Lung Ultrasound Score as a Predictor of Failure to Wean COVID-19 Elderly Patients off Mechanical Ventilation: A Prospective Observational Study.

Background: The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear. Methods: This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC). Results: The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770-0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups. Conclusion: The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard. Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05706441.

Combination and Comparison of Sound Coding Strategies Using Cochlear Implant Simulation With Mandarin Speech.

Three cochlear implant (CI) sound coding strategies were combined in the same signal processing path and compared for speech intelligibility with vocoded Mandarin sentences. The three CI coding strategies, biologically-inspired hearing aid algorithm (BioAid), envelope enhancement (EE), and fundamental frequency modulation (F0mod), were combined with the advanced combination encoder (ACE) strategy. Hence, four singular coding strategies and four combinational coding strategies were derived. Mandarin sentences with speech-shape noise were processed using these coding strategies. Speech understanding of vocoded Mandarin sentences was evaluated using short-time objective intelligibility (STOI) and subjective sentence recognition tests with normal-hearing listeners. For signal-to-noise ratios at 5 dB or above, the EE strategy had slightly higher average scores in both STOI and listening tests compared to ACE. The addition of EE to BioAid slightly increased the mean scores for BioAid+EE, which was the combination strategy with the highest scores in both objective and subjective speech intelligibility. The benefits of BioAid, F0mod, and the four combinational coding strategies were not observed in CI simulation. The findings of this study may be useful for the future design of coding strategies and related studies with Mandarin.

Probable Change of Sleep Parameters after Resection and Reconstruction Surgeries in Patients with Oral Cavity or Oropharyngeal Cancers.

In patients of oral cavity or oropharyngeal cancers, resection of the tumor and reconstruction of the defect may reduce the framework, add a bulky flap, alter the tissue flexibility, and contribute to postoperative obstructive sleep apnea (OSA). Postoperative OSA and the potential consequences may decrease the survival rate and reduce patients' quality of life. It is unclear whether the surgery is associated with postoperative OSA. Here, we compared the polysomnographies (PSGs) before and after the surgery in 15 patients of oral cavity or oropharyngeal cancers (out of 68 patients of head and neck cancers) without a chemo- or radio-therapy. Each patient received the second PSG before the start of any indicated adjuvant therapy to prevent its interference. There were 14 men and 1 woman, with a mean age and a standard deviation (SD, same in the following) of 56.2 ± 12.8 years. There were 6 tongue cancers, 5 buccal cancers, 2 tonsil cancer, 1 lower gum cancer, and 1 trigone cancer. The results show that the surgery changed sleep parameters insignificantly in apnea-hypopnea index (AHI), mean oxyhemoglobin saturation of pulse oximetry (SpO2), minimum SpO2, mean desaturation, and desaturation index but increased mean heart rate in the patients with free flaps. These results hint that the effect of surgery on developing OSA was small in this sample, with a longer plate or a larger framework for a bulkier free flap. It needs future studies with a large sample size to generalize this first observation.

A randomized trial in the investigation of anxiety and depression in patients with coronavirus disease 2019 (COVID-19).

BACKGROUND: In March 2020, the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern. A small proportion of patients infected with COVID-19 go on to develop pneumonia. We speculated that COVID-19 may be likely to result in psychological disorders such as anxiety and depression. In this study, we conducted an investigation of anxiety and depression in patients with COVID-19. METHODS: Sixty-five COVID-19 patients were randomly enrolled into this study. Anxiety and depression among participants were measured through the completion of anonymous Chinese-language Zung self-rating anxiety scale and self-rating depression scale questionnaires. Data were analyzed using independent samples t-tests, Mann-Whitney U-tests, and χ2 tests. RESULTS: The questionnaire results showed that 26.15% and 41.54% of participants suffered from anxiety and depression, respectively, although there was no significantly statistical difference between the proportions of COVID-19 patients with anxiety and depression. Statistically significant differences in employment status, partial pressure of oxygen, and corticosteroid application existed between moderate- and severe COVID-19 patients (P<0.05). In particular, the partial pressure of oxygen was significantly lower in severe COVID-19 patients than in their moderate counter parts (71.31±23.54 vs. 101.06±34.43, U=156, P=0.006). Total lymphocytes was lower in severe group than in moderate group [1.659±0.643 vs. 0.745 (0.645, 0.928), U=109, P=0.000]. Also, a higher proportion of female than male patients had anxiety (χ2=5.388, P=0.02). COVID-19 patients who received antiviral medications also displayed a higher rate of anxiety (χ2=4.481, P=0.034). Total lymphocytes between the non-anxiety and anxiety had statistical difference (U=321, P=0.019). Meanwhile, total lymphocytes between the non-depression and depression also had statistical difference (U=389.5, P=0.01). CONCLUSIONS: Among patients with COVID-19, females and those treated with antiviral medications were more likely to experience anxiety. In addition, our findings reflected the effect of anxiety and depression on immune system.

Safety Assessment of the Auto Manipulation Device for Acupuncture in Sprague-Dawley Rats: Preclinical Evaluation of the Prototype.

BACKGROUND: The Auto Manipulation Device for Acupuncture (AMDA) is designed for providing stable, quantified effects and higher frequency when doing lifting and thrusting manipulation. The purpose of this study is to investigate the safety of manipulation by AMDA in different frequency and duration in healthy rats. METHODS: The study was divided into two parts: single intervention and once a day for a week. 12 rats and 15 rats were randomly allocated to different groups: Control (needle insertion only), AMDA (2Hz/10Mins), AMDA (2Hz/20Mins), AMDA (20Hz/10Mins), and AMDA (20Hz/20Mins) for single and repeated interventions. Real-time physiological functions, laboratory data, and the bilateral muscle tissue of acupoint (ST 36) were obtained after the intervention. RESULTS: We found neither real-time physiological functions nor laboratory data differences between control group and AMDA groups in both parts. In the muscle tissue samples, the slight damage had been observed in the AMDA group with a frequency of 2 Hz for 20 minutes after once intervention, and the repeated session groups noted more obvious tissue damage with fibrotic change. Although the period was shorter, higher frequency manipulation caused more damage that fibroblast nuclei became more slender and obvious. However, no significant adverse effect was noted such as crippled and molting in the whole process. CONCLUSION: Our study suggested that the safety issue of AMDA operation in rats is feasible because there was no difference between control group and AMDA groups among real-time physiological functions and laboratory data. However, manipulation with higher frequency should be more preserved.

An acoustic feature-based similarity scoring system for speech rehabilitation assistance.

The purpose of this study is to develop a tool to assist speech therapy and rehabilitation, which focused on automatic scoring based on the comparison of the patient's speech with another normal speech on several aspects including pitch, vowel, voiced-unvoiced segments, strident fricative and sound intensity. The pitch estimation employed the use of cepstrum-based algorithm for its robustness; the vowel classification used multilayer perceptron (MLP) to classify vowel from pitch and formants; and the strident fricative detection was based on the major peak spectral intensity, location and the pitch existence in the segment. In order to evaluate the performance of the system, this study analyzed eight patient's speech recordings (four males, four females; 4-58-years-old), which had been recorded in previous study in cooperation with Taipei Veterans General Hospital and Taoyuan General Hospital. The experiment result on pitch algorithm showed that the cepstrum method had 5.3% of gross pitch error from a total of 2086 frames. On the vowel classification algorithm, MLP method provided 93% accuracy (men), 87% (women) and 84% (children). In total, the overall results showed that 156 tool's grading results (81%) were consistent compared to 192 audio and visual observations done by four experienced respondents. Implication for Rehabilitation Difficulties in communication may limit the ability of a person to transfer and exchange information. The fact that speech is one of the primary means of communication has encouraged the needs of speech diagnosis and rehabilitation. The advances of technology in computer-assisted speech therapy (CAST) improve the quality, time efficiency of the diagnosis and treatment of the disorders. The present study attempted to develop tool to assist speech therapy and rehabilitation, which provided simple interface to let the assessment be done even by the patient himself without the need of particular knowledge of speech processing while at the same time, also provided further deep analysis of the speech, which can be useful for the speech therapist.

Choice of flap affects fistula rate after salvage laryngopharyngectomy.

Due to the significant morbidity and mortality associated with pharyngocutaneous fistula in pharyngoesophageal reconstruction following cancer resection, the purpose of this retrospective study is to examine the selection of tubed skin flaps that impact anastomotic integrity. The flaps evaluated included radial forearm flap versus anterolateral thigh flap, and fasciocutaneous anterolateral thigh flap versus chimeric anterolateral thigh flap. The outcome of interest is the incidence of pharyngocutaneous fistula. The radial forearm group had a significantly higher rate of fistula than the anterolateral thigh group (56.6% vs. 30.2%, p = 0.03). No significant difference in the incidence of fistula was demonstrated between fasciocutaneous and chimeric anterolateral thigh flap (36.8% vs. 25%, p = 0.51). The anastomotic integrity in pharyngoesopharyngeal reconstruction is affected by choice of skin flaps. Anterolateral thigh flap appears to be a viable option for pharyngoesophageal reconstruction. The more technical demand of the anterolateral thigh flap must be weighed against an easily harvested radial forearm flap.

Is distal fibular fracture an absolute contraindication to free fibular flap harvesting? A review of evidence in the literature and illustration by a successful case.

Despite the advantages of a fibula flap, many surgeons would often be hesitant in its use in patients with a history of distal fibular fracture. The chief concern is the potential vascular damage sustained during the injury. From our experience, however, we noticed that the blood supply of various components of a fibula flap rarely relies on its distal part alone. Avoiding the use of this flap may unnecessarily forgo the optimal reconstructive option in many patients. Free fibula flap was harvested from a 41-year-old man who had a history of left fibula fracture 10 years before surgery. The fracture was treated with open reduction with internal fixation. The plate was removed 1 year after the trauma surgery. We used this fractured and healed fibula to reconstruct the intraoral and mandibular defect after tumor extirpation. The harvesting process was straight-forward and the flap survived uneventfully. On the basis of our experience and current evidence in the literature, we believe that a history of previous fibular fracture should not be considered as an absolute contraindication for free fibular flap harvesting. With a good knowledge of the lower limb anatomy and appropriate patient selection, the fibular flap can still be a safe option that incurs no additional risk.

Influence of diabetes mellitus on postoperative complications and failure in head and neck free flap reconstruction: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to determine whether diabetic patients have an increased rate of postoperative complications compared to nondiabetic patients after head and neck free flap reconstruction. A systematic review of PubMed Database between 1966 and 2012 was performed. RevMan 5.0 was used for meta-analysis. A retrospective medical chart review of 7890 patients to identify those who had a failed microsurgical reconstruction of the head and neck region at Chang Gung Memorial Hospital was also carried out. The result revealed that patients with diabetes mellitus have a 1.76 increased risk of complications (odds ratio [OR] = 1.76; 95% confidence interval [CI] = 1.11-2.79) with minimal heterogeneity (I( 2) = 22%; p = .28). The prevalence of diabetes mellitus in patients with failed free flaps for head and neck reconstruction is 15%. The incidence of diabetes mellitus in these patients with failed free flaps is 2.3 times higher than in the general population.

Development of Automatic Manipulation Device for Acupuncture (AMDA).

Needle lifting and thrusting manipulation is one of common skills in acupuncture. However, there exists artificial error in frequency and amplitude due to individual difference when performing lifting and thrusting during acupuncture. For providing stable and quantified effects and higher frequency when doing lifting and thrusting manipulation, a well controlled device is needed. The aim of this article is to report the preliminary results of the development of Auto Manipulation Device for Acupuncture (AMDA) and characterization of its functional parameters. A tissue-simulating Agar gel phantom with 4.8%, 5.2%, and 5.4% concentrations was prepared and used for characterization of the AMDA. Tests of the linearity, reliability and safety of the AMDA were implemented with conditions of different drive voltages, frequencies, and simulated tissues. Our preliminary results have demonstrated the developed AMDA its plausibility in the clinical application of acupuncture.