Functional outcome in 17 patients whose mandibles were reconstructed with free fibular flaps

<p><b>Objective:</b> The vascularised free fibular flap is considered to be a reliable choice for reconstruction of oromandibular defects, especially after resection of malignant tumours in the area. This study evaluates the functional outcome of this method.</p> <p><b>Method:</b> From January 2001 - May 2014, 37 patients were treated at the University Hospital of Linköping using the free fibular flap. The authors present the results from 17. This study reviewed their records and used the University of Washington Quality-of-Life questionnaire (UW-QoL), the Head and Neck Performance Status Scale (PSS), and interviews to assess their outcome.</p> <p><b>Results and conclusions:</b> Functional evaluation showed a significant decrease in chewing (16 out of 17 patients), appearance (<i>n</i> = 10), salivation (<i>n</i> = 6), sensitivity in the mouth and skin (<i>n</i> = 16), occlusive problems in the mouth (<i>n</i> = 13), and range of mouth opening (<i>n</i> = 12). The remaining domains showed acceptable results, although most of them probably could not compare with the preoperative function. Out of 17 patients, six had to adjust their eating in public significantly, three thought their activity to be considerably restricted and two their recreation to be notably diminished. Common postoperative complications were infections or fistula in the mandible (<i>n</i> = 6), partial or complete rejection of the cutaneous flap (<i>n</i> = 4), and rupture of some of the sutures (<i>n</i> = 3). Nine patients required at least one more operation to repair defects, and six required a new soft tissue flap.</p

Selective Nonsteroidal Glucocorticoid Receptor Modulators for the Inhaled Treatment of Pulmonary Diseases

A class of potent, nonsteroidal, selective indazole ether-based glucocorticoid receptor modulators (SGRMs) was developed for the inhaled treatment of respiratory diseases. Starting from an orally available compound with demonstrated anti-inflammatory activity in rat, a soft-drug strategy was implemented to ensure rapid elimination of drug candidates to minimize systemic GR activation. The first clinical candidate <b>1b</b> (AZD5423) displayed a potent inhibition of lung edema in a rat model of allergic airway inflammation following dry powder inhalation combined with a moderate systemic GR-effect, assessed as thymic involution. Further optimization of inhaled drug properties provided a second, equally potent, candidate, <b>15m</b> (AZD7594), that demonstrated an improved therapeutic ratio over the benchmark inhaled corticosteroid <b>3</b> (fluticasone propionate) and prolonged the inhibition of lung edema, indicating potential for once-daily treatment