Nationwide randomised trial evaluating elective neck dissection for early stage oral cancer (SEND study) with meta-analysis and concurrent real-world cohort.

BACKGROUND: Guidelines remain unclear over whether patients with early stage oral cancer without overt neck disease benefit from upfront elective neck dissection (END), particularly those with the smallest tumours. METHODS: We conducted a randomised trial of patients with stage T1/T2 N0 disease, who had their mouth tumour resected either with or without END. Data were also collected from a concurrent cohort of patients who had their preferred surgery. Endpoints included overall survival (OS) and disease-free survival (DFS). We conducted a meta-analysis of all six randomised trials. RESULTS: Two hundred fifty randomised and 346 observational cohort patients were studied (27 hospitals). Occult neck disease was found in 19.1% (T1) and 34.7% (T2) patients respectively. Five-year intention-to-treat hazard ratios (HR) were: OS HR = 0.71 (p = 0.18), and DFS HR = 0.66 (p = 0.04). Corresponding per-protocol results were: OS HR = 0.59 (p = 0.054), and DFS HR = 0.56 (p = 0.007). END was effective for small tumours. END patients experienced more facial/neck nerve damage; QoL was largely unaffected. The observational cohort supported the randomised findings. The meta-analysis produced HR OS 0.64 and DFS 0.54 (p < 0.001). CONCLUSION: SEND and the cumulative evidence show that within a generalisable setting oral cancer patients who have an upfront END have a lower risk of death/recurrence, even with small tumours. CLINICAL TRIAL REGISTRATION: NIHR UK Clinical Research Network database ID number: UKCRN 2069 (registered on 17/02/2006), ISCRTN number: 65018995, ClinicalTrials.gov Identifier: NCT00571883.

Harvesting Environmental Microalgal Blooms for Remediation and Resource Recovery: A Laboratory Scale Investigation with Economic and Microbial Community Impact Assessment.

A laboratory based microflotation rig termed efficient FLOtation of Algae Technology (eFLOAT) was used to optimise parameters for harvesting microalgal biomass from eutrophic water systems. This was performed for the dual objectives of remediation (nutrient removal) and resource recovery. Preliminary experiments demonstrated that chitosan was more efficient than alum for flocculation of biomass and the presence of bacteria could play a positive role and reduce flocculant application rates under the natural conditions tested. Maximum biomass removal from a hyper-eutrophic water retention pond sample was achieved with 5 mg·L-1 chitosan (90% Chlorophyll a removal). Harvesting at maximum rates showed that after 10 days, the bacterial diversity is significantly increased with reduced cyanobacteria, indicating improved ecosystem functioning. The resource potential within the biomass was characterized by 9.02 µg phosphate, 0.36 mg protein, and 103.7 µg lipid per mg of biomass. Fatty acid methyl ester composition was comparable to pure cultures of microalgae, dominated by C16 and C18 chain lengths with saturated, monounsaturated, and polyunsaturated fatty acids. Finally, the laboratory data was translated into a full-size and modular eFLOAT system, with estimated costs as a novel eco-technology for efficient algal bloom harvesting.

Pathological fracture of the coronoid process secondary to medication-related osteonecrosis of the jaw (MRONJ).

INTRODUCTION: Medication-related osteonecrosis of the jaw (MRONJ) is a growing problem within the field of oral and maxillofacial surgery. It is defined as the presence of exposed necrotic alveolar bone that does not resolve over a period of 8 weeks in a patient taking bisphosphonates, who has not had radiotherapy to the jaw [1]. Since the first report in 2003 that highlighted the potential harm caused by MRONJ, many more patients have been diagnosed with the condition [2]. The growth in recent years is likely due to the more potent drugs delivered intravenously however there is some evidence that oral bisphosphonates given over longer periods of time can have similar effects. Bone exposure may occur spontaneously or most commonly occurs following an invasive dental procedure, as shown in the case below [3]. PRESENTATION OF CASE: This case report demonstrates the unpredictable nature of symptoms associated with medication related osteonecrosis and its management within the hospital environment. DISCUSSION: This case demonstrastes the unpredictable nature of MRONJ and how the disease can progress to cause significant morbidity. In this case extensive surgery was required to remove the necrotic fragments of bone with no guarnatee that the necrosis will stop spreading. CONCLUSION: It seems a matter of great importance that the lasting effects of MRONJ are known to general dental and medical practitioners alike. Nationally recognised evidence based guidelines are lacking and uniformity in the management of MRONJ is required amongst the speciality.