ABSTRACT
Abstract Introduction Acquired tracheomalacia (ATM) is characterized by a loss of structural strength of the tracheal framework, resulting in airway collapse during breathing. Near half of the patients undergoing prolonged invasive mechanical ventilation will suffer tracheal lesions. Treatment for ATM includes external splinting with rib grafts, prosthetic materials, and tracheal resection. Failure in the use of prosthetic materials has made reconsidering natural origin scaffolds and tissue engineering as a suitable alternative. Objective To restore adequate airway patency in an ovine model with surgicallyinduced ATM employing a tissue-engineered extraluminal tracheal splint (TE-ETS). Methods In the present prospective pilot study, tracheal rings were partially resected to induce airway collapse in 16 Suffolk sheep (Ovis aries). The TE-ETS was developed with autologous mesenchymal-derived chondrocytes and allogenic decellularized tracheal segments and was implanted above debilitated tracheal rings. The animals were followed-up at 8, 12, and 16 weeks and at 1-year postinsertion. Flexible tracheoscopies were performed at each stage. After sacrifice, a histopathological study of the trachea and the splint were performed. Results The TE-ETS prevented airway collapse for 16 weeks and up to 1-year postinsertion. Tracheoscopies revealed a noncollapsing airway during inspiration. Histopathological analyses showed the organization of mesenchymal-derived chondrocytes in lacunae, the proliferation of blood vessels, and recovery of epithelial tissue subjacent to the splint. Splints without autologous cells did not prevent airway collapse. Conclusion It is possible to treat acquired tracheomalacia with TE-ETS without further surgical removal since it undergoes physiological degradation. The present study supports the development of tissue-engineered tracheal substitutes for airway disease.
ABSTRACT
Abstract Introduction Voice is a gender marker and can therefore be a source of gender dysphoria. There is a relationship between symptoms of anxiety and depression and voice-related difficulties in trans women (TW). Hormonal replacement treatment (HRT) in TW does not play a role in voice feminization. Access to voice feminization procedures is limited while the population demanding transgender healthcare is increasing. Objective To describe the degree of voice-related dysphoria experienced by TW that seek a voice feminization treatment. Method A descriptive, cross-sectional study, 26 TW completed quality of life (QoL) questionnaires and stated their reasons for seeking voice feminization. Fundamental frequency (f0) was measured. Results 77% of the participants were legally recognized as women, 96% were under HRT, and 27% had a history of gender affirmation surgery. Median f0 for TW was 131 Hz. f0 had a poor correlation with QoL measures. The mean score in the Trans Women Voice Questionnaire was 95 (SD = 14.3). Achieving a feminine voice that allows gender conformity was the main reason for seeking treatment. Discussion and conclusion Voice non-conformity affects QoL. None of the participants perceived their voice as feminine while 97% described their ideal voice as feminine. The inability to satisfy gender assurance needs has a detrimental effect on QoL. Improving access to affirmation procedures in public institutions without pathologization of transgender people is a pending agenda. Despite evidence that TW benefit from voice feminization treatments, it is difficult to define how to measure success.
Resumen Introducción La voz es un marcador de género y como tal puede ocasionar disforia de género. Existe una relación entre la ansiedad y la depresión y las dificultades relacionadas con la voz en mujeres trans (MT). La terapia de sustitución hormonal (TSH) en MT no feminiza la voz. El acceso a un tratamiento de feminización de voz es limitado, mientras que la población que demanda servicios de salud transgénero está aumentando. Objetivo Describir el grado de disforia relacionado con la voz de las MT que buscan un tratamiento de feminización de voz. Método Estudio descriptivo, transversal, 26 MT respondieron cuestionarios de calidad de vida (CV) y expresaron los motivos para buscar feminizar su voz. Se midió la frecuencia fundamental (f0). Resultados El 77% de las participantes eran reconocidas legalmente como mujeres, 96% tomaban TSH y 27% tenía antecedente de una cirugía de afirmación de género. La mediana de la f0 fue de 131 Hz. El puntaje medio en el Cuestionario de Voz para Mujeres Trans fue de 95 puntos (DE = 14.3) y tuvo una mala correlación con la f0. La expectativa principal fue lograr una voz femenina que permitiera una conformidad de género. Discusión y conclusión Una voz género-discordante afecta la CV. El 97% describió que su voz ideal sería femenina, pero ninguna percibió su voz como tal. La incapacidad para satisfacer las necesidades de afirmación de género tiene un efecto negativo sobre la CV. Mejorar el acceso a procedimientos de afirmación de género en instituciones públicas sin patologizar a las personas transgénero es una agenda pendiente. Existe evidencia de que los procedimientos de feminización de voz benefician a las MT, aunque se desconoce cuál es la mejor manera de medir el éxito.