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1.
BMC Health Serv Res ; 24(1): 789, 2024 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-38982360

RESUMO

BACKGROUND: To ensure a safe patient discharge from hospital it is necessary to transfer all relevant information in a discharge summary (DS). The aim of this study was to evaluate a bundle of measures to improve the DS for physicians, nurses and patients. METHODS: In a double-blind, randomized, controlled trial, four different versions of DS (2 original, 2 revised) were tested with physicians, nurses and patients. We used an evaluation sheet (Case report form, CRF) with a 6-point Likert scale (1 = completely agree; 6 = strongly disagree). RESULTS: In total, 441 participants (physicians n = 146, nurses n = 140, patients n = 155) were included in the study. Overall, the two revised DS received significant better ratings than the original DS (original 2.8 ± 0.8 vs. revised 2.1 ± 0.9, p < 0.001). Detailed results for the main domains are structured DS (original 1.9 ± 0.9 vs. revised 2.2 ± 1.3, p = 0.015), content (original 2.7 ± 0.9 vs revised 2.0 ± 0.9, p < 0.001) and comprehensibility (original 3.8 ± 1.2vs. revised 2.3 ± 1.2, p < 0.001). CONCLUSION: With simple measures like avoiding abbreviations and describing indications or therapies with fixed contents, the DS can be significantly improved for physicians, nurses and patients at the same time. TRIAL REGISTRATION: First registration 13/11/2020 NCT04628728 at www. CLINICALTRIALS: gov , Update 15/03/2023.


Assuntos
Letramento em Saúde , Humanos , Método Duplo-Cego , Masculino , Feminino , Áustria , Pessoa de Meia-Idade , Adulto , Segurança do Paciente , Alta do Paciente , Sumários de Alta do Paciente Hospitalar/normas , Idoso , Assistência Centrada no Paciente
2.
Eur Arch Otorhinolaryngol ; 281(1): 301-310, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37823895

RESUMO

PURPOSE: Vocal fold injuries are associated with fibrosis and dysphonia, which is a major obstacle to surgical treatment. The aim of this study is to evaluate the effect of topical hyaluronic acid with or without diclofenac on the inflammatory phase of vocal fold wound healing. METHODS: Forty-one male Sprague-Dawley rats were randomly assigned to four groups: an uninjured control group, an injured control group without any treatment, and two intervention groups in which hyaluronic acid with or without diclofenac was applied to the injured vocal fold. Gene expression of inflammatory markers and ECM-related molecules were examined. RESULTS: Vocal fold injury resulted in a significant upregulation of inflammatory parameters [Ptgs2, Il1b and Il10] and Has1. Tgfb1, Has3 and Eln gene expression were significantly downregulated by the topical application of hyaluronic acid. The combination of hyaluronic acid and diclofenac did not result in any significant changes. CONCLUSIONS: Vocal fold wound healing was significantly improved by a single post-operative topical application of hyaluronic acid. The addition of diclofenac may provide no additional benefit.


Assuntos
Ácido Hialurônico , Prega Vocal , Ratos , Masculino , Animais , Prega Vocal/cirurgia , Ratos Sprague-Dawley , Ácido Hialurônico/farmacologia , Diclofenaco/metabolismo , Diclofenaco/farmacologia , Cicatrização
3.
Eur Arch Otorhinolaryngol ; 281(8): 4379-4384, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-38743079

RESUMO

PURPOSE: The rise of digitization promotes the development of screening and decision support tools. We sought to validate the results from a machine learning based dysphagia risk prediction tool with clinical evaluation. METHODS: 149 inpatients in the ENT department were evaluated in real time by the risk prediction tool, as well as clinically over a 3-week period. Patients were classified by both as patients at risk/no risk. RESULTS: The AUROC, reflecting the discrimination capability of the algorithm, was 0.97. The accuracy achieved 92.6% given an excellent specificity as well as sensitivity of 98% and 82.4% resp. Higher age, as well as male sex and the diagnosis of oropharyngeal malignancies were found more often in patients at risk of dysphagia. CONCLUSION: The proposed dysphagia risk prediction tool proved to have an outstanding performance in discriminating risk from no risk patients in a prospective clinical setting. It is likely to be particularly useful in settings where there is a lower incidence of patients with dysphagia and less awareness among staff.


Assuntos
Transtornos de Deglutição , Aprendizado de Máquina , Humanos , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Masculino , Feminino , Pessoa de Meia-Idade , Medição de Risco/métodos , Idoso , Adulto , Estudos Prospectivos , Idoso de 80 Anos ou mais , Sensibilidade e Especificidade , Algoritmos , Fatores de Risco
4.
Dysphagia ; 38(4): 1238-1246, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36625964

RESUMO

Based on a large number of pre-existing documented electronic health records (EHR), we developed a machine learning (ML) algorithm for detection of dysphagia and aspiration pneumonia. The aim of our study was to prospectively apply this algorithm in two large patient cohorts. The tool was integrated in the hospital information system of a secondary care hospital in Austria. Based on existing data such as diagnoses, laboratory, and medication, dysphagia risk was predicted automatically, and patients were stratified into three risk groups. Patients' risk groups and risk factors were visualized in a web application. Prospective predictions of 1270 admissions to geriatric or internal medicine departments were compared with the occurrence of dysphagia or aspiration pneumonia of routinely documented events. The discriminative performance for internal medicine patients (n = 885) was excellent with an AUROC of 0.841, a sensitivity of 74.2%, and a specificity of 84.1%. For the smaller geriatric cohort (n = 221), the AUROC was 0.758, sensitivity 44.4%, and specificity 93.0%. For both cohorts, calibration plots showed a slight overestimation of the risk. This is the first study to evaluate the performance of a ML-based prediction tool for dysphagia in a prospective clinical setting. Future studies should validate the predictions on data of systematic dysphagia screening by specialists and evaluate user satisfaction and acceptance. The ML-based dysphagia prediction tool achieved an excellent performance in the internal medicine cohort. More data are needed to determine the performance in geriatric patients.


Assuntos
Transtornos de Deglutição , Pneumonia Aspirativa , Humanos , Idoso , Transtornos de Deglutição/diagnóstico , Estudos Prospectivos , Hospitalização , Aprendizado de Máquina , Estudos Retrospectivos
5.
J Acoust Soc Am ; 153(5): 2803, 2023 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-37154554

RESUMO

With age, the atrophy of the thyroarytenoid muscle (TAM), and thus atrophy of the vocal folds, leads to decreased glottal closure, increased breathiness, and a loss in voice quality, which results in a reduced quality of life. A method to counteract the atrophy of the TAM is to induce hypertrophy in the muscle by functional electric stimulation (FES). In this study, phonation experiments were performed with ex vivo larynges of six stimulated and six unstimulated ten-year-old sheep to investigate the impact of FES on phonation. Electrodes were implanted bilaterally near the cricothyroid joint. FES treatment was provided for nine weeks before harvesting. The multimodal measurement setup simultaneously recorded high-speed video of the vocal fold oscillation, the supraglottal acoustic signal, and the subglottal pressure signal. Results of 683 measurements show a 65.6% lower glottal gap index, a 22.7% higher tissue flexibility (measured by the amplitude to length ratio), and a 473.7% higher coefficient of determination (R2) of the regression of subglottal and supraglottal cepstral peak prominence during phonation for the stimulated group. These results suggest that FES improves the phonatory process for aged larynges or presbyphonia.


Assuntos
Qualidade de Vida , Prega Vocal , Ovinos , Animais , Prega Vocal/fisiologia , Fonação/fisiologia , Músculos Laríngeos , Estimulação Elétrica
6.
Mol Cell Proteomics ; 18(8): 1511-1525, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31123107

RESUMO

Reinke's edema is a smoking-associated, benign, mostly bilateral lesion of the vocal folds leading to difficulties in breathing and voice problems. Pronounced histological changes such as damaged microvessels or immune cell infiltration have been described in the vocal fold connective tissue, the lamina propria Thus, vocal fold fibroblasts, the main cell type of the lamina propria, have been postulated to play a critical role in disease mediation. Yet information about the pathophysiology is still scarce and treatment is only surgical, i.e. symptomatic. To explore the pathophysiology of Reinke's edema, we exposed near-primary human vocal fold fibroblasts to medium conditioned with cigarette smoke extract for 24 h as well as 4 days followed by quantitative mass spectrometry.Proteomic analyses after 24 h revealed that cigarette smoke increased proteins previously described to be involved in oxidative stress responses in other contexts. Correspondingly, gene sets linked to metabolism of xenobiotics and reactive oxygen species were significantly enriched among cigarette smoke-induced proteins. Among the proteins most downregulated by cigarette smoke, we identified fibrillar collagens COL1A1 and COL1A2; this reduction was validated by complementary methods. Further, we found a significant increase of UDP-glucose 6-dehydrogenase, generating a building block for biosynthesis of hyaluronan, another crucial component of the vocal fold lamina propria In line with this result, hyaluronan levels were significantly increased because of cigarette smoke exposure. Long term treatment of 4 days did not lead to significant changes.The current findings corroborate previous studies but also reveal new insights in possible disease mechanisms of Reinke's edema. We postulate that changes in the composition of the vocal folds' extracellular matrix -reduction of collagen fibrils, increase of hyaluronan- may lead to the clinical findings. This might ease the identification of better, disease-specific treatment options.


Assuntos
Fumar Cigarros , Edema/metabolismo , Fibroblastos/metabolismo , Doenças da Laringe/metabolismo , Fumaça , Prega Vocal/metabolismo , Células Cultivadas , Humanos , Proteômica
7.
Eur Arch Otorhinolaryngol ; 275(10): 2535-2540, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30141109

RESUMO

PURPOSE: There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe. METHODS: A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society. RESULTS: 100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (ß = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (ß = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1. CONCLUSIONS: The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.


Assuntos
Consenso , Eletromiografia/métodos , Laringe/diagnóstico por imagem , Fonação/fisiologia , Especialização , Paralisia das Pregas Vocais/diagnóstico , Prega Vocal/diagnóstico por imagem , Estudos Transversais , Humanos , Laringoscopia/métodos , Valor Preditivo dos Testes , Inquéritos e Questionários , Paralisia das Pregas Vocais/fisiopatologia , Prega Vocal/fisiopatologia
8.
Curr Neurol Neurosci Rep ; 17(5): 43, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28390033

RESUMO

PURPOSE OF REVIEW: Substantial research exists focusing on the various aspects and domains of early human development. However, there is a clear blind spot in early postnatal development when dealing with neurodevelopmental disorders, especially those that manifest themselves clinically only in late infancy or even in childhood. RECENT FINDINGS: This early developmental period may represent an important timeframe to study these disorders but has historically received far less research attention. We believe that only a comprehensive interdisciplinary approach will enable us to detect and delineate specific parameters for specific neurodevelopmental disorders at a very early age to improve early detection/diagnosis, enable prospective studies and eventually facilitate randomised trials of early intervention. In this article, we propose a dynamic framework for characterising neurofunctional biomarkers associated with specific disorders in the development of infants and children. We have named this automated detection 'Fingerprint Model', suggesting one possible approach to accurately and early identify neurodevelopmental disorders.


Assuntos
Biomarcadores , Diagnóstico Precoce , Transtornos do Neurodesenvolvimento/diagnóstico , Humanos
9.
J Vasc Surg ; 64(5): 1303-1310, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27475467

RESUMO

OBJECTIVE: Iatrogenic injury of the vagus nerve or its branches during carotid endarterectomy (CEA) can result in globus sensation, dysphagia, and even vocal fold immobility. Knowledge of morphologic and functional laryngopharyngeal outcomes after CEA is poor. The present study was performed to determine potential iatrogenic damage to the laryngeal innervation after CEA. An area of particular interest was the supraglottic sensory threshold, which was examined by Fiberoptic Endoscopic Evaluation of Swallowing With Sensory Testing (FEESST; Pentax Medical Company, Montvale, NJ), a validated and safe method for the determination of the motor and sensory components of swallowing. METHODS: FEESST was used preoperatively in 32 patients scheduled to undergo CEA and twice postoperatively to examine the motor and sensory components of swallowing. In this endolaryngeal examination, laryngopharyngeal sensory thresholds (in mm Hg) were defined as normal at <4.0 mm Hg air pulse pressure (APP), moderate deficit at 4.0 to 6.0 mm Hg APP, or severe deficit at >6.0 mm Hg APP, with a value >10.0 mm Hg APP indicating abolished laryngeal adductor reflex. Acoustic voice parameters were also analyzed for further functional changes of the larynx. RESULTS: The mean ± standard deviation preoperative FEESST measures showed no significant differences (P = .065) between the operated-on side (6.73 ± 1.73 mm Hg) and the opposite side (5.83 ± 1.68 mm Hg). At 2 days postoperatively, the threshold increased (P = .001) to 7.62 ± 1.98 mm Hg on the operated-on side. A laryngopharyngeal mucosal hematoma on the operated side was endoscopically detectable in eight patients (30.8%); in these patients, we found a markedly elevated (P = .021) measure of 9.50 ± 0.93 mm Hg. On the opposite (nonoperated-on) side of the laryngopharynx, the thresholds remained at the same level as preoperatively over all assessments (P >.05), whereas the differences between the operated and nonoperated-on sides and the hematoma and nonhematoma groups were highly significant (P = .004 and P = .001, respectively). Surprisingly, the sensory threshold on the operated-on side (6.08 ± 2.02 mm Hg) decreased significantly at the 6-week follow-up, even in relation to the preoperative measure (P = .022). With the exception of one patient with permanent unilateral vocal fold immobility, no signs of nerve injury were detected. CONCLUSIONS: In accordance with previous reports, injuries to the recurrent laryngeal nerve during CEA seem to be rare. In most patients, postoperative symptoms (globus, dysphagia, dysphonia) and signs fade within a few weeks without any specific therapeutic intervention. This study shows an improved long-term postoperative superior laryngeal nerve function with regard to laryngopharyngeal sensitivity.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Endarterectomia das Carótidas , Nervos Laríngeos/fisiopatologia , Laringe/fisiopatologia , Atividade Motora , Limiar Sensorial , Acústica , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/fisiopatologia , Deglutição , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Disfonia/etiologia , Disfonia/fisiopatologia , Endarterectomia das Carótidas/efeitos adversos , Esofagoscopia , Feminino , Tecnologia de Fibra Óptica , Humanos , Doença Iatrogênica , Traumatismos do Nervo Laríngeo/etiologia , Traumatismos do Nervo Laríngeo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pressão , Estudos Prospectivos , Recuperação de Função Fisiológica , Medida da Produção da Fala , Fatores de Tempo , Resultado do Tratamento , Qualidade da Voz
12.
Eur Arch Otorhinolaryngol ; 271(5): 1107-12, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24077847

RESUMO

Vocal fold (VF) fibroblasts are the central subject of interest in fibrogenesis and wound healing after VF injury. Scar fibroblasts (SF) exhibit an aberrant production of several extracellular matrix (ECM) components which lead either to VF fibrosis or scarless wound healing. This study aimed to investigate the role of age at the time of injury on ECM production of SF. This is designed as an animal study. VF injury was established unilaterally in eight male Sprague-Dawley rats [3 months of age (n = 4), 11 months of age (n = 4)], while the other side was left intact. Three months after injury the larynges were excised and fibroblasts were extracted from VF [normal fibroblasts (NF)­scar fibroblasts (SF)] and cultured in vitro. After first passage, VF fibroblasts were plated in 24-well plates and levels of hyaluronic acid (HA) and collagen type I were determined enzymatically from supernatant after 24 and 72 h. Cultured SF from younger animals produced significantly higher levels of HA compared to NF fibroblasts from the same animals. HA concentrations of the older animals did not differ significantly between the NF and SF cultures, but the range in SF cultures was large. In contrast to previous studies, we found that even 3 months after VF injury cultured SF from young animals expressed higher levels of HA in comparison to SF from older animals. No difference in collagen levels were observed between the younger and older animals. Age of animals is an essential factor during VF healing and has to be considered for study design.


Assuntos
Cicatriz/patologia , Modelos Animais de Doenças , Matriz Extracelular/patologia , Fibroblastos/patologia , Prega Vocal/patologia , Cicatrização/fisiologia , Fatores Etários , Animais , Colágeno Tipo I/análise , Ácido Hialurônico/análise , Técnicas In Vitro , Masculino , Ratos
13.
J Voice ; 2024 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-38705740

RESUMO

OBJECTIVES: The isolated or combined effects of vibration and smoke extract (SE) from the IQOS™ "heat-not-burn" technology on human vocal fold fibroblasts (hVFF) were evaluated in an in vitro setting in order to elucidate their influence on vocal fold (patho-) physiology. STUDY DESIGN: Experimental pilot study using intervention with IQOS™-SE in vitro. METHODS: Immortalized hVFF were exposed to IQOS™-SE or control medium under static or vibrational conditions. A phonomimetic bioreactor was used to deliver vibrational patterns to hVFF over a period of 5days. Cytotoxicity was quantified by lactate dehydrogenase assay. Effects on extracellular matrix production, inflammation, fibrogenesis, and angiogenesis were assessed by reverse transcription-quantitative polymerase chain reaction, western blot, enzyme-linked immunosorbent assay, and Magnetic Luminex assays. RESULTS: We observed significant changes induced either by IQOS™-SE exposure alone (matrix metalloproteinase 1, fibronectin, cyclooxygenase (COX)1, interleukin-8 gene expression), or by the combination of IQOS™-SE and vibration (hyaluronidase 2, COX2, interleukin-8 protein levels, vascular endothelial growth factor D). CONCLUSION: Short-term in vitro exposure of hVFF to IQOS™-SE did not result in cytotoxicity and reduced the gene expression of measured inflammation mediators, but had no effect on their protein expression. However, the clinical effects of long-term IQOS™ use are still not known and further research is needed in order to assess, if IQOS™ is in fact less harmful than conventional cigarettes.

14.
PLoS One ; 19(2): e0297168, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38335206

RESUMO

Studies have shown that certain vocal fold pathologies are more common in one sex than the other. This is often explained by differences in the composition of the lamina propria and anatomical differences between female and male vocal folds, resulting in e.g. different fundamental frequencies. Here, we investigated a potential sex-specific voice frequency effect in an in vitro setting using vocal fold fibroblasts from one male and one female donor with and without cigarette smoke extract (CSE) addition. After exposure to either male or female vibration frequency with or without CSE, cells and supernatants were harvested. Gene and protein analysis were performed by means of qPCR, western blot, ELISA and Luminex. We found that exposure of cells to both male and female vibration pattern did not elicit significant changes in the expression of extracellular matrix-, inflammation-, and fibrosis-related genes, compared to control cells. The addition of CSE to vibration downregulated the gene expression of COL1A1 in cells exposed to the female vibration pattern, as well as induced MMP1 and PTGS2 in cells exposed to both female and male vibration pattern. The protein expression of MMP1 and COX2 was found to be significantly upregulated only in cells exposed to CSE and female vibration pattern. To conclude, different vibration patterns alone did not cause different responses of the cells. However, the female vibration pattern in combination with CSE had a tendency to elicit/maintain more pro-inflammatory responses in cells than the male vibration pattern.


Assuntos
Metaloproteinase 1 da Matriz , Prega Vocal , Masculino , Feminino , Humanos , Prega Vocal/fisiologia , Metaloproteinase 1 da Matriz/genética , Metaloproteinase 1 da Matriz/metabolismo , Vibração/efeitos adversos , Fibroblastos/metabolismo , Western Blotting
15.
Laryngoscope ; 134(2): 848-854, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37597167

RESUMO

OBJECTIVES: The aim of the study was to increase muscle volume and improve phonation characteristics of the aged ovine larynx by functional electrical stimulation (FES) using a minimally invasive surgical procedure. METHODS: Stimulation electrodes were placed bilaterally near the terminal adduction branch of the recurrent laryngeal nerves (RLN). The electrodes were connected to battery powered pulse generators implanted subcutaneously at the neck region. Training patterns were programmed by an external programmer using a bidirectional radio frequency link. Training sessions were repeated automatically by the implant every other day for 1 week followed by every day for 8 weeks in the awake animal. Another group of animals were used as sham, with electrodes positioned but not connected to an implant. Outcome parameters included gene expression analysis, histological assessment of muscle fiber size, functional analysis, and volumetric measurements based on three-dimensional reconstructions of the entire thyroarytenoid muscle (TAM). RESULTS: Increase in minimal muscle fiber diameter and an improvement in vocal efficiency were observed following FES, compared with sham animals. CONCLUSION: This is the first study to demonstrate beneficial effects in the TAM of FES at molecular, histological, and functional levels. FES of the terminal branches of the RLN reversed the effects of age-related changes and improved vocal efficiency. LEVEL OF EVIDENCE: NA Laryngoscope, 134:848-854, 2024.


Assuntos
Terapia por Estimulação Elétrica , Paralisia das Pregas Vocais , Ovinos , Animais , Modelos Animais de Doenças , Músculos Laríngeos/inervação , Terapia por Estimulação Elétrica/métodos , Estimulação Elétrica/métodos
16.
J Voice ; 2023 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-38007365

RESUMO

OBJECTIVES/HYPOTHESIS: Hoarseness and limited voice capacity are often associated with benign vocal fold (VF) lesions. Despite their high clinical prevalence, epidemiological investigations focusing on these structural alterations are rare. The aim of the study was to present current European data on five typical lesion types (VF nodules, polyp, cyst, contact granuloma, Reinke´s edema). STUDY DESIGN: Retrospective investigation. METHODS: Video recordings of laryngoscopies from all patients with one of the above-mentioned VF pathologies were subjected to a review process. Data collected arose from a single institution over a period of 13 years. They were evaluated statistically with respect to lesion type, sex, age at first diagnosis, and affected side. RESULTS: In a total of 535 patients, VF polyps occurred most frequently, followed by Reinke's edema and nodules. Each of the lesion types studied was significantly associated with sex and, except VF cysts, all diagnoses were also significantly related to age. Female sex was a risk factor for VF nodules, cysts, and Reinke's edema, whereas male sex was associated with polyps and contact granulomas. VF nodules occurred predominantly in young patients, VF polyps in middle-aged, Reinke's edema, and contact granulomas in later adulthood. The predominantly affected side (bilateral, right, or left VF) depended on sex. CONCLUSIONS: Different prevalences from previous studies resulted from inconsistencies in terms of classification framework, terminology, and definition. In addition to endoscopic findings, socio-cultural backgrounds must also be considered when studying benign VF lesions. Prophylactic voice care education for all populations and concomitant efficacy studies are required. Further research is needed to verify possible correlations between sex and the affected side. A non-binary view could broaden the spectrum of phoniatric research issues.

17.
J Voice ; 2023 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-37696688

RESUMO

OBJECTIVES: To explore the effects of short- and long-term cigarette smoke extract (CSE) stimulation on the expression of extracellular matrix (ECM) components and inflammatory cytokines in an in vitro model for studying Reinke's edema using human vocal fold fibroblasts (hVFF). STUDY DESIGN: Experimental pilot study using intervention with CSE in vitro. METHODS: Immortalized hVFF were pretreated with 5% CSE or control medium over a period of 2 or 8 weeks, followed by a final 3-day incubation time. We evaluated cell proliferation and examined gene and protein expression of control- and CSE-treated cells using quantitative polymerase chain reaction, Western Blot and enzyme linked immunosorbent assay. RESULTS: Cell numbers of CSE-treated hVFF strongly decreased after 8 weeks and limited the overall duration of the experiment. We observed significant upregulations in gene expression and protein levels of inflammatory markers (cyclooxygenase COX1, COX2) and ECM components (decorin, matrix metalloproteinase 1, transglutaminase 2, gremlin 2) induced by CSE after 2 and 8 weeks. Interleukin 1 receptor 1, prostaglandin I2 synthase, collagen- and hyaluronan-related gene expression showed minor upregulations. The majority of the observed genes were similarly regulated at both time points. However, the CSE-induced mRNA level of COX1 was ablated after 8 weeks. CONCLUSION: Long-term treatment did not yield results significantly different from the short-term protocol. Therefore, we propose that prolonged CSE exposure is not superior to short-term settings, which save both time and materials.

18.
PLoS One ; 18(6): e0287634, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37390090

RESUMO

Research of human vocal fold (VF) biology is hampered by several factors. The sensitive microstructure of the VF mucosa is one of them and limits the in vivo research, as biopsies carry a very high risk of scarring. A laryngeal organotypic model consisting of VF epithelial cells and VF fibroblasts (VFF) may overcome some of these limitations. In contrast to human VFF, which are available in several forms, availability of VF epithelial cells is scarce. Buccal mucosa might be a good alternative source for epithelial cells, as it is easily accessible, and biopsies heal without scarring. For this project, we thus generated alternative constructs consisting of immortalized human VF fibroblasts and primary human buccal epithelial cells. The constructs (n = 3) were compared to native laryngeal mucosa at the histological and proteomic level. The engineered constructs reassembled into a mucosa-like structure after a cultivation period of 35 days. Immunohistochemical staining confirmed a multi-layered stratified epithelium, a collagen type IV positive barrier-like structure resembling the basement membrane, and an underlying layer containing VFF. Proteomic analysis resulted in a total number of 1961 identified and quantified proteins. Of these, 83.8% were detected in both native VF and constructs, with only 53 proteins having significantly different abundance. 15.3% of detected proteins were identified in native VF mucosa only, most likely due to endothelial, immune and muscle cells within the VF samples, while 0.9% were found only in the constructs. Based on easily available cell sources, we demonstrate that our laryngeal mucosa model shares many characteristics with native VF mucosa. It provides an alternative and reproducible in vitro model and offers many research opportunities ranging from the study of VF biology to the testing of interventions (e.g. drug testing).


Assuntos
Mucosa Laríngea , Laringe , Humanos , Cicatriz , Proteômica , Epitélio
19.
Dev Med Child Neurol ; 54(5): 451-6, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22348320

RESUMO

AIM: Our aim was to contribute new findings related to the pre-regressional verbal development of females with a variant of Rett syndrome (RTT) as the loss of spoken language is one of the key clinical features of RTT, and it would be of particular interest to study the early speech-language development of females who are considered to have preserved some speech-language abilities. METHOD: We analysed 461 minutes of audio-video recordings containing play situations and the daily routines of six females (aged 7 to 24 months; mean birthweight 3057g, SD 195g) with the preserved speech variant (PSV) of RTT. All videos were recorded by parents and analysed retrospectively after the diagnosis PSV was made. RESULTS: From the age of 7 months onwards, we observed two types of vocalizations, appearing intermittently: (1) apparently normal sequences; and (2) atypical (i.e. inhalatory, pressed, or high-pitched crying-like) vocalizations. Some participants failed to reach the milestone of canonical babbling. We observed a limited phonological and lexical complexity and a restricted compositional variability. Volubility was reduced during the whole period under observation. Hand stereotypies with simultaneous atypical vocalizations appeared only during the second year of life. INTERPRETATION: The intermittent character of normal versus abnormal verbal behaviours might contribute to an early identification of children with a possible genetic mutation, and provides evidence that speech-language functions are abnormal from the very beginning.


Assuntos
Transtornos do Desenvolvimento da Linguagem/diagnóstico , Síndrome de Rett/diagnóstico , Transtornos da Comunicação/diagnóstico , Transtornos da Comunicação/genética , Análise Mutacional de DNA , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Seguimentos , Variação Genética/genética , Humanos , Lactente , Transtornos do Desenvolvimento da Linguagem/genética , Estudos Longitudinais , Proteína 2 de Ligação a Metil-CpG/genética , Fonética , Síndrome de Rett/genética , Comportamento Estereotipado
20.
Proteomics Clin Appl ; 16(2): e2100050, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34792860

RESUMO

The vast majority of voice disorders is associated with changes of the unique, but delicate, human vocal fold mucosa. The ability to develop new effective treatment methods is significantly limited by the physical inaccessibility and the extremely rare occasions under which healthy tissue biopsies can be obtained. Therefore, the interest in laryngological research has shifted to human oral (buccal) mucosa, a similar and more easily available tissue. The harvesting process is less invasive and accompanied with faster healing and less scarring, compared to vocal fold mucosa. Here we report a descriptive proteomic comparison of paired human buccal and vocal fold mucosa by high-resolution mass spectrometry (CID-MS/MS). Our study identified a total of 1575 proteins detected within both tissues that are highly consistent in several crucial biological processes, cellular components, and molecular functions. Hence, our proteomic analysis will provide a fundamental resource for the laryngological research community.


Assuntos
Proteômica , Prega Vocal , Cicatriz/metabolismo , Cicatriz/patologia , Humanos , Mucosa Bucal/metabolismo , Mucosa Bucal/patologia , Espectrometria de Massas em Tandem , Prega Vocal/metabolismo , Prega Vocal/patologia
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