Functional Electrical Stimulation Leads to Increased Volume of the Aged Thyroarytenoid Muscle.

OBJECTIVES/HYPOTHESIS: To reverse sarcopenia and increase the volumes of atrophied laryngeal muscles by functional electrical stimulation (FES) using a minimal invasive surgical procedure in an aged ovine model. STUDY DESIGN: Prospective animal study. METHODS: A stimulation electrode was placed unilaterally near the terminal adduction branch of the recurrent laryngeal nerve (RLN) adjacent to the right cricothyroid joint. The electrode was connected to an implant located subcutaneously at the neck region. Predesigned training patterns were automatically delivered by a bidirectional radio frequency link using a programming device and were repeated automatically by the implant every other day over 11 weeks in the awake animal. Outcome parameters comprised volumetric measurements based on three-dimensional reconstructions of the entire thyroarytenoid muscle (TAM), as well as gene expression analyses. RESULTS: We found significant increases of the volumes of the stimulated TAM of 11% and the TAM diameter at the midmembranous parts of the vocal folds of nearly 40%. Based on gene expression, we did not detect a shift of muscle fiber composition. CONCLUSIONS: FES of the terminal branches of the RLN is a secure and effective way to reverse the effects of age-related TAM atrophy and to increase volumes of atrophied muscles. LEVEL OF EVIDENCE: NA Laryngoscope, 2018

Bilateral Functional Electrical Stimulation for the Treatment of Presbyphonia in a Sheep Model

Objectives: The aim of the study was to increase muscle volume and improve phonation characteristics of the aged ovine larynx by functional electrical stimulation (FES) using a minimally invasive surgical procedure. Methods: Stimulation electrodes were placed bilaterally near the terminal adduction branch of the recurrent laryngeal nerves (RLN). The electrodes were connected to battery powered pulse generators implanted subcutaneously at the neck region. Training patterns were programmed by an external programmer using a bidirectional radio frequency link. Training sessions were repeated automatically by the implant every other day for 1 week followed by every day for 8 weeks in the awake animal. Another group of animals were used as sham, with electrodes positioned but not connected to an implant. Outcome parameters included gene expression analysis, histological assessment of muscle fiber size, functional analysis, and volumetric measurements based on three-dimensional reconstructions of the entire thyroarytenoid muscle (TAM). Results: Increase in minimal muscle fiber diameter and an improvement in vocal efficiency were observed following FES, compared with sham animals. Conclusion: This is the first study to demonstrate beneficial effects in the TAM of FES at molecular, histological, and functional levels. FES of the terminal branches of the RLN reversed the effects of age-related changes and improved vocal efficiency

Associations between XPD Asp312Asn Polymorphism and Risk of Head and Neck Cancer: A Meta-Analysis Based on 7,122 Subjects

Background: To investigate the association between XPD Asp312Asn polymorphism and head and neck cancer risk through this meta-analysis. Methods: We performed a meta-analysis of 9 published case-control studies including 2,670 patients with head and neck cancer and 4,452 controls. An odds ratio (OR) with a 95 % confidence interval (CI) was applied to assess the association between XPD Asp312Asn polymorphism and head and neck cancer risk. Results: Overall, no significant association between XPD Asp312Asn polymorphism and head and neck cancer risk was found in this meta-analysis (Asn/Asn vs. Asp/Asp: OR = 0.95, 95%CI = 0.80–1.13, P = 0.550, Pheterogeneity = 0.126; Asp/Asn vs. Asp/Asp: OR = 1.11, 95%CI = 0.99–1.24, P = 0.065, P heterogeneity = 0.663; Asn/Asn+Asp/Asn vs. Asp/Asp: OR = 1.07, 95%CI = 0.97–1.19, P = 0.189, P heterogeneity = 0.627; Asn/Asn vs. Asp/Asp+Asp/Asn: OR = 0.87, 95%CI = 0.68–1.10, P = 0.243, Pheterogeneity = 0.089). In the subgroup analysis by HWE, ethnicity, and study design, there was still no significant association detected in all genetic models. Conclusions: This meta-analysis demonstrates that XPD Asp312Asn polymorphism may not be a risk factor for developing head and neck cancer

No association of vitamin D metabolism-related polymorphisms and melanoma risk as well as melanoma prognosis: a case–control study

Melanoma is one of the most aggressive human cancers. The vitamin D system contributes to the pathogenesis and prognosis of malignancies including cutaneous melanoma. An expression of the vitamin D receptor (VDR) and an anti-proliferative effect of vitamin D in melanocytes and melanoma cells have been shown in vitro. Studies examining associations of polymorphisms in genes coding for vitamin D metabolism-related proteins (1α-hydroxylase [CYP27B1], 1,25(OH)2D-24hydroxylase [CYP24A1], vitamin D-binding protein [VDBP]) and cancer risk are scarce, especially with respect to melanoma. Mainly VDR polymorphisms regarding melanoma risk and prognosis were examined although other vitamin D metabolism-related genes may also be crucial. In our hospital-based case–control study including 305 melanoma patients and 370 healthy controls single nucleotide polymorphisms in the genes CYP27B1 (rs4646536), CYP24A1 (rs927650), VDBP (rs1155563, rs7041), and VDR (rs757343, rs731236, rs2107301, rs7975232) were analyzed for their association with melanoma risk and prognosis. Except VDR rs731236 and VDR rs2107301, the other six polymorphisms have not been analyzed regarding melanoma before. To further improve the prevention as well as the treatment of melanoma, it is important to identify further genetic markers for melanoma risk as well as prognosis in addition to the crude phenotypic, demographic, and environmental markers used in the clinic today. A panel of genetic risk markers could help to better identify individuals at risk for melanoma development or worse prognosis. We, however, found that none of the polymorphisms tested was associated with melanoma risk as well as prognosis in logistic and linear regression models in our study population

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)

Untersuchung der Auswirkungen von FES als potentielle Therapie der Altersstimme am ex-vivo Schafmodell

Hintergrund: Mit dem Alter vermindert sich häufig die Stimmqualität. Dies geschieht aufgrund der altersbedingten Degeneration von Nerven und Atrophie der Muskeln und wird Presbyphonie genannt. Wenn dies, aufgrund von Unwohlsein bei verbaler Kommunikation der betroffenen Personen, zu einer Vermeidung von sozialen Kontakten führt, folgt daraus ein Verlust an Lebensqualität. Eine Möglichkeit die Degeneration von Nerven und Muskeln zu verringern bzw. das Muskelvolumen wieder zu vergrößern, ist die Funktionelle Elektrostimulation (FES). Um den Einfluss von FES auf die Altersstimme näher zu untersuchen, wurden Schwingungsversuche an exzidierten Schafskehlköpfen durchgeführt. Dazu wurden Kehlköpfe von stimulierten und nicht-stimulierten alten Schafen (10 Jahre) untersucht.Material und Methoden: Um den Musculus thyroarytaenoideus zu stimulieren wurden Elektroden am Nervus laryngeus recurrens implantiert. Die Stimulation erfolgte über einen Zeitraum von neun Wochen, täglich für 20 Minuten und mit einer Stromstärke zwischen 3 mA und 8 mA.Für die Schwingungsversuche wurde das Gewebe oberhalb der Stimmlippen teilweise entfernt um die Stimmlippenschwingung mit einer Hochgeschwindigkeitskamera (4.000 FPS) aufzeichnen zu können. Durch laterale Kompression der Kehlköpfe auf Höhe der Aryknorpel wurden die Stimmlippen in präphonatorische Stellung gebracht. Um unterschiedliche Elongationen der Stimmlippen nachzubilden, wurden Gewichte am Schildknorpel angebracht. Ausgehend vom Phonationsbeginn wurde der Luftfluss in 15 Stufen erhöht. Für jede Luftflussstufe wurde neben der Hochgeschwindigkeits-Videoaufnahme der Stimmlippenschwingung auch der subglottale Druck und das akustische Signal mit einer Abtastrate von 96 kHz aufgezeichnet. Die drei Signale wurden synchron aufgenommen und mit unserer hauseigenen Software Glottis Analysis Tools (GAT), Matlab und SPSS ausgewertet.Ergebnisse: Besonderer Fokus der Auswertung liegt auf der Analyse der Änderung des Glottisschlusses, sowie der resultierenden akustischen Signalqualität. Basierend auf den Videoaufnahmen teilen wir die Daten in drei Gruppen ein: vollständiger Glottisschluss, teilweiser Glottisschluss und kein Glottisschluss. Erste Ergebnisse zeigen nur kleine Verbesserungen des Glottisschlusses und der Signalqualität (CPP) durch FES.Fazit: Anhand unserer Untersuchung diskutieren wir das Potential von FES als mögliche Therapie von Altersstimme