Risk factors associated with short-term complications in mandibular fractures: the MANTRA study—a Maxillofacial Trainee Research Collaborative (MTReC)

Abstract Introduction Complications following mandibular fractures occur in 9–23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. Methods The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. Results Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. Discussion We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications. </jats:sec

Tumor treatment with chemo-virotherapy and MEK inhibitor: A mathematical model of Caputo fractional differential operator

Mitogen-activated protein kinase (MEK) inhibitors and oncolytic virotherapy are identified as promising cancer therapies that can enhance the efficacy of other cancer treatments. A few studies demonstrate that cancer cells proliferate when exposed to virotherapy with MEK inhibitors in an integer order model or without them in a fractional order model. None of them are intended to investigate tumor cell growth under the combined treatment strategy of chemo-virotherapy with a MEK inhibitor in a fractional order model. In this paper, a mathematical model based on fractional order ordinary differential equations (ODEs) is developed for the mutual interactions among tumor cells, as well as a therapeutic combination of chemotherapy, oncolytic viruses and the functional consequence of MEK inhibitor, to investigate how virotherapy could enhance chemotherapy under the action of MEK inhibitor. The numerical results show that virus burst size and MEK inhibitors have a noticeable impact on regulating the trend of tumor cell proliferation. While virotherapy responses to tumor cell proliferation are undoubtedly quicker than chemotherapeutic treatment responses, MEK intensity clearly affects the success of the treatment regimen. The results of this study can contribute to the development of a therapeutic strategy that combines MEK inhibitor functional monitoring with tumor cell growth control

Prevalence and clinical characteristics of non-malignant CT detected incidental findings in the SUMMIT lung cancer screening cohort

Background Pulmonary and extrapulmonary incidental findings are frequently identified on CT scans performed for lung cancer screening. Uncertainty regarding their clinical significance and how and when such findings should be reported back to clinicians and participants persists. We examined the prevalence of non-malignant incidental findings within a lung cancer screening cohort and investigated the morbidity and relevant risk factors associated with incidental findings. We quantified the primary and secondary care referrals generated by our protocol.Methods The SUMMIT study (NCT03934866) is a prospective observational cohort study to examine the performance of delivering a low-dose CT (LDCT) screening service to a high-risk population. Spirometry, blood pressure, height/weight and respiratory history were assessed as part of a Lung Health Check. Individuals at high risk of lung cancer were offered an LDCT and returned for two further annual visits. This analysis is a prospective evaluation of the standardised reporting and management protocol for incidental findings developed for the study on the baseline LDCT.Results In 11 115 participants included in this analysis, the most common incidental findings were coronary artery calcification (64.2%) and emphysema (33.4%). From our protocolised management approach, the number of participants requiring review for clinically relevant findings in primary care was 1 in 20, and the number potentially requiring review in secondary care was 1 in 25.Conclusions Incidental findings are common in lung cancer screening and can be associated with reported symptoms and comorbidities. A standardised reporting protocol allows systematic assessment and standardises onward management