Application of an Intraoperative Neuromonitoring System Using a Surface Pressure Sensor in Parotid Surgery: A Rabbit Model Study.

OBJECTIVES: Facial nerve monitoring (FNM) can be used to identify the facial nerve, to obtain information regarding its course, and to evaluate its status during parotidectomy. However, there has been disagreement regarding the efficacy of FNM in reducing the incidence of facial nerve palsy during parotid surgery. Therefore, instead of using electromyography (EMG) to identify the location and state of the facial nerve, we applied an intraoperative neuromonitoring (IONM) system using a surface pressure sensor to detect facial muscle twitching. The objective of this study was to investigate the feasibility of using the IONM system with a surface pressure sensor to detect facial muscle twitching during parotidectomy. METHODS: We evaluated the stimulus thresholds for the detection of muscle twitching in the orbicularis oris and orbicularis oculi, as well as the amplitude and latency of EMG and the surface pressure sensor in 13 facial nerves of seven rabbits, using the same stimulus intensity. RESULTS: The surface pressure sensor detected muscle twitching in the orbicularis oris and orbicularis oculi in response to a stimulation of 0.1 mA in all 13 facial nerves. The stimulus threshold did not differ between the surface pressure sensor and EMG. CONCLUSION: The application of IONM using a surface pressure sensor during parotidectomy is noninvasive, reliable, and feasible. Therefore, the IONM system with a surface pressure sensor to measure facial muscle twitching may be an alternative to EMG for verifying the status of the facial nerve.

Simple technique to preserve the external branch of the superior laryngeal nerve during thyroidectomy: Clinical practicability of an attachable nerve stimulator.

OBJECTIVE: This study aimed to demonstrate the usefulness of an attachable magnetic nerve stimulator for preservation of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. METHODS: We retrospectively analyzed 120 female patients, of which 60 underwent thyroidectomy with an attachable magnetic nerve stimulator (magnetic group) and the remaining 60 underwent thyroidectomy with a conventional method without EBSLN identification (control group). For both groups, objective and subjective voice parameters were investigated on the day before surgery and at 2 weeks and 2 months after surgery. RESULTS: In the magnetic group, a magnetic nerve stimulator was used to ligate only the site without cricothyroid muscle (CTM) twitching, and thyroid surgery was successfully performed without damage to the EBSLN. In the control group, objective voice parameters, including fundamental frequency, voice range profile (VRP), highest VRP (VRP-H), and maximal phonation time, and the subjective thyroidectomy-related voice questionnaire score were significantly decreased at 2 months after surgery compared to preoperative values. Compared to the control group, the magnetic group did not show a significant decrease in the objective VRP and VRP-H at 2 months after surgery. CONCLUSION: The use of metallic surgical instruments with an attachable magnetic nerve stimulator may provide surgeons with real-time feedback on CTM twitching feedback and EBSLN status. Compared to direct EBSLN identification during thyroidectomy, this is a simple, easy, and noninvasive method for EBSLN preservation that is useful, especially for less-experienced surgeons.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study.

OBJECTIVES: The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model. METHODS: We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared. RESULTS: No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery. CONCLUSION: The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

Spectral characteristics of caries autofluorescence obtained from different locations and caries severities.

Dental caries usually occurs at interproximal and occlusal surfaces. The purpose of the present study was to determine if characteristic spectral factors extracted from autofluorescence (AF) spectra are informative regarding caries detection and the determination of caries stage as compared with DIAGNOdent results. AF spectra were obtained from caries lesions of different severities at two locations using a 405 nm laser. Three spectral factors, that is, spectral slope at 550 to 600 nm, spectral area under the curve at 500 to 590 nm and two-peak ratio between 625 and 667 nm, were extracted. The values of three spectral factors linearly decreased as caries progressed. According to micro-CT images, conventional visual and tactile inspections of lesions under or overestimated (25%-65%) caries states, and brown or thickly stained layer on interproximal or occlusal surfaces, respectively, caused misclassifications of caries stage. Of the spectral factors examined, spectral slope and area under curve for interproximal and occlusal surfaces, respectively, were found to be significantly related to caries stage and showed least data overlap. For interproximal and occlusal surfaces, DIAGNOdent readings of different stages overlapped considerably though their mean values were significantly different regardless of stage.

A new injection rate estimation technique for on-site screening test of medication infusion pump by nurses.

Medication infusion pumps are the most popular device in almost all areas of a hospital; therefore, it is important to frequently inspect the accuracy of the infusion pump operation to prevent underdose/overdose accidents. However, the conventional infusion pump inspection devices are not suitable for quick and convenient on-site inspection by nurses. In this study, a new IR estimation technique for peristaltic infusion pumps that facilitates on-site pre-screening test with shorter inspection time was proposed. A thin membrane potentiometer was attached to a catheter and the actual IR was estimated based on a time interval between two successive line pushes of an identical cam follower using power function estimation. To evaluate the performance of the proposed IR estimation technique, in vitro experiments were performed using 11 infusion pumps (three for Infusion Pump SET 1 (IPSET-1) and eight for Infusion Pump SET 2 (IPSET-2)) with the same model. In experiments, error rate between the actual and the measured values (using conventional inspection device) were 0.04-1.17% range for IPSET-1 and 2.09-4.32% for IPSET-2, and those between the actual and the estimated values (using proposed method) were 0.02-0.62% range for IPSET-1 and 1.31-4.23% for IPSET-2. The proposed technique had almost equivalent performance with a commercial inspection device, but the time for inspection was reduced to almost one third. We expect that the proposed technique can provide a tool for simple and convenient on-site pre-screening of infusion pumps by nurses to improve patient safety.

Application of Deep Learning System into the Development of Communication Device for Quadriplegic Patient.

OBJECTIVE: In general, quadriplegic patients use their voices to call the caregiver. However, severe quadriplegic patients are in a state of tracheostomy, and cannot generate a voice. These patients require other communication tools to call caregivers. Recently, monitoring of eye status using artificial intelligence (AI) has been widely used in various fields. We made eye status monitoring system using deep learning, and developed a communication system for quadriplegic patients can call the caregiver. METHODS: The communication system consists of 3 programs. The first program was developed for automatic capturing of eye images from the face using a webcam. It continuously captured and stored 15 eye images per second. Secondly, the captured eye images were evaluated for open or closed status by deep learning, which is a type of AI. Google TensorFlow was used as a machine learning tool or library for convolutional neural network. A total of 18,000 images were used to train deep learning system. Finally, the program was developed to utter a sound when the left eye was closed for 3 seconds. RESULTS: The test accuracy of eye status was 98.7%. In practice, when the quadriplegic patient looked at the webcam and closed his left eye for 3 seconds, the sound for calling a caregiver was generated. CONCLUSION: Our eye status detection software using AI is very accurate, and the calling system for the quadriplegic patient was satisfactory.

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study.

OBJECTIVES: The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. METHODS: We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. RESULTS: The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. CONCLUSION: Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study.

OBJECTIVES: False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. METHODS: We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. RESULTS: The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. CONCLUSION: It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.

Real-Time Light-Guided Vocal Fold Injection: Ex Vivo Feasibility Study in a Canine Model.

OBJECTIVE: The transcricothyroid (CT) membrane approach is a good option for office-based vocal fold injection (VFI). However, because the needle tip is invisible during injection using the CT approach, precise localization requires a high level of experience, and mastering this approach involves a steep learning curve. To overcome current limitations, we conceptualized a novel technique: real-time light-guided VFI (RL-VFI), which enables simultaneous VFI under direct visualization of the lighted needle tip. Herein, we aimed to verify the feasibility of RL-VFI in cadaveric canine model, simulating the setting of office-based VFI, as well as to explore its clinical usefulness. STUDY DESIGN: Animal study. METHODS: A customized prototype device was developed. It consisted of three parts: light source, controller, and injector. Light source comprised laser diodes of two wavelengths (635 nanometers [nm], red; 532 nm, green). Four types of injector were developed using 40-mm needles of 23- and 25-gauge and optic fibers of 50 and 100 µm. ex vivo canine larynx was prepared for the experiment. Flexible laryngoscopy system was used to examine canine vocal folds. RESULTS: Various routes from three insertion points (3 mm, 10 mm, and 17 mm from the midline) were validated using the device. Regardless of the injection routes, the location of the needle tip was accurately indicated by light. RL-VFI was feasible under light guidance without difficulties. Moreover, precise and simultaneous re-injection could be performed at the intended point using the device. CONCLUSION: We introduced RL-VFI using our customized prototype device in an ex vivo canine larynx, simulating the setting of office-based VFI. Clinical application of RL-VFI will improve safety and precision of CT approach, as well as expand its applications in laryngology. LEVEL OF EVIDENCE: NA. Laryngoscope, 129:935-942, 2019.

Feasibility and safety of nerve stimulator attachment to energy-based devices: A porcine model study.

BACKGROUND: Recently, several energy-based devices (EBDs) have been developed and applied in the context of thyroid surgery. EBDs can reduce operation time, blood loss, and postoperative pain. Compared to conventional electrocautery, EBDs operate at a relatively lower temperature and produce minimal lateral tissue damage. Yet, during device operation, the tip of the EBD is hot enough to cause thermal nerve damage, increasing the need for surgeons to be cautious about EBD application. To increase the safety of EBDs, we attached nerve stimulators to the tips of two EBDs and compared them to conventional monopolar nerve stimulation using a porcine model. METHODS: Three piglets (30-40 kg) underwent total thyroidectomy after orotracheal intubation with a nerve integrity monitor (NIM) electromyography (EMG) endotracheal tube. Nerve stimulators were attached to two EBDs (Harmonic Focus®+ and LigaSure™). After dissection and identification of six recurrent laryngeal nerves in the three piglets, both of the EBDs with attached nerve stimulators and a conventional monopolar nerve stimulator were applied near the nerve and EMG parameters were recorded using the NIM 3.0 system. The stimulus intensity was varied from 5 mA to 1 mA and the maximum distance and amplitude at which nerve detection was achieved were measured. RESULTS: There were no statistically significant differences between the maximum distance or mean amplitude obtained from nerve stimulators attached to EBDs and those obtained from the conventional nerve stimulator. Additionally, there were no adverse EMG events related to the use of nerve stimulators attached to EBDs. CONCLUSIONS: Attachment of a nerve stimulator to an EBD for nerve detection during thyroidectomy was as safe and effective as attachment of a conventional nerve stimulator. Use of a nerve stimulator attachment may reduce the likelihood of EBD-associated nerve damage during thyroid surgery.

The effect of biomechanical stimulation on osteoblast differentiation of human jaw periosteum-derived stem cells.

BACKGROUND: This study was to investigate the effect of biomechanical stimulation on osteoblast differentiation of human periosteal-derived stem cell using the newly developed bioreactor. METHODS: Human periosteal-derived stem cells were harvested from the mandible during the extraction of an impacted third molar. Using the new bioreactor, 4% cyclic equibiaxial tension force (0.5 Hz) was applied for 2 and 8 h on the stem cells and cultured for 3, 7, and 14 days on the osteogenic medium. Biochemical changes of the osteoblasts after the biomechanical stimulation were investigated. No treatment group was referred to as control group. RESULTS: Alkaline phosphatase (ALP) activity and ALP messenger RNA (mRNA) expression level were higher in the strain group than those in the control group. The osteocalcin and osteonectin mRNA expressions were higher in the strain group compared to those in the control group on days 7 and 14. The vascular endothelial growth factor (VEGF) mRNA expression was higher in the strain group in comparison to that in the control group. Concentration of alizarin red S corresponding to calcium content was higher in the strain group than in the control group. CONCLUSIONS: The study suggests that cyclic tension force could influence the osteoblast differentiation of periosteal-derived stem cells under optimal stimulation condition and the force could be applicable for tissue engineering.

Development of a Novel Alarm System to Improve Adaptation to Non-invasive Ventilation in Patients With High Cervical Spinal Cord Injury.

In this case report, we want to introduce a successful way of applying non-invasive ventilation (NIV) with a full face mask in patients with high cervical spinal cord injury through a novel alarm system for communication. A 57-year-old man was diagnosed with C3 American Spinal Injury Association impairment scale (AIS) B. We applied NIV for treatment of hypercapnia. Because of mouth opening during sleep, a full face mask was the only way to use NIV. However, he could not take off the mask by himself, and this situation caused great fear. To solve this problem, we designed a novel alarm system. The best intended motion of the patient was neck rotation. Sensing was performed by a balloon sensor placed under the head of the patient. A beep sound was generated whenever the pressure was above the threshold, and more than three consecutive beeps within 3,000 ms created a loud alarm for caregivers.

Development of a device for real-time light-guided vocal fold injection: A preliminary report.

OBJECTIVES/HYPOTHESIS: Vocal fold injection is a minimally invasive technique for various vocal fold pathologies. The shortcomings of the cricothyroid (CT) membrane approach are mainly related to invisibility of the injection needle. If localization of the needle tip can be improved during vocal fold injection with the CT approach, the current problems of the technique can be overcome. We have conceptualized real-time light-guided vocal fold injection that enables simultaneous injection under precise localization. In this study, we developed a device for real-time light-guided vocal fold injection and applied it in excised canine larynx. STUDY DESIGN: Animal model. METHODS: A single optic fiber was inserted in an unmodified 25-gauge needle. A designated connector for the device was attached to the needle, the optic fiber, and the syringe. A laser diode module was used as the light source. An ex vivo canine larynx model was used to validate the device. RESULTS: The location of the needle tip was accurately indicated, and the depth from the mucosa could be estimated according to the brightness and size of the red light. The needle was inserted and could be localized in the canine vocal fold by the light of the device. Precise injection at the intended location was easily performed with no manipulation of the device or the needle. CONCLUSIONS: Real-time light-guided vocal fold injection might be a feasible and promising technique for treatment of vocal fold pathology. It is expected that this technique can improve the precision of vocal fold injection and expand its indication in laryngology. LEVEL OF EVIDENCE: NA.

Effect of two lasers on the polymerization of composite resins: single vs combination.

The selection of a light-curing unit for the curing composite resins is important to achieve best outcomes. The purpose of the present study was to test lasers of 457 and 473 nm alone or in combination under different light conditions with respect to the cure of composite resins. Four different composite resins were light cured using five different laser combinations (530 mW/cm(2) 457 nm only, 530 mW/cm(2) 473 nm only, 177 mW/cm(2) 457 + 177 mW/cm(2) 473 nm, 265 mW/cm(2) 457 + 265 mW/cm(2) 473 nm, and 354 mW/cm(2) 457 + 354 mW/cm(2) 473 nm). Microhardness and polymerization shrinkage were evaluated. A light-emitting diode (LED) unit was used for comparison purposes. On top surfaces, after aging for 24 h, microhardness achieved using the LED unit and the lasers with different conditions ranged 42.4-65.5 and 38.9-67.7 Hv, respectively, and on bottom surfaces, corresponding ranges were 25.2-56.1 and 18.5-55.7 Hv, respectively. Of the conditions used, 354 mW/cm(2) 457 nm + 354 mW/cm(2) 473 nm produced the highest bottom microhardness (33.8-55.6 Hv). On top and bottom surfaces, microhardness by the lowest total light intensity, 354 (177 × 2) mW/cm(2), ranged 39.0-60.5 and 18.5-52.8 Hv, respectively. Generally, 530 mW/cm(2) at 457 nm produced the lowest polymerization shrinkage. However, shrinkage values obtained using all five laser conditions were similar. The study shows the lasers of 457 and 473 nm are useful for curing composite resins alone or in combination at much lower light intensities than the LED unit.

Effect of a DPSS laser on the shear bond strength of ceramic brackets with different base designs.

This study evaluated the shear bond strength (SBS) and adhesive remnant index (ARI) of ceramic brackets with different base designs using a 473-nm diode-pumped solid-state (DPSS) laser to test its usefulness as a light source. A total of 180 caries-free human premolars were divided into four groups according to the base designs: microcrystalline, crystalline particle (CP), dovetail, and mesh. For each base design, teeth were divided into three different subgroups for light curing using three different light-curing units (LCUs) (quartz-tungsten-halogen unit, light-emitting diode unit, and a DPSS laser of 473 nm). Applied light intensities for the DPSS laser and the other LCUs were approximately 630 and 900 mW/cm(2), respectively. Stainless steel brackets with a mesh design served as controls. The failure modes of debonded brackets were scored using ARI. As a result, brackets bonded using the DPSS laser had the highest SBS values (16.5-27.3 MPa) among the LCUs regardless of base design. Regarding base designs, the CP groups showed the highest SBS values (22.9-27.3 MPa) regardless of LCU. Furthermore, stainless steel brackets with a mesh design had the lowest SBS values regardless of LCU. In many cases, brackets bonded using the DPSS laser had higher ARI scores and had more adhesive on their bases than on tooth surfaces. The study shows that the 473-nm DPSS laser has considerable potential for bonding ceramic brackets at lower light intensities than the other light-curing units examined.

Effect of energy density on low-shrinkage composite resins: diode-pumped solid state laser versus quartz-tungsten-halogen light-curing unit.

OBJECTIVE: The purpose of the present study was to evaluate the effect of energy density on the polymerization of low-shrinkage composite resins. BACKGROUND DATA: The number of photons needs to initiate the polymerization process can be controlled by light intensity and curing time through the form of energy density. MATERIALS AND METHODS: For the study, two methacrylate-based (Premise [PR] and Venus Diamond [VE]) and one silorane-based (Filtek LS [LS]) composite resins were light cured using a quartz-tungsten-halogen (QTH) light-curing unit (LCU) and a 473 nm diode-pumped solid state (DPSS) laser. Degree of conversion (DC), microhardness, refractive index, and polymerization shrinkage were evaluated under different energy densities. Through the study, the feasibility of DPSS laser as a light source was tested as well. RESULTS: LS showed the highest DC and refractive index both on the top and bottom surfaces, and the least polymerization shrinkage among the tested specimens. For the same or similar energy density, QTH and DPSS showed insignificant DC difference (p>0.05). On the other hand, for microhardness, except for one case at the bottom surface, QTH and DPSS showed significant difference (p<0.001). DPSS generated slightly lower polymerization shrinkage than that by QTH. CONCLUSIONS: DC, microhardness, refractive index, and polymerization shrinkage were linearly correlated with energy density. In most cases, there was a strong linear correlation among DC, mirohardness, and refractive index. The DPSS laser of 473 nm could polymerize low-shrinkage composite resins to the level that was achieved by the conventional QTH unit.

The color stability of silorane- and methacrylate-based resin composites.

The purpose of this study were to evaluate the discoloration of a silorane-based resin and two methacrylated-based resin composites upon exposure to different staining solutions coffee, red wine, porcine liver esterase and distilled water for 7 days. The colors of all specimens before and after storage in the solutions were measured by a spectrophotometer based on CIE Lab system, and the color differences thereby calculated. Data were statistically analyzed by ANOVA and Scheffe's test. For coffee and red wine, the mean color change in silorane-based resin was significantly lower than that in methacylate-based resin composites (p<0.05). For porcine liver esterase and distilled water, there was no significant difference in the mean values of color change between silorane- and methacrylate-based resin composites (p>0.05). In conclusion, the silorane-based resin composites exhibited better color stability (less ΔE) after exposure to the colored staining solutions.

Evaluation of an Experimentally Designed Stereotactic Guidance System for Determining Needle Entry Point during Uniplanar Fluoroscopy-guided Intervention.

BACKGROUND: In discography performed during percutaneous endoscopic lumbar discectomy (PELD) via the posterolateral approach, it is difficult to create a fluoroscopic tunnel view because a long needle is required for discography and the guide-wire used for consecutive PELD interrupts rotation of fluoroscope. A stereotactic system was designed to facilitate the determination of the needle entry point, and the feasibility of this system was evaluated during interventional spine procedures. METHODS: A newly designed stereotactic guidance system underwent a field test application for PELD. Sixty patients who underwent single-level PELD at L4-L5 were randomly divided into conventional or stereotactic groups. PELD was performed via the posterolateral approach using the entry point on the skin determined by premeasured distance from the midline and angles according to preoperative magnetic resonance imaging (MRI) findings. Needle entry accuracy provided by the two groups was determined by comparing the distance and angle measured by postoperative computed tomography with those measured by preoperative MRI. The duration and radiation exposure for determining the entry point were measured in the groups. RESULTS: The new stereotactic guidance system and the conventional method provided similarly accurate entry points for discography and consecutive PELD. However, the new stereotactic guidance system lowered the duration and radiation exposure for determining the entry point. CONCLUSIONS: The new stereotactic guidance system under fluoroscopy provided a reliable needle entry point for discography and consecutive PELD. Furthermore, it reduced the duration and radiation exposure associated with determining needle entry.

Development of laser ruler in rigid laryngoscope.

OBJECTIVES: The objective of this study was to develop a new device that provides a simple, noninvasive method of measuring accurate lesion size while using an endoscope. METHODS: We developed a rigid laryngoscope with a built-in laser-ruler using a one-light emitting diode and an acrylic plate. The invention incorporates a built-in laser diode that projects an auto-parallel beam into the optical path of the rigid laryngoscope to form two spots in the field of view. RESULTS: While the interspot distance remains consistent despite changes in focal plane, magnification, or viewing angle of the laryngoscope, projection to an uneven surface introduces certain variations in the shape, and size of the spots, and the distance between the two spots. CONCLUSION: The device enables a laryngologist to easily measure the distance between landmarks, as well as the change in real size, and the progressive change of vocal fold lesions in an outpatient setting.

Expression of VEGF, HGF, IL-6, IL-8, MMP-9, Telomerase in Peripheral Blood of Patients with Head and Neck Squamous Cell Carcinoma.

OBJECTIVES: This study investigated the telomerase expression in peripheral blood mononuclear cells (PBMCs) and the relationship between the serum level of several soluble factors such as vascular endothelial growth factor (VEGF), hepatocyte growth factor, interleukin (IL)-6, IL-8, and matrix metallopeptidase-9 and the clinicopathological features of patients with head and neck squamous cell carcinoma (HNSCC). METHODS: Peripheral blood samples were collected from 50 HNSCC patients and 15 normal controls. The telomerase activity in the PBMCs was measured by Telomere Repeat Amplification Protocols. The serum levels of the soluble factors were analyzed by enzyme-linked immunosorbent assay. RESULTS: The expression of telomerase in the PBMCs of HNSCC patients was significantly correlated with the N and American Joint Committee on Cancer (AJCC) stages. The serum VEGF level was significantly higher in the patients with an advanced T stage, N stage and AJCC stage. Serum VEGF was significantly related with the expression of telomerase in the PBMCs. The telomerase expression and the VEGF expression were shown to be independent factors associated with poor survival. CONCLUSION: The telomerase expression in the PBMCs and the serum VEGF level of HNSCC patients were significantly correlated with the N stage, the AJCC stage and the prognosis.