Barts and The London School of Medicine and Dentistry, commonly known as Barts, is a medical and dental school in London, England. The school is part of Queen Mary University of London, a constituent college of the federal University of London, and a member of the United Hospitals. It was formed in 1995 by the merger of the London Hospital Medical College (the first school to be granted an official charter for medical teaching in 1785) and St Bartholomew's Hospital Medical College (the oldest remaining hospital in the United Kingdom, having been founded in 1123, with medical teaching beginning from that date). The school exists on two main sites, having a presence at the site of both of the former colleges at and near their respective hospitals, St Bartholomew's Hospital (in Smithfield in the City of London and nearby in Charterhouse Square), and the Royal London Hospital in Whitechapel with an additional site at Queen Mary's main (Mile End) campus.As of 2018, the school had 2,235 undergraduate and 1,175 postgraduate students, for a total of 3,410 students.
The impact of body mass index (BMI) on the outcomes of head and neck free flap reconstructions, the gold standard method for treating complex defects, is not well-established. Understanding this relationship is essential for improving preoperative patient optimization. Studies investigating the association between BMI and outcomes of head and neck free flap reconstruction were identified from systematic searches of the PubMed, EMBASE and CENTRAL databases. The quality of evidence was assessed using the Newcastle-Ottawa Scale. Due to study design variability, a narrative synthesis was employed rather than a meta-analysis. 63 studies from 15 countries, encompassing 28,008 patients, were included. These studies were a mix of 34 cohort and 29 case-control studies. Underweight patients (BMI < 18.5 kg/m2) had reduced survival rates (5 out of 6 studies), higher transfusion requirements (2 out of 4 studies), and greater post-hospital rehabilitation needs (2 out of 2 studies). Obese patients (BMI > 30 kg/m2) showed an increased risk of venous thromboembolism (3 out of 4 studies) and postoperative pulmonary complications (2 out of 3 studies). No significant associations were found between BMI and other outcomes like flap failure, surgical site infections, unplanned readmissions, length of stay, and functional outcomes. The findings indicate that underweight patients may be at higher risk of reduced survival, increased transfusion needs, and more postoperative rehabilitation. Conversely, obese patients face heightened risks of venous thromboembolism and pulmonary complications. This study offers valuable insights into enhancing patient risk stratification and optimisation before head and neck free flap reconstruction.
IntroductionAccurate classification of pediatric dental diseases from panoramic radiographs is essential for early diagnosis and effective treatment planning. While deep learning models traditionally operate directly on image data, text-based representations generated from radiographs may provide an alternative strategy for disease classification.MethodsThis study proposed a text-driven framework in which a natural language transformer was used to generate structured textual descriptions from panoramic radiographs. These descriptions were subsequently classified for binary disease detection using three deep learning architectures: a one-dimensional convolutional neural network (1D-CNN), a long short-term memory (LSTM) network, and a pretrained Bidirectional Encoder Representations from Transformer (BERT) model. Model performance was evaluated and compared against three pretrained convolutional neural networks trained directly on radiographic images.ResultsThe 1D-CNN achieved the highest performance with 84% accuracy, demonstrating balanced classification across disease categories. The BERT model reached 77% accuracy, showing strong performance in detecting periapical infections but comparatively lower sensitivity for caries identification. The LSTM model performed substantially worse, achieving 57% accuracy. Both the 1D-CNN and BERT text-based approaches outperformed the three image-based pretrained CNN models.DiscussionThese findings suggest that text-based classification of panoramic radiographs is a potential alternative to conventional image-based deep learning methods. Language-driven models show promise for radiographic interpretation; however, challenges remain in achieving consistent generalizability across disease types. Future research should focus on improving radiograph-to-text generation quality, developing hybrid architectures that integrate textual and visual features, and validating performance on larger and more diverse datasets to strengthen clinical applicability.
BACKGROUND:Physician-based prehospital teams provide advanced critical care services in the UK (eg, prehospital anaesthesia). The last review of such teams in 2009, which included England, Wales and Northern Ireland, reported only one physician-based prehospital team available 24/7. Helicopter Emergency Medical Services (HEMS) across the UK offer paid physician-based teams, while other organisations may provide physician-based teams on a voluntary ad hoc basis. The primary aim of this study was to determine if access to a physician-based HEMS team has changed in the past 12 years. METHODS:An online survey was distributed to all UK HEMS organisations in January 2024. The primary outcome measure was the number of physician-based teams operated by HEMS in 2024 and the operational hours of such teams. Secondary outcomes included interventions offered by HEMS teams and any additional medical teams offered (eg, paramedic only). RESULTS:All 21 HEMS responded. The number of potentially available physician-based HEMS teams has increased from 11 in England, Wales and Northern Ireland in 2009 to 28 in 2024, with two services in Scotland (total=30). HEMS providing consistent 24/7 physician-based prehospital teams increased from one (5.9%) in 2009 to 11 (52.4%) in 2024. The East of England has the highest 24/7 availability, with Northern Ireland, South West England and Northern England the least. Within physician-based teams, variation remains in advanced interventions available-for example, 19 services (90.4%) offer blood transfusion while only one (4.7%) offers resuscitative balloon occlusion of the aorta. Only one service is completely government funded; the others are funded by charity alone or a combination of charity and government sources. CONCLUSION:Both geographical and temporal variations in access to a physician-based HEMS remain across the UK, although there has been improvement since 2009. However, within this provision, variation exists in terms of interventions provided such as the provision of blood products.
Background: Chest wall perforator flap (CWPF) reconstruction is becoming increasingly used in oncoplastic breast-conserving surgery. It enables tissue replacement after large tumor resections in single-stage operations without symmetrization surgery, all while achieving adequate margins to avoid mastectomy. Literature on BREAST-Q outcomes for CWPFs remains scarce. This study details our institutions' experience with CWPFs and evaluates their health-related quality of life outcomes. Methods: Forty patients underwent CWPF reconstruction at our institution between February 2022 and November 2024. Patient demographics, tumor characteristics, surgical factors, and complications were collected through retrospective chart review. The reconstruction module of the BREAST-Q questionnaire assessed postoperative patient-reported outcomes, with a response rate of 78% (n = 31). Results: The most common flaps were based on the lateral intercostal artery perforators (70.0%, n = 28), medial/anterior intercostal artery perforators (25.0%, n = 10), and lateral thoracic artery perforators (5.0%, n = 2). Margin re-excision and conversion to mastectomy rates were 23.1% (n = 9) and 10.3% (n = 4), respectively. Postoperative events needing intervention (seroma and complications) were associated with diabetes mellitus (P = 0.02). The median scores for BREAST-Q domains were as follows: 71.0 (satisfaction with breasts), 80.0 (physical well-being: chest), 83.0 (psychosocial well-being), 62.0 (sexual well-being), and 69.0 (breast sensation). Conclusions: Our findings suggest that CWPF reconstruction is well tolerated and achieves postoperative satisfaction rates and health-related quality of life outcomes comparable to other forms of oncoplastic breast-conserving surgery. Longitudinal studies with greater statistical power are needed to reliably assess predictors of breast satisfaction and postoperative morbidity.
