as a cause of recurrent hemoptysis when routine biological and radiological investigations are negative.

Active reclamation is often necessary to ensure a transformation of mining waste into Technosols -“soils dominated or strongly influenced by human made material” - and restore its utility and environmental value. The objective of this study was to assess the spatial variation of the physicochemical properties of a Technosol forming on dredged sediment landfills left by alluvial gold mining in a chronosequence of reclamation (0, 4, 8 and 12 years). We hypothesized a higher spatial dependency of most soil properties with increasing time of Technosol formation and an overall homogenization of the soil resulting from pedogenetic processes. Our results showed that most of the investigated physical and chemical properties changed significantly among Technosols of different ages. The content of organic matter, phosphorus, and exchangeable cations showed the highest spatial variability in Technosols of all ages. In older Technosols, most soil properties showed less spatial variability than in younger Technosols. A multivariate geostatistical assessment allowed the delineation of spatial clusters i.e. homogeneous zones with distinctive physicochemical properties within areas of the chronosequence. This spatial clustering showed that reclamation and Technosol formation led to spatially-dependent fragmentation processes reflected in more and smaller homogeneous zones in the oldest Technosol assessed in the chronosequence. From the perspective of reclamation management, understanding the spatial variability of highly heterogeneous Technosols where substantial changes can be observed within small distances can support the development of reclamation strategies suitable to the characteristics of each field as well as the determination of its potential uses.

Grassland degradation can affect plant eco-physiological properties and thus influence ecosystem productivity and ecosystem function. However, how land degradation affects the relationship between plant biomass and eco-physiological properties of active restoration grasslands and native grasslands in alpine meadow is less understood. A series of degraded grasslands (non-degraded, slightly degraded, moderately degraded, heavily degraded and extremely degraded grasslands) and a series of active restoration grasslands (active restored grasslands with different growth time, 5 years, 9 years, 11 years, 14 years and 17 years) were selected to investigate the relationship between eco-physiological properties and aboveground biomass (AGB) of grasses alongside degradation. Results showed that the AGB, net photosynthetic rate (Pn) and plant nitrogen (N) concentration decreased significantly with increased levels of degradation in native grasslands. Plant photosynthetic capacity, plant N and phosphorus (P) concentration significantly decreased at 9th year or longer than 9 years of replanting time in active restoration grasslands. Plant eco-physiological properties in active restoration grasslands shows stronger association with its AGB than native grasslands. In native grasslands, degradation affect AGB directly and through Pn indirectly. In active restoration grasslands, degradation affect AGB directly and through Pn, plant N and P indirectly. Our results indicated that through improving plant nutrients to restore degraded active grasslands may be more effective than to restore degraded native grasslands.

Struma ovarii is a rare ovarian lesion characterized by the presence of thyroid tissue. The symptoms of this tumor are nonspecific and thus misdiagnosis to other lesions are common. The initial footprint of the tumor is mostly based on incidental imaging, but definitive diagnosis is possible based on pathological studies.

We read with great interest recent research by Anderson et al.1 on how NICU respiratory support affects infant feeding, and by Behnke et al.2 on the potential interference of infant feeding with successful respiratory stabilization of the preterm infant. Since both preclinical and human studies have established that nutrition plays a key role in preterm lung growth and development, a crucial aspect of any research undertaken in the field of neonatal respiratory outcomes should be the breastfeeding history. It is now becoming well established that human milk feeding actively contributes in limiting lung injury among vulnerable neonates.

Herein we present a case of concomitant congenital anomalies with an iatrogenic defect. The female patient underwent a percutaneous mitral balloon valvuloplasty due to rheumatic mitral stenosis. Unfortunately, an iatrogenic atrial septal defect (ASD) occurred and also, partial anomalous pulmonary venous return was observed at post-procedure evaluation. The patient had severe symptoms and the right heart chambers were dilated on imaging. But perhaps, the most crucial point was that the patient was planning a pregnancy. After a difficult and patient-involved decision process, the patient underwent to successful robotic surgery for iatrogenic ASD and partial anomalous pulmonary venous return. After operation, the patient was asymptomatic and right heart chambers normalized.

The fatigue behaviour of continuous wire polymer composite (CWPC) fabricated by fused filament fabrication was investigated. Four compositions were examined: polylactic acid (PLA), PLA with copper wire (Cu), thermoplastic polyurethane (TPU), and TPU with Cu wire. Residual properties were measured after different sets of number of cycles (10 2, 10 4, 10 5). Residual strengths were 89.736% and 70.464% of the ultimate tensile strength of the original material after 10 5 cycles for PLA CWPC and TPU CWPC, respectively. A one-way analysis of variance (ANOVA) statistical tests showed insignificant changes in the residual strengths of PLA-based materials after an increasing number of cycles and significant changes for the TPU-based materials. CWPC electromechanical properties under fatigue test demonstrated reverse piezoresistivity behavior. A strain-controlled fatigue life analytical model was compared to the experimental results showing good agreement. This study demonstrates the applicability of FFF technique to print sensors with continuous integrated wire with tunable properties.

Original Manuscript ID: BJOG-21-1723.R1 Descriptive: The Impact of Respectful and Compassionate Bereavement Care Following Stillbirth Running Title: Respectful Bereavement Care After Stillbirth Author information: Mehali Patel, Senior Research Officer, Saving Babies’ Lives Team, Sands Contact Details: 07709602633 Mehali.patel@sands.org.uk Sands Office, CAN Mezzanine, 49-51 East Road, London, N1 6AH

Although the presence of morphea following COVID-19 has been rarely reported, development of its generalized form following COVID-19 vaccination has not been reported yet. Here, we reported the first case of generalized morphea following COVID-19 vaccination and another similar case following SARS-Cov-2 infection. Other etiologic factors were also dealt with

Introduction Most people tend to shy away from conversations around mental health. This is due to the stigma that is rooted in the long mistreatment of people with mental illness. In this article, I aim to bring conversations about mental health to the forefront and advocate for a change in culture so that the field of computing better supports the mental health of the community and is more inclusive of people with mental illness.

Despite straw application within rice agriculture being widely practiced, both in China and globally, there remain few studies on the maize straw substituted for chemical fertilizers. In this study, maize straw substituted for chemical fertilizers to a double-cropping rice field and compared the effects of medium (MS 9,600 kg·ha−1·year−1) and high (HS 19,200 kg·ha−1·year−1) application on rice yield and soil characteristics with that of the application of single chemical fertilizers (CF) over a period of 1982 to present. The yields of late and early rice increased by 42.66 and 25.04% in 2019 and 2020, respectively. The soil bulk density of MS and HS decreased significantly by 15.94 and 33.35% compared with that of CF, whereas total soil porosity increased significantly by 9.46 and 20.17%, respectively. Long-term straw application significantly improved the soil stable aggregates content (> 0.25 mm). Straw application increased soil urease, protease, alkaline phosphatase (ALP), acid phosphatase (ACP) and catalase activities, microbial biomass carbon (C), microbial biomass nitrogen (N), and soil nutrients content compared with CF, especially HS. Correlation analysis showed that double-cropping rice yield was highly significantly correlated with soil bulk density, total porosity, catalase, microbial biomass C, microbial biomass N, and available P. In conclusion, maize straw substituted for chemical fertilizers not only makes rational use of straw resources, but also improves soil characteristics to improve crop yield.

An oral appliance with anterior opening to reduce intraoral pressure was effective for a 57-year-old man with obstructive sleep apnea syndrome accompanying pneumoparotid, which refers to the retrograde insufflation of air inside the parotid gland or Stensen's duct.

Oriana Sanchez-Mahecha1* , Sophia Klink2* , Robin Heinen1 , Michael Rothballer2 , Sharon Zytynska1,3

A novel mutation in SLC39A7 identified in a patient with autosomal recessive agammaglobulinemia

Background Vertigo can have a negative impact on the quality of life of patients. Mobile health apps have the potential to promote autonomy, and improve symptoms through self-management and vestibular rehabilitation exercises. This study aimed to systematically evaluate the quality of apps for vertigo using the published literature and smartphone stores. Design A systematic review of the literature, utilising Embase, Medline, Cochrane and clinicaltrials.org, and Apple and Google Play Stores were used to identify mobile device apps relating to vertigo. Apps were evaluated for characteristics, content, healthcare involvement and quality using the Mobile App Rating Score (MARS) system (a standardised tool for assessing app quality). Results The literature search identified no eligible articles. The app search identified and evaluated 32 eligible apps. Four main categories of apps were identified: exercise provision, information provision, symptom monitoring and assessment. Six apps included healthcare professionals in their development. MARS scoring ranged between 1.8 and 4.05 (maximum 5), with only 25% of apps scoring the minimum acceptability score of 3. The highest scoring apps were those providing rehabilitation exercises and symptom monitoring. Conclusion There is great potential in the use of mobile apps to help monitor and manage vertigo. This article demonstrates that despite numerous readily available vertigo apps, few are of an acceptable standard. There is scope for apps to improve. We propose involving health professionals and patients in their development to ensure high quality evidence-based information and evaluating their efficacy through future patient-centred trials.

Background and Purpose: Isorhamnetin, a natural flavonoid, has strong antioxidant and anti-fibrotic effects, and a regulatory effect against Ca2+-handling. Atrial remodeling due to fibrosis and abnormal intracellular Ca2+ activities contributes to initiation and persistence of atrial fibrillation (AF). This study investigated the effect of isorhamnetin on angiotensin II (AngII)-induced AF in mice. Experimental Approach: Wild-type male mice (C57BL/6J, 8 weeks old) were assigned to three groups: (1) control group, (2) AngII-treated group, and (3) AngII-and isorhamnetin-treated groups. AngII (1000 ng/kg/min) and isorhamnetin (5 mg/kg) were administered continuously via an implantable osmotic pump for two weeks and intraperitoneally one week before initiating AngII administration, respectively. AF induction and electrophysiological studies, Ca2+ imaging with isolated atrial myocytes and HL-1 cells, and action potential duration (APD) measurements using HL-1 cells were performed. AF-related molecule expression was assessed and histopathological examination was performed. Key Results: Isorhamnetin decreased AF inducibility compared to the AngII group and restored AngII-induced atrial effective refractory period prolongation. Isorhamnetin eliminated abnormal diastolic intracellular Ca2+ activities induced by AngII. Isorhamnetin also abrogated AngII-induced APD prolongation and abnormal Ca2+ loading in HL-1 cells. Furthermore, isorhamnetin strongly attenuated AngII-induced left atrial enlargement and atrial fibrosis. AngII-induced elevated expression of AF-associated molecules, such as ox-CaMKII, p-RyR2, p-JNK, p-ERK, and TRPC3/6, was improved by isorhamnetin treatment. Conclusion and Implications: The findings of this study suggest that isorhamnetin prevents AngII-induced AF vulnerability and arrhythmogenic atrial remodeling via modulating CaMKII-RyR2 and TRPC-mediated MAPK pathways, highlighting its potential as an anti-arrhythmogenic pharmaceutical or dietary supplement.