We are starting a monthly online journal club to try and stimulate discussion about the latest research in surgery. We will pick one article per month and post it a few days before we post our appraisal of the paper. Then we hope this will stimulate debate amongst our readers. If there are any particular papers you wish to submit then email us and better still if you would like to contribute to journal club then we would also love to hear from you. The reason we are doing this is it is difficult to keep up with what's happening in research on top of all the clinical and extra-curricular activities. We hope this will help in some small way.
The article I have chosen for this month is:
Eur Arch Otorhinolaryngol. 2011 Mar;268(3):405-14. Epub 2010 Sep 15.
Laryngeal transplantation in minipigs: vascular, myologic and functional outcomes.
Birchall MA, Kingham PJ, Murison PJ, Ayling SM, Burt R, Mitchard L, Jones A, Lear P, Stokes CR, Terenghi G, Bailey M, Macchiarini P.
You can find it on pubmed and sign in via athens/institutional login to get the full text.
Amel
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4 comments:
Thank you very much! That's very kind of you to say.
Amel
Thanks for taking the time to discuss this, I feel strongly about it and love learning more on this topic. If possible, as you gain expertise, would you mind updating your blog with more information? It is extremely helpful for me.
Web Design
Just read the article - i am not sure if it was just me, but there were many concepts in there that were new to me. especially the myology!
a promising article
interesting to note that the solutions proposed to premature deaths were successful in preventing further adverse deaths in the minipigs.
despite the rigorous design, i dont think the laryngeal transplantations are quite ready or feasible in human trials, mainly because 1) it was difficult to assess vascular patency in the models using doppler flow (thus it becomes difficult to assess whether increased use of larnyngeal muscles/phonation as time proceeds (and recovery) would increase demands of nutrients/O2 - in which case it is very likely that these demands cannot be met by the collaterals that may have been perfusing the larynx in the models.
2) there was evidence of denervation atrophy (such a complex surgery is certainly going to involve damage to the nerves (recurrent laryngeal and superior larnyngeal; possibly even vagus if complications occur - such as bleeding/thrombosis)- in such a case, desired (or quality) function of the muscles in phonation for changes in tone/pitch will certainly not be regained.
3) the above complications may not be preferred in the face of mere benefits of minimal swalloing and phonation.
Nonetheless, it certainly has the potential to grow (especially it was the first major study on myologic and vascular outcomes).
what does everyone think?
Naz
Thank you Naz for a very insightful critique of this paper. I agree with your view that translating this engineered tissue into human subjects may provide obstacles that animal models may not be able to accurately model. However, Prof Birchall's team have managed to carry a out a tracheal transplant in a patient with tracheal stenosis using autologous stem-cell derived chondrocytes seeded onto an acellular scaffold. The patient still had a functional airway with normal mechanical and physical properties at 4-months follow up post procedure. If anyone is interested, here are the details of the paper which was published in the lancet in 2008:
Clinical transplantation of a tissue-engineered airway.
Macchiarini P, Jungebluth P, Go T, Asnaghi MA, Rees LE, Cogan TA, Dodson A, Martorell J, Bellini S, Parnigotto PP, Dickinson SC, Hollander AP, Mantero S, Conconi MT, Birchall MA.
I must declare that I have a special interest in this topic and I am currently conducting research using adult and cord derived stem cells to try to make skeletogenic cells so I am a tad biased in my optimism :)
Great input though, thank you and I apologise that it took me so long to reply (I have been doing a placement in the USA and research).
Amel
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