Mammalian target of rapamycin (mTOR) inhibitors and skin cancer risk in nonrenal solid organ transplant recipients: systematic review and meta-analysis.

BACKGROUND: Solid organ transplant recipients have an increased risk of malignancy compared with the general population. Mammalian target of rapamycin (mTOR) inhibitors have been used as immunosuppressants in transplant recipients. There remains a lack of evidence of this treatment in nonrenal solid organ transplantation. We aimed to perform a systematic review and meta-analysis to assess the effects of mTOR inhibitors on secondary nonmelanoma skin cancer (NMSC) malignancies in nonrenal transplant recipients. METHODS: A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligible studies for the present systematic review and meta-analysis included those in which patient cohorts underwent heart, liver, lung, and pancreas (i.e. nonrenal solid organ) transplantation, with treatment group being those treated with an mTOR inhibitor such as sirolimus or everolimus, and control group being placebo, or alternative non-mTOR inhibitor treatment such as calcineurin inhibitors or as per standard treatment protocol. RESULTS: From the six included studies, we found no significant difference in the odds of either primary or secondary NMSC (OR 0.73, 95% CI 0.41-1.29, P = 0.28). Pooled analysis of patients with secondary NMSC demonstrated a trend toward significant benefit with mTOR inhibitor treatment (OR 0.61, 95% CI 0.37-1.02, P = 0.06) but no protective effect for primary NMSC (OR 0.53, 95% CI 0.03-9.96, P = 0.67). CONCLUSIONS: Our results suggest that in nonrenal transplant recipients, mTOR inhibitors may have a protective effect against secondary NMSC but not primary NMSC posttransplantation. Extrapolating the findings of reduced NMSC in renal transplant populations to nonrenal transplant cases should be cautioned.

Moebius syndrome: measures of observer intelligibility with versus without visual cues in bilateral facial paralysis.

OBJECTIVE: This study investigated observers' intelligibility for the spoken output of an individual with Moebius syndrome (MoS) with and without visual cues. DESIGN: An audiovisual recording of the speaker's output was obtained for 50 Speech Intelligibility in Noise sentences consisting of 25 high predictability and 25 low predictability sentences. Stimuli were presented to observers under two conditions: audiovisual and audio only. Data were analyzed using a multivariate repeated measures model. OBSERVERS: Twenty students and faculty affiliated with the Department of Speech Pathology and Audiology at the University of Nevada, Reno. RESULTS: ANOVA mixed design revealed that intelligibility for the audio condition only was significantly greater than intelligibility for the audiovisual condition; and accuracy for high predictability sentences was significantly greater than accuracy for low predictability sentences. CONCLUSIONS: The compensatory substitutional placements for phonemes produced by MoS speakers may detract from the intelligibility of speech. This is similar to the McGurk-MacDonald effect, whereby an illusory auditory signal is perceived when visual information from lip movements does not match the auditory information from speech. It also suggests that observers use contextual clues, more than the acoustic signal alone, to arrive at the accurate recognition of the message of the speakers with MoS. Therefore, speakers with MoS should be counseled in the top-down approach of auditory closure. When the speech signal is degraded, predictable messages are more easily understood than unpredictable ones. It is also important to confirm the speaking partner's understanding of the topic before proceeding.

Perception of spasmodic dysphonia speech in background noise.

The purpose of this investigation was to judge whether the Lombard effect, a characteristic change in the acoustical properties of speech produced in noise, existed in adductor spasmodic dysphonia speech, and if so, whether the effect added to or detracted from speaker intelligibility. Intelligibility, as described by Duffy, is the extent to which the acoustic signal produced by a speaker is understood by a listener based on the auditory signal alone. Four speakers with adductor spasmodic dysphonia provided speech samples consisting of low probability sentences from the Speech Perception in Noise test to use as stimuli. The speakers were first tape-recorded as they read the sentences in a quiet speaking condition and were later tape-recorded as they read the same sentences while exposed to background noise. The listeners used as subjects in this study were 50 undergraduate university students. The results of the statistical analysis indicated a significant difference between the intelligibility of the speech recorded in the quiet versus noise conditions (F(1,49) = 57.80, p < or = .001). It was concluded that a deleterious Lombard effect existed for the adductor spasmodic dysphonia speaker group, with the premise that the activation of a Lombard effect in such patients may detract from their overall speech intelligibility.

Measurement of speech disfluency through magnitude estimation and interval scaling.

The purpose was to assess whether equal-appearing interval or magnitude-estimation scaling resulted in a data set with a closer correlation to the physical stimuli, made up of speech samples with varying amounts of disfluency. 20 young adults completed two tasks. In Task 1, subjects used a 7-point equal-appearing interval scale to rate the disfluency of 10 speech samples having varying within sentence pause, presented randomly at 65 dB SPL. In Task 2, subjects used magnitude-estimation scaling to rate these stimuli, presented in a randomized order. Analysis showed significantly high correlations for both scaling techniques and the speech stimuli (Spearman rho=.90 and 1.00, respectively). It appears that subjects can use either scaling technique to rate accurately varied speech disfluency.

Intelligibility of tracheoesophageal speech in noise.

The purpose of this investigation is to determine the extent to which background noise negatively impacts the intelligibility of tracheoesophageal (TE) speech. Four male TE speakers provided speech samples that were recorded in quiet and in noise conditions. The listener/subjects occupied a sound-treated booth and were presented with two tasks. In Task 1, the subjects were required to transcribe TE speech stimuli recorded in quiet. In Task 2, the subjects were required to transcribe TE speech stimuli recorded in noise. Repeated measures 2 x 4 factorial analyses of variance were calculated for the dataset. The results of the statistical analysis revealed that the TE speech produced in quiet was significantly more intelligible to the listeners than the TE speech produced in noise for three of the four TE speakers. Furthermore, the results seem to support the hypothesis that the activation of a Lombard effect in TE speakers may detract from their overall speech intelligibility.