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Κυριακή 29 Μαΐου 2022

3D Reconstruction of Phonatory Glottal Shape and Volume: Effects of Neuromuscular Activation

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3D Reconstruction of Phonatory Glottal Shape and Volume: Effects of Neuromuscular Activation

In this study, we utilized a 3D reconstruction approach to visualize the vocal fold medial surface during phonation in an in vivo canine hemilarynx, and we obtained direct measurements of glottal movement, and glottal volume waveform, and resulting voice quality. We present the glottal volume waveform as a correlate of laryngeal vibratory dynamics and highlight the importance of intrinsic laryngeal muscles in modulating medial surface dynamics to achieve improved voice quality.


Introduction

Although phonatory glottal posture and airflow pulse shape affect voice quality, studies to date have been limited by visualization of vocal fold (VF) vibration from a superior view. We performed a 3D reconstruction of VF vibratory motion during phonation from a medial view and assessed the glottal volume waveform and resulting acoustics as a function of neuromuscular stimulation.

Study Design

In vivo canine hemilarynx phonation.

Methods

Across 121 unique combinations of the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) stimulation, the hemilarynx was excited to the oscillation with airflow. VF medial surface reference points were tracked on high-speed video, mapped into 3D space, and surface shape was restored using cubic spline interpolation. Glottal surface shape, reconstruction-based parameters, and glottal volume waveform were calculated. Fundamental frequency (F0), cepstral peak prominence (CPP), and harmonic amplitude (H1-H2) were measured from high-quality audio samples.

Results

The glottis was convergent during opening and divergent during closing. Neuromuscular activation changed phonatory glottal shape and reduced glottal volume. Significant reduction in glottal volume and closing quotient were present with SLN stimulation. RLN stimulation significantly increased F0 and CPP and decreased H1-H2 (constricted glottis), while SLN effects were similar and synergistic with concurrent RLN stimulation.

Conclusion

3D reconstruction of in vivo medial surface vibration revealed effects of laryngeal nerve stimulation on glottal vibratory pattern and acoustic correlates of voice quality. SLN activation resulted in significantly quicker glottal closure per cycle, decreased glottal volume, and higher-pitched, less breathy, and less noisy voice. RLN had a similar effect on acoustic measures.

Level of Evidence

N/A, Basic Science Laryngoscope, 2022
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Could the Audiometric Criteria for Sudden Sensorineural Hearing Loss Miss Vestibular Schwannomas?

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Could the Audiometric Criteria for Sudden Sensorineural Hearing Loss Miss Vestibular Schwannomas?

Patients with sudden hearing loss whose audiograms did not meet the formal audiometric criteria for sudden sensorineural hearing loss were found to have a similar rate of vestibular schwannoma as those who did. Therefore, we advocate a high index of suspicion of a concomitant vestibular schwannoma with sudden hearing loss of any severity, and urge our colleagues to consider referring those patients to an MRI scan regardless of the hearing loss severity.


Objective

To investigate the likelihood of missing a vestibular schwannoma (VS) diagnosis in patients who present with a sudden hearing loss (SHL) that does not meet the most accepted audiometric criteria for sudden sensorineural hearing loss (SSNHL) (a decrease of ≥30 dB at three consecutive frequencies).

Methods

All adult patients (>18 years) diagnosed with SHL of any severity in a tertiary care referral medical center between 2015 and 2020 and who underwent an MRI scan to rule out VS were included. Statistical analyses were conducted to evaluate the difference between the rate of VS among patients with an initial audiogram, which met the abovementioned criteria, and those who did not. Other audiometric criteria for SNHL were also evaluated (≥10 dB at ≥2 frequencies and ≥ 15 dB at one frequency).

Results

Of the 332 patients included in the study, 152 met the audiometric criteria for SSNHL, and 180 did not. Both groups had a similar VS rate (8.6% vs. 8.9%, p = 0.914). Similar results were found when other audiometric criteria for asymmetric SNHL were analyzed. In a subgroup analysis of patients with VS-associated SSNHL, neither the tumor size nor the Koos classification was associated with any of the audiometric criteria systems.

Conclusion

There should be a high index of suspicion for the presence of VS in patients with an SHL of any severity.

Level of Evidence

3 Laryngoscope, 2022
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Πέμπτη 26 Μαΐου 2022

Translating core intervention strategies into action: Interpersonal validation among selfinjuring adolescents and their mothers

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Abstract

Introduction

Most evidence-supported treatments for psychiatric problems teach clients skills to incorporate into their daily lives. Yet little research rigorously examines the extent to which individuals absorb these strategies and can competently apply them outside of the therapeutic relationship.

Objectives

The current study examined the degree to which selfinjuring adolescents and their mothers (n = 30 dyads) and typical control mother–daughter dyads (n = 30) were able to utilize a multicomponent interpersonal validation-oriented skill from dialectical behavior therapy, after a single teaching. We also aimed to assess whether variance in Gentle, Interested, Validate, and Easy (GIVE) skill practice was associated with a physiological index of emotion regulation (respiratory sinus arrhythmia [RSA]).

Method

An observational coding system was developed to measure skill-related behavior across four key domains (be[ing] gentle, act[ing] interested, validation, and us[ing] an easy manner; GIVE) and applied during two family conflict discussions (pre- and postskills training). Mother and adolescent RSA data were collected at rest and across discussion tasks.

Results

Behavioral indicators of skill use improved pre-to-post skills training across the entire sample, except in one GIVE domain (easy manner). Selfinjuring youth and their mothers demonstrated greater improvements than control dyads with respect to being gentle. RSA reactivity scores predicted behavioral validation, such that higher RSA was associated with higher validation scores.

Conclusions

As a field, we currently have a limited understanding of how intervention skills are used, and what factors predict effective skill application. Results suggest selfinjuring adolescents and their mothers can learn and improve on most aspects of a core intervention strategy after a single teaching and that better physiological regulation during conflict is associated with more validating behaviors.
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Serum Neutralizing Antibody Titers 12 months after COVID-19 mRNA Vaccination:

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Abstract
Background
We studied whether comorbid conditions impact strength and duration of immune responses after SARS-CoV-2 mRNA vaccination in a US-based, adult population.
Methods
Sera (pre-and-post-BNT162b2 vaccination) were tested serially up to 12 months after two doses of vaccine for SARS-CoV-2-anti-Spike neutralizing capacity by pseudotyping assay in 124 individuals; neutralizing titers were correlated to clinical variables with multivariate regression. Post-booster (third dose) effect was measured at 1 and 3 months in 72 and 88 subjects respectively.
Results
After completion of primary vaccine series, neutralizing antibody IC50 values were high at one month (14-fold increase from pre-vaccination), declined at six months (3.3-fold increase), and increased at one month post-booster (41.5-fold increase). Three months post-booster, IC50 decreased in COVID-naïve individuals (18-fold increase) and increased in prior COVID-19 + individuals (132-fold increase). Age >65 years (β=-0.94, p = 0.001) and malignancy (β=-0.88, p = 0.002) reduced strength of response at 1 month. Both neutralization strength and durability at 6 months, respectively, were negatively impacted by end-stage renal disease [(β=-1.10, p = 0.004); (β=-0.66, p = 0.014)], diabetes mellitus [(β=-0.57, p = 0.032); (β=-0.44, p = 0.028)], and systemic steroid use [(β=-0.066, p = 0.032); (β=-0.55, p = 0.037)]. Post-booster IC50 was robust against WA-1 and B.1.617.2. Post-booster neutralization increased with prior COVID-19 (β = 2.9, p-value < 0.0001), and malignancy reduced neutralization response (β=-0.68, p = 0.03), regardless of infection status.
Conclusion
Multiple clinical factors impact the strength and duration of neutralization response post-primary series vaccination, but not the post-booster dose strength. Malignancy was associated with lower booster-dose response regardless of prior COVID infection, suggesting a need for clinically guided vaccine regimens.
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Humoral immune response to authentic circulating SARS‐CoV‐2 variants elicited by booster vaccination with distinct RBD subunits in mice

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Abstract

SARS-CoV-2 variants could induce immune escape by mutations of the spike protein which are threatening to weaken vaccine efficacy. A booster vaccination is expected to increase the humoral immune response against SARS-CoV-2 variants in the population. We showed that immunization with two doses of wild type receptor-binding domain (RBD) protein, and booster vaccination with wild type or variant RBD protein all significantly increased binding and neutralizing antibody titers against wild type SARS-CoV-2 and its variants in mice. Only the booster immunization by Omicron (BA.1)RBD induced a strong antibody titer against the omicron virus strain and comparable antibody titers against all the other virus strains. These findings might shed the light on COVID-19 booster immunogens.

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COVID Salivary diagnostics: a comparative technical study

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ABSTRACT

Since the beginning of the COVID-19 pandemic, molecular diagnostics of SARS-CoV-2 have taken center stage in the detection of infected individuals for isolation purposes but also in the mass surveillance as a preventive strategy to contain the virus spread. While nasopharyngeal swabs (NPS) have remained the golden standard substrate, salivary diagnostic for SARS-CoV-2 has been proposed as an alternative and non-invasive measure in vulnerable individuals. Nevertheless, there is a widespread assumption that salivary RT-PCR does not match the quality of testing using NPS and particular care should be taken in respect to food or beverage intake, when sampling saliva. Our study indicates that without any precaution in the selection of 190 patients, nor restriction over the time-window of sampling, there is 99% match in the COVID-19 positivity between NPS and saliva when using RT-PCR, with a reported Delta in thermal cycles (Cts) values for the viral genes Envelop e (E) and Open reading frame 1ab (Orf1ab) between 0 and 2, a 98.7% Sensitivity and 100% Specificity. This high accuracy is maintained in pooling configurations that can be used for mass-testing purposes in professional and educational settings. The further advantage to using crude saliva as compared to NPS or mouthwash is that direct methods yield robust results. Overall, our study validates and promotes the use of salivary diagnostic for COVID-19 eliminating the need of a medical practitioner for the sampling, resolving the unpleasantness of the NPS intervention and empowering the patient to do self-testing in times of need.

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Carbohydrate quantity is more closely associated with glycaemic control than weight in pregnant women with type 1 diabetes; insights from the Diabetes and Pre‐eclampsia Intervention Trial (DAPIT)

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Abstract

Aim

To explore the relationships between carbohydrate intake, body mass index and glycaemic control (HbA1c) in pregnant women with type 1 diabetes mellitus (T1DM)

Methods

Secondary analysis of data was undertaken to assess dietary intake in a cohort of women who participated in a randomized controlled trial (RCT) of antioxidant supplementation to prevent pre-eclampsia (DAPIT10). Study specific peripheral venous blood samples were obtained for HbA1c at 26 weeks and 34 weeks. Diet was collected using a validated semi-quantitative food frequency questionnaire at 26-28 weeks gestation which assessed dietary intake over 2 weeks. Mean daily average nutrient intakes were analysed using Q Builder nutritional software (Tinuviel Software, UK) and SPSS Version 25).

Results

Dietary data were available for 547 pregnant women (72% of cohort) aged 29 years (95% CI 28.9-29.9) with average diabetes duration 11.8 years (95% CI 11.1-12.6). Averag e BMI (<16 weeks gestation) was 26.7 kg/m2 (95% CI 26.3 -27 range 18.8-45.6 kg/m2); 43% (n=234) were overweight (BMI 25.0 - 29.9kg/m2) and 20% (n= 112) were obese (BMI>30kg/m2). Differences in HbA1c and carbohydrate quantity and quality were found when adjusted for age and insulin dose. No differences between BMI group were observed in total carbohydrate and glycaemic control, however, differences were noted in fibre and glycaemic index.

Conclusion

Average quantity of dietary carbohydrate influenced HbA1c when adjusted for insulin dose however, BMI had less impact. More research is required on the relationship between carbohydrate consumption and glycaemic control in pregnancy.

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Activin A downregulates the CD69-MT2A axis via p38MAPK to induce erythroid differentiation that sensitizes BCR-ABL-positive cells to imatinib

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Publication date: Available online 26 May 2022

Source: Experimental Cell Research

Author(s): Chih-Wei Chen, Nai-Kuei Huang, Yueh-Lun Lee, Chia-Kwung Fan, Yen-Chou Chen, Chin-Wei Liu, Huei-Mei Huang
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Pediatric Button Battery Injuries—Current State and What’s Next?

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The study by Philteos et al in this issue of JAMA Otolaryngology–Head & Neck Surgery is a systematic review of published cases of airway injury among pediatric patients who ingested button batteries (BBs). Although these types of severe complications associated with BB ingestion have been previously reported, to date this is the largest review focused on airway injuries. Given the direct proximity of the esophagus and the trachea, airway injury is a possible risk in cases of BB ingestion. The authors' review of the literature and dat a from the National Capital Poison Center (NCPC) database yielded 195 cases total. The mean age at BB ingestion was 17.8 months, and the mean time between ingestion and removal was 5.8 days. The duration of impaction is difficult to precisely determine because many ingestions are unwitnessed and have a delayed diagnosis. Button batteries at least 20 mm in diameter (with lithium chemistry) are more likely to become impacted in the pediatric esophagus, but smaller BBs (including those with nonlithium chemistry) also pose a substantial risk; 11% of the injury cases with known BB diameters in this report involved BBs smaller than 20 mm, with the smallest diameter being 10 mm. Tracheoesophageal fistula (TEF), a life-threatening complication of BB ingestion, was found to be the most common airway injury (79%). Most TEFs required surgical management, and all 14 deaths reported TEF involvement. Other airway complications found included unilateral and bilateral vocal cord paralysis, subglott ic stenosis, tracheal stenosis, and tracheomalacia. The use of injury mitigation strategies before or after BB removal was not assessed in this study, which is limited by the known underreporting of these cases to any data source. This review by Philteos et al describes complications from BB ingestions associated with airway injury, invaluably highlighting a significant source of pediatric morbidity and mortality.
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Concomitant and Exceedingly Rare Causes of Oropharyngeal Dysphagia

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This case report describes a man in his 40s who presented with a 5-month history of worsening dysphonia and dysphagia and was subsequently diagnosed with extranodal natural killer/T-cell lymphoma.
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