Double Blind Study Investigating the Effect of Different Voice Prostheses on Ease of Swallowing and Residue Post Laryngectomy.

Voice prostheses have been examined for their effect on voice production but there is little datum on their effect on swallow function. This study investigated the difference between six commonly available voice prostheses in terms of swallowing. Laryngectomy patients had up to six voice prostheses placed in a random order over two visits. Swallowing was evaluated for each prosthesis using FEES (Fibreoptic Endoscopic Evaluation of Swallowing). After each prosthesis trial, patients self-evaluated their experience of swallowing. Three independent experts indicated which prosthesis they considered best for swallowing for each patient and judged residue on the voice prosthesis and in the upper esophagus. Raters were blinded to participant details, voice prosthesis type and scores of other raters. On patient self-evaluation, scores were equally distributed across all prostheses for swallowing. Experts most frequently chose the Blom Singer Low pressure and Blom Singer Classic Indwelling voice prostheses as best for swallowing but consensus was poor for most patients. Experts found that the Blom Singer Classic Indwelling and the Provox Vega had least residue on the voice prosthesis on thin liquid (p ≤ 0.001) and soft (p = 0.001), respectively. Experts also found that the Blom Singer Low Pressure had least residue in the upper esophagus on soft consistency (p ≤ 0.001). While self-evaluation by patients did not identify a consistently preferred prosthesis for swallow, many patients expressed personal preferences, suggesting benefits to involving patients in the choice of prosthesis. Some voice prostheses may be associated with lower levels of residue on the prosthesis and upper esophagus with certain consistencies

Reabilitação vocal de laringectomizados com prótese traqueoesofágica Vocal reabilitation of patients with laringectomy using tracheoesofogeal proteses

Material: No período de 23 de fevereiro de 1999 a junho de 2000 foram estudados 23 pacientes submetidos à laringectomia total que receberam a prótese traqueoesofágica do tipo Blom-Singer Indeweling Low Presure, sendo 22 pacientes do sexo masculino, com faixa etária variando de 40 a 80 anos. O tempo de acompanhamento variou de 150 a 462 dias. Um paciente era do estádio clínico I, com comprometimento da comissura posterior; um, do estádio II, com lesão na subglote; 13, do estádio III; e sete do IV. Forma de estudo: Prospectivo clínico não randomizado. Método: A prótese foi locada concomitante à laringectomia em sete pacientes; secundariamente, com anestesia geral, em cinco; e, por endoscopia digestiva alta, sob sedação e anestesia local, em quatorze. Foram estudadas as complicações decorrentes da colocação e uso da prótese vocal, avaliação da qualidade da voz e da inteligibilidade de fala, utilizando parâmetro perceptivo-auditivo, antes e depois da fonoterapia e do tempo necessário para reabilitação vocal. Resultados: Houve três complicações pós-operatórias relacionadas com procedimento cirúrgico terapêutico, que impossibilitaram a reabilitação vocal; dos vinte possíveis de serem reabilitados com a prótese, dezoito se reabilitaram com índice de 90% de sucesso. O tempo médio para reabilitação variou de um a 65 dias. Conclusão: Concluímos que as complicações decorrentes da colocação e uso da prótese não inviabilizaram o sucesso do método; o tempo médio para aquisição da voz foi de sete dias; a qualidade vocal e a inteligibilidade de fala apresentaram melhora após a realização da fonoterapia, sem diferença estatística significativa; e a colocação secundária da prótese vocal, utilizando nova técnica, por endoscopia digestiva alta, mostrou-se mais eficaz em relação às técnicas convencionais.<br>We studied the complications resulting from the placement and use of the vocal prosthesis, assessment of voice quality and speech intelligibility using perceptive-auditory parameters before and after speech therapy and the period needed for vocal rehabilitation. From February 1999 to June 2000, a study was conducted on 23 patients who underwent total laryngectomy and were given a tracheoesophageal prosthesis like the Blom-Singer Indwelling Low Pressure. Study design: Prospective clinical not randomized. Material and method: The study consisted of 22 males and their ages ranged from 40 years to 80 years. The follow up period varied between 150 days to 462 days. One patient with the posterior commissure affected was at stadium I; stadium II had one patient with a lesion in the subglottic region; stadium III had 13 patients; stadium IV had four patients. The prosthesis was placed in seven patients concomitantly with the laryngectomy, while the placement was secondary in the remaining group. Aim: We studied the complications resulting from the placement and use of the vocal prosthesis, assessment of voice quality and speech intelligibility using perceptive-auditory parameters before and after speech therapy and the period needed for vocal rehabilitation impossible. The success rating was 90% with 18 patients rehabilitated with the help of the prosthesis. The rehabilitation period varied between one day to 65 days. Conclusions: the complications resulted from placement and use of this prosthesis did not hamper its success; the average time taken for voice acquisition was seven days, vocal quality and intelligibility of speech showed improvement after the phonoterapy without significant statistics difference and the secondary placement through new surgical technique by digestive endoscopy is better than the conventional technique

Single cell atlas identifies lipid-processing and immunomodulatory endothelial cells in healthy and malignant breast

Since a detailed inventory of endothelial cell (EC) heterogeneity in breast cancer (BC) is lacking, here we perform single cell RNA-sequencing of 26,515 cells (including 8433 ECs) from 9 BC patients and compare them to published EC taxonomies from lung tumors. Angiogenic ECs are phenotypically similar, while other EC subtypes are different. Predictive interactome analysis reveals known but also previously unreported receptor-ligand interactions between ECs and immune cells, suggesting an involvement of breast EC subtypes in immune responses. We also identify a capillary EC subtype (LIPEC (Lipid Processing EC)), which expresses genes involved in lipid processing that are regulated by PPAR-γ and is more abundant in peri-tumoral breast tissue. Retrospective analysis of 4648 BC patients reveals that treatment with metformin (an indirect PPAR-γ signaling activator) provides long-lasting clinical benefit and is positively associated with LIPEC abundance. Our findings warrant further exploration of this LIPEC/PPAR-γ link for BC treatment

Real-life assessment of chronic rhinosinusitis patients using mobile technology: The mySinusitisCoach project by EUFOREA

Background: Chronic rhinosinusitis (CRS) is a chronic inflammatory disease associated with a substantial personal and socioeconomic burden. Monitoring of patient-reported outcomes by mobile technology offers the possibility to better understand real-life burden of CRS. Methods: This study reports on the cross-sectional evaluation of data of 626 users of mySinusitisCoach (mSC), a mobile application for CRS patients. Patient characteristics of mSC users were analysed as well as the level of disease control based on VAS global rhinosinusitis symptom score and adapted EPOS criteria. Results: The mSC cohort represents a heterogeneous group of CRS patients with a diverse pattern of major symptoms. Approximately half of patients reported nasal polyps. 47.3% of all CRS patients were uncontrolled based on evaluation of VAS global rhinosinusitis symptom score compared to 40.9% based on adapted EPOS criteria. The impact of CRS on sleep quality and daily life activities was significantly higher in uncontrolled versus well-controlled patients. Half of patients had a history of FESS (functional endoscopic sinus surgery) and reported lower symptom severity compared to patients without a history of FESS, except for patients with a history of more than 3 procedures. Patients with a history of FESS reported higher VAS levels for impaired smell. Conclusion: Real-life data confirm the high disease burden in uncontrolled CRS patients, clearly impacting quality of life. Sinus surgery improves patient-reported outcomes, but not in patients with a history of more than 3 procedures. Mobile technology opens a new era of real-life monitoring, supporting the evolution of care towards precision medicine