Experimental animal model for assessment of tracheal epithelium regeneration

Objectives/Hypothesis

To develop an experimental model in rabbits for assessment of tracheal epithelium regeneration through application of either natural or artificial polymer scaffolds.

Study Design

First, we identified the size of full‐thickness mucosal defect, which does not allow self‐healing (a "critical defect"), thus representing an adequate experimental model for regenerative therapy of tracheal epithelium damage. Then, two methods of polymer scaffold fixation at the site of the epithelium defect were compared: suturing and fixation with a stent. This was done through: 1) formation of a full‐thickness anterolateral mucosal defect by tracheal mucosa excision; and 2) fixation of the scaffold at the site of the tracheal epithelium defect using sutures (through a tracheal wall "window") or a vascular stent (through a small tracheal incision).

Results

The dimension of a critical anterolateral mucosal defect of the trachea for rabbits was found to be 1.5 cm in length and more than 50% of the tracheal circumference. Fixation of the scaffold with a stent proved to be more efficient due to a uniform distribution of the pressure over the entire surface of the scaffold, whereas the suturing of the scaffold provided unsatisfactory results. In addition, fixation of the scaffold by suturing required formation of a large "window" in the tracheal wall. Thus, using the stent appeared to be technically less complicated and much less traumatic as compared to suturing.

Conclusion

We present an experimental in vivo animal model of tracheal epithelium injury and recovery. It can be effectively used with certain further modifications as a basis for routine testing of bioengineered constructs.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2A6JhmP

Ultrasonographic assessment of costochondral cartilage for microtia reconstruction

https://ift.tt/2TrXt2p

Mortality associated with tracheostomy complications in the United States: 2007–2016

Objectives/Hypothesis

To investigate patterns of tracheostomy‐associated death in the United States.

Study Design

Retrospective database review.

Methods

We used Multiple Cause‐of‐Death data from the Centers for Disease Control and Prevention to determine cumulative national mortality associated with tracheostomy complications in the United States from 2007 to 2016. Using International Classification of Diseases, Tenth Revision data, we investigated how frequently tracheostomy‐related complications were reported in cause of death data. We then compared the characteristics of patients with tracheostomy‐related mortality to patients reported to have died of other causes.

Results

Over the 10‐year period studied, we identified 623 tracheostomy‐related deaths (537 adults and 86 children) out of 25,587,306 total deaths reported. Although absolute mortality was higher in adults, the reported base rate of tracheostomy complication–associated mortality was tenfold higher in children. Most tracheostomy‐related deaths occurred in a hospital facility (74.5% in adults). Deaths associated with tracheostomy complications were significantly more common for African American children (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.26‐3.24) and adults (OR: 1.59, 95% CI: 1.29‐1.96) or in Hispanic adults (OR: 1.42, 95% CI: 1.06‐1.89). Deaths related to a tracheostomy complication more commonly occurred on the weekend (OR: 1.24, 95% CI: 1.04‐1.49) and in the most recent 2‐year period (OR: 1.31, 95% CI: 1.03‐1.68). Adults with a bachelor's, master's or doctorate degree were significantly less likely to have mortality associated with a tracheostomy‐related complication (OR: 0.54, 95% CI: 0.39‐0.75).

Conclusions

Tracheostomy‐related complications were implicated in the deaths of a significant number of individuals. Several demographic groups had increased likelihood of tracheostomy‐related mortality. Future research is necessary to develop targeted interventions to decrease harm.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2A31SA9

Nimodipine improves vocal fold and facial motion recovery after injury: A systematic review and meta‐analysis

Introduction

Nimodipine is a calcium channel blocker that has been used to treat hypertension and vasospasm. Emerging evidence in the literature suggests that it is neuroprotective by reducing cellular apoptosis after neuronal injury and promoting axonal sprouting at the nodes of Ranvier.

Objectives

To conduct a systematic review of the usage of nimodipine in cranial nerve injury and to perform a meta‐analysis to estimate the efficacy of nimodipine on functional recovery of the injured cranial nerves.

Methods

Literature search was performed in eight databases using preferred reporting items for systematic reviews and meta analyses (PRISMA) guidelines. Human studies that used nimodipine as a monotherapy for treating cranial nerve injury were included for review. Cranial nerve function recovery was the primary outcome measure.

Results

672 records were screened and 58 full texts in English were assessed. Nine studies were included in the final review. 5 of these, including 110 participants who received nimodipine for either recurrent laryngeal nerve or facial nerve injury and 556 controls, were used for meta‐analysis. Nimodipine significantly increased the odds of vocal fold motion recovery (odds ratio [OR] 13.73, 95% confidence interval [CI] 6.21, 30.38, P < .01), and the odds of facial motion recovery (OR 2.78, 95% CI 1.20, 6.44, P = .02). Overall, nimodipine‐treated patients had significantly higher odds of recovering vocal fold or facial motion compared with controls (OR 6.09, 95% CI 3.41, 10.87, P < .01).

Conclusion

Existing evidence supports the positive effect of nimodipine on vocal fold and facial motion recovery after injury. Future research should focus on randomized clinical trials comparing recovery rates between nimodipine‐ and placebo‐treated groups.

Level of Evidence

2a. Laryngoscope, 2018

https://ift.tt/2Tq15Ce

Autologous platelet‐rich gel for facial rejuvenation and wrinkle amelioration: A pilot study

Summary

Background

The demand for safe and minimally invasive soft tissue augmentation procedures has increased. Recently, a novel injectable gel based on the autologous platelet rich in growth factor (PRGF) technology has been developed to provide long‐term shape and volume stability. It can be customized into low (LVG) or high viscosity (HVG) gel forms to meet different dermatological requirements.

Objectives

The mechanical and biological properties of both gel forms have been evaluated. The clinical efficacy and safety of this autologous procedure were also evaluated.

Methods

Growth factor content and biomechanical properties of both gel forms were determined. The in vitro biological capacity on human dermal fibroblasts proliferation was assessed. Clinical performance analysis over ten patients was evaluated by standardized macrophotographs, 3D topographic images, and ultrasound analysis over periocular and nasolabial areas.

Results

Both gel types showed similar growth factor concentration. HVG showed a higher stiffness profile indicating its suitability for deeper tissue defect viscosupplementation while LVG showed optimal rheologic characteristics for superficial volumization. Both gels showed a noticeable biostability after catalytic enzyme degradation. Both forms significantly increased the mitogenic activity of dermal fibroblasts. All patients referred to be highly satisfied and presented optimal clinical results after one month. Overall clinical improvement was maintained for 16 weeks. At the end of the study, the ultrasound examination revealed a cutaneous regenerative effect. No adverse events occurred.

Conclusions

This preliminary study suggests that autologous platelet gels have desirable mechanical and bioactive properties and allows moderate wrinkle reduction and efficient facial volume reposition with natural results.

https://ift.tt/2QUSUfw

In this Issue: Graphical Abstracts

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Issue Information ‐ TOC

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