Innate Immune Response of the Pig Laryngeal Mucosa to Endotracheal Intubation.

OBJECTIVE: The aim of this study was to measure the effects of endotracheal intubation on innate immune response within the pig laryngeal mucosa. STUDY DESIGN: Prospective controlled basic science study. SETTING: The animal experiments and analyses were conducted at the University of Bristol. SAMPLES AND METHODS: Eighteen pigs, matched at the major histocompatibility complex (MHC), were used in the study. The pigs were divided into 9 pairs. One of each pair (9 pigs in total) was intubated with an endotracheal tube under general anesthesia for 90 minutes. Two days later, pinch biopsies were taken from the supraglottis (specifically the false cords) and subglottis of both pigs. The experiment was repeated 8 more times. Based on quantitative immunohistochemistry, percentage areas of positive staining for CD172a, CD163, MHC class II, CD14, and CD16 were calculated separately for the epithelium and lamina propria of each biopsy. RESULTS: Total areas of laryngeal mucosa (epithelium and lamina propria) expressing CD172a and coexpressing CD163 and CD172a were significantly reduced at 2 days following endotracheal intubation (P = .039 and P = .037, respectively). MHC class II expression and MHC class II coexpression with CD172a were similarly reduced following intubation (P = .003 and P = .005, respectively). In the supraglottis, MHC class II coexpression with CD16 and CD14 was also reduced following endotracheal intubation (P = .037). CONCLUSIONS: Our results indicate that endotracheal intubation reduces the number of innate immune cells within the upper airway mucosa. This may be an important first step in a cascade leading to chronic wound and scar formation causing airway stenosis.

Comparison of Audiometric and Functional Outcomes Between the Standard and Modified 360 Nitinol Shape Memory Stapes Prostheses.

OBJECTIVE: To compare audiometric and functional outcomes between two designs of heat-activated self-crimping stapes prostheses-a modified shape memory circumferential nitinol-Teflon piston versus its predecessor-in patients with otosclerosis. STUDY DESIGN: A retrospective analysis of preoperative and postoperative hearing thresholds. SETTING: Tertiary referral center and teaching hospital. PATIENTS: One hundred sixty-three consecutive procedures of primary stapes surgery for clinically proven otosclerosis in 108 women and 55 men with an average age of 46 years. INTERVENTION: Stapedotomy and insertion of either a standard or a circumferential stapes prosthesis. MAIN OUTCOME MEASURES: Four-frequency pure-tone average preoperative and postoperative air-bone thresholds were recorded. A secondary outcome measure was stability of the implant, as measured by failure rates. RESULTS: Success of closure of the air-bone gap to within 10 dB was achieved in 97% and comparable in both groups (original prosthesis, 23.6; standard deviation, 7.3, with the average reduction seen in the circumferential prosthesis group being 22.6, standard deviation, 5.6). All the differences were not statistically significant using two-way analysis of variance. Failure rate for the original piston was 6%, with no failures seen with the circumferential piston. CONCLUSION: Both prostheses showed comparable postoperative hearing outcomes, with the circumferential prosthesis being found to be more stable.

Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model.

OBJECTIVES: To compare the effect and cost effectiveness of bivalent and quadrivalent human papillomavirus (HPV) vaccination, taking into account differences in licensure indications, protection against non-vaccine type disease, protection against disease related to HPV types 6 and 11, and reported long term immunogenicity. DESIGN: A model of HPV transmission and disease previously used to inform UK vaccination policy, updated with recent evidence and expanded to include scenarios where the two vaccines differ in duration of protection, cross protection, and end points prevented. SETTING: United Kingdom. Population Males and females aged 12-75 years. MAIN OUTCOME MEASURE: Incremental cost effectiveness ratios for both vaccines and additional cost per dose for the quadrivalent vaccine to be equally cost effective as the bivalent vaccine. RESULTS: The bivalent vaccine needs to be cheaper than the quadrivalent vaccine to be equally cost effective, mainly because of its lack of protection against anogenital warts. The price difference per dose ranges from a median of £19 (interquartile range £12-£27) to £35 (£27-£44) across scenarios about vaccine duration, cross protection, and end points prevented (assuming one quality adjusted life year (QALY) is valued at £30,000 and both vaccines can prevent all types of HPV related cancers). CONCLUSIONS: The quadrivalent vaccine may have an advantage over the bivalent vaccine in reducing healthcare costs and QALYs lost. The bivalent vaccine may have an advantage in preventing death due to cancer. However, considerable uncertainty remains about the differential benefit of the two vaccines.

Optical and molecular techniques to identify tumor margins within the larynx.

Failure to remove tumor cells from the larynx significantly increases the risk of local recurrence following surgical excision. Healthy tissue must be preserved to optimize long-term vocal and swallowing function. It is essential to accurately distinguish between healthy mucosa, dysplasia, and invasive carcinoma. Optical and molecular examining technologies have been developed to improve tumor margin identification in vivo. We aimed to review the efficacy of these technologies. Published articles were identified using MEDLINE, EMBASE, and Cochrane central register of controlled trials (CENTRAL). Randomized clinical trials are required to establish the benefit to patients and cost to the health service of using 5-aminolevulinic acid (ALA)-induced fluorescent imaging, contact endoscopy, and optical coherence tomography (OCT). Furthermore, primary research is required to validate other techniques, such as confocal endomicroscopy and Raman spectroscopy, and to develop their clinical applications in the larynx.