Tracheostoma Closure Technique Using Three Local Flaps.

When a tracheostoma is no longer needed, the opening normally closes spontaneously after cannula removal, but some cases require tracheostoma closure. This procedure has been well described, but must be performed in such a way as to minimize its invasiveness and complications while securing a high closure rate. Our procedure for conducting tracheostoma closure technique involves the creation of two hinge flaps and one cover flap to close the tracheostomy opening. We reviewed the medical records of 23 patients (12 men, 11 women; mean age 60.0 SD19.7 years) who underwent tracheostoma closure technique between 2001 and 2019. Surgery was indicated for patients in whom closure had not occurred after conservative monitoring for ≥ 2 months following cannula removal. The surgical procedure began by raising two hinge flaps on either side of the tracheostomy opening, turning the skin surface to the luminal side to form the anterior tracheal wall. Rather than a single layer of skin, multiple skin layers were sutured together to prevent air leakage from between hinge flaps. A further cover flap was produced to cover the anterior tracheal wall, closing the tracheostomy opening. Postoperatively, the tracheal lumen was observed via fiberscopy. No stenosis of the tracheal lumen occurred in any patients, and the tracheocutaneous fistula was successfully closed in all cases. Tracheostoma closure technique using hinge flaps to reconstruct the anterior tracheal wall and a cover flap as a skin flap to cover the skin defect appears useful for patients with failure of spontaneous tracheocutaneous fistula closure.

Repeated Surgery in a Case of Epithelial-Myoepithelial Carcinoma of the Parotid Gland that was Difficult to Distinguish from Pleomorphic Adenoma.

Epithelial-myoepithelial carcinoma (EMC) of the parotid gland is a comparatively rare tumor that accounts for less than 1% of all salivary gland tumors. A patient with EMC of the parotid gland that was initially diagnosed as pleomorphic adenoma and that recurred locally during the watchful waiting period but was controlled by surgery under local anesthesia is reported. An 80-year-old man had noticed a swelling in the left infra aural region. A left parotid gland tumor was suspected, and he was referred to our department. Magnetic resonance imaging (MRI) and fine-needle aspiration cytology findings were suggestive of pleomorphic adenoma of the superficial lobe of the parotid gland, and this was therefore resected under general anesthesia. Postoperative histopathological examination, immunostaining, and genetic tests resulted in a diagnosis of EMC. Postoperative pathological review showed that part of the resection margin was positive. The possibility of recurrence was explained to the patient, and additional treatment was recommended, but since the patient did not desire this, a policy of watchful waiting was adopted. Signs of cutaneous metastasis in the left infra aural region were detected at 13 months postoperatively, and this metastasis was excised under local anesthesia. The resection margin was negative, and the patient's course remains uneventful. EMC is classified as a low-grade malignant tumor, but it requires stringent monitoring because of its frequent local recurrence. Since local control can usually be achieved by surgical treatment alone, and postoperative adjuvant therapy may not necessarily warranted.

Effect of a Single Injection of Basic Fibroblast Growth Factor into the Vocal Folds: A 36-Month Clinical Study.

OBJECTIVE: A single injection of basic fibroblast growth factor (bFGF) into the vocal folds of patients with glottal insufficiency has been shown to be effective for a few years. However, the long-term therapeutic effect of a single injection of bFGF into the vocal folds has yet to be demonstrated. In this study, the therapeutic effect of a single injection of bFGF into the vocal folds was investigated over several years by monitoring patients for 36 months following this treatment. METHODS: Nineteen patients with glottal insufficiency received injections of bFGF diluted to 20 µg/mL in the superficial layer of the lamina propria of the bilateral vocal folds. The following parameters were evaluated at preinjection baseline and 6, 12, 18, 24, and 36 months later, and statistical comparisons were performed. The parameters evaluated were: the Grade, Rough, Breathy, Asthenic, and Strained (GRBAS) scale score; maximum phonation time; acoustic analysis; and glottal wave analysis (GWA) and kymograph edge analysis (KEA) using high-speed digital imaging (HSDI). The amplitude perturbation quotient (APQ) and period perturbation quotient (PPQ) were measured by acoustic analysis. The mean minimum glottal area during vocalization and mean minimum distance between the vocal folds were measured by GWA. The amplitudes of the bilateral vocal folds were measured by KEA. RESULTS: Postinjection, the GRBAS scale score decreased from 6 months after injection, and maximum phonation time was prolonged. The mean minimum glottal area during vocalization and the mean minimum distance between the vocal folds calculated by GWA of HSDI decreased significantly after 6 months. These effects persisted until 36 months postinjection. APQ and PPQ derived from acoustic analysis tended to decrease, but not significantly. There was no clear change in the amplitudes of the bilateral vocal folds calculated by KEA of HSDI before and after injection. CONCLUSIONS: These results suggest that the effects of a single injection of bFGF into the vocal folds persist for 36 months.

A Printed Flexible Humidity Sensor with High Sensitivity and Fast Response Using a Cellulose Nanofiber/Carbon Black Composite.

In the emerging Internet of Things (IoT) society, there is a significant need for low-cost, high-performance flexible humidity sensors in wearable devices. However, commercially available humidity sensors lack flexibility or require expensive and complex fabrication methods, limiting their application and widespread use. We report a high-performance printed flexible humidity sensor using a cellulose nanofiber/carbon black (CNF/CB) composite. The cellulose nanofiber enables excellent dispersion of carbon black, which facilitates the ink preparation and printing process. At the same time, its hydrophilic and porous nature provides high sensitivity and fast response to humidity. Significant resistance changes of 120% were observed in the sensor at humidity ranging from 30% RH to 90% RH, with a fast response time of 10 s and a recovery time of 6 s. Furthermore, the developed sensor also exhibited high-performance uniformity, response stability, and flexibility. A simple humidity detection device was fabricated and successfully applied to monitor human respiration and noncontact fingertip moisture as a proof-of-concept.

Printed Soft Sensor with Passivation Layers for the Detection of Object Slippage by a Robotic Gripper.

Tactile sensing, particularly the detection of object slippage, is required for skillful object handling by robotic grippers. The real-time measurement and identification of the dynamic shear forces that result from slippage events are crucial for slip detection and effective object interaction. In this study, a ferroelectric polymer-based printed soft sensor for object slippage detection was developed and fabricated by screen printing. The proposed sensor demonstrated a sensitivity of 8.2 µC·cm-2 and was responsive to shear forces applied in both the parallel and perpendicular directions. An amplifier circuit, based on a printed organic thin-film transistor, was applied and achieved a high sensitivity of 0.1 cm2/V·s. Therefore, this study experimentally demonstrates the effectiveness of the proposed printable high-sensitivity tactile sensor, which could serve as part of a wearable robotic e-skin. The sensor could facilitate the production of a system to detect and prevent the slippage of objects from robotic grippers.