The Application of I-Scan Imaging for Evaluating Benign Vocal Lesions.

Current standard methods for evaluating benign vocal lesions, including white light laryngoscopy and video laryngostroboscopy, may struggle to identify smaller lesions. While histopathological results obtained from laryngeal microsurgery provide definitive results, their invasiveness can lead to scarring and impaired phonological outcomes. Intralesional steroid injection has recently gained acceptance, but it lacks pathological diagnostic capabilities. Therefore, there is a growing need for a simple examination that can enhance the diagnosis of benign vocal lesions. NBI, from Olympus Corporation, has shown promising outcomes in detecting and characterizing laryngeal lesions. The i-scan technology by PENTAX, while providing the ability to improve visual clarity during endoscopic procedures, has been addressed less in this field. Our study aims to further investigate the application of i-scan imaging in benign vocal lesions, enrolling patients diagnosed with vocal cysts, polyps, and nodules. We conducted i-scan imaging prior to office-based intralesional steroid injection, assessing the possibility of its providing additional diagnostic information for benign vocal lesions without additional burden.

Automatic Segmentation of Membranous Glottal Gap Area with U-Net-Based Architecture.

BACKGROUND: While videostroboscopy is recognized as the most popular approach for investigating vocal fold function, evaluating the numerical values, such as the membranous glottal gap area, remains too time consuming for clinical applications. METHODS: We used a total of 2507 videostroboscopy images from 137 patients and developed five U-Net-based deep-learning image segmentation models for automatic masking of the membranous glottal gap area. To further validate the models, we used another 410 images from 41 different patients. RESULTS: During development, all five models exhibited acceptable and similar metrics. While the VGG19 U-Net had a long inference time of 1654 ms, the other four models had more practical inference times, ranging from 16 to 138 ms. During further validation, Efficient U-Net demonstrated the highest intersection over union of 0.8455, the highest Dice coefficient of 0.9163, and the lowest Hausdorff distance of 1.5626. The normalized membranous glottal gap area index was also calculated and validated. Efficient U-Net and VGG19 U-Net exhibited the lowest mean squared errors (3.5476 and 3.3842) and the lowest mean absolute errors (1.8835 and 1.8396). CONCLUSIONS: Automatic segmentation of the membranous glottal gap area can be achieved through U-net-based architecture. Considering the segmentation quality and speed, Efficient U-Net is a reasonable choice for this task, while the other four models remain valuable competitors. The models' masked area enables possible calculation of the normalized membranous glottal gap area and analysis of the glottal area waveform, revealing promising clinical applications for this model. LEVEL OF EVIDENCE: NA Laryngoscope, 134:2835-2843, 2024.

Voice Outcomes of Intensive Voice Feminization Therapy for Transgender Women Delivered via Telepractice: Pilot Study.

OBJECTIVES: The aim of this pilot study is to investigate the efficacy of an intensive voice feminization therapy program provided via telepractice. METHODS: A total of 10 transgender women participated, with nine completing the therapy program. All participants received 12 sessions of resonant voice therapy in combination with Vocal Function Exercises and voice hygiene, which were completed within 4weeks. Acoustic and aerodynamic measures, auditory-perceptual ratings, Trans Woman Voice Questionnaire (TWVQ) and self-rated voice femininity were conducted before and after treatment. RESULTS: Statistical analysis showed significant improvements in acoustic measures such as fundamental frequency and semitones, TWVQ scores, auditory-perceptual ratings and self-perception of voice femininity after intensive voice therapy. CONCLUSIONS: This study provides preliminary evidence to suggest that transgender women can benefit from intensive voice therapy when provided via telepractice, with a more feminine voice and better self-perceived voice-related quality of life. The limitations of this study were that the single-group study design lacked a control group for comparison, and the small sample size. Therefore, a randomize controlled and follow-up study with a larger sample size, exploring the effects of different treatment modalities on transgender women's voices is warranted.

Office-Based Structural Autologous Fat Injection Laryngoplasty for Unilateral Vocal Fold Paralysis.

Unilateral vocal fold paralysis (UVFP) is a common cause of incomplete glottic closure, leading to significant somatic and social disabilities. Office-based autologous fat injection laryngoplasty (AFIL) has been proposed as an effective treatment for glottic insufficiency but has not been well-studied for UVFP. We enrolled 23 patients who underwent office-based structural AFIL due to unilateral vocal paralysis at our institution between February 2021 and January 2022. In the procedure, autologous fat was harvested and injected into the vocal fold under the guidance of flexible digital endoscopy for structural fat grafting. The voice handicap index-10 (VHI-10) score and perceptual voice measurements were collected before the operation, 2 weeks postoperatively, and 3 months postoperatively. Twenty-two patients were followed-up for at least 3 months. The VHI-10 score improved significantly from 29.65 ± 8.52 preoperatively to 11.74 ± 7.42 at 2 weeks (p < 0.0001) and 5.36 ± 6.67 at 3 months (p < 0.0001). Significant improvements in grades of dysphonia (p < 0.0001), breathiness (p < 0.0001), and asthenia (p = 0.004) were also noted at 3 months postoperatively when perceptual measurements were investigated. Office-based structural AFIL is an effective treatment for improving voice-related disability for UVFP patients.

Evaluation of the Grafting Efficacy of Active Biomolecules of Phosphatidylcholine and Type I Collagen on Polyether Ether Ketone: In Vitro and In Vivo.

Biomolecule grafting on polyether ether ketone (PEEK) was used to improve cell affinity caused by surface inertness. This study demonstrated the sequence-polished (P) and sulfonated (SA) PEEK modification to make a 3D structure, active biomolecule graftings through PEEK silylation (SA/SI) and then processed with phosphatidylcholine (with silylation of SA/SI/PC; without SA/PC) and type I collagen (COL I, with silylation of SA/SI/C; without SA/C). Different modified PEEKs were implanted for 4, 8, and 12 weeks for histology. Sulfonated PEEK of SA showed the surface roughness was significantly increased; after the silylation of SA/SI, the hydrophilic nature was remarkably improved. The biomolecules were effectively grafted through silylation, and the cells showed improved attachment after 1 h. Furthermore, the SA/SI/PC group showed good in vitro mineralization. The new bone tissues were integrated into the 3D porous structures of SA/SI/PC and SA/SI/C in vivo making PEEK a potential alternative to metals in orthopedic implants.

Chemical cross-linking on gelatin-hyaluronan loaded with hinokitiol for the preparation of guided tissue regeneration hydrogel membranes with antibacterial and biocompatible properties.

The mechanical properties and structural stability of hydrogels and their performance in antidegradation can be enhanced by cross-linking them with N-(3-dimethylaminopropyl)-N'-ethylcarbodiimide hydrochloride (EDC). However, residual EDC compromises the biocompatibility of cross-linked hydrogels and the formability of un-cross-linked hydrogels. In this study, a facile process for preparing hydrogel regenerative membranes exerting antibacterial effects and containing gelatin/hyaluronic acid (G/HA) through solution casting was proposed. The membranes were cross-linked with EDC (G/HA-Ec-0H) and impregnated with two concentrations of the antibacterial agent of hinokitiol (G/HA-Ec-2H and G/HA-Ec-4H). Amide bonds formed, and the rate of active amino acid fixation was higher than 90%, which was directly proportional to the degree of cross-linking. The G/HA-Ec-2H and G/HA-Ec-4H groups with hinokitiol showed good antibacterial properties. The rate of hydrogel degradation decreased, and the integrity of sample morphology was maintained at more than 80% for over 3 days in the immersion. Then, the hydrogel structures relaxed and disintegrated through a rapid degradation reaction within 24 h. The biocompatibility results showed that low concentrations of hinokitiol did not affect cell viability. Moreover, hydrogel membranes after 14 days of cell incubation showed good cell adhesion and proliferation. In summary, the membrane biostability of the cross-linked gelatin/hyaluronan hydrogels was enhanced by EDC at a biocompatible concentration, and the functionalized group of G/HA-Ec-2H shows potential as a biodegradable material for biocompatible tissue-guarded regeneration membranes with antibacterial properties.

An in vitro assessment and comparative effectiveness of silanized-glutaraldehyde functionalized titanium surfaces with phosphatidylcholine and type I collagen grafts.

OBJECTIVE: This study aims to evaluate sequence-modified Ti surfaces functionalized with silanized glutaraldehyde and further grafted with the active biomolecules of phosphatidylcholine and type I collagen (COL I). METHODS: The properties of the functional surfaces were investigated by various surface analysis techniques and characterized their capability in osteogenic cell attachment, differentiation, and mineralization in vitro. RESULTS: The Ti surfaces grafted with phosphatidylcholine and COL I effectively improved the hydrophilicity. In addition, an effect of COL I concentrations (higher than 2.5µg/mL) do not stimulate subsequent alkaline phosphatase (ALP) activity during osteogenesis in vitro. However, the result is different in phosphatidylcholine, that is, as the concentration of phosphatidylcholine increased enhances subsequent osteogenetic properties. The Ti groups with bioactive molecules affected cell characteristics in vitro in contrast to the controlled Ti group. The proliferation and differentiation levels of osteoprogenetor cells were enhanced and ALP was strongly expressed in the groups grafted with phosphatidylcholine and COL I. SIGNIFICANCE: This modification promotes progenitor bone cell adhesion, proliferation, and differentiation and thus drastically improves the success rate for implant modification by accelerating surface osseointegration.

Characterization of genipin-crosslinked gelatin/hyaluronic acid-based hydrogel membranes and loaded with hinokitiol: In vitro evaluation of antibacterial activity and biocompatibility.

Hydrogel membranes are often used as physical barriers in oral tissue reconstruction and facial surgery to isolate connective and epithelial tissues and form a closed space for undisturbed bone healing. In this study, gelatin and hyaluronic acid were crosslinked with genipin and loaded with a hinokitiol additive as a bacteriostatic agent for potential applications as regeneration membranes. This bifunctional membrane had biocompatibility and antibacterial activities on each membrane side for proper biodegradation. Different membrane groups of gelatin/hyaluronic acid were obtained via a solution casting technique and were genipin crosslinked. The membrane groups were further loaded with adequate hinokitiol at a loading concentration of up to 0.16 g/L (hinokitiol to phosphate buffered saline). Fourier transform infrared spectroscopy showed that gelatin and hyaluronic acid were crosslinked with genipin through cross-linking amide bond (CONH) formation with a cross-linking degree of over 84%. The groups with hinokitiol showed substantial antibacterial activity. Meanwhile, the addition of hinokitiol on hydrogel membranes did not significantly affect the tensile strength. However, it decreased the solubility of the membranes by slowing down the relaxation and degradation of their molecular junctions as hinokitiol is a hydrophobic compound with low permeability. Consequently, the degradation of hydrogel membranes with hinokitiol was delayed. In vitro cytocompatibility indicated that the cell viability of the groups with hinokitiol increased with incubation time, demonstrating that cell viability and proliferation were not affected by cell culture testing.

Early Postoperative Oral Exercise Improves Swallowing Function Among Patients With Oral Cavity Cancer: A Randomized Controlled Trial.

Dysphagia remains an unsolved problem for patients with oral cavity cancer who have undergone surgery. This randomized controlled trial was conducted to determine the effect of oral exercise in addition to standard general care and diet counseling on the physiology of swallowing. Fifty patients (25 in each group) with oral and oropharyngeal cancer who underwent tumor resection, neck dissection, and reconstruction were enrolled in this study. The Rosenbek penetration-aspiration scale and modified barium swallow study were administered at 1 and 4 month(s) postoperatively. We observed significant improvements in the intervention group regarding the penetration-aspiration scale (P = .037), and oral and pharyngeal residue with thickened boluses (Nectar P < .001, Honey P < .001, and Pudding P < .001). In conclusion, oral exercise significantly improves the postoperative swallowing function of patients with oral cavity cancers.

Dysphagia with fatal choking in oculopharyngeal muscular dystrophy: Case report.

RATIONALE: Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant late-onset progressive muscle disorder typically characterized by ptosis, difficulty in swallowing, and proximal limb weakness. Underdiagnosis of OPMD is common in Asian countries and results in delayed diagnoses and fatal events. PATIENT CONCERNS: Here, we report the case of a 53-year-old female who suffered from progressive dysphagia and experienced several choking events involving solid material. An extensive family history of dysphagia was noted, and 2 family members had died as a result of aspiration. DIAGNOSES: PABPN1 genotyping and DNA sequence analysis revealed a heterozygous (GCG)10(GCA)3GCG mutation that led to the diagnosis of OPMD. INTERVENTIONS: Rehabilitation exercises, namely, the Shaker exercise and the Masako maneuver, were suggested. OUTCOMES: Improved swallowing ability with safe food intake was noted after 2 months of training. Surgical intervention will be considered when progression of the disease is noted. LESSONS: Underdiagnosis and a lack of awareness of OPMD may lead to choking, aspiration pneumonia, and death in multiple members of affected families. Currently, there is no definitive treatment for OPMD, but rehabilitation exercises and surgical intervention are helpful in relieving dysphagia.

Two non-consensus Clp binding sites are involved in upregulation of the gum operon involved in xanthan polysaccharide synthesis in Xanthomonas campestris pv. campestris.

Biosynthesis of xanthan polysaccharide, a virulence factor of phytopathogenic Xanthomonas campestris pv. campestris (Xcc), involves the gum operon and the cyclic AMP receptor protein (CRP) homologue Clp. Clp was shown to have the same DNA binding specificity as the CRP at positions 5, 6, and 7 (GTG motif) of the left arm. Therefore, Clp binding sites (CBSs) have typically been identified by pattern searching of the Xcc genome using the consensus CRP binding sequence. Here, results of a reporter assay and electrophoretic mobility shift assay suggest that Clp upregulates the gum operon by binding to two non-consensus sites, in which a more conserved right arm may compensate for the lack of conservation in the left arm, a high GC content in the central region (6 bp) may be important for binding, and binding may be enhanced if the GC-rich central region is palindromic. These suggest that atypical CBSs exist in Xcc promoters and that Clp, while retaining the capacity to bind typical CBSs, has evolved to bind atypical CBS because: 1) Clp shares only moderate homology with the CRP and is modulated by cyclic di-GMP; and 2) Xcc has a higher GC content (65%) than Escherichia coli (50%).

The cAMP receptor-like protein CLP is a novel c-di-GMP receptor linking cell-cell signaling to virulence gene expression in Xanthomonas campestris.

Cyclic-di-GMP [bis-(3'-5')-cyclic diguanosine monophosphate] controls a wide range of functions in eubacteria, yet little is known about the underlying regulatory mechanisms. In the plant pathogen Xanthomonas campestris, expression of a subset of virulence genes is regulated by c-di-GMP and also by the CAP (catabolite activation protein)-like protein XcCLP, a global regulator in the CRP/FNR superfamily. Here, we report structural and functional insights into the interplay between XcCLP and c-di-GMP in regulation of gene expression. XcCLP bound target promoter DNA with submicromolar affinity in the absence of any ligand. This DNA-binding capability was abrogated by c-di-GMP, which bound to XcCLP with micromolar affinity. The crystal structure of XcCLP showed that the protein adopted an intrinsically active conformation for DNA binding. Alteration of residues of XcCLP implicated in c-di-GMP binding through modeling studies caused a substantial reduction in binding affinity for the nucleotide and rendered DNA binding by these variant proteins insensitive to inhibition by c-di-GMP. Together, these findings reveal the structural mechanism behind a novel class of c-di-GMP effector proteins in the CRP/FNR superfamily and indicate that XcCLP regulates bacterial virulence gene expression in a manner negatively controlled by the c-di-GMP concentrations.

Leiomyoma of the hand mimicking a pearl ganglion.

Leiomyomas rarely occur in the hand. To our knowledge, there have been no reports of a leiomyoma of the hand mimicking a pearl ganglion in the English literature. We report such a case with a leiomyoma of the right third finger in a 59-year-old woman. The tumor was excised together with the underlying sheet of tissue. The pathology revealed that the tumor was linked to the underlying structure of a vascular wall by a stalk of tumor tissue. This report serves to remind clinicians to include leiomyoma in the differential diagnosis when encountering a 'ganglion-like lesion'. Also, this report demonstrates the link between a leiomyoma and its underlying origin.