Synthesis and Photophysical Properties of Small Helical Carbon Nanohoops Combined with Computational Studies on Racemization Pathway.

We herein report the facile synthesis of two helical carbon nanorings with small ring sizes, cyclo[6]paraphenylene-1,5-naphthylene ([6]CPPNap1,5), and cyclo[6]paraphenylene-1,5-anthrylene ([6]CPPAn1,5). The structures were determined by NMR and HR-MS. X-ray single-crystal data of [6]CPPNap1,5 was also achieved. The strain energy and racemization processes were investigated by DFT calculations. The reduced ring sizes result in increased ring strain and elevated energy barriers. The photophysical properties were studied by UV-Vis absorption, fluorescence emission, and time-resolved fluorescence decay.

DAFT-Net: Dual Attention and Fast Tongue Contour Extraction Using Enhanced U-Net Architecture.

In most silent speech research, continuously observing tongue movements is crucial, thus requiring the use of ultrasound to extract tongue contours. Precisely and in real-time extracting ultrasonic tongue contours presents a major challenge. To tackle this challenge, the novel end-to-end lightweight network DAFT-Net is introduced for ultrasonic tongue contour extraction. Integrating the Convolutional Block Attention Module (CBAM) and Attention Gate (AG) module with entropy-based optimization strategies, DAFT-Net establishes a comprehensive attention mechanism with dual functionality. This innovative approach enhances feature representation by replacing traditional skip connection architecture, thus leveraging entropy and information-theoretic measures to ensure efficient and precise feature selection. Additionally, the U-Net's encoder and decoder layers have been streamlined to reduce computational demands. This process is further supported by information theory, thus guiding the reduction without compromising the network's ability to capture and utilize critical information. Ablation studies confirm the efficacy of the integrated attention module and its components. The comparative analysis of the NS, TGU, and TIMIT datasets shows that DAFT-Net efficiently extracts relevant features, and it significantly reduces extraction time. These findings demonstrate the practical advantages of applying entropy and information theory principles. This approach improves the performance of medical image segmentation networks, thus paving the way for real-world applications.

Epidemiology of Maxillofacial Fracture Injury in a Hospital in Xi'an: A 2-Year Retrospective Study.

Despite their limitations, epidemiological studies provide information useful for formulating effective and efficient injury prevention strategies. The aim is to carry out an epidemiology study of maxillofacial fracture in Xijing Hospital. Level of Evidence: Level II-therapeutic study.

TM-Score predicts immunotherapy efficacy and improves the performance of the machine learning prognostic model in gastric cancer.

Immunotherapy is becoming increasingly important, but the overall response rate is relatively low in the treatment of gastric cancer (GC). The application of tumor mutational burden (TMB) in predicting immunotherapy efficacy in GC patients is limited and controversial, emphasizing the importance of optimizing TMB-based patient selection. By combining TMB and major histocompatibility complex (MHC) related hub genes, we established a novel TM-Score. This score showed superior performance for immunotherapeutic selection (AUC = 0.808) compared to TMB, MSI status, and EBV status. Additionally, it predicted the prognosis of GC patients. Subsequently, a machine learning model adjusted by the TM-Score further improved the accuracy of survival prediction (AUC > 0.8). Meanwhile, we found that GC patients with low TM-Score had a higher mutation frequency, higher expression of HLA genes and immune checkpoint genes, and higher infiltration of CD8+ T cells, CD4+ helper T cells, and M1 macrophages. This suggests that TM-Score is significantly associated with tumor immunogenicity and tumor immune environment. Notably, based on the RNA-seq and scRNA-seq, it was found that AKAP5, a key component gene of TM-Score, is involved in anti-tumor immunity by promoting the infiltration of CD4+ T cells, NK cells, and myeloid cells. Additionally, siAKAP5 significantly reduced MHC-II mRNA expression in the GC cell line. In addition, our immunohistochemistry assays confirmed a positive correlation between AKAP5 and human leukocyte antigen (HLA) expression. Furthermore, AKAP5 levels were higher in patients with longer survival and those who responded to immunotherapy in GC, indicating its potential value in predicting prognosis and immunotherapy outcomes. In conclusion, TM-Score, as an optimization of TMB, is a more precise biomarker for predicting the immunotherapy efficacy of the GC population. Additionally, AKAP5 shows promise as a therapeutic target for GC.

A deep convolutional neural network for the automatic segmentation of glioblastoma brain tumor: Joint spatial pyramid module and attention mechanism network.

This study proposes a deep convolutional neural network for the automatic segmentation of glioblastoma brain tumors, aiming sat replacing the manual segmentation method that is both time-consuming and labor-intensive. There are many challenges for automatic segmentation to finely segment sub-regions from multi-sequence magnetic resonance images because of the complexity and variability of glioblastomas, such as the loss of boundary information, misclassified regions, and subregion size. To overcome these challenges, this study introduces a spatial pyramid module and attention mechanism to the automatic segmentation algorithm, which focuses on multi-scale spatial details and context information. The proposed method has been tested in the public benchmarks BraTS 2018, BraTS 2019, BraTS 2020 and BraTS 2021 datasets. The Dice score on the enhanced tumor, whole tumor, and tumor core were respectively 79.90 %, 89.63 %, and 85.89 % on the BraTS 2018 dataset, respectively 77.14 %, 89.58 %, and 83.33 % on the BraTS 2019 dataset, and respectively 77.80 %, 90.04 %, and 83.18 % on the BraTS 2020 dataset, and respectively 83.48 %, 90.70 %, and 88.94 % on the BraTS 2021 dataset offering performance on par with that of state-of-the-art methods with only 1.90 M parameters. In addition, our approach significantly reduced the requirements for experimental equipment, and the average time taken to segment one case was only 1.48 s; these two benefits rendered the proposed network intensely competitive for clinical practice.

Suppressing HIFU interference in ultrasound images using 1D U-Net-based neural networks.

Objective.One big challenge with high-intensity focused ultrasound (HIFU) is that the intense acoustic interference generated by HIFU irradiation overwhelms the B-mode monitoring images, compromising monitoring effectiveness. This study aims to overcome this problem using a one-dimensional (1D) deep convolutional neural network.Approach. U-Net-based networks have been proven to be effective in image reconstruction and denoising, and the two-dimensional (2D) U-Net has already been investigated for suppressing HIFU interference in ultrasound monitoring images. In this study, we propose that the one-dimensional (1D) convolution in U-Net-based networks is more suitable for removing HIFU artifacts and can better recover the contaminated B-mode images compared to 2D convolution.Ex vivoandinvivoHIFU experiments were performed on a clinically equivalent ultrasound-guided HIFU platform to collect image data, and the 1D convolution in U-Net, Attention U-Net, U-Net++, and FUS-Net was applied to verify our proposal.Main results.All 1D U-Net-based networks were more effective in suppressing HIFU interference than their 2D counterparts, with over 30% improvement in terms of structural similarity (SSIM) to the uncontaminated B-mode images. Additionally, 1D U-Nets trained usingex vivodatasets demonstrated better generalization performance ininvivoexperiments.Significance.These findings indicate that the utilization of 1D convolution in U-Net-based networks offers great potential in addressing the challenges of monitoring in ultrasound-guided HIFU systems.

Case report: A case of rare metastasis of gastric cancer to the axillary lymph node metastasis treated with combination immunotherapy.

Lymph node (LN) metastasis is a common mode of metastasis in advanced gastric cancer (GC), while axillary LN metastasis infrequently occurs in GC. There are few reports on this rare type of metastasis - especially its clinicopathological features - and systemic treatment are unclear. We describe a case of GC with extensive metastasis, including the rare axillary LN metastasis. The patient achieved partial response of optimal efficacy, who was treated with combination immunotherapy as second-line treatment for nearly two years. The potential mechanisms were revealed by clinical and immune characteristics, such as high expression of PD-L1, high tumor mutational burden (TMB-H), Epstein-Barr virus (EBV) positive and CD8+ tumor-infiltrating lymphocyte positive.

Lollipop-Like Costal Cartilage Graft with a Peach-Shaped Head for East Asian Rhinoplasty.

BACKGROUND: Nasal tip refinement is a challenging step of East Asian rhinoplasty due to complex anatomical defects. Autologous costal cartilage grafts are commonly used to provide nasal tip support. This study aims to evaluate the efficacy and safety of a modified technique using a lollipop-like cartilage graft with a peach-shaped head. METHODS: A retrospective review was conducted on Chinese patients who underwent primary rhinoplasty with the modified technique between November 2018 and March 2021 at our center. Preoperative and postoperative facial photographs, patient-reported outcome measures including the visual analog scale (VAS) and the rhinoplasty outcome evaluation (ROE), as well as surgery-related complications, were collected for outcome assessment. RESULTS: A total of 31 adult patients were included in this retrospective cohort study, with a mean follow-up period of 17.12 ± 3.89 months. The majority of patients (28/31; 90.3%) expressed satisfaction with the aesthetic outcomes, as evidenced by a significant increase in mean VAS score from 3.97 ± 1.52 preoperatively to 7.39 ± 0.22 postoperatively (P < 0.01), and a significant increase in mean ROE score from 11.77 ± 2.33 to 17.22 ± 2.47 (P < 0.01). Photogrammetric analysis also demonstrated significant improvements in nasal anatomical measurements. Among the three patients with unsatisfactory feedback, two had mild columella deviations and one had a mild dorsum deviation. No other notable complications were reported. CONCLUSION: The current study supports the safety and utility of the modified technique utilizing the lollipop-like costal cartilage graft with a peach-shaped head for major tip refinement in East Asian patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Gender Attributions by Cisgender and Gender Diverse Listeners Rating Vowels, Reading, and Monologues.

OBJECTIVES: To determine if listeners' attributions of speakers' gender vary by linguistic context and/or the listeners' gender identity. METHODS: Seventeen self-identified transgender adults assigned male at birth were audio-recorded prolonging /a/, reading sentences, and saying spontaneous monologues. Eighteen adults (10 cisgender and 8 gender-diverse individuals) listened and used a 1-5 scale (1: very masculine, 2: somewhat masculine, 3: androgynous, 4: somewhat feminine, and 5: very feminine) to rate the gender attribution of each speech sample. RESULTS: The intra-rater reliability was moderate to excellent (0.62-1.00). Ratings by cisgender and gender-diverse listeners were not significantly different. Ratings were not significantly different between different speech contexts of vowel, reading, and spontaneous monologue speech samples. CONCLUSIONS: Transwomen have many variables available to consider and use in their communication. The linguistic context (eg, reading a speech versus spontaneous monologue) or listener's gender does not appear to be highly influential factors in how listeners attribute gender.

Introduction of Voice Type Component (VTC) as an Effective Acoustic Voice Analysis Method in Tele-evaluation.

OBJECTIVE: Telepractice in voice health care and evaluation services has attracted much attention in recent years. Multiple studies have proven the effectiveness of voice therapy with telepractice. However, voice evaluations are still mostly conducted in person due to the lack of sensitive acoustic analysis methods. METHODS: This study examined various acoustic analysis methods for voice evaluation in telepractice. Eighteen female elementary school teachers with self-reported voice disorders volunteered to participate in the study. Speech samples were collected before and after the interventions using two voice sampling methods concurrently. One set of data was collected using the traditional voice sample collection method by the therapist in person. The second set of data was collected on the same speech samples using the clients' own smartphones, and the collected voice samples were later sent to the researcher for further acoustic analysis. The voice type component (VTC) measurement represented the proportion of different VTCs in a voice by measuring the chaos and intrinsic dimension. RESULTS: Voice analyses were conducted on both sets of data, and the correlation between the two sampling procedures was analyzed. It appears that the VTC could be a more reliable method for producing acoustic analysis results with voice samples collected from smartphones compared to other objective voice assessment procedures. This reliability has been demonstrated via statistical analysis, including correlation coefficient, pairwise t test, d-prime, and area under the curve. The results of this study highlighted the VTC as an effective and accurate acoustic analysis method in tele-evaluation. CONCLUSIONS: This feasible voice sampling method, which utilizes participants' own smartphones, will reduce barriers to accessing limited voice specialists due to distance and will decrease the cost of care by minimizing expenses associated with travel and additional equipment for voice sampling. Ultimately, this approach will enhance the effectiveness of voice care delivered through telepractice to patients in remote and underserved areas.

Comprehensive spatiotemporal mapping of single-cell lineages in developing mouse brain by CRISPR-based barcoding.

A fundamental interest in developmental neuroscience lies in the ability to map the complete single-cell lineages within the brain. To this end, we developed a CRISPR editing-based lineage-specific tracing (CREST) method for clonal tracing in Cre mice. We then used two complementary strategies based on CREST to map single-cell lineages in developing mouse ventral midbrain (vMB). By applying snapshotting CREST (snapCREST), we constructed a spatiotemporal lineage landscape of developing vMB and identified six progenitor archetypes that could represent the principal clonal fates of individual vMB progenitors and three distinct clonal lineages in the floor plate that specified glutamatergic, dopaminergic or both neurons. We further created pandaCREST (progenitor and derivative associating CREST) to associate the transcriptomes of progenitor cells in vivo with their differentiation potentials. We identified multiple origins of dopaminergic neurons and demonstrated that a transcriptome-defined progenitor type comprises heterogeneous progenitors, each with distinct clonal fates and molecular signatures. Therefore, the CREST method and strategies allow comprehensive single-cell lineage analysis that could offer new insights into the molecular programs underlying neural specification.

Thermal effect on sulfamethoxazole degradation in a trivalent copper involved peroxymonosulfate system.

Persulfate (PS) activated by thermal or homogeneous metals can generate reactive oxygen species (ROS) and high-valence-state metals for contaminants degradation, showing great potential for applications. However, thermal effect in peroxymonosulfate (PMS) system with high-valence-state metal is still ambiguous. In this study, divalent copper (Cu(II)) catalysis was taken to explore thermal effect on PMS performance. Results showed that the Sulfamethoxazole (SMX) removal efficiency in the Cu(II)/PMS system at 60 min increased by only 5.9% with temperature increase from 30 °C to 60 °C. Moreover, SMX removal efficiency was excellent at neutral or basic pH, best with PMS concentration of 2.4 mM, and slightly affected by Cu(II) concentration. The singlet oxygen (1O2) was identified as main active species at low temperature while sulfate radicals (SO4-) was more effective at high temperature with Cu(II) co-activation. Also, trivalent copper (Cu(III)) was an important active species. The higher Cu(III) content, the better SMX removal efficiency, but the stronger intermediates toxicity. In combination with removal efficiency and intermediates toxicity at different temperatures, 30 °C was the optimal reaction temperature. Overall, this study provides new perspective on utilization of waste heat and high-valence-state metal for organic wastewater treatment in PMS systems.

Chaos Behavior Analysis of Alaryngeal Voices Including Esophageal and Tracheoesophageal Voices.

HYPOTHESIS/OBJECTIVES: This study's objective was to develop a method to evaluate the chaotic characteristic of alaryngeal speech. The proposed method will be capable of distinguishing between normal and alaryngeal voices, including esophageal (SE) and tracheoesophageal (TE) voices. It has been previously shown that alaryngeal voices exhibit chaotic characteristics due to the aperiodicity of their signals. The proposed method will be applied for future use to quantify both chaos behavior (CB) and the difference between SE and TE voices. STUDY DESIGN: A total of 74 voice recordings including 34 normal and 40 alaryngeal (26 SE and 14 TE) were used in the study. Voice samples were analyzed to distinguish alaryngeal voices from normal voices and to investigate different chaotic characteristics of SE and TE speech. METHODS: A chaotic distribution detection-based method was used to investigate the CB of alaryngeal voices. This CB was used to detect the difference between SE and TE voice types. Quantification of the CB parameter was performed. Statistical analyses were used to compare the results of the CB analysis for both the SE and TE voices. RESULTS: Statistical analysis revealed that CB effectively differentiated between all normal and alaryngeal voice types (p < 0.01). Subsequent multiclass receiver operating characteristic (ROC) analysis demonstrated that CB (area under the curve) possessed the greatest classification accuracy relative to correlation dimension (D2). CONCLUSIONS: The CB metric shows strong promise as an accurate, useful metric for objective differentiation between all normal and alaryngaeal, SE and TE voice types. The CB calculations showed expected results, as SE voices have significantly more CB than TE voices, constituting substantial improvement over previous methods and becoming the first SE and TE classification method. This metric can help clinicians obtain additional acoustic information when monitoring the efficacy of treatment for patients undergoing total laryngectomies.

Effects of Botulinum Toxin A on the Blood Flow in Expanded Rat Skin.

Background Poor blood supply can easily lead to expander extrusion and necrosis at the distal expanded flap. Botulinum toxin A (BTX-A) has been previously found to improve pedicled flap blood flow perfusion, but its effects on the blood supply of expanded skin remain unclear. Therefore, this study aimed to evaluate the effects of BTX-A on blood flow perfusion during and after expansion.Methods Eighteen Sprague-Dawley rats were randomly divided into a BTX-A group and a control group. BTX-A or normal saline was injected intradermally into the marked skin on the back immediately. Then expanders were implanted in the rats. One week later, inflation of the expander with normal saline was started and performed twice a week to reach an intracapsular pressure of 8 kPa. The skin blood flow was measured before each injection. After 4 weeks of expansion, the sample was harvested for histological staining to measure the diameter and density of blood vessels; meanwhile, a 2 cm× 8 cm expanded random flap was elevated and sutured in situ. Blood flow perfusion and flap survival were observed.Results Compared with the control group, the BTX-A group had more blood flow, a larger blood vessel diameter, and higher blood vessel density in the expanded skin. Additionally, the flap of the BTX-A group had good blood flow perfusion and a high proportion of flap survival area within 7 days after expanded flap transfer. Data were analyzed using an independent t-test.Conclusion Pre-surgical BTX-A treatment may increase angiogenesis and vasodilatation, with subsequent blood perfusion elevation during and after expansion, and obtain a greater proportion of survival area of the transferred expanded flap.

Recent progress in the fabrication of flexible materials for wearable sensors.

Wearable sensors have been widely studied because of their small size, light weight, and potential for the noninvasive tracking and monitoring of human physiological information. Wearable flexible sensors generally consist of two parts: a flexible substrate in contact with the skin and a signal processing module. At present, wearable electronics cover many fields, such as machinery, physics, chemistry, materials science, and biomedicine. The design concept and selection of materials are very important to the function of a sensor. In this review, we summarize the latest developments in flexible materials for wearable sensors, including developments in flexible materials, electrode materials, and new flexible biodegradable materials, and describe the important role of innovation in material and sensor design in the development of wearable flexible sensors. Strategies and challenges related to the improvement of the performances of wearable flexible sensors, as well as the development prospects of wearable devices based on flexible materials, are also discussed.

Active sites decoration on sewage sludge-red mud complex biochar for persulfate activation to degrade sulfanilamide.

Active sites on catalyst surface play significant roles in oxidative species formation. The work focused on the regulation of main active sites on catalyst surface and oxidative species formation. Herein, sewage sludge (SS)-red mud (RM) complex biochar (SRCB) and N-functionalized SRCB (NSRCB) were served as activators of peroxymonosulfate (PMS) for sulfanilamide (SMX) degradation. Specially, NSRCB-1 showed excellent catalytic performance with 97.5% removal of SMX within 110 min. Additionally, the effects of N incorporation on the reconstruction of N species, conversion of intrinsic Fe species and ketonic CO groups in SRCB were studied systematically. Both radical (hydroxyl radicals (OH), sulfate radicals (SO4-) and superoxide radical (O2-)) and non-radical (electron transfer and singlet oxygen (1O2)) pathways were confirmed by quenching experiments, electron paramagnetic resonance (EPR) testing and electrochemical measurements. Ketonic CO groups, pyridinic N and pyrrolic N were responsible for non-radical pathway in SMX degradation process. Besides, Fe(II) modulated by N-doping was the main actives site for radicals generation. The contribution of active sites on catalyst surface to oxidative species formation provided fundamental basis for practical water treatment in PMS process.

Conversion of plastic waste into fuels: A critical review.

Plastic wastes have posed serious threats to the environment, including decrease of soil nutrient effectiveness and agricultural production as well as emerge of ecological instability. Fuel conversion from plastic waste is regarded as a promising strategy for its disposal and energy utilization. Plastic wastes can be converted into target fuels by adjusting cracking of chemical bonds. Currently, numerous technologies regarding fuel conversion from plastic wastes have been reported, including conventional pyrolysis, novel heat treatment and advanced oxidation. However, systematic summary and comparative analysis of different technologies are still scarcely reported. In this review, fuel conversion from plastic wastes was summarized comprehensively, highlighting novel heat treatment and advanced oxidation technologies reported in recent years. Furthermore, the superiority and drawbacks of each technology were analyzed, and future prospects of technology application were proposed. With lower reaction temperature and higher-value fuel, novel heat treatment of plastics is more popular than traditional one. Advanced oxidation can be controlled to convert plastics into fuels under room temperature and pressure, guiding the new normal in energy utilization of plastic wastes. This review aims to provide inspiration for energy utilization of solid waste, addressing the issues of white pollution and energy shortage.

Comparison Between Combination of Resonant Voice Therapy and Vocal Hygiene Education and Vocal Hygiene Education Only for Female Elementary School Teachers.

OBJECTIVE: The study compares the rehabilitation outcome of two voice intervention methods for female elementary school teachers with self-reported voice disorders. METHODS: A total of 34 female teachers from two primary schools volunteered in the study. Participants from one school were assigned to the experimental group (16 teachers), who received the combination of vocal hygiene education and resonant voice therapy. Participants from the other school were assigned to the control group (18 teachers), who received vocal hygiene education only. Pre- and post-treatment data were compared. RESULT: The total score of the Voice Handicap Index (VHI) decreased significantly from 12.19 ± 8.58 to 8.63 ± 7.27 (P < 0.05); the functional score of VHI significantly decreased from 5.38 ± 3.9 to 3.81 ± 3.62 (P < 0.05). No statistical significance was found in physiological and emotional scores of VHI. No statistical significance was found in the control group. In the experimental group, the maximum phonation time was increased from 14.34 ± 6.80s to 17.21 ± 6.06s (P < 0.05), Jitter decreased from 0.45% ± 0.13% to 0.26% ± 0.05% (P < 0.05), and Shimmer decreased from 0.21 ± 0.10. to 0.12 ± 0.03 (P < 0.05). Furthermore, the harmonic to noise ratio increased from 23.06 ± 2.99 to 25.23 ± 1.92 (P < 0.05), Spectrum Convergence Ratio increased from 0.53 ± 0.12 to 0.60 ± 0.11 (P < 0.05), yet no statistical significance was found in Nonlinear Energy Difference Ratio data for the experimental group. No statistical significance was found in the control group. In the auditory perception assessment (GRBAS), the G score decreased from 1.19 ± 0.54 to 0.81 ± 0.40 (P < 0.05), and the R score decreased from 1.19 ± 0.54 to 0.75 ± 0.45 (P < 0.05) in the experimental group. No statistical significance was found in the B, A, and S scores in the experimental group; moreover, none of the GRBAS scores in the control group demonstrated statistical significance. In the voice type component profile (VTC), the proportion of VTC1 of the experimental group increased significantly, while the proportions of VTC3 and VTC4 decreased significantly, indicating the improvement of voice quality was obvious after the intervention. The proportions of VTC of the control group did not demonstrate significant change. CONCLUSION: The results of this study show that a combination of vocal hygiene education and resonant voice therapy can significantly improve the voice function of professional voice users and effectively improve their voice quality. In this study, the professional voice users receiving vocal hygiene education only did not show significant improvement of their voice quality.

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders.

PURPOSE: The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders. METHODS: Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared. RESULTS: There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion. CONCLUSIONS: Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.