The conformation of the pseudokinase STRADα, which is regulated by binding to ATP and to the scaffolding protein MO25α, is key to the activiation of the LKB1 tumor suppressor complex.

Background: Chronic rhinosinusitis (CRS) with nasal polyps is a common chronic condition. The exact cause of nasal polyps remains unknown. Recently, we made the novel observation of intracellular localization of Staphylococcus aureus within mast cells in nasal polyps. Objective: This follow-up study aimed to further characterize interactions between S aureus and mast cells in this setting and elucidate potential internalization mechanisms with particular emphasis on the role of staphylococcal enterotoxin B (SEB). Methods: A prospective study was performed using an explant tissue model with ex vivo inferior turbinate mucosa obtained from patients with chronic rhinosinusitis with nasal polyps (n 5 7) and patients without CRS (n 5 5).

Surgery for pleomorphic adenoma recurrence presents a significant risk of facial nerve damage that can result in facial weakness effecting patients’ ability to communicate, mental health and self-image. We report two case studies that had marked facial weakness after resection of recurrent pleomorphic adenoma and their progress with electrical stimulation. Subjects received electrical stimulation twice daily for 24 weeks during which photographs of expressions, facial measurements and Sunnybrook scores were recorded. Both subjects recovered good facial function demonstrating Sunnybrook scores of 54 and 64 that improved to 88 and 96, respectively. Neither subjects demonstrated adverse effects of treatment. We conclude that electrical stimulation is a safe treatment and may improve facial palsy in patients after resection of recurrent pleomorphic adenoma. Larger studies would be difficult to pursue due to the low incidence of cases.

Traumatic aortic regurgitation is a rare complication of blunt chest wall injury. Cardiovascular decompensation can occur rapidly as the heart struggles to maintain cardiac output. As the condition is often not apparent at the time of injury, these patients may be brought by ambulance to trauma units without cardiothoracic facilities under the care of general and orthopaedic surgeons. Here, we report a case of traumatic aortic regurgitation secondary to a high-speed motor vehicle accident and the management in a district general trauma unit leading to transfer to a cardiothoracic centre. The diagnosis of traumatic aortic regurgitation should be considered in patients who experience blunt chest wall injuries and demonstrate signs of cardiac decompensation.

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BackgroundHealthcare systems face unprecedented numbers of patients waiting for elective treatments in the wake of the COVID-19 pandemic. Hospitals must urgently optimise patient pathways and build capacity to meet the populations health needs. Criteria-led discharge (CLD) is frequently used to optimise elective care pathways but may hold potential in discharging patients at the end of an acute hospital admission.MethodsWe conducted a quality improvement project to design and introduce a novel inpatient pathway using CLD for patients with severe acute tonsillitis. Our analysis compared the standardisation of treatment, length of stay, discharge time and readmission rate between those treated on the novel pathway compared with standard treatment.ResultsThe study population included 137 patients admitted to a tertiary centre with acute tonsillitis. Introduction of the tonsillitis pathway using CLD resulted in a significant reduction in median length of stay from 24 hours to 18 hours. Of those treated on the tonsillitis pathway, 52.2% were discharged prior to midday compared with 29.1% who received standard treatment. No patient discharged using CLD required readmission.ConclusionCLD is safe and effective at reducing length of stay in patients requiring acute hospital admission for acute tonsillitis. CLD should be used and evaluated in further novel patient pathways across different areas of medicine to optimise care and build capacity for provision of elective healthcare services. Further research is required to investigate safe and optimal criteria which indicate patients are fit for discharge.

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Background: Nasal packing is often used after functional endoscopic sinus surgery (FESS). Various non-absorbable agents are used but these packs can be uncomfortable and cause pain and bleeding on removal. Increasingly, biodegradable nasal packs are being used and have shown promising effects on post-operative bleeding and healing after FESS. Aim: We evaluate the safety and efficacy of biodegradable Nasopore®(polyurethane glycol) in FESS, particularly in the day-case setting. Methods: A retrospective chart review of 100 consecutive patients receiving Nasopore following FESS. Results: Our patients had chronic rhinosinusitis not responding to medical therapy and the extent of the surgery was determined by the extent of disease. Procedures performed in addition to FESS included septoplasty, trimming of the inferior turbinates and polypectomy. Approximately half of patients were discharged home the same day and post-operative complications were minimal. Only two patients developed post-operative bleeding, and four reported post-operative sinus infection requiring oral antibiotics. One patient developed minor intranasal adhesions of no functional significance. Conclusions: Nasopore is a safe and effective option after FESS. It is associated with minimal discomfort, no pain on removal and few post-operative complications. Nasopore is useful in achieving day-case FESS.