No abstract

SummaryThe laryngeal mask airway is included as a first line airway device during adult resuscitation by first responders. However, there is little evidence for its role in paediatric resuscitation. Using anaesthetised children as a model for paediatric cardiopulmonary arrest, we compared the ability of critical care nurses to manually ventilate the anaesthetised child via the laryngeal mask airway compared with the facemask and oropharyngeal airway. The airway devices were inserted in random order and chest expansion was measured using an ultrasound distance transducer. The critical care nurses were able to place the laryngeal mask airway and achieve successful ventilation in 82% of children compared to 70% using the facemask and oropharyngeal airway, although the difference was not statistically significant (p = 0.136). The median time to first successful breath using the laryngeal mask airway was 39 s compared to 25 s using the facemask (p < 0.001). In this group of nurses, we did not show a difference in ventilation via a laryngeal mask airway or facemask, although facemask ventilation was achieved more quickly.

Induction of a long-term immunological memory, which can expand and defend the host upon pathogen encounter, is the ''holy grail'' of vaccinology. Here, using a sensitive cultured IFN-c ELISPOT assay, we show that 50% (15 out of 30) of healthy, HIV-1/2-uninfected volunteers who received pTHr.HIVA DNA prime-modified vaccinia virus Ankara. HIVA boost vaccine regimen 1 to 3 1/2 years ago had detectable HIV-1-specific T-cell responses. These T cells, predominantly of the CD4 1 subtype, could proliferate and produce multiple cytokines in response to in vitro peptide stimulation. Peptide mapping studies showed that the vaccine-induced CD4 1 T cells were mostly directed toward epitopes targeted in HIV-1-infected individuals. In addition, we used the same assay to re-evaluate 51 volunteers from past vaccine trial IAVI-006 and corrected the previously reported 10% of vaccine responders to 50%. Thus, we confirmed that cultured assays are a valuable tool for studying T-cell memory. These results are discussed in the context of the current state-of-affairs of the HIV-1 vaccine field.Key words: Clinical trial . DNA-MVA vaccines . HIV-1 . Memory T cells IntroductionDespite proven methods of prevention and/or decrease of transmission, all efforts to slow the rate of new HIV-1 infections are failing in most countries around the world, including the USA (http://www.unaids.org/). The best solution to control of the HIV-1 epidemic remains the development of a safe, effective and accessible preventive vaccine [1]. The aim of vaccination is induction of long-lived, pathogen-specific circulating antibodies and cellular immunological memory, which together provide a faster and more efficient defense of the host following exposure to the pathogen. A central role in both the T-and B-cell memory development is played by CD4 1 T cells [2,3], the functionality of which is tuned by the non-adaptive innate response [4]. It is the CD4 1 T-cell population that is decimated by HIV-1-infection, which eventually leads to opportunistic infections [5,6].The long-term aim of our effort is development of an effective HIV-1 vaccine. In particular, we explore strategies for eliciting HIV-1-specific T-cell responses, which could on their own, or together with vaccine-induced anti-HIV-1 antibodies, limit tissue damage during HIV-1 infection. Our first vaccine platform was designed as a heterologous DNA prime-modified vaccinia virus Ankara (MVA) boost regimen delivering a common immunogen HIVA, which consists of consensus African clade A Gag p24 and The most sensitive assay employed and validated by the IAVI-016 trial was the IFN-g ELISPOT assay combined with a prior 10-day-culture expansion of PBMC using immunogen-derived peptides and externally supplemented cytokines. This so called cultured IFN-g ELISPOT assay increased the frequencies of specific T cells more than 24-fold compared with the ex vivo assay and detected vaccine-induced HIV-1-specific responses in all (8 out of 8) IAVI-016 subjects who received the pTHr.HIVA DNA-MVA.HIVA regimen [14]. Thes...

The nurses' confidence increased as a result of practising these ventilating techniques on patients. They felt that being able to insert an LMA as a second-line airway when the OGA was not providing adequate ventilation was useful. However, they also felt that they would need continuous training to update this skill.