No abstract

Objectives While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non‐specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non‐specialist colleagues’ diagnostic certainty as well as to support ENT surgeons’ triage of these referrals. Design Prospective, multicentre observational study. Setting Primary and secondary care. Participants Patients >16 years with symptoms of sore throat. Data We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration‐proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally. Results 100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; and uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively. We validated the latest (third) iteration of the LPS internally (ie, on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85%; and negative predictive value 96%. The area under the receiver operating characteristics (AUROC) curve was 0.970. Conclusions We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non‐specialist colleagues.

Background: Dog bite injuries are a common presentation to Accident and Emergency. In the United Kingdom ~250,000 people attend emergency units each year as a result of dog wounds. Currently, there is a lack of consistency in the approach and management of such wounds across plastic surgery units in the United Kingdom. Method: A retrospective review of medical record of patients who were admitted under the care of the Plastic Surgery Department at University Hospital North Midlands NHS Foundation Trust with dog-bite wounds between January and December 2018. Results: Of the 69 patients that were included in the study, 14 (20%) of them had been prescribed antibiotics that were ineffective and against antimicrobial guidelines. Following liaison with the antimicrobial governance team and input from NICE guidelines, the trust’s MicroGuide Antibiotic Prescribing Guidelines App was updated. A reaudit from November 2019 to February 2020 showed that there was 100% compliance with guidance. Conclusion: Updating the University Hospital of North Midlands NHS Trust’s MicroGuide antibiotic prescribing guidelines for the treatment of dog-bite injuries resulted in 100% of patients being treated with the correct antibiotic. Given the polymicrobial nature of animal-bite wounds, and the high levels of resistance demonstrated by organisms commonly found in such injuries, this increased compliance with guidelines helps minimize patient suffering, morbidity, length of stay, and disability, while reducing costs incurred. The intervention should be implemented within other units within the United Kingdom who similarly lack clear, detailed guidelines, in order to maximize treatment continuity and patient outcomes nationwide.

Peritonsillar abscesses (PTA, also known as quinsies) are a frequently occurring presentation to emergency departments and represent a common reason for referral to an ENT service. Management options include drainage of the abscess and antibiotic therapy. Without intervention, PTA can develop into deep neck space infections (DNSI) which carry significant morbidity and mortality. 1 Patients who undergo drainage of their PTA have been shown to experience quicker resolution of symptoms. 2

The field of robotic surgery is an exciting and growing field that has bolstered its way to become a mainstream application in a number of surgical disciplines. The application of robotic surgery in cleft surgery is novel and has captivated many with the benefit it provides: the slender and small arms with wrist articulation at the instrument tip; motion scaling; tremor elimination; and high fidelity, three-dimensional visualization make the robot a very attractive platform for use in confined spaces with small surgical targets. The story of the origin of robotic surgery in cleft surgery is an interesting one, and one that has arisen from other allied surgical specialities to render robotic cleft surgery as its own specialised field. A field that has coined its own terms and has demonstrated a number of applications for its use. This review details the origins of robotic cleft surgery, its evolution and its current status and elaborates on future directions to enhance its application.

No abstract

No abstract

Background：Angiotensin-converting enzyme 2 (ACE2) has been confirmed to be a receptor for the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, cell surface ACE2 expression is reported to be inconsistent with clinical tissue tropism of SARS-CoV-2, which complicates understanding of the pathogenesis of 2019 novel coronavirus disease (COVID-19). The consumption of ACE2 by internalization and shedding processes may explain this discordance. Results：To understand the discordance between ACE2 expression and the tissue tropism of SARS-CoV-2, we examined the chromatin accessibility of ACE2 promoter in hundreds of tissues and cell lines using public DNase-seq and assay for transposase-accessible chromatin with high throughput sequencing (ATAC-seq) data. We find that ACE2 promoter is only accessible in three tissues including lung, large intestine and placenta. Also, we examined tumors tissues and ACE2 promoter is observed accessible in five tumors with reported SARS-CoV-2 susceptibility. We confirmed the susceptibility by performing SARS-CoV-2 pseudovirus infection in several cell lines. Conclusions：We propose that open chromatin at the promoter mediates the ACE2 supplementary effect and ensures the entry of SARS-CoV-2. This hypothesis provides a new view and potential clues for further investigation of COVID-19 pathogenesis.