The Royal London Hospital is a large teaching hospital in Whitechapel in the London Borough of Tower Hamlets. It is part of Barts Health NHS Trust. The Royal London provides district general hospital services for the City and Tower Hamlets and specialist tertiary care services for patients from across London and elsewhere. There are 845 beds, 110 wards and 26 operating theatres at The Royal London Hospital. The new building opened in February 2012.The Royal London was founded in September 1740 and was originally named The London Infirmary. The name changed to The London Hospital in 1748, and in 1990 to The Royal London Hospital. The first patients were treated at a house in Featherstone Street, Moorfields. In May 1741, the hospital moved to Prescot Street, and remained there until 1757 when it moved to its current location on the south side of Whitechapel Road, Whitechapel, in the London Borough of Tower Hamlets.The hospital's roof-top helipad is the London's Air Ambulance operating base. The helicopter is stored overnight at RAF Northolt.
Muscle dysfunction is a critical construct in dysphagia. Despite the availability of diverse techniques to evaluate muscle function, a comprehensive synthesis of measurement items and their properties is lacking. A systematic review of studies examining the measurement techniques used to directly evaluate oropharyngeal muscle function was performed. Studies investigating the use of surface electromyography, tongue dynamometry, ultrasound, high-resolution pharyngeal manometry, magnetic resonance imaging and computed tomography and reporting measurement properties in line with the COnsensus-based Standards for the selection of health Measurement InstrumeNts (COSMIN) were included. Measurement outcomes derived from these techniques were operationalised as single-item measures. Methodological quality was evaluated using the QualSyst tool. From the 6279 records, 125 eligible studies were identified. The breakdown of techniques was surface electromyography (n = 33), tongue dynamometry (n = 34), ultrasound (n = 17), high-resolution pharyngeal manometry (n = 15), magnetic resonance imaging (n = 5), computed tomography (n = 4) and combined techniques (n = 17). Single-item measures were heterogenous, covering a range of domains including muscle activation, coordination, strength, endurance, composition, thickness, and kinematics. Studies focused predominantly on oral rather than pharyngeal musculature. Validity (n = 117) was widely reported, primarily via known-group validity or hypothesis testing. Fewer studies examined reliability (n = 20) and responsiveness (n = 25); however, where reported, results indicated excellent intra- and inter-rater reliability and responsiveness to therapeutic interventions. A diverse range of single-item measures were identified across included measurement techniques. Measurement properties were sparsely reported. Future research should focus on rigorous measurement instrument design and standardisation to comprehensively evaluate the underlying mechanisms of dysphagia.
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.
The optimal treatment strategy for elderly patients with aneurysmal subarachnoid hemorrhage (aSAH) remains uncertain. While endovascular coiling and surgical clipping are both established interventions, age-related physiological vulnerability and comorbidity burden may alter the risk–benefit profile. We performed a systematic review and meta-analysis to compare outcomes between these two modalities in elderly patients with aSAH. Searches of PubMed, Embase, Scopus, and Cochrane CENTRAL were conducted from inception to 20th July 2025. The definition of elderly patients aged ≥ 60 years was adopted as per the World Health Organization. Primary outcomes were favorable functional outcome (modified Rankin Scale [mRS] 0–2) and mortality. Secondary outcomes were delayed cerebral ischemia (DCI), delayed hydrocephalus and rebleed. Twenty studies (2 randomized controlled trials, 18 observational) were included. A total of 44,526 patients were included with 24,724 aneurysms clipped and 19,802 coiled. The mean age was 72.1 years in the coiling cohort and 72.8 years in the clipping cohort. Aneurysm location was anterior in 94
Reconstruction of finger defects remains challenging, especially when protective sensation and mobility are required. The distal dorsoulnar artery perforator free flap (DDUAPF) provides neuro-sensate soft tissue coverage with low donor morbidity. No systematic review has previously combined outcomes of the DDUAPF in digital reconstruction; this study addresses this gap, and highlights a potential modification. A systematic search of Pubmed, Medline, EBSCO was performed. Screening followed PRISMA guidelines and the review was registered on PROSPERO (CRD420241137681). Outcomes included flap survival, complications, donor morbidity, range of motion (ROM), and sensory recovery. Study quality was assessed using Critical-Appraisal-Skills-Programme (CASP) checklist and Risk-of-Bias-In-Non-randomised-Studies-of-Interventions (ROBINS-I). Ten studies involving 178 patients and 184 flaps were included. Mean age was 33.7 years. Indications included trauma, degloving, infection, burns and ischaemia. Average flap size was 12.3 cm2 (range 3- 71.5 cm2). Flap failure occurred in 0.5
BACKGROUND:Trichophyton species cause the greatest burden of dermatophytosis worldwide, with the Trichophyton mentagrophytes species complex being particularly associated with the emergence of new aggressive infections. One emerging species, Trichophyton indotineae is notable for its clinical resistance to terbinafine antifungal treatment and rapid global spread. In this study we aim to characterise the epidemiology of this emerging pathogen using genomics. METHODS:In this retrospective genomic epidemiology study, to better understand the epidemiology of this disease, we sourced isolates collected from patients with severe cases of dermatophytosis (identified either by internal transcribed spacer sequencing or phenotypic characterisation) in the UK, Ireland, France, Canada, and India for the period 2014-23, including the T indotineae type strain from Japan. We used whole-genome sequencing to confirm 90 isolates were T indotineae, and antifungal susceptibility testing to assess susceptibility to terbinafine. FINDINGS:103 cases of severe dermatophytosis caused by Trichophyton species collected between 2018 and 2023 in the UK, France, Canada, Ireland, and India were included in this study. Susceptibility testing indicated that 63 (70%) of 90 T indotineae isolates were resistant to terbinafine (minimum inhibitory concentration [MIC] ≥0·5 mg/L). Pairwise genetic distances showed very high identity with only 147 (range 1-414) single-nucleotide polymorphisms (SNPs) separating isolates that were nested within a monophyletic phylogeny, supporting a single evolutionary origin of T indotineae. Genome-wide analyses identified multiple non-synonymous SNPs in SQLE (ERG1), the squalene epoxidase target of terbinafine, that were associated with terbinafine in vitro resistance of 0·5 mg/L or higher. However, six isolates exhibited high MIC values without SQLE mutations, suggesting the presence of alternative resistance mechanisms. INTERPRETATION:That no clear geographical clustering of isolates was observed confirms the rapid transcontinental spread of T indotineae from its likely centre of diversity in Asia. Our findings highlight the importance of better genomic surveillance to understand and manage this severe and rapidly emerging terbinafine-resistant dermatophyte. FUNDING:None.
