[Aerosols and SARS-CoV-2: Statement of the "Expert Group Aerosols" on the development, infectivity, spread and reduction of airborne, virus-containing particles in the air]. / Stellungnahme des "Expertenkreises Aerosole": Aerosole und SARS-CoV-2 ­ Entstehung, Infektiosität, Ausbreitung und Minderung luftgetragener, virenhaltiger Teilchen in der Atemluft.

Aerosols are currently seen as one of the main transmission routes for SARS-CoV-2, but a comprehensive understanding of the processes and appropriate action/adaptation of protection concepts requires the exchange of information across interdisciplinary boundaries. Against this background, the Baden-Württemberg state government launched in October 2020 a multidisciplinary "Expert Group Aerosols" comprising engineers, natural scientists and medical professionals. In its statement, the group has compiled the current state of knowledge in all relevant disciplines in the context of airborne SARS-CoV-2 infection. In addition to the well-known hygiene and social distancing rules, the importance of the correct use of effective masks is emphasized. Furthermore, the necessity for dynamic and correct ventilation is pointed out and illustrated with ventilation intervals and periods for different scenarios as examples. The effectiveness of stationary or mobile cabin air filters as an important component in the protection concept is discussed. The first opinion of the expert group makes it clear that the existing hygiene and social distancing rules offer the best possible protection against SARS-CoV-2 infection only when correctly applied in combination.

["Online from tomorrow on please": comparison of digital framework conditions of curricular teaching at national university ENT clinics in times of COVID-19 : Digital teaching at national university ENT clinics]. / "Ab morgen bitte online": Vergleich digitaler Rahmenbedingungen der curricularen Lehre an nationalen Universitäts-HNO-Kliniken in Zeiten von COVID-19 : Digitale Lehre an nationalen Universitäts-HNO-Kliniken.

BACKGROUND: The corona crisis not only affects professional activities but also teaching and learning at universities. Buzzwords, such as e­learning and digitalization suggest the possibility of innovative teaching approaches that are readily available to solve the problems of teaching in the current COVID-19 pandemic. The current conversion to digital teaching is not primarily driven by didactic rationale or institutional strategy but by external circumstances. OBJECTIVE: The aim of the study was to determine the teaching situation at national university ENT clinics and academic teaching hospitals at the start of the virtual corona summer semester in 2020. MATERIAL AND METHODS: A specifically self-designed questionnaire regarding the local situation and conditions as well as nationwide scenarios was sent to all 39 national university ENT clinics and 20 ENT departments at academic teaching hospitals. RESULTS: A total of 31 university hospitals and 10 academic teaching hospitals took part in the survey. There were obvious discrepancies between available resources and effectively available digital teaching and learning contents. Further criticism was expressed regarding the communication with the medical faculty, the digital infrastructure and particularly the frequent lack of collaboration with central support facilities, such as media, didactics and datacenters. CONCLUSION: There are positive examples of successful transformation of classroom teaching to an exclusively virtual summer semester 2020 within the university ENT clinics; however, critical ratings of assistant professors and medical directors regarding the current teaching situation predominated. A time-critical strategic advancement is urgently needed.

Influence of patient and tumor characteristics on early therapy persistence with letrozole in postmenopausal women with early breast cancer: results of the prospective Evaluate-TM study with 3941 patients.

Background: Patients' compliance and persistence with endocrine treatment has a significant effect on the prognosis in early breast cancer (EBC). The purpose of this analysis was to identify possible reasons for non-persistence, defined as premature cessation of therapy, on the basis of patient and tumor characteristics in individuals receiving adjuvant treatment with letrozole. Patients and methods: The EvAluate-TM study is a prospective, multicenter, noninterventional study in which treatment with the aromatase inhibitor letrozole was evaluated in postmenopausal women with hormone receptor-positive EBC in the early therapy phase. Treatment persistence was evaluated at two pre-specified study visits after 6 and 12 months. As a measure of early therapy persistence the time from the start to the end of treatment (TTEOT) was analyzed. Cox regression analyses were carried out to identify patient characteristics and tumor characteristics predicting TTEOT. Results: Out of the total population of 3941 patients with EBC, 540 (13.7%) events involving treatment cessation unrelated to disease progression were observed. This was due to drug-related toxicity in the majority of cases (73.5%). Persistence rates were 92.2%, 86.9%, and 86.3% after 6, 12, and 15 months, respectively. The main factors influencing premature treatment discontinuation were older age [hazard ratio (HR) 1.02/year], comorbidities (HR 1.06 per comorbidity), low body mass index, and lower tumor grade (HR 0.85 per grade unit). Conclusion: These results support the view that older, multimorbid patients with low tumor grade and low body mass index are at the greatest risk for treatment discontinuation and might benefit from compliance and support programs.

[Impact of functional mass lesions in professional female singers : Biomechanics of vocal fold oscillation in the register transition regions]. / Auswirkungen von Phonationsverdickungen bei professionellen Sängerinnen : Biomechanik der Stimmlippenschwingungen in den Registerübergangsregionen.

BACKGROUND: The influence of functional mass lesions on vocal fold oscillation patterns in vocally challenging tasks is not yet understood in detail. MATERIALS UND METHODS: Glissandi on the vowel [a:] from 220 to 440 Hz and 440 to 880 Hz were analyzed in three groups of four professional female singers: without a mass lesion or dysphony (group A), with a functional mass lesion (swellings without a great impact on oscillation patterns during stroboscopy; group B), and with organic dysphony (group C). High-speed digital imaging (HSDI; 20,000 fps), and acoustic and electroglottographic (EGG) signals were used for analysis. Based on the EGG sample entropy, time windows for analysis of register transition phenomena were constructed. The voice signals (glottal area waveform, GAW; acoustic and EGG signals) were perceptually rated in terms of the noticeability of registration events. RESULTS: The absolute sample entropy revealed maxima in fundamental frequency regions where register transitions typically occur. Groups A and B could be distinguished neither by perceptual rating nor based on sample entropy values. In comparison to the other two groups, the absolute sample entropy values of group C were greater in the lower glissando. However, the larger vocal fold oscillatory irregularities were observable for the upper glissando in this group. CONCLUSION: Functional mass lesions do not influence biomechanics adversely in vocally challenging tasks such as register transitions. The use of sample entropy as a criterion for detection of register transitions is promising, but needs further validation.

[Psychological effects of preventive voice care training in student teachers]. / Psychologische Effekte eines präventiven Stimmtrainings im Lehramtsreferendariat.

BACKGROUND: Studies on the effectiveness of preventive voice care programs have focused mainly on voice parameters. Psychological parameters, however, have not been investigated in detail so far. OBJECTIVES: The effect of a voice training program for German student teachers on psychological health parameters was investigated in a longitudinal study. METHODS: The sample of 204 student teachers was divided into the intervention group (n = 123), who participated in the voice training program, and the control group (n = 81), who received no voice training. Voice training contained ten 90-min group courses and an individual visit by the voice trainer in a teaching situation with feedback afterwards. Participants were asked to fill out questionnaires (self-efficacy, Short-Form Health Survey, self-consciousness, voice self-concept, work-related behaviour and experience patterns) at the beginning and the end of their student teacher training period. RESULTS: The training program showed significant positive influences on psychological health, voice self-concept (i.e. more positive perception and increased awareness of one's own voice) and work-related coping behaviour in the intervention group. On average, the mental health status of all participants reduced over time, whereas the status in the trained group diminished significantly less than in the control group. Furthermore, the trained student teachers gained abilities to cope with work-related stress better than those without training. CONCLUSION: The training program clearly showed a positive impact on mental health. The results maintain the importance of such a training program not only for voice health, but also for wide-ranging aspects of constitutional health.

[On the Evaluation of Therapeutic Success in Dysphonic Patients]. / Zur Beurteilung der Therapieerfolge bei dysphonen Patienten.

INTRODUCTION: Multidimensional voice evaluation is considered as gold standard in voice medicine. In this respect, the European Laryngological Society recommended a protocol for standardized evaluation (ELS-Protocol). However, there are only rare data analyzing changes during therapeutical follow-up. MATERIAL AND METHODS: Using this protocol, 276 patients (136 after phonosurgery, 81 after voice therapy and as a control group 59 patients without voice impairment) were evaluated with regard to their vocal capacity before and after voice therapy or phonosurgery, respectively. RESULTS: The parameters of the ELS-protocol showed significant improvement under therapy with respect to DSI, VHI, and RBH-scale. It has been confirmed, that these measurements are suitable for the assessment of dysphonic patients with organic as well as functional voice disorders. However, detailed analysis of all the obtained parameters showed only weak or no correlation between all regarding parameters, which should be expected to provide comparable information, such as perturbation parameters or such parameters, that are derived from the acoustical spectrum. DISCUSSION: Multidimensional evaluation of the voice as recommended by the ELS protocol is independent from the therapeutical approach able to document therapeutical success. The lack of sufficient correlations of values which should provide comparable information shows that an optimization or standardization of measuring instruments, computer hardware and software is necessary.

Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study.

BACKGROUND: Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. METHODS: Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). RESULTS: For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. CONCLUSION: Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.

[Development of a questionnaire for the assessment of the voice self-concept]. / Entwicklung eines Fragebogens zur Erfassung des stimmlichen Selbstkonzepts.

BACKGROUND: Common self-assessment questionnaires on voice diagnostics focus mostly on functionality of the voice and the impact on the quality of life. Personal aspects such as the relationship with one's own voice and its self-perception are for the most part not taken into consideration. OBJECTIVES: In this article a questionnaire for the assessment of the voice self-concept (Fragebogen zur Erfassung des stimmlichen Selbstkonzepts, FESS) is introduced. MATERIALS AND METHODS: Reliability and validity were tested with a sample of 308 student teachers. For external validity, the scales were correlated with standardized questionnaires of vocal, physical, and mental health. The scale reliability was also retested in 94 participants. RESULTS: The principal component analysis confirmed the internal consistency of three subscales on the relationship with one's own voice, the awareness of the use of one's own voice, and the perception of the connection between voice and emotional changes. CONCLUSION: The FESS questionnaire was shown to be a reliable and valid instrument which supplements existing voice questionnaires by self-related aspects of the voice.

Age-dependent differences in borderline ovarian tumours (BOT) regarding clinical characteristics and outcome: results from a sub-analysis of the Arbeitsgemeinschaft Gynaekologische Onkologie (AGO) ROBOT study.

BACKGROUND: Approximately one-third of all borderline ovarian tumours (BOT) are diagnosed in patients with child-bearing potential. Detailed information regarding their specific characteristics and prognostic factors is limited. METHODS: Clinical parameters of BOT patients treated between 1998 and 2008 in 24 German centres were retrospectively investigated. Central pathology review and prospective follow-up were carried out. Patients <40 versus ≥40 years were analysed separately and then compared regarding clinico-pathological variables and prognosis. RESULTS: A total of 950 BOT patients with a median age of 49.1 (14.1-91.5) years were analysed [280 patients <40 years (29.5%), 670 patients ≥40 years (70.5%)]. Fertility-preserving surgery was carried out in 53.2% (149 of 280) of patients <40 years with preservation of the primarily affected ovary in 32 of these 149 cases (21.5%). Recurrence was significantly more frequent in patients <40 years (19.0% versus 10.1% 5-year recurrence rate, P < 0.001), usually in ovarian tissue, whereas disease-specific overall survival did not differ between the subgroups. In case of recurrent disease, malignant transformation was less frequent in younger than in older patients (12.0% versus 66.7%, P < 0.001), mostly presenting as invasive peritoneal carcinomatosis. Multivariate analysis for patients <40 years identified advanced International Federation of Gynecology and Obstetrics (FIGO) stage and fertility-sparing approach as independent prognostic factors negatively affecting progression-free survival (PFS) while, for patients ≥40 years, higher FIGO stage and incomplete staging was associated with impaired PFS. CONCLUSIONS: Despite favourable survival, young BOT patients with child-bearing potential are at higher risk for disease recurrence. However, relapses usually remain BOT in the preserved ovaries as opposed to older patients being at higher risk for malignant transformation in peritoneal or distant localisation. Therefore, fertility-sparing approach can be justified for younger patients after thorough consultation.

Hydrogen-fluorine exchange in NaBH4-NaBF4.

Hydrogen-fluorine exchange in the NaBH4-NaBF4 system is investigated using a range of experimental methods combined with DFT calculations and a possible mechanism for the reactions is proposed. Fluorine substitution is observed using in situ synchrotron radiation powder X-ray diffraction (SR-PXD) as a new Rock salt type compound with idealized composition NaBF2H2 in the temperature range T = 200 to 215 °C. Combined use of solid-state (19)F MAS NMR, FT-IR and DFT calculations supports the formation of a BF2H2(-) complex ion, reproducing the observation of a (19)F chemical shift at -144.2 ppm, which is different from that of NaBF4 at -159.2 ppm, along with the new absorption bands observed in the IR spectra. After further heating, the fluorine substituted compound becomes X-ray amorphous and decomposes to NaF at ~310 °C. This work shows that fluorine-substituted borohydrides tend to decompose to more stable compounds, e.g. NaF and BF3 or amorphous products such as closo-boranes, e.g. Na2B12H12. The NaBH4-NaBF4 composite decomposes at lower temperatures (300 °C) compared to NaBH4 (476 °C), as observed by thermogravimetric analysis. NaBH4-NaBF4 (1:0.5) preserves 30% of the hydrogen storage capacity after three hydrogen release and uptake cycles compared to 8% for NaBH4 as measured using Sievert's method under identical conditions, but more than 50% using prolonged hydrogen absorption time. The reversible hydrogen storage capacity tends to decrease possibly due to the formation of NaF and Na2B12H12. On the other hand, the additive sodium fluoride appears to facilitate hydrogen uptake, prevent foaming, phase segregation and loss of material from the sample container for samples of NaBH4-NaF.

Motor functions in trumpet playing-a real-time MRI analysis.

INTRODUCTION: The function of the orofacial and pharyngeal musculature for sound generation in brass instruments is insufficiently investigated. The contribution of muscles defying direct observation remains poorly understood. Time-resolved magnetic resonance imaging (MRI) allows visualization of muscle function as well as changes of the oropharyngeal cavities during muscle activation. METHODS: We used fast 3-T MRI imaging to analyze motor activation during sound generation in brass instruments. Twelve professional trumpeters were analyzed at different pitch, loudness and dynamic. MR images were analyzed for position of the mouthpiece to lips and teeth, pivoting, nasopharyngeal closure and changes in the area of oral and pharyngeal cavity. RESULTS: Of the 12 subjects, eight positioned the mouthpiece mainly to the upper lip, three in equal parts to upper and lower lip, and only one mostly to the lower lip. The last turned out to be the only subject with upward pivoting. All subjects had a complete velopharyngeal closure. Measurements of the oral and pharyngeal cavities showed an increase when subjects were playing higher pitches. The increase in areas of oral and pharyngeal cavity was present also when switching from lower to higher loudness and when performing crescendo to decrescendo. Enlargement of the oral and pharyngeal cavity was less pronounced with increasing loudness. But no general difference in change of oral and pharyngeal cavity could be observed. CONCLUSIONS: The present study shows that it is possible to measure motor function and its implications on oral as well as pharyngeal cavities during sound generation in brass instruments. These changes seem to follow a reproducible pattern.

[Validation of the German version of the Singing Voice Handicap Index]. / Validierung des Singing Voice Handicap Index in der deutschen Fassung.

The Singing Voice Handicap Index (SVHI) was developed in the United States for the self-assessment of patients with singing problems. It has been translated into German and its reliability and validity have been assessed. In total, 54 (35 female, 19 male) dysphonic singers and 130 (74 female, 56 male) non-dysphonic professional singers were included in the study. Reliability rested on high test-retest reliability (r = 0.960, p ≤ 0.001, Pearson correlation) and a Cronbach's α of 0.975. A principal component analysis using the Varimax method and the results of the screeplot suggest the SVHI scored as a single scale. Validity rested on a highly significant correlation between the severity of the self-rated voice impairment by the patient and the total SVHI score. Dysphonic singers have significantly higher SVHI scores than healthy singers. The SVHI is thus suited to implementation as a diagnostic tool in German-speaking countries.

[Change of vocal capacity due to different vocal loading tests]. / Veränderung der stimmlichen Leistungsfähigkeit durch verschiedene Stimmbelastungstests.

BACKGROUND: Vocal loading tests are an important element in the evaluation of vocal function. In Germany mostly tests with changes of loading intensity between 75 and 80 dB(A) or tests with continuous intensity of 80 dB(C) are used. MATERIAL AND METHODS: 17 subjects with healthy vocal function were analyzed in 3 test conditions (1. continuous loading of 80 dB(A), 2. loading with changes of intensity between 75 and 80 dB(A) and 3. without loading for 10 min) concerning DSI and visual analog scale in their time course. The measurements were performed pre, directly after and 20, 40 and 60 min after the loading. The loading test was performed using the German text "Das tapfere Schneiderlein". RESULTS: The data show that the deviation and percentages of lower values of the intended dB loading were much greater for the test with changes of intensity compared to the test with continuous loading. There were no significant differences of the DSI between both loading conditions. After the loading there was a drop of the DSI followed by a short recovery and a drop after 60 min. CONCLUSION: The loading test with continuous intensity appears more stable for healthy subjects and can be fulfilled more easily. Both tests show comparable courses concerning the DSI after the loading tests.

A phase II trial (AGO 2.11) in platinum-resistant ovarian cancer: a randomized multicenter trial with sunitinib (SU11248) to evaluate dosage, schedule, tolerability, toxicity and effectiveness of a multitargeted receptor tyrosine kinase inhibitor monotherapy.

BACKGROUND: Recurrent platinum-resistant ovarian cancer usually has a poor outcome with conventional chemotherapeutic therapy and new treatment modalities are warranted. This phase II study was conducted to evaluate sunitinib, an oral antiangiogenic multitargeted tyrosin kinase inhibitor, in this setting. MATERIAL AND METHODS: The primary end point of this randomized phase II trial was the objective response rate according to RECIST criteria and/or Gynecologic Cancer InterGroup CA125 response criteria to sunitinib in patients with recurrent platinum-resistant ovarian cancer who were pretreated with up to three chemotherapies. A selection design was employed to compare two schedules of sunitinib (arm 1: 50 mg sunitinib daily orally for 28 days followed by 14 days off drug; and arm 2: 37.5 mg sunitinib administered daily continuously). RESULTS: Of 73 patients enrolled, 36 patients were randomly allocated to the noncontinuous treatment arm (arm 1) and 37 patients were randomly allocated to the continuous treatment arm (arm 2). The mean age was 58.8 and 58.5 years, respectively. We observed six responders (complete response + partial response) in arm 1 (16.7%) and 2 responders in arm 2 (5.4%). The median progression-free survival (arm 1: 4.8 [2.9-8.1] months; arm 2: 2.9 [2.9-5.1] months) and the median overall survival (arm 1: 13.6 [7.0-23.2] months; arm 2: 13.7 [8.4-25.6] months) revealed no significant difference. Adverse events included fatigue as well as cardiovascular, gastrointestinal and abdominal symptoms, hematologic and hepatic laboratory abnormalities. Pattern and frequency of adverse events revealed no substantial differences between both treatment groups. CONCLUSIONS: Sunitinib treatment is feasible and moderately active in relapsed platinum-resistant ovarian cancer. The noncontinuous treatment schedule should be chosen for further studies in ovarian cancer.

Effects of perfusion and cyclic compression on in vitro tissue engineered meniscus implants.

PURPOSE: The purpose of this study was to investigate the influence of continuous perfusion and mechanical stimulation on bone marrow stromal cells seeded on a collagen meniscus implant. METHODS: Bone marrow aspirates from 6 donors were amplified in vitro. 10(6) human BMSC were distributed on a collagen meniscus implant. Scaffolds were cultured under static conditions (control) or placed into a bioreactor system where continuous perfusion (10 ml/min) or perfusion and mechanical stimulation (8 h of 10% cyclic compression at 0.5 Hz) were administered daily. After 24 h, 7 and 14 days, cell proliferation, synthesis of procollagen I and III peptide (PIP, PIIIP), histology, and the equilibrium modulus of the constructs were analyzed. RESULTS: Proliferation demonstrated a significant increase over time in all groups (p < 0.001). PIP synthesis was found to increase from 0.1 ± 0.0 U/ml/g protein after 24 h to 2.0 ± 0.5 (perfusion), 3.8 ± 0.3 (mechanical stimulation), and 1.8 ± 0.2 U/ml/g protein (static control, lower than perfusion and mechanical stimulation, p < 0.05). These differences were also evident after 2 weeks (2.7 ± 0.3, 4.0 ± 0.6, and 1.8 ± 0.2 U/ml/g protein, p < 0.01); PIIIP synthesis was found to increase from 0.1 ± 0.0 U/ml/g protein after 24 h to 2.9 ± 0.7 (perfusion), 3.1 ± 0.9 (mechanical stimulation), and 1.6 ± 0.3 U/ml/g protein (controls) after 1 week and remained significantly elevated under the influence of perfusion and mechanical stimulation (p < 0.01) after 2 weeks. Mechanical stimulation increased the equilibrium modulus more than static culture and perfusion after 2 weeks (24.7 ± 7.6; 12.3 ± 3.7; 15.4 ± 2.6 kPa; p < 0.02). CONCLUSION: Biomechanical stimulation and perfusion have impact on collagen scaffolds seeded with BMSCs. Cell proliferation can be enhanced using continuous perfusion and differentiation is fostered by mechanical stimulation.

Prognostic nomogram to predict progression-free survival in patients with platinum-sensitive recurrent ovarian cancer.

BACKGROUND: Patients with platinum-sensitive recurrent ovarian cancer are a heterogeneous group, and it is not possible to accurately predict the progression-free survival (PFS) in these patients. We developed and validated a nomogram to help improve prediction of PFS in patients treated with platinum-based chemotherapy. METHODS: The nomogram was developed in a training cohort (n=955) from the CALYPSO trial and validated in the AGO-OVAR 2.5 Study (n=340). The proportional-hazards model (nomogram) was based on pre-treatment characteristics. RESULTS: The nomogram had a concordance index (C-index) of 0.645. Significant predictors were tumour size platinum-chemotherapy-free interval, CA-125, number of organ metastatic sites and white blood count. When the nomogram was applied without CA-125 (CA-125 was not available in validation cohort), the C-indices were 0.624 (training) and 0.594 (validation). When classification was based only on the platinum-chemotherapy-free interval, the indices were 0.571 (training) and 0.560 (validation). The calibration plot in the validation cohort based on four predictors (without CA-125) suggested good agreement between actual and nomogram-predicted 12-month PFS probabilities. CONCLUSION: This nomogram, using five pre-treatment characteristics, improves prediction of PFS in patients with platinum-sensitive ovarian cancer having platinum-based chemotherapy. It will be useful for the design and stratification of patients in clinical trials and also for counselling patients.

Microbial Profiling of Cultural Systems for Suppression of Phytophthora Root Rot in Fraser Fir.

Phytophthora root rot of Fraser fir, caused by several Phytophthora spp., is a severe problem in Christmas tree production. Since fungicides are not economically viable for disease management in field plantings and host resistance is not available, cultural control methods were investigated. Mulches, dairy compost, and soil pH adjustment were tested at five field sites in North Carolina. Treatments included wood chips, wood chips plus compost, or pine bark as raised beds, and compost or sulfur tilled into soil. Soil and mulch microbial populations were characterized by dilution plating and calculation of a log series diversity index, and by enzyme analyses at 5, 12, 17, and 24 months after planting. Bacterial and fungal counts, microbial activity, and cellulase activity were higher in mulch than in soil at all sites and times (P < 0.01), and generally did not differ among mulch types or among soils. Treatments significantly affected disease ratings and tree survival at three of five sites, with one or more mulch treatments yielding lower disease ratings and greater survival than controls. Tree mortality at each time point varied significantly with cellulase activity in the upper root zone (P = 0.005). Other biological variables did not show significant relationships with disease ratings or mortality.

[Medical treatment of singers' voices]. / Stimmärztliche Betreuung und Behandlung von Sängern.

ENT/phoniatrics specialists are frequently the primary reference persons for patients who have problems with the professional use of their voice. Singers show the highest risk factors for voice disorders among all professional voice users. The treatment and care of singers requires specific knowledge and competence of the physician, as well as a treatment setting adapted to the needs of this special group of patients, whose existence depends on the use of their voice. To some extent, evidence based concepts can be taken into account when treating professional singers. In cases for which no concepts have yet been developed and evaluated, recourse to clinical experience is necessary. In the present paper, current concepts for the treatment of singers are discussed on the basis of scientific publications and on long-standing experience of consultations in musician's medicine and ENT, under the aspects of diagnosis, therapy as well as prevention, taking into account the most frequent voice problems in professional singers.

[Laryngeal alterations following endotracheal intubation and use of larynx masks]. / Laryngeale Veränderungen nach endotrachealer Intubation und Anwendung der Larynxmaske.

After endotracheal intubation patients most frequently report pharyngolaryngeal complaints. Subsequent impairment of vocal performance might lead to general impairment of communication and job-related performance. Most prevalently, swollen mucosa, hematomas, granuloma and edema in the larynx can be observed after intubation. Limitations of respiratory vocal fold mobility appear less frequently. Knowledge of the pathophysiological aspects and causative factors associated with laryngopharyngeal morbidity are essential cornerstones of quality assurance in perioperative respiratory tract management. This review describes the effects of endotracheal intubation and application of larynx masks in relation to laryngeal morbidity.