Analysis of tracheostoma morphology

Objectives: Existing fixation methods of automatic speaking valves (ASVs) suffer from shortcomings which partly are the result of insufficient conformity of the intratracheal fixation method’s shape to the tracheostoma anatomy. However, quantitative data are lacking and will be helpful to analyse solutions for airtight fixation. This article provides such data. Patients and methods: The tracheostoma morphology was measured in computerized tomography scans of 20 laryngectomized patients. Measured were transverse and sagittal diameters, transition angle between skin level and tracheostoma lumen and between the tracheostoma lumen to the trachea, TE valve placement and stoma depth. Results: The mean transverse and sagittal diameters of the stoma at the peristomal lip are 19.2 mm [standard deviation (SD 5.2 mm)] and 17.6 mm (SD 5.3 mm), respectively. The mean transition angles are 84.5° (SD 15.6°) at skin level and 153.6° (SD 11.7°) into the trachea. The mean distance between TE valve and peristomal lip is 13.5 mm (SD 7.0 mm). The mean stoma depth is 14.0 mm (SD 6.4 mm). Conclusions: Due to the large variation, no ‘average tracheostoma morphology’, suitable for shaping a generic intratracheal fixation device, can be defined. Therefore, providing an airtight fixation in each patient would require a large range of different sizes, customization or a new approach

The comparison of lipid profiling in mouse brain and liver after starvation and a high-fat diet : A medical systems biology approach

We investigated with LC-MS techniques, measuring approximately 109 lipid compounds, in mouse brain and liver tissue after 48 hours of starvation and a High-Fat Diet if brain and liver lipid composition changed. We measured Cholesterolesters (ChE), Lysophosphatidyl-cholines (LPC), Phosphatidylcholine (PC), Sphingomyelin (SPM) and Triacylglycerols (TG's) for liver tissue while for brain tissue we had an extra lipid compound the Plasmalogens. In addition, dynamics of hepatic steatosis were determined in an in vivo mouse model with localized non-invasive Magnetic Resonance Spectroscopy (1H-MRS) techniques. In the experimental design Male C57bl6 mice (age 8-12 weeks) were exposed to three treatments: A: They were fed a chow Diet for a period of approximately 40 days (Control group); B: They were fed a High-Fat Diet, containing 0.25% cholesterol (Ch) and 24% energy from bovine lard for a period of approximately 40 days, C: Or they were exposed to 48 hours of starvation. For whole brain tissue of these mice groups the LC-MS techniques indicated that the brain was rather invulnerable to Dietary intervention. The (phospho-) lipid-composition of the brain was unchanged in the starvation group but the cholesterol-ester content was significantly increased in the high High-Fat Diet group. These observations suggest that the brain lipid composition is insensitive to starvation but can be affected by a high High-Fat Diet. In contrast, for liver tissue both 24 h starvation and the 40 day High-Fat Diet resulted in exponential hepatic fat accumulation, although their time course (measured with 1H MRS) techniques was distinctly different. Mass spectrometry (LC-MS) demonstrated for liver tissue remarkable differences in lipid profiles between treatments. 1H-MRS proved to be a reliable method for frequent, repetitive determination of hepatic fat in vivo and a noninvasive alternative to biopsy. Moreover, LC-MS and Principal Component Analysis (PCA) demonstrated that in liver tissue different lipid end products are formed as result of Dietary composition Apparently, for liver tissue starvation and a High-Fat Diet result in a process called hepatic steatosis which is regulated under both conditions via different metabolic pathways. In addition, 1H-MRS techniques demonstrated for liver that the relative amount of unsaturated bindings is significantly higher in the High-Fat Diet group (P≤0.001), which can be deducted from the relative intensities of the (CH=CH) elements and their conjugated unsaturated elements (C-CCH2C=C). We conclude, comparing brain vs. liver tissue that both tissues have a totally different metabolic response to both treatments. The brain is insensitive to starvation but can be affected by a High-Fat Diet while in liver tissue both treatments result paradoxically in a hepatic steatosis. However, for the liver, the dynamics and the lipid profiles of this process of this hepatic steatosis under starvation or a High-Fat Diet are totally different.</p

Analysis of tracheostoma morphology

Objectives: Existing fixation methods of automatic speaking valves (ASVs) suffer from shortcomings which partly are the result of insufficient conformity of the intratracheal fixation method’s shape to the tracheostoma anatomy. However, quantitative data are lacking and will be helpful to analyse solutions for airtight fixation. This article provides such data. Patients and methods: The tracheostoma morphology was measured in computerized tomography scans of 20 laryngectomized patients. Measured were transverse and sagittal diameters, transition angle between skin level and tracheostoma lumen and between the tracheostoma lumen to the trachea, TE valve placement and stoma depth. Results: The mean transverse and sagittal diameters of the stoma at the peristomal lip are 19.2 mm [standard deviation (SD 5.2 mm)] and 17.6 mm (SD 5.3 mm), respectively. The mean transition angles are 84.5° (SD 15.6°) at skin level and 153.6° (SD 11.7°) into the trachea. The mean distance between TE valve and peristomal lip is 13.5 mm (SD 7.0 mm). The mean stoma depth is 14.0 mm (SD 6.4 mm). Conclusions: Due to the large variation, no ‘average tracheostoma morphology’, suitable for shaping a generic intratracheal fixation device, can be defined. Therefore, providing an airtight fixation in each patient would require a large range of different sizes, customization or a new approach

Improving Hands-free Speech Rehabilitation in Patients With a Laryngectomy: Proof-of-Concept of an Intratracheal Fixation Device

Permanent hands-free speech with the use of an automatic speaking valve (ASV) is regarded as the optimal voice rehabilitation after total laryngectomy. Due to fixation problems, regular ASV use in patients with a laryngectomy is limited. We have developed an intratracheal fixation device (ITFD) composed of an intratracheal button augmented by hydrophilic foam around its shaft. This study evaluates the short-term effectiveness and experienced comfort of this ITFD during hands-free speech in 7 participants with a laryngectomy. We found that 4 of 7 participants had secure ASV fixation inside the tracheostoma during hands-free speech for at least 30 minutes with the ITFD. The ITFD’s comfort was perceived positively overall. The insertion was perceived as being mildly uncomfortable but not painful. This proof-of-concept study demonstrates the feasibility of the ITFD that might improve stomal attachment of ASVs, and it provides the basis for further development toward a prototype suitable for long-term daily use

Orthosis for a human leg

An orthosis (1) for a leg of a human body comprises an above knee body support (2) for supporting a portion of said human body above the leg's knee; a below foot ground support (3) for resting upon the ground (8) while not supporting the leg's foot (9); a connection mechanism (4) interconnecting said body support and said ground support and being suitable for transferring loads via the ground support to the ground, while bypassing the knee and the foot, said mechanism comprising a pair of strut assemblies (11, 21), each strut assembly comprising a hinge (14, 24) arranged to be pivotable proximate the knee to permit bending of the knee during walking; and at least one distraction element (5, 6) for exerting a force on the below the knee portion of the leg for pulling apart opposing condyles of at least one condylar joint in the knee