Plasma cell mucositis of the larynx.

Stridor is a symptom with a number of causes, usually identified through careful history taking and examination. When the cause is unclear, as in our case, consider investigations such as blood tests, biopsy, and imaging. We discuss a rare diagnosis of plasma cell mucositis, treated with some success by steroids.

An Update on the Therapeutic Potential of Stem Cells.

The seeming setbacks noted for stem cells underscore the need for experimental studies for safe and efficacious application to patients. Both clinical and experimental researchers have gained valuable knowledge on the characteristics of stem cells, and their behavior in different microenvironment. This introductory chapter focuses on adult mesenchymal stem cells (MSCs) based on the predominance in the clinic. MSCs can be influenced by inflammatory mediators to exert immune suppressive properties, commonly referred to as "licensing." Interestingly, while there are questions if other stem cells can be delivered across allogeneic barrier, there is no question on the ability of MSCs to provide this benefit. This property has been a great advantage since MSCs could be available for immediate application as "off-the-shelf" stem cells for several disorders, tissue repair and gene/drug delivery. Despite the benefit of MSCs, it is imperative that research continues with the various types of stem cells. The method needed to isolate these cells is outlined in this book. In parallel, safety studies are needed; particularly links to oncogenic event. In summary, this introductory chapter discusses several potential areas that need to be addressed for safe and efficient delivery of stem cells, and argue for the incorporation of microenvironmental factors in the studies. The method described in this chapter could be extrapolated to the field of chimeric antigen receptor T-cells (CAR-T). This will require application to stem cell hierarchy of memory T-cells.

3D Bioprinting and Stem Cells.

Three-dimensional (3D) in vitro modeling is increasingly relevant as two-dimensional (2D) cultures have been recognized with limits to recapitulate the complex endogenous conditions in the body. Additionally, fabrication technology is more accessible than ever. Bioprinting, in particular, is an additive manufacturing technique that expands the capabilities of in vitro studies by precisely depositing cells embedded within a 3D biomaterial scaffold that acts as temporary extracellular matrix (ECM). More importantly, bioprinting has vast potential for customization. This allows users to manipulate parameters such as scaffold design, biomaterial selection, and cell types, to create specialized biomimetic 3D systems.The development of a 3D system is important to recapitulate the bone marrow (BM) microenvironment since this particular organ cannot be mimicked with other methods such as organoids. The 3D system can be used to study the interactions between native BM cells and metastatic breast cancer cells (BCCs). Although not perfect, such a system can recapitulate the BM microenvironment. Mesenchymal stem cells (MSCs), a key population within the BM, are known to communicate with BCCs invading the BM and to aid in their transition into dormancy. Dormant BCCs are cycling quiescent and resistant to chemotherapy, which allows them to survive in the BM to resurge even after decades. These persisting BCCs have been identified as the stem cell subset. These BCCs exhibit self-renewal and can be induced to differentiate. More importantly, this BCC subset can initiate tumor formation, exert chemoresistance, and form gap junction with endogenous BM stroma, including MSCs. The bioprinted model detailed in this chapter creates a MSC-BC stem cell coculture system to study intercellular interactions in a model that is more representative of the endogenous 3D microenvironment than conventional 2D cultures. The method can reliably seed primary BM MSCs and BC stem cells within a bioprinted scaffold fabricated from CELLINK Bioink. Since bioprinting is a highly customizable technique, parameters described in this method (i.e., cell-cell ratio, scaffold dimensions) can easily be altered to serve other applications, including studies on hematopoietic regulation.

A retrospective study of patient outcomes and satisfaction following pinnaplasty.

INTRODUCTION: Up to 5% of all children have prominent ears. Psychological distress and bullying adversely affect these children and can cause significant social exclusion. In times of austerity, cosmetic procedures such as surgical correction of prominent ears are felt to be an unnecessary cost to the health service. MATERIALS AND METHODS: A retrospective case note review of all patients undergoing pinnaplasty was undertaken. Postoperative outcomes were compared against the Royal College of Surgeons of England standards. The Glasgow Benefit Inventory, a validated post-intervention questionnaire, was then posted out to all patients. RESULTS: A total of 72 patients were identified. Average age at procedure was 13 years. Eleven patients were above the age of 19 years. Twenty-eight patients were male and forty-four female. Sixty-two cases underwent bilateral pinnaplasty. No patients developed hematoma, and there were no readmissions within 30 days of surgery. Twenty-nine patients responded to the questionnaire (40%), of whom 27 reported a positive impact on their psychosocial well-being with a mean score of 36. CONCLUSION: Pinnaplasty offers patients an opportunity to alleviate the psychological distress of bullying and harassment secondary to the appearance of prominent ears.

UK childbirth delivery options in 2001-2002: alternatives to consultant unit booking and delivery.

BACKGROUND: Government policy advocates maternal choice in pregnancy care. Two key issues are place of birth and type of lead professional. Anecdotal evidence suggests there is variation in both these issues across the UK, but there has been no recent national assessment of whether maternal options are in line with government policy. AIM: To establish the range of women's childbirth delivery options, degree of midwife autonomy, and supporting training and governance mechanisms. DESIGN: Two postal questionnaires. SETTING: UK maternity units. METHOD: Questionnaires were sent to maternity services managers. MAIN OUTCOME MEASURES: number and type of units and births, transfers and care types; midwifery procedures; clinical governance and training activities. RESULTS: Completed questionnaires were received from 301 out of 308 (97.7%) units in 2002 and from 258 out of 309 (83.5%) units in 2001. Midwife-led care is available in 186 English (76.9%), 15 Welsh (78.9%), 18 Scottish (48.6%) and three Northern Ireland (30.0%) units. There are 73 (24.3%) stand-alone, 22 (7.3%) alongside, 127 (42.2%) integrated and 79 (26.2%) consultant units (for definitions of unit types, see main text), with a median 2215 hospital, 25 home and 210 midwife-led births. The median antenatal and labour transfers from midwife-led units are 25.5% (interquartile range [IQR] = 18.5-36.5%) and 18.0% (IQR = 13.4-24.8%) respectively; transfers are independent of distance to nearest consultant unit, country and unit type. CONCLUSIONS: Despite government policy promoting greater parental choice, this is not in evidence in many parts of the UK. The wide variations in home birth, midwife-led care and maternity-unit types merit further exploration. If more midwife-led units are to be established as a way of promoting parental choice and dealing with junior doctor rota problems, then such units must have adequate governance and training activities in place.