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Banus MS, Birchall MA, Graveston JA. Developing control algorithms of a voluntary cough for an artificial bioengineered larynx using surface electromyography of chest muscles: A prospective cohort study. Clin Otolaryngol 2018; 43:562-566. [PMID: 29069534 DOI: 10.1111/coa.13022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This prospective cohort study investigates the prediction of a voluntary cough using surface electromyography (EMG) of intercostal and diaphragm muscles, to develop control algorithms for an EMG-controlled artificial larynx. SETTING The Ear Institute, London. MAIN OUTCOME MEASURES Electromyography onset compared to voluntary cough exhalation onset and to 100 ms (to give the artificial larynx the time to close the bioengineered vocal cords) before voluntary cough exhalation onset, in twelve healthy participants. RESULTS In the 189 EMG of intercostal muscle-detected voluntary coughs, 172 coughs (91% CI 70-112) were detected before onset of cough exhalation and 128 coughs (67.6% CI 33.7-101.7) 100 ms before onset of cough exhalation. In the 158 EMG of diaphragm muscle-detected voluntary coughs, 149 coughs (94.3% CI 76.3-112.3) were detected before onset of cough exhalation and 102 coughs (64.6% CI 26.6-102.6) 100 ms before onset of cough exhalation. More coughs were detected before onset of cough exhalation when combining EMG activity of intercostal and diaphragm muscles and comparing this to intercostal muscle activity alone (183 coughs [96.8% CI 83.8-109.8] vs 172 coughs, P = .0294). When comparing the mentioned combination to diaphragm muscle activity alone, the higher percentage of detected coughs before cough exhalation onset was not found to be significant (183 coughs vs 149 coughs, P = .295). In addition, more coughs were detected 100 ms before onset of cough exhalation with the mentioned combination of EMG activity and comparing this to intercostal muscles alone (149 coughs [78.8% CI 48.8-108.8] vs 128 coughs, P = .0198) and to diaphragm muscles alone (149 coughs vs 102 coughs, P = .0038). CONCLUSIONS Most voluntary coughs can be predicted based on combined EMG signals of intercostal and diaphragm muscles, and therefore, these two muscle groups will be useful in controlling the bioengineered vocal cords within the artificial larynx during a voluntary cough.
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Affiliation(s)
- M S Banus
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - M A Birchall
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
| | - J A Graveston
- Department of Otolaryngology, Head and Neck surgery, The Ear Institute, University College of London, London, UK
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2
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Herrmann P, Ansari T, Southgate A, Varanou Jenkins A, Partington L, Carvalho C, Janes S, Lowdell M, Sibbons PD, Birchall MA. In vivo implantation of a tissue engineered stem cell seeded hemi-laryngeal replacement maintains airway, phonation, and swallowing in pigs. J Tissue Eng Regen Med 2017; 13:1943-1954. [PMID: 29048769 DOI: 10.1002/term.2596] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/15/2017] [Accepted: 10/09/2017] [Indexed: 01/27/2023]
Abstract
Laryngeal functional impairment relating to swallowing, vocalisation, and respiration can be life changing and devastating for patients. A tissue engineering approach to regenerating vocal folds would represent a significant advantage over current clinical practice. Porcine hemi-larynx were de-cellularised under negative pressure. The resultant acellular scaffold was seeded with human bone marrow derived mesenchymal stem cells and primary human epithelial cells. Seeded scaffolds were implanted orthotopically into a defect created in the thyroid cartilage in 8 pigs and monitored in vivo for 2 months. In vivo assessments consisted of mucosal brushing and bronchoscopy at 1, 2, 4, and 8 weeks post implantation followed by histological evaluation post termination. The implanted graft had no adverse effect on respiratory function in 6 of the 8 pigs; none of the pigs had problems with swallowing or vocalisation. Six out of the 8 animals survived to the planned termination date; 2 animals were terminated due to mild stenosis and deep tissue abscess formation, respectively. Human epithelial cells from mucosal brushings could only be identified at Weeks 1 and 4. The explanted tissue showed complete epithelialisation of the mucosal surface and the development of rudimentary vocal folds. However, there was no evidence of cartilage remodelling at the relatively early censor point. Single stage partial laryngeal replacement is a safe surgical procedure. Replacement with a tissue engineered laryngeal graft as a single procedure is surgically feasible and results in appropriate mucosal coverage and rudimentary vocal fold development.
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Affiliation(s)
- P Herrmann
- NPIMR, Harrow, UK.,UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | | | | | - A Varanou Jenkins
- Department Lungs for Living Research Centre, Division of Medicine, Rayne Building, University College London, London, UK
| | - L Partington
- Department of Haematology, University College London, London, UK
| | - C Carvalho
- Department of Haematology, University College London, London, UK
| | - S Janes
- Department Lungs for Living Research Centre, Division of Medicine, Rayne Building, University College London, London, UK
| | - M Lowdell
- Department of Haematology, University College London, London, UK
| | | | - M A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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3
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Arulanandam S, Hakim AJ, Aziz Q, Sandhu G, Birchall MA. Laryngological presentations of Ehlers-Danlos syndrome: case series of nine patients from two London tertiary referral centres. Clin Otolaryngol 2016; 42:860-863. [PMID: 27434416 DOI: 10.1111/coa.12708] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S Arulanandam
- Department of Otolaryngology, Singapore General Hospital, Singapore
| | - A J Hakim
- The Hospital of St John and St Elizabeth, London, UK
| | - Q Aziz
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - G Sandhu
- Charing Cross Hospital, London, UK
| | - M A Birchall
- Royal National Throat Nose and Ear Hospital, London, UK
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, McLaren CA, Butler CR, Crowley C, Janes SM, O'Callaghan C, Culme-Seymour EJ, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Reply to: "Recent Advances in Circumferential Tracheal Replacement and Transplantation". Am J Transplant 2016; 16:1336-7. [PMID: 26813777 DOI: 10.1111/ajt.13736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- N J Hamilton
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Kanani
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - D J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R J Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, London, UK
| | - R Cetto
- Department of Aeronautics, Imperial College London, London, UK
| | - C A McLaren
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - C R Butler
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C Crowley
- University College London Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
| | - S M Janes
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C O'Callaghan
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | | | - C Mason
- London Regenerative Medicine Network, London, UK
| | - P De Coppi
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - M W Lowdell
- Department of Haematology, Royal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular Therapeutics, London, UK
| | - M J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - M A Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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5
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Mat Baki M, Wood G, Alston M, Ratcliffe P, Sandhu G, Rubin JS, Birchall MA. Reliability of OperaVOX against Multidimensional Voice Program (MDVP). Clin Otolaryngol 2015; 40:22-8. [PMID: 25263076 DOI: 10.1111/coa.12313] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the agreement between OperaVOX and MDVP. DESIGN Cross sectional reliability study. SETTING University teaching hospital. METHODS Fifty healthy volunteers and 50 voice disorder patients had supervised recordings in a quiet room using OperaVOX by the iPod's internal microphone with sampling rate of 45 kHz. A five-seconds recording of vowel/a/was used to measure fundamental frequency (F0), jitter, shimmer and noise-to-harmonic ratio (NHR). All healthy volunteers and 21 patients had a second recording. The recorded voices were also analysed using the MDVP. The inter- and intrasoftware reliability was analysed using intraclass correlation (ICC) test and Bland-Altman (BA) method. Mann-Whitney test was used to compare the acoustic parameters between healthy volunteers and patients. RESULTS Nine of 50 patients had severe aperiodic voice. The ICC was high with a confidence interval of >0.75 for the inter- and intrasoftware reliability except for the NHR. For the intersoftware BA analysis, excluding the severe aperiodic voice data sets, the bias (95% LOA) of F0, jitter, shimmer and NHR was 0.81 (11.32, -9.71); -0.13 (1.26, -1.52); -0.52 (1.68, -2.72); and 0.08 (0.27, -0.10). For the intrasoftware reliability, it was -1.48 (18.43, -21.39); 0.05 (1.31, -1.21); -0.01 (2.87, -2.89); and 0.005 (0.20, -0.18), respectively. Normative data from the healthy volunteers were obtained. There was a significant difference in all acoustic parameters between volunteers and patients measured by the Opera-VOX (P < 0.001) except for F0 in females (P = 0.87). CONCLUSION OperaVOX is comparable to MDVP and has high internal consistency for measuring the F0, jitter and shimmer of voice except for the NHR.
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Affiliation(s)
- M Mat Baki
- Ear Institute, University College London, London, UK; Royal National Throat Nose Ear Hospital, University College London Hospital NHS Trust, London, UK; Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, Culme‐Seymour EJ, Toll E, Bates AJ, Comerford AP, McLaren CA, Butler CR, Crowley C, McIntyre D, Sebire NJ, Janes SM, O'Callaghan C, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Tissue-Engineered Tracheal Replacement in a Child: A 4-Year Follow-Up Study. Am J Transplant 2015; 15:2750-7. [PMID: 26037782 PMCID: PMC4737133 DOI: 10.1111/ajt.13318] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/16/2015] [Accepted: 03/07/2015] [Indexed: 02/06/2023]
Abstract
In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs.
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Affiliation(s)
- N. J. Hamilton
- University College London Ear InstituteRoyal National Throat Nose and Ear HospitalLondonUK
| | - M. Kanani
- Department of Cardiothoracic SurgeryGreat Ormond Street HospitalLondonUK
| | - D. J. Roebuck
- Department of RadiologyGreat Ormond Street HospitalLondonUK
| | - R. J. Hewitt
- Department of OtorhinolaryngologyGreat Ormond Street HospitalLondonUK
| | - R. Cetto
- Imperial College London, Department of AeronauticsLondonUK
| | | | - E. Toll
- Department of Cardiothoracic SurgeryGreat Ormond Street HospitalLondonUK
| | - A. J. Bates
- Imperial College London, Department of AeronauticsLondonUK
| | | | - C. A. McLaren
- Department of RadiologyGreat Ormond Street HospitalLondonUK
| | - C. R. Butler
- Lungs for Living Research CentreRayne InstituteLondonUK
| | - C. Crowley
- University College London Centre for Nanotechnology and Regenerative MedicineRoyal Free HospitalLondonUK
| | - D. McIntyre
- Department of Cardiothoracic SurgeryGreat Ormond Street HospitalLondonUK
| | - N. J. Sebire
- Department of HistopathologyGreat Ormond Street HospitalLondonUK
| | - S. M. Janes
- Lungs for Living Research CentreRayne InstituteLondonUK
| | - C. O'Callaghan
- Department of Respiratory MedicineGreat Ormond Street HospitalLondonUK
| | - C. Mason
- London Regenerative Medicine NetworkLondonUK
| | - P. De Coppi
- Department of SurgeryGreat Ormond Street HospitalLondonUK
| | - M. W. Lowdell
- Department of HaematologyRoyal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular TherapeuticsLondonUK
| | - M. J. Elliott
- Department of Cardiothoracic SurgeryGreat Ormond Street HospitalLondonUK
| | - M. A. Birchall
- University College London Ear InstituteRoyal National Throat Nose and Ear HospitalLondonUK
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7
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Hamilton NJ, Kanani M, Roebuck DJ, Hewitt RJ, Cetto R, Culme-Seymour EJ, Toll E, Bates AJ, Comerford AP, McLaren CA, Butler CR, Crowley C, McIntyre D, Sebire NJ, Janes SM, O'Callaghan C, Mason C, De Coppi P, Lowdell MW, Elliott MJ, Birchall MA. Tissue-Engineered Tracheal Replacement in a Child: A 4-Year Follow-Up Study. Am J Transplant 2015. [PMID: 26037782 DOI: 10.1111/ajt.13318.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In 2010, a tissue-engineered trachea was transplanted into a 10-year-old child using a decellularized deceased donor trachea repopulated with the recipient's respiratory epithelium and mesenchymal stromal cells. We report the child's clinical progress, tracheal epithelialization and costs over the 4 years. A chronology of events was derived from clinical notes and costs determined using reference costs per procedure. Serial tracheoscopy images, lung function tests and anti-HLA blood samples were compared. Epithelial morphology and T cell, Ki67 and cleaved caspase 3 activity were examined. Computational fluid dynamic simulations determined flow, velocity and airway pressure drops. After the first year following transplantation, the number of interventions fell and the child is currently clinically well and continues in education. Endoscopy demonstrated a complete mucosal lining at 15 months, despite retention of a stent. Histocytology indicates a differentiated respiratory layer and no abnormal immune activity. Computational fluid dynamic analysis demonstrated increased velocity and pressure drops around a distal tracheal narrowing. Cross-sectional area analysis showed restriction of growth within an area of in-stent stenosis. This report demonstrates the long-term viability of a decellularized tissue-engineered trachea within a child. Further research is needed to develop bioengineered pediatric tracheal replacements with lower morbidity, better biomechanics and lower costs.
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Affiliation(s)
- N J Hamilton
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - M Kanani
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - D J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - R J Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, London, UK
| | - R Cetto
- Imperial College London, Department of Aeronautics, London, UK
| | | | - E Toll
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - A J Bates
- Imperial College London, Department of Aeronautics, London, UK
| | - A P Comerford
- Imperial College London, Department of Aeronautics, London, UK
| | - C A McLaren
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - C R Butler
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C Crowley
- University College London Centre for Nanotechnology and Regenerative Medicine, Royal Free Hospital, London, UK
| | - D McIntyre
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - N J Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | - S M Janes
- Lungs for Living Research Centre, Rayne Institute, London, UK
| | - C O'Callaghan
- Department of Respiratory Medicine, Great Ormond Street Hospital, London, UK
| | - C Mason
- London Regenerative Medicine Network, London, UK
| | - P De Coppi
- Department of Surgery, Great Ormond Street Hospital, London, UK
| | - M W Lowdell
- Department of Haematology, Royal Free Hospital, University College London Paul O'Gorman Laboratory of Cellular Therapeutics, London, UK
| | - M J Elliott
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - M A Birchall
- University College London Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
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8
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Lange P, Greco K, Partington L, Carvalho C, Oliani S, Birchall MA, Sibbons PD, Lowdell MW, Ansari T. Pilot study of a novel vacuum-assisted method for decellularization of tracheae for clinical tissue engineering applications. J Tissue Eng Regen Med 2015; 11:800-811. [PMID: 25689270 DOI: 10.1002/term.1979] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Revised: 10/07/2014] [Accepted: 11/07/2014] [Indexed: 12/18/2022]
Abstract
Tissue engineered tracheae have been successfully implanted to treat a small number of patients on compassionate grounds. The treatment has not become mainstream due to the time taken to produce the scaffold and the resultant financial costs. We have developed a method for decellularization (DC) based on vacuum technology, which when combined with an enzyme/detergent protocol significantly reduces the time required to create clinically suitable scaffolds. We have applied this technology to prepare porcine tracheal scaffolds and compared the results to scaffolds produced under normal atmospheric pressures. The principal outcome measures were the reduction in time (9 days to prepare the scaffold) followed by a reduction in residual DNA levels (DC no-vac: 137.8±48.82 ng/mg vs. DC vac 36.83±18.45 ng/mg, p<0.05.). Our approach did not impact on the collagen or glycosaminoglycan content or on the biomechanical properties of the scaffolds. We applied the vacuum technology to human tracheae, which, when implanted in vivo showed no significant adverse immunological response. The addition of a vacuum to a conventional decellularization protocol significantly reduces production time, whilst providing a suitable scaffold. This increases clinical utility and lowers production costs. To our knowledge this is the first time that vacuum assisted decellularization has been explored. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- P Lange
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK.,Department of Haematology, UCL, Medical School, London, UK
| | - K Greco
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
| | - L Partington
- Department of Haematology, UCL, Medical School, London, UK
| | - C Carvalho
- Department of Haematology, UCL, Medical School, London, UK
| | - S Oliani
- Immunomorphology Laboratory, Department of Biology, IBILCE-UNESP, São José do Rio Preto, Brazil
| | - M A Birchall
- UCL Ear Institute, Royal National Throat Nose and Ear Hospital, London, UK
| | - P D Sibbons
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
| | - M W Lowdell
- Department of Haematology, UCL, Medical School, London, UK
| | - T Ansari
- Department of Surgical Research, NPIMR, Watford Rd, Harrow, UK
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9
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Teoh GZ, Crowley C, Birchall MA, Seifalian AM. Development of resorbable nanocomposite tracheal and bronchial scaffolds for paediatric applications. Br J Surg 2015; 102:e140-50. [DOI: 10.1002/bjs.9700] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/12/2014] [Accepted: 10/10/2014] [Indexed: 11/07/2022]
Abstract
Abstract
Background
Congenital tracheal defects and prolonged intubation following premature birth have resulted in an unmet clinical need for tracheal replacement. Advances in stem cell technology, tissue engineering and material sciences have inspired the development of a resorbable, nanocomposite tracheal and bronchial scaffold.
Methods
A bifurcated scaffold was designed and constructed using a novel, resorbable nanocomposite polymer, polyhedral oligomeric silsesquioxane poly(ϵ-caprolactone) urea urethane (POSS-PCL). Material characterization studies included tensile strength, suture retention and surface characteristics. Bone marrow-derived mesenchymal stem cells (bmMSCs) and human tracheobronchial epithelial cells (HBECs) were cultured on POSS-PCL for up to 14 days, and metabolic activity and cell morphology were assessed. Quantum dots conjugated to RGD (l-arginine, glycine and l-aspartic acid) tripeptides and anticollagen type I antibody were then employed to observe cell migration throughout the scaffold.
Results
POSS-PCL exhibited good mechanical properties, and the relationship between the solid elastomer and foam elastomer of POSS-PCL was comparable to that between the cartilaginous U-shaped rings and interconnective cartilage of the native human trachea. Good suture retention was also achieved. Cell attachment and a significant, steady increase in proliferation were observed for both cell types (bmMSCs, P = 0·001; HBECs, P = 0·003). Quantum dot imaging illustrated adequate cell penetration throughout the scaffold, which was confirmed by scanning electron microscopy.
Conclusion
This mechanically viable scaffold successfully supports bmMSC and HBEC attachment and proliferation, demonstrating its potential as a tissue-engineered solution to tracheal replacement.
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Affiliation(s)
- G Z Teoh
- Division of Surgery and Interventional Science, London, UK
- University College London Centre for Nanotechnology and Regenerative Medicine, London, UK
| | - C Crowley
- Division of Surgery and Interventional Science, London, UK
- Institute of Child Health, London, UK
| | - M A Birchall
- Ear Institute, University College London, London, UK
- Department of Surgery, Royal National Throat, Nose and Ear Hospital, London, UK
| | - A M Seifalian
- Division of Surgery and Interventional Science, London, UK
- University College London Centre for Nanotechnology and Regenerative Medicine, London, UK
- Department of Surgery, Royal Free NHS Foundation Trust Hospital, London, UK
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10
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Siddiqui J, Sherren PB, Birchall MA. Evidence-based guidelines and protocols for the management of adult patients with a tracheostomy: a systematic review. Crit Care 2013. [PMCID: PMC3642482 DOI: 10.1186/cc12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Partington L, Mordan NJ, Mason C, Knowles JC, Kim HW, Lowdell MW, Birchall MA, Wall IB. Biochemical changes caused by decellularization may compromise mechanical integrity of tracheal scaffolds. Acta Biomater 2013; 9:5251-61. [PMID: 23059415 DOI: 10.1016/j.actbio.2012.10.004] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Revised: 09/29/2012] [Accepted: 10/03/2012] [Indexed: 12/13/2022]
Abstract
Tissue-engineered airways have achieved clinical success, but concerns remain about short-term loss of biomechanical properties, necessitating a stent. This study investigated the effect of chemical-enzymatic decellularization on biochemical properties of trachea important for cell attachment and vascularization (fibronectin and laminin) and cartilage matrix homeostasis (type II collagen and glycosaminoglycans (GAG)), as well as biomechanical status. Native trachea was used as a control, and NDC trachea stored in phosphate buffered saline (PBS) in parallel to decellularization was used as a time-matched control. Decellularization removed most cells, but chondrocytes and DNA remained after 25 cycles. Fibronectin was retained throughout the lamina propria and laminin at basement membranes. DNA accumulation along ECM fibres was seen. A decline in soluble collagen was observed in decellularized tissue. GAG content of cartilage rings was reduced, even in PBS control tissue from 20 cycles onwards (p<0.05), but decellularization caused the greatest loss (p<0.01). Tensile strength declined throughout the process, but was significant only at later time points. The data demonstrate that the substantial reduction in GAG might contribute to loss of mechanical integrity of biotracheas. Overcoming structural changes that cause an imbalance in cartilage matrix equilibrium will be necessary to optimize clinical benefit, enabling widespread use of biotracheas.
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Affiliation(s)
- L Partington
- Department of Biochemical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
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12
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Birchall MA, Ayling SM, Harley R, Murison PJ, Burt R, Mitchard L, Jones A, Macchiarini P, Stokes CR, Bailey M. Laryngeal transplantation in minipigs: early immunological outcomes. Clin Exp Immunol 2012; 167:556-64. [PMID: 22288599 DOI: 10.1111/j.1365-2249.2011.04531.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Despite recent tissue-engineering advances, there is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. A recent clinical transplant was a success. Using quantitative immunofluorescence targeted at immunologically relevant molecules, we have studied the early (48 h and 1 week) immunological responses within larynxes transplantated between seven pairs of National Institutes of Health (NIH) minipigs fully homozygous at the major histocompatibility complex (MHC) locus. There were only small changes in expression of some molecules (relative to interindividual variation) and these were clearest in samples from the subglottic region, where the areas of co-expression of CD25(+) CD45RC(-) CD8(-) and of CD163(+) CD172(+) MHC-II(-) increased at 1 week after transplant. In one case, infiltration by recipient T cells was analysed by T cell receptor (TCR) Vβ spectratype analysis; this suggested that changes in the T cell repertoire occur in the donor subglottis mucosal tissues from day 0 to day 7, but that the donor and recipient mucosal Vβ repertoires remain distinct. The observed lack of strong immunological responses to the trauma of surgery and ischaemia provides encouraging evidence to support clinical trials of laryngeal transplantation, and a basis on which to interpret future studies involving mismatches.
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Affiliation(s)
- M A Birchall
- Department of Clinical Sciences at South Bristol, University of Bristol, Bristol, UK.
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13
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Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P. Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes. Eur Arch Otorhinolaryngol 2010; 268:405-14. [PMID: 20842506 PMCID: PMC3192951 DOI: 10.1007/s00405-010-1355-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Accepted: 07/25/2010] [Indexed: 12/01/2022]
Abstract
There is no effective way of replacing all the functions of the larynx in those requiring laryngectomy. Regenerative medicine offers promise, but cannot presently deliver implants with functioning neuromuscular units. A single well-documented laryngeal transplant in man was a qualified success, but more information is required before clinical trials may be proposed. We studied the early response of the larynx to laryngeal transplantation between 17 pairs of NIH minipigs full matched at the MHC2 locus. Following iterative technical improvements, pigs had good swallowing and a patent airway at 1 week. No significant changes in mucosal blood flux were observed compared with pre-operative measurements. Changes in muscle morphology and fibre phenotype were observed in transplant muscles retrieved after 7 days: the levels of fast and slow myosin heavy chain (MyHC) protein were reduced and embryonic MyHC was up regulated consistent with denervation induced atrophy. At 1 week laryngeal transplantation can result in good swallowing, and is not associated with clinical evidence of ischemia-reperfusion injury in MHC-matched pigs.
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Affiliation(s)
- M A Birchall
- Department of Clinical Sciences at South Bristol, Bristol, UK.
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14
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15
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Grant DG, Bradley PT, Pothier DD, Bailey D, Caldera S, Baldwin DL, Birchall MA. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34:103-12. [PMID: 19413607 DOI: 10.1111/j.1749-4486.2009.01889.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. DESIGN A prospective cohort study and qualitative systematic review. SETTING Multi-cancer networks in the South West of England, Hampshire and the Isle of White. PARTICIPANTS One hundred and seventy-two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty-one patients had radiologically inserted gastrostomy (RIG). Twenty-seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. MAIN OUTCOME MEASURES Post-procedure mortality, major and minor complications. RESULTS In the present series, mortality rates were 1.0% (1/121) for PEG and 3.9% (2/51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4/121) and 15.6% (9/51) respectively. In our systematic review and meta-analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014-0.034) following PEG and 1.8% (95% CI 0.010-0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9-9.3%) and 8.9% (95% CI 7.0-11.2%) after RIG. CONCLUSIONS Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.
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Affiliation(s)
- D G Grant
- Department of Otolaryngology, Head and Neck Surgery, Southmead Hospital, Bristol, UK.
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16
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Murison PJ, Jones A, Mitchard L, Burt R, Birchall MA. Development of perioperative care for pigs undergoing laryngeal transplantation: a case series. Lab Anim 2009; 43:338-43. [PMID: 19535394 DOI: 10.1258/la.2009.008101] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pigs are ideal animal models for airway surgical research, facilitating the successful translation of science into clinical practice. Despite their ubiquitous use, there is a paucity of information on the perioperative care of pigs, especially for major procedures. In a series of experiments to investigate laryngeal transplantation, we combined veterinary and medical experience to develop protocols for perioperative management of pigs, including high dependency care. Novel airway management methods were developed. A pain scoring system was used to direct analgesia use. Fluid balance and electrolytes were monitored closely. Recent animals received a central venous line via the femoral vein two days prior to transplantation to facilitate blood sampling and drug delivery. Intensive monitoring and airway management were required to ensure a successful outcome. Methods for optimal perioperative care are proposed. These results will help future groups wishing to use pigs in airway research, will reduce numbers of animals used and improve animal welfare.
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Affiliation(s)
- P J Murison
- University of Bristol, Department of Clinical Veterinary Science, Langford House, Langford, Bristol BS40 5DU, UK
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17
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Abstract
Results are encouraging
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Affiliation(s)
- M A Birchall
- The Royal National Throat, Nose and Ear Hospital and UCL Ear Institute, 330 Gray's Inn Road, London WC1X 8DA, UK
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18
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Grant DG, Birchall MA. Concurrent chemoradiotherapy is not the only answer. Clin Otolaryngol 2007; 32:416-7. [PMID: 17883586 DOI: 10.1111/j.1749-4486.2007.01488.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hobbs CGL, Rees LEN, Heyderman RS, Birchall MA, Bailey M. Major histocompatibility complex class I expression in human tonsillar and laryngeal epithelium. Clin Exp Immunol 2006; 145:365-71. [PMID: 16879258 PMCID: PMC1809683 DOI: 10.1111/j.1365-2249.2006.03125.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Understanding the immunological structure of the upper aerodigestive tract is important for analysing the interaction between incident challenges, such as human papillomavirus infection, and disease, particularly head and neck cancer. We have shown previously that tonsillar and laryngeal epithelium express major histocompatibility complex (MHC) class II locus products, but that expression of human leucocyte antigen (HLA)-DQ is reduced compared to HLA-DR. This may confer a decreased repertoire of presented T cell epitopes generated by the processing of exogenous peptides in upper airway mucosa. To determine whether the peptide repertoire presented by MHC class I loci varies in stratified squamous epithelium, laryngeal and tonsillar biopsies were taken from 19 otherwise healthy patients (M : F 6 : 13, 16-64 years). Quantitative immunofluorescence microscopy, using antibodies to MHC class I alpha-chain (pan-locus specific, HLA-A, HLA-B + C) and beta(2)-microglobulin, showed lower expression of the alpha-chain in laryngeal and tonsillar epithelium than in either lamina propria (tonsil 73% versus 89%, P < 0.0001; larynx 68% versus 85%, P < 0.005). Within the epithelium itself, the intensity of alpha-chain expression decreased from the basal to apical layers. In paired squamous epithelia from the two sites, alpha-chain expression was significantly higher in the tonsil compared to the larynx (79% versus 62%, P < 0.05). We suggest that these findings reflect functional stratification of these epithelia with the superficial layer, most exposed to incident challenges, less equipped to present antigens to conventional T cells. This may affect immunosurveillance directed at viral and tumour-related epitopes in the upper airway.
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Affiliation(s)
- C G L Hobbs
- Clinical Sciences at South Bristol, Division of Veterinary Pathology, Immunity and Infection, University of Bristol, Bristol, UK.
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20
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Hobbs CGL, Sterne JAC, Bailey M, Heyderman RS, Birchall MA, Thomas SJ. Human papillomavirus and head and neck cancer: a systematic review and meta-analysis. Clin Otolaryngol 2006; 31:259-66. [PMID: 16911640 DOI: 10.1111/j.1749-4486.2006.01246.x] [Citation(s) in RCA: 269] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
It has been suggested that the link between human papillomavirus (HPV) and head and neck squamous cell carcinoma (HNSCC) is specific to carcinoma of the tonsil. We systematically reviewed studies that tested for HPV16 exposure in anatomically defined sites in the head and neck and a control group. The association between HPV16 and cancer was strongest for tonsil (OR: 15.1, 95% CI: 6.8-33.7), intermediate for oropharynx (OR: 4.3, 95% CI: 2.1-8.9) and weakest for oral (OR: 2.0, 95% CI: 1.2-3.4) and larynx (OR: 2.0, 95% CI: 1.0-4.2). To investigate heterogeneity, further stratification by method of HPV16 detection, suggested that variation in the magnitude of the HPV-cancer association with cancer site was restricted to studies using ELISA: among studies using PCR, the magnitude of the summary odds ratios was similar across the four sites. The association between HPV16 infection and HNSCC in specific sites suggests the strongest and most consistent association is with tonsil cancer, and the magnitude of this association is consistent with an infectious aetiology. However, the method of viral detection may be an important source of heterogeneity. Resolution of this issue will require further studies using both methods, examining associations separately in different sites.
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Affiliation(s)
- C G L Hobbs
- Clinical Science at South Bristol, University of Bristol, Bristol, UK
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21
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Abstract
There is no good surgical, medical or prosthetic solution to the problems faced by those with a larynx whose function is irreversibly damaged by tumor or trauma. Over the past 10 years, the pace of research designed to establish laryngeal transplantation as a therapeutic option for these persons has increased steadily. The biggest milestone in this field was the world's first true laryngeal transplant performed in Cleveland, Ohio in 1998. The recipient's graft continues to function well, in many respects, even after 7 years. However, it has also highlighted the remaining barriers to full-scale clinical trials. Stimulated by these observations, several groups have accumulated data which point to answers to some of the outstanding questions surrounding functional reinnervation and immunomodulation. This review seeks to outline the progress achieved in this field by 2005 and to point the way forward for laryngeal transplantation research in the 21st century.
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Affiliation(s)
- M A Birchall
- Division of Surgery and Oncology, University of Liverpool, Liverpool, UK.
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22
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Mal RK, Birchall MA. Dysgeusia related to urinary obstruction from benign prostatic disease: a case control and qualitative study. Eur Arch Otorhinolaryngol 2005; 263:176-9. [PMID: 16133464 DOI: 10.1007/s00405-005-0973-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Anecdotal reports suggest that dysgeusia may be related to a variety of systemic factors, including bladder outflow obstruction. This is a hospital-based case-controlled study involving 111 patients who were admitted to urological wards for transurethral resection of the prostate for benign prostatic disease with age- and sex-matched control of 137 subjects. We used a semi-structured questionnaire by a trained interviewer at admission (preoperative), at the postoperative period and at follow-up between 4-6 months (median 5 months). Analysis used unpaired t-test and chi(2) test. The incidence of dysgeusia was 22% in the study group and 13% in the control group (P=N.S.). However, strikingly, the dysgeusia in the study group was relieved promptly by relief of urinary obstruction in 100% of cases and did not return within the follow-up period. The mechanism of the dysgeusia associated with dysuria in benign prostatic disease is unknown, but we suggest that the dysgeusia could be from the stress of dysuria or due to a release of an unknown chemical from the urinary tract or an overflow of neural impulse from pontine/cortical micturition centres to the taste centres. An association between dysgeusia and dysuria has not been described before.
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Affiliation(s)
- R K Mal
- Department of Otolaryngology, University of Bristol, Southmead Hospital, Bristol, BS10 5ND, UK.
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23
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Al-Hazzaa A, Bowen ID, Randerson P, Birchall MA. The effect of ZD1839 (Iressa), an epidermal growth factor receptor tyrosine kinase inhibitor, in combination with cisplatin, on apoptosis in SCC-15 cells. Cell Prolif 2005; 38:77-86. [PMID: 15842252 PMCID: PMC6760735 DOI: 10.1111/j.1365-2184.2005.00332.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to determine the effect of ZD1839 on growth and apoptosis in SCC-15 (a human head and neck cancer cell line) lone, or in combination with cisplatin. High expression of the epidermal growth factor receptor has been implicated in the development of squamous cell carcinomas of head and neck. ZD1839 ('Iressa') is an orally active, selective epidermal growth factor receptor tyrosine kinase inhibitor that blocks signal transduction pathways implicated in proliferation and survival of cancer cells, and other host-dependent processes promoting cancer growth. Here, growth arrest was observed with 3.64 microm ZD1839. The 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (sMTT) viability assay revealed a significant decrease (P < 0.001) in the percentage of surviving cells upon treatment with ZD1839 and cisplatin compared with cisplatin or ZD1839 on their own. Combined therapy of 3.64 microm ZD1839 for 24 h, prior to administration of 100 microm cisplatin, significantly (P < 0.001) and additively increased the cytotoxicity effect of cisplatin. p53-independent apoptosis was seen with cisplatin treatment, a novel finding. These data support the use of ZD1839 in anti-cancer therapy, and particularly in combination therapy. Cisplatin may induce p53-independent apoptosis. Over-expression of Bcl-2 in head and neck squamous cell carcinoma tumour cell lines is unlikely to be a general mechanism to protect these cells from apoptosis.
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Affiliation(s)
- A Al-Hazzaa
- Cardiff School of Biosciences, University of Wales, Cardiff, UK
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24
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Thornton MR, Mantovani C, Birchall MA, Terenghi G. Quantification of N-CAM and N-cadherin expression in axotomized and crushed rat sciatic nerve. J Anat 2005; 206:69-78. [PMID: 15679872 PMCID: PMC1571456 DOI: 10.1111/j.0021-8782.2005.00369.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2004] [Indexed: 11/28/2022] Open
Abstract
Adhesion molecules are important in supporting axonal regeneration. Qualitative studies have described increased expression of neural cell adhesion molecule (NCAM) and N-cadherin in models of nerve injury allowing active regeneration. In this study we have used quantitative immunohistochemistry to compare expression of NCAM and N-cadherin after nerve injury either with active regeneration (crush) into the distal stump or without (axotomy and capping). Quantification was performed 15 days after axotomy in proximal and distal stumps. Quantification after crush either proximal, distal or within the crushed area was performed at 2, 7, 15 and 30 days after injury. Axotomy induced increases in expression in proximal stumps between two and three times those in uninjured nerves for both molecules. In distal stumps, N-cadherin levels increased seven-fold, yet NCAM levels did not exceed control values. After crush, NCAM immunoreactivity increased in the crushed area and distal stump in contrast to axotomy and NCAM-positive axons co-localized with PGP9.5. N-cadherin levels in the distal stump increased above control levels, but the magnitude of the increase seen after crush was different to those seen after axotomy. In conclusion, increased expression of adhesion molecules, particularly NCAM, in the distal stump of injured nerves is dependent upon the presence of regenerating axons.
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Affiliation(s)
- M R Thornton
- Blond McIndoe Laboratories, Plastic & Reconstructive Surgery Research, University of Manchester, UK
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25
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Rees LE, Ayoub O, Haverson K, Birchall MA, Bailey M. Differential major histocompatibility complex class II locus expression on human laryngeal epithelium. Clin Exp Immunol 2004; 134:497-502. [PMID: 14632757 PMCID: PMC1808879 DOI: 10.1111/j.1365-2249.2003.02301.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The survival of a laryngeal allograft will be dependent on the immunological composition of the donor larynx and, in particular, on the expression of major histocompatibility complex (MHC) class II antigens on professional and non-professional antigen-presenting cells. Laryngeal and tonsillar biopsies from normal individuals aged 18-78 years were processed and prepared for quantitative, multiple-colour immunofluorescence using mouse antihuman monoclonal antibodies to human leucocyte antigen (HLA)-DR, HLA-DQ and CD45. The laryngeal epithelium expressed HLA-DR locus products at variable levels, but expression of HLA-DQ was virtually absent. Tonsillar epithelial cells expressed HLA-DR at the basal layer only, while HLA-DQ was similarly not expressed. In contrast, both HLA-DR and -DQ locus products were present on lamina propria and intraepithelial leucocytes in both laryngeal and tonsillar mucosae, although at varying levels. The finding that laryngeal epithelial cells express MHC class II antigens has implications for the survival of laryngeal allografts and suggests that they may require significant immunomodulation. In addition, antigen presentation by epithelial cells has been hypothesized to contribute to the immunoregulatory function of mucosal tissues, and the finding that HLA-DQ locus products are only expressed at low levels by laryngeal epithelium raises questions about the repertoire of peptides to which the mucosal immune system can respond.
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Affiliation(s)
- L E Rees
- Laryngeal Research Group, Department of Otolaryngology, Division of Surgery, University of Bristol, Bristol, UK.
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26
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Abstract
Angiogenesis is a cascade-like mechanism, essential for the progression of solid tumours. Quantifying microvessel density is considered the gold standard for measuring baseline angiogenesis and indeed "the response to intervention". Applying immunohistochemical techniques to biopsies conventionally does this; however, it would be very helpful to have a less invasive, reliable method of quantifying blood flux, and hence angiogenesis. The aim of the study was to validate the use of a laser Doppler flux meter as an experimental tool in laryngology. The principle and technique of laser Doppler flux-metry is described. A validation study designed to estimate the reproducibility and ability to measure change was performed in the human larynx and in an animal model. Statistical advice was sought and analysis was performed using SPSS software. Our experiments show good reproducibility of laser Doppler measurements in the human and animal model (correlation coefficient 0.956 and 0.947, respectively, P=0.01). We have also shown that the laser Doppler flux meter is capable of detecting change when it is expected ( P<0.01). Utilising a standardised technique, laser Doppler flux-metry appears to be a reliable and reproducible method of estimating blood flux in the larynx.
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Affiliation(s)
- A Jacob
- Department of Otolaryngology, Head and Neck Surgery, Guys Hospital, SE1 9RT, London, UK,
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27
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Abstract
Tumour angiogenesis has recently attracted a great deal of attention as a critical part of oncogenesis and a necessary prerequisite for a malignant phenotype. Novel antiangiogenic therapy for solid tumours including laryngeal cancer is entering clinical trials. Quantifying microvessel density is considered the gold standard for measuring baseline angiogenesis and indeed 'the response to intervention'. We hypothesize that laser Doppler flux-metry could provide a non-invasive reliable method of quantifying blood flux within tumours. The aims were to determine whether a laser Doppler flux meter could be used as a reliable and reproducible method of estimating blood flux in the human larynx and to establish baseline Doppler flux recordings for the human larynx. The method used was a validation study in patients with laryngeal squamous cell cancer and normal controls. Statistical analysis was performed using SPSS software. We have demonstrated good reproducibility of laser Doppler measurements in human laryngeal mucosa (correlation coefficient 0.956 @P = 0.01). We have also derived arbitrary means of laser Doppler flux-metry in normal laryngeal mucosa and in squamous cell carcinoma of the larynx. Comparisons between normal and tumour laser Doppler flux-metry (LDF) readings showed no significant difference. We suggest that Laser Doppler flux-metry is a potentially useful tool with which to study blood flow in the larynx and propose arbitrary LDF levels for the normal and diseased human larynx.
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Affiliation(s)
- A Jacob
- Department of Otolaryngology/Head and Neck Surgery, Guys Hospital, London, UK.
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28
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Abstract
BACKGROUND Although a human laryngeal transplant has been undertaken successfully, important questions remain that require a suitable animal model. METHODS A pig model for allotransplantation has been developed. Organ perfusion was studied in nine animals before four transplants were performed in congenic (unrecovered) animals and eight in unmatched (recovered) animals. Larynges were regularly examined endoscopically until death at 14 days. Immunosuppression included the use of tacrolimus. Revascularization was achieved by anastomosing the donor right cervical vascular tree to the recipient common carotid. In recovered animals, four allografts were placed orthotopically and four heterotopically. RESULTS The pig larynx was perfused adequately via the right cervical vascular tree and congenic grafts were well tolerated. Of eight allografts, seven were well tolerated and remained healthy for the duration of the study (14 days). One allograft became infected between days 4 and 7 after operation. Median operating time was 6 h, with a median cold ischaemia time of 3 h. CONCLUSION Revascularized allotransplants of the larynx can be undertaken reliably in pigs and this provides a preclinical model for studies of laryngeal transplantation.
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Affiliation(s)
- M A Birchall
- Department of Otolaryngology, University of Bristol, Bristol, UK.
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Wheelwright R, Birchall MA, Boaden R, Pearce G, Lennon A. Critical path analysis in head and neck cancer: a management technique for surgical oncology. Eur J Oncol Nurs 2002; 6:148-54. [PMID: 12849589 DOI: 10.1054/ejon.2002.0196] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This paper describes a study of critical path analysis (CPA) as applied to the process of care for patients with head and neck cancer. CPA is a management technique, which has been developed in both the Armed Forces and a wide range of industries. It identifies the parts of a process where improvements are most likely to make an impact on the overall time for that process. There is evidence that reducing the overall times for an oncology care process has a major impact on outcome for patients. This paper describes an appraisal of a formal application of CPA in the setting of oncology. The technique was applied to a single head and neck unit. The results were compared with published standards for times in the care process and with the comparable times for the whole of the South and West of England. The critical path (the combination of processes that limits the total time taken for the whole process) at this unit ran through the combined oncology clinic, leading to a decision to increase the frequency of these clinics, which lead to a reduction in overall process time for patients. A randomised controlled trial in five centres in the South and West region will follow which includes patient quality of life outcomes and collaborative practice to assess the impact of CPA on the patient care process.
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Affiliation(s)
- R Wheelwright
- Department of Surgery, University of Bristol, South & West Cancer Intelligence Service, King Square House, King Square, Bristol BS2 8EE, UK.
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30
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Abstract
Interleukin 7 (IL-7) and IL-12 have major roles in cell-mediated tumour immunity. In head and neck squamous cell cancer, depressed cell-mediated immunity is well documented and may account for the poor prognosis. This is the first study to assess intratumour expression of IL-7 and IL-12 in head and neck squamous cell cancer (HNSCC). Immunohistochemistry was used to identify IL-7 and IL-12 expression in snap-frozen tumour specimens from 25 patients with HNSCC and the results of immunohistochemical staining were semiquantitatively graded. Both IL-7 and IL-12 were expressed in all tumour samples and expression was not related to tumour stage or site. A trend towards better survival was associated with high expression of IL-7 and IL-12, this being more pronounced with IL 7. The universal expression suggests that the depressed cell-mediated immunity in HNSCC is not caused by reduced production of IL-7 and IL-12. Further studies with larger cohorts, especially of IL-7, are certainly warranted.
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Affiliation(s)
- V Paleri
- Department of Otolaryngology, University of Bristol, UK.
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31
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Smith WK, Mair R, Marshall L, Bilous S, Birchall MA. Assessment of hearing in persons with learning disabilities: the Phoenix NHS Trust, January 1997 to September 1998. J Laryngol Otol 2000; 114:940-3. [PMID: 11177362 DOI: 10.1258/0022215001904662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
People with learning disabilities are at increased risk of impaired hearing. The aims of this study were to assess the prevalence of hearing impairment and ear disease in people attending the specialist Otolaryngology/Hearing Therapy clinic at the Phoenix NHS Trust, Bristol. The present and future process of such a service was explored. Data were obtained from the referral form and notes made by the consultant otolaryngologist. In 20 months, there were 226 consultations, 188 of which were new referrals. The majority of patients had verbal communication to some extent. Suspected infection/inflammation and unobtainable/abnormal tympanograms, each accounted for 43 per cent of reasons for referral. Twenty per cent of patients were normal otologically. Eighteen per cent were provided with hearing aids and nine per cent required surgery. Ten patients underwent brainstem evoked response testing, half of whom had aidable hearing. Our results are comparable to published data of similar units. It is recommended that combined otolaryngology/specialist hearing therapy services are continued and further developed.
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Affiliation(s)
- W K Smith
- Department of Otolaryngology, Southmead Hospital, Bristol, UK
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Plummeridge MJ, Armstrong L, Birchall MA, Millar AB. Reduced production of interleukin 12 by interferon gamma primed alveolar macrophages from atopic asthmatic subjects. Thorax 2000; 55:842-7. [PMID: 10992536 PMCID: PMC1745617 DOI: 10.1136/thorax.55.10.842] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Asthma is characterised pathologically by an inflammatory pulmonary infiltrate rich in T helper (Th) 2 cells and eosinophils. Interleukin (IL)-12 is a heterodimeric cytokine critical for driving the development of uncommitted Th cells to express a Th 1 phenotype. Reduced pulmonary production of IL-12 may therefore play a role in the pathogenesis of asthma by contributing to the pulmonary cytokine imbalance seen in asthma. METHODS IL-12 p70 protein levels in bronchoalveolar lavage fluid and p70 protein levels and IL-12 messenger RNA in alveolar macrophage cultures from normal and atopic asthmatic subjects were measured. RESULTS There was a significant difference between the mean IL-12 p70 protein level in the bronchoalveolar lavage fluid from asthmatic subjects (37.5 pg/ml) and from normal subjects (131 pg/ml, p = 0.04). Alveolar macrophages from asthmatic subjects produced significantly less IL-12 protein (30 pg/ml) and messenger RNA than those from normal subjects (69.5 pg/ml, p<0.005). These differences were not caused by inhibition of IL-12 production by IL-10 nor to generalised hyporesponsiveness of asthmatic alveolar macrophages from subjects to the effects of interferon (IFN)-gamma. CONCLUSIONS Pulmonary IL-12 production is lower in asthmatic subjects. This reduction is not the result of generalised hyporesponsiveness to IFN-gamma. Reduced IL-12 levels may contribute to the development of asthmatic pulmonary inflammation through dysregulation of Th cell development.
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Affiliation(s)
- M J Plummeridge
- Lung Research Group, University of Bristol, Medical School Unit, Southmead Hospital, Westbury on Trym, Bristol BS10 5NB, UK
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Jardine AH, Davies GR, Birchall MA. Recurrence and malignant degeneration of 89 cases of inverted papilloma diagnosed in a non-tertiary referral population between 1975 and 1995: clinical predictors and p53 studies. Clin Otolaryngol Allied Sci 2000; 25:363-9. [PMID: 11012648 DOI: 10.1046/j.1365-2273.2000.00357.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Eighty-nine patients with sinonasal inverted papilloma presenting between 1975 and 1995 were reviewed with the aims of studying predictors of tumour behaviour and correlating outcome with p53 expression. Correlation of clinical, radiological features and p53 status was made using chi2 and multiple logistic regression analysis with recurrence and malignant degeneration as the main outcome measures. Two patients had synchronous malignancy but no malignant degeneration was seen. There was no significant difference in recurrence between minor intranasal procedures and more extensive surgery for the first event. Younger patients were more likely to recur. (P = 0.0493, odds ratio 0.43). Those who smoked showed a trend towards multiple recurrence. p53 was expressed in 41% but did not predict recurrence. Morbidity was related to the extent of surgery. Inverted papilloma presenting to a non-tertiary centre is more benign than previously reported. Initial management by less extensive endoscopic surgery may reduce morbidity.
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Affiliation(s)
- A H Jardine
- Department of Otolaryngology, University of Bristol and South and West Cancer Intelligence Unit, Bristol, UK.
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Birchall MA, Bailey D, Lennon A. Performance and standards for the process of head and neck cancer care: South and West audit of head and neck cancer 1996-1997 (SWAHN I). South and West Regional Cancer Organisation Tumour Panel for Head and Neck Cancer. Br J Cancer 2000; 83:421-5. [PMID: 10945484 PMCID: PMC2374665 DOI: 10.1054/bjoc.2000.1302] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Evidence suggests wide variation in cancer care between different hospitals in the UK. To establish bench-marking data, we designed a prospective, 1 year regional study comparing key performance measures with established standards for the 28 hospital Trusts in the South and West of England involved in head and neck cancer care. 566 sequential patients with a newly-diagnosed head and neck cancer were included. Numbers referred and treated per hospital Trust were 1-58 and 1-65 respectively. 59% of patients received a pretreatment chest X-ray (standard 95%). 45% of patients were seen in a multidisciplinary clinic pretreatment (standard 95%), and this was proportional to the frequency of clinics held (P<0.0001). Median number of cases treated per surgeon was 4 (1-26), and by radiotherapist was 10 (1-51). Times between parts of the process of oral cancer care were closer to the standards than those for laryngeal cancer. Two patients were entered into a clinical trial. One had a quality-of-life score. Thus, in 1996-1997, in the South and West of England, there were major discrepancies between actual performance and established standards in many fundamental aspects of head and neck cancer care. Re-audit is essential to determine if the implementation of the Calman-Hine report has resulted in improvements.
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Affiliation(s)
- M A Birchall
- University Department of Otolaryngology, Head and Neck Surgery, Southmead Hospital, Bristol, UK
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Gorti GK, Birchall MA, Haverson K, Macchiarini P, Bailey M. A preclinical model for laryngeal transplantation: anatomy and mucosal immunology of the porcine larynx. Transplantation 1999; 68:1638-42. [PMID: 10609939 DOI: 10.1097/00007890-199912150-00006] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND A major step in translating work on laryngeal transplantation into clinical practice is the establishment of a preclinical model. We have investigated the anatomy and mucosal immunology of the porcine larynx in eight Minnesota Minipigs (12-37 weeks). METHODS Neck dissections were carried out and the vascular tree was mapped. Snap-frozen biopsies from epiglottis, supraglottis, glottis, and subglottis were prepared for conventional histology, immunohistochemistry (CD45), and single and two-color immunofluorescence (CD3, MHC-II, CD45). RESULTS The anatomy of the laryngeal skeleton was broadly similar to that of the human larynx. The blood supply is predominantly via the caudal thyroid vessels, with assistance from the cranial laryngeal artery. The porcine larynx is clearly highly immunologically active. Structured collections of leukocytes were found in the mucosal epithelium, around tubuloacinar glands, and occasionally in the submucosa. MHC-II and CD 3 cells were predominantly found within the epithelium. The highest densities of all cell types were observed in the epiglottis, tailing off caudally. The lowest densities were seen in the vocal cords. CONCLUSIONS The porcine larynx is both anatomically and immunologically similar to the human larynx and contains a high level of immunological organization. It presents an ideal preclinical model for laryngeal transplantation.
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Affiliation(s)
- G K Gorti
- Department of Otolaryngology, Head and Neck Surgery, University of Bristol, Southmead Hospital, UK
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Wood SJ, Bloxam KR, Stark R, Birchall MA, Corfield AP. The expression of mucin genes by nasal polyps. Clin Otolaryngol 1999. [DOI: 10.1046/j.1365-2273.1999.00254-15.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Saunders MW, Wheatley AH, George SJ, Lai T, Birchall MA. Do corticosteroids induce apoptosis in nasal polyp inflammatory cells? In vivo and in vitro studies. Laryngoscope 1999; 109:785-90. [PMID: 10334231 DOI: 10.1097/00005537-199905000-00019] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE/HYPOTHESIS Corticosteroids are an effective treatment for nasal polyposis. The exact mechanism of action is not certain. Recent research demonstrates that apoptosis (programmed cell death) in inflammatory cells is an important factor in the resolution of inflammation, and apoptosis is induced in eosinophils in cell culture with steroids. We hypothesized that inflammatory cell apoptosis is a key feature of regression of nasal polyps on exposure to steroids and examined this hypothesis in vivo and in vitro. METHODS A double-blind, placebo-controlled pilot study of fluticasone propionate aqueous nasal spray (FPANS) in nasal polyposis in humans in vivo was undertaken, and the effect of treatment on indices of cell death and proliferation measured. In addition, explants of nasal polyp tissue were maintained in vitro in short-term tissue culture with dexamethasone at increasing doses (0.1-50 micromol) over varying time intervals and then analyzed for similar indices of proliferation and cell death. RESULTS Apart from a marginal increase in apoptotic:mitotic ratio in epithelium, little difference between the effect of FPANS and placebo was demonstrated in vivo. However, in vitro, apoptotic index was significantly increased in the stromal layers in relation to time of incubation (P = .0169), and a significant dose-response relationship was demonstrated at 24 hours between stromal cell apoptosis and dexamethasone concentration (P = .001). Eosinophil apoptosis was confirmed by in situ end labeling and transmission electron microscopy. No steroid or time effect on epithelial cells was demonstrated in vitro. CONCLUSION Corticosteroids induce apoptosis in inflammatory cells in human nasal polyps in vitro. This is not reflected by a similar response to FPANS at 14 days in vivo, but may still play a part in regression of polyps with other forms of administration or at other time points.
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Affiliation(s)
- M W Saunders
- Department of Otolaryngology-Head and Neck Surgery, University of Bristol, United Kingdom
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Al-hazzaa AA, Bowen ID, Birchall MA. A comparison of the anti-histone and Apop-Tag technique for demonstrating apoptosis with option for silver enhancement. Cell Biol Int 1999; 22:271-6. [PMID: 10101043 DOI: 10.1006/cbir.1998.0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A novel immunocytochemical method is presented for the qualitative detection of DNA fragmentation in apoptosis. Anti-histone antibody is employed to localize exposed nucleosomal histones (H1, H2a, H2b, H3 and H4) rather than tagging the cut ends of fragmenting DNA as in conventional technique. The method was tested on squamous cell carcinoma of the larynx routinely fixed in formaldehyde and embedded in paraffin wax and compared with results obtained employing Apop-Tag kit (Oncor).
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Affiliation(s)
- A A Al-hazzaa
- School of Pure and Applied Biology, University of Wales Cardiff, Cardiff, Wales, CF1 3TL, U.K
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Gorti GK, Birchall MA, Haverson K, Bailey M. Otorhinolaryngology Research Society Abstracts. A preclinical model for laryngology: mucosal immunology of the porcine larynx. ACTA ACUST UNITED AC 1999. [DOI: 10.1046/j.1365-2273.1999.00196-1.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Loss of a functional larynx has marked implications for quality of life that remain after both laryngectomy and its alternatives. One solution is laryngeal transplantation. We hypothesised that laryngeal transplantation would be unacceptable to a population of laryngectomees, and that such a lack of acceptability would not be affected by age, sex or time elapsed since operation. In addition, we sought the views of laryngectomees on priorities for research. A questionnaire was developed and mailed to 1000 members of laryngectomee clubs. A total of 372 of 404 responses were suitable for analysis. Seventy-five percent of the respondents said they would accept a transplant under ideal conditions; the number dropped to 58.9% when a stoma was to be retained. Fifty percent would accept a graft even if it did not result in a normal voice. A positive response was more likely in younger respondents (P < 0.001 all questions; linear regression). Some 47.3% of respondents thought research money could be better spent on other projects, and this response was commoner in older respondents (P = 0.0001). Highest priorities for research into laryngeal cancer were development of new treatments (63.2%), prevention (60.2%) and optimisation of quality of life (57%). In short, there appears to be a surprisingly high level of support for laryngeal transplantation amongst those who have had a laryngectomy.
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Affiliation(s)
- C P Potter
- University Department of Otorhinolaryngology, Head and Neck Surgery, Southmead Hospital, Bristol, UK
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Potter CP, Birchall MA. Laryngectomees' views on laryngeal transplantation. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb00832.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- M W Saunders
- Department of Otolaryngology, Great Ormond Street Hospital, London, U.K
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Birchall MA. Consensus standards for the process of cancer care: a modified expert panel method applied to head and neck cancer. South and West Expert Tumour Panel for Head and Neck Cancer. Br J Cancer 1998; 77:1926-31. [PMID: 9667669 PMCID: PMC2150344 DOI: 10.1038/bjc.1998.319] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
There are many pressures to improve the standard of care delivered to cancer patients, including the reforms subsequent to the Calman-Hine report. The establishment of standards is a prerequisite for audit, benchmarking and certification of cancer centres and units. Randomized trials of head and neck cancer are uncommon, and other forms of evidence often conflicting. In the south and west of England, a multidisciplinary expert panel consensus method has been applied to the development of standards. A panel representative of specialties involved in the process of care at all three levels, plus social medicine and lay members, was constructed. A model for the process of care was developed consisting of activity areas. For each activity, a near exhaustive list of tasks and standards was established. A three-iteration method with statistical group response was then used to refine the standards. The same method was also applied to the production of a minimum data set for registration, recording and audit. The resulting standards will be regularly reviewed. We have developed a model of the care process, and an expert panel methodology that is applicable to a wide range of problems in clinical oncology.
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Affiliation(s)
- M A Birchall
- University Department of Otolaryngology-Head & Neck Surgery, Southmead Hospital, Bristol, UK
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Saunders NC, Birchall MA, Armstrong SJ, Killingback N, Singh GD. Morphometry of paranasal sinus anatomy in chronic rhinosinusitis: a pilot study. Arch Otolaryngol Head Neck Surg 1998; 124:656-8. [PMID: 9639475 DOI: 10.1001/archotol.124.6.656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To test the null hypothesis that there is no relationship between anatomical variations around the ostiomeatal complex and a predisposition to chronic rhinosinusitis and to define such variations with increased precision. DESIGN Case-control study of anatomical variations in diseased and normal sinuses. Eight homologous landmarks defining the ostiomeatal complex were located on coronal computed tomographic scans, and their x and y coordinates were digitized using image analysis. SUBJECTS Ten patients with unilateral sinus disease and 10 subjects without sinus disease (scanned for facial pain) who were selected retrospectively by case-note analysis. RESULTS Logistic regression showed that the only significant spatial change predictive of a person with rhinosinusitis was the vertical position of the middle turbinate (P=.04), although this was not confirmed by Wilcoxon testing (P>.10). When examined by sinus, however, the horizontal position of the uncinate process was more laterally placed in persons with rhinosinusitis (P=.01), confirmed on Wilcoxon testing (P=.04), but there was no significant difference when compared with sinuses in persons without rhinosinusitis. CONCLUSIONS Our findings suggest that there are no anatomical differences within the ostiomeatal complex between patients with and without rhinosinusitis. Patients with rhinosinusitis, however, are more likely to develop it in the side with a more laterally positioned uncinate process. Further studies, with more patients and more advanced techniques, including thin-plate spline analysis, are indicated.
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Affiliation(s)
- N C Saunders
- Department of Otolaryngology-Head and Neck Surgery, Southmead Hospital, Bristol, England
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Thorne P, Etherington D, Birchall MA. Head and neck cancer in the South West of England: influence of socio-economic status on incidence and second primary tumours. Eur J Surg Oncol 1997; 23:503-8. [PMID: 9484919 DOI: 10.1016/s0748-7983(97)92917-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study examined possible links between the incidence of head and neck squamous cell carcinoma (HNSCC) and social deprivation. Data on all HNSCC registered between 1985 and 1991 in the South West of England were collected. Excluding tumours of the lip and skin there were 1570 cases, 72% in males. Of these, 1467 were identified as first primary tumours. Corrected chi-squared tests, accepting significance at the 5% level, were used to examine the association of socio-economic status (Carstairs index) with incidence at different sites. Overall, the incidence of HNSCC was higher in the socially deprived group. In males, the most deprived group had a significantly higher incidence of oral carcinoma than all other groups (P<0.05), whereas the incidence of laryngeal carcinoma showed a gradual rise with increasing deprivation. In females, where numbers were relatively low, the trend remained, but was less clear. In total, seventy-two (4.9%) cases went on to develop a second primary, of which 35% were in the lung and 13% in the bladder. Socio-economic status did not affect the development of a second primary tumour. The association of HNSCC with carcinoma of the bladder is a new finding.
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Affiliation(s)
- P Thorne
- University of Bristol Cancer Epidemiology Unit, UK
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Birchall MA, Schock E, Harmon BV, Gobé G. Apoptosis, mitosis, PCNA and bcl-2 in normal, leukoplakic and malignant epithelia of the human oral cavity: prospective, in vivo study. Oral Oncol 1997; 33:419-25. [PMID: 9509126 DOI: 10.1016/s0964-1955(97)00033-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Disordered balance between proliferation and apoptosis may contribute to carcinogenesis. Thirty-two oral biopsies were collected prospectively: 10 normal (N), 10 leukoplakia (dysplasia, D = 5; hyperplasia, H = 5) and 12 squamous cell carcinoma (C: 11). Distant normal tissue was also collected (HN, DN, CN). Based on counts of 1000 cells/slide, mitotic (MI), apoptotic (AI) and proliferating cell nuclear antigen (PCNA: PI) indices were calculated and bcl-2 expression recorded. AI correlated with MI (P < 0.001), but not PI or bcl-2 expression. PCNA was higher in H and HN than other groups (P < 0.0001). bcl-2 was reduced in C and CN (P < 0.001). Peak mitosis shifted basally in dysplasia, whilst peak apoptosis remained unaltered. These data confirm topographical alterations in proliferation relative to apoptosis in dysplasia of the oral cavity. Reduced bcl-2 in carcinoma and related 'normal' epithelium was unexpected, and may contribute to the high incidence of metachronous carcinomas in these patients.
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Affiliation(s)
- M A Birchall
- Department of ENT Surgery, Royal Brisbane Hospital, Australia
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Affiliation(s)
- S J Wood
- University Department of Otolaryngology, Southmead Hospital, Bristol, U.K
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Wood SJ, Birchall MA, Irimura T, Corfield AP. The influence of allergy and smoking on the sulphation of nasal mucins. Biochem Soc Trans 1997; 25:506S. [PMID: 9388727 DOI: 10.1042/bst025506s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- S J Wood
- University Department of Otolaryngology, Southmead Hospital, Bristol, U.K
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