Voice parameters in children with cochlear implants: a systematic review and meta-analysis

ABSTRACT: Introduction: An intact auditory system is essential for the development and maintenance of voice quality and speech prosody. On the contrary hearing loss affects the adjustments and appropriate use of organs involved in speech and voice production. Spectro-acoustic voice parameters have been valuated in CI users, and the authors of previous systematic reviews on the topic concluded that preliminary Fundamental Frequency seemed the most reliable parameter to evaluate voice alterations in adult CI users. The main aim of this systematic review and meta-analysis was to clarify the vocal parameters and prosodic alterations of speech in pediatric CI users. Materials and methods: The protocol of the systematic review was registered on the PROSPERO database International prospective register of systematic reviews. We conducted a search of the English literature published in the period between January 1st 2005 and April 1st 2022 on the Pubmed and Scopus databases. A meta-analysis was conducted to compare the values of voice acoustic parameters in CI users and nonhearing-impaired controls. The analysis was conducted using the standardized mean difference as the outcome measure. A random-effects model was fitted to the data. Results: A total of 1334 articles were initially evaluated using title and abstract screening. After applying inclusion/exclusion criteria, 20 articles were considered suitable for this review. The age of the cases ranged between 25 to 132 months at examination. The most studied parameters were F0, Jitter, Shimmer and Harmoni Noise Ratio (HNR); other parameters were seldom reported. A total of 11 studies were included in the meta-analysis of F0, with the majority of estimates being positive (75%); the estimated average standardized mean difference based on the random-effects model was 0.3033 (95% CI: 0.0605 to 0.5462; p = 0.0144). For Jitter (0.2229; 95% CI: -0.1862 to 0.7986; p = 0.2229) and shimmer (0.2540; 95% CI: -0.1404 to 0.6485; p = 0.2068) there was a trend toward positive values without reaching statistical significance. Discussion and conclusions: This meta-analysis confirmed that higher F0 values have been observed in the pediatric population of CI users compared to age-matched normal hearing volunteers, whereas the parameters of voice noise were not significantly different between cases and controls. Prosodic aspects of language need further investigations. In longitudinal contexts, prolonged auditory experience with CI has brought voice parameters closer to the norm. Following the available evidence, we stress the utility of inclusion of vocal acoustic analysis in the clinical evaluation and follow-up of CI patients to optimize the rehabilitation process of pediatric patients with hearing loss

A Comprehensive Comparison of Bovine and Porcine Decellularized Pericardia: New Insights for Surgical Applications

Xenogeneic pericardium-based substitutes are employed for several surgical indications after chemical shielding, limiting their biocompatibility and therapeutic durability. Adverse responses to these replacements might be prevented by tissue decellularization, ideally removing cells and preserving the original extracellular matrix (ECM). The aim of this study was to compare the mostly applied pericardia in clinics, i.e. bovine and porcine tissues, after their decellularization, and obtain new insights for their possible surgical use. Bovine and porcine pericardia were submitted to TRICOL decellularization, based on osmotic shock, detergents and nuclease treatment. TRICOL procedure resulted in being effective in cell removal and preservation of ECM architecture of both species' scaffolds. Collagen and elastin were retained but glycosaminoglycans were reduced, significantly for bovine scaffolds. Tissue hydration was varied by decellularization, with a rise for bovine pericardia and a decrease for porcine ones. TRICOL significantly increased porcine pericardial thickness, while a non-significant reduction was observed for the bovine counterpart. The protein secondary structure and thermal denaturation profile of both species' scaffolds were unaltered. Both pericardial tissues showed augmented biomechanical compliance after decellularization. The ECM bioactivity of bovine and porcine pericardia was unaffected by decellularization, sustaining viability and proliferation of human mesenchymal stem cells and endothelial cells. In conclusion, decellularized bovine and porcine pericardia demonstrate possessing the characteristics that are suitable for the creation of novel scaffolds for reconstruction or replacement: differences in water content, thickness and glycosaminoglycans might influence some of their biomechanical properties and, hence, their indication for surgical use

Application of Patients Reported Outcome measures in Cochlear Implant patients: implications for the design of specific rehabilitation programs

Introduction: Cochlear implants (CI) had been developed to enable a satisfying verbal communication, music experiences have remained in the background of research and development and consequently many CI users are dissatisfied by the music they listen to. Nonetheless, concise indications for clinicians to test music abilities and prescribe rehabilitation programs are still lacking. The main aim of the present study was to test the utility of the application of two different Patient Reporting Outcomes (PRO) measures in a group of CI users. A secondary objective was to identify items capable of driving the indication and design specific music rehabilitation programs for CI patients. Material and Methods: A consecutive series of 73 CI patients referred to the Audiology Unit - University of Padova - was enrolled from November 2021 to May 2022 and evaluated with audiological battery test and PRO measures: Musica e Qualità della Vita (MUSQUAV) and Nijmegen Cochlear Implant Questionnaire (NCIQ) Italian version. Results: The Reliability analysis showed good consistency between the different PRO measures, (Cronbach alpha = 0.873). After accounting for epidemiological and clinical variables, PRO measures showed a correlation with audiological outcomes in only one case (rho=-0.170 for NCIQ-T with CI-Pure Tone Average. A willingness for musical rehabilitation was present in 63% of patients, (Rehab Factor, mean value of 0.791±0.675). Conclusions: we support the role of the application of MUSQUAV and NCIQ to improve the clinical and audiological evaluation of CI patients. Moreover, we proposed a derivative item, called Rehab Factor, which could be used in clinical practice and future studies to clarify the indication and priority of specific music rehabilitation programs

Surgery for anomalous aortic origin of coronary arteries : a multicentre study from the European Congenital Heart Surgeons Association

OBJECTIVES: We sought to describe early and late outcomes in a large surgical series of patients with anomalous aortic origin of coronary arteries. METHODS: We performed a retrospective multicentre study including surgical patients with anomalous aortic origin of coronary arteries since 1991. Patients with isolated high coronary takeoff and associated major congenital heart disease were excluded. RESULTS: We collected 156 surgical patients (median age 39.5 years, interquartile range 15-53) affected by anomalous right (67.9%), anomalous left (22.4%) and other anatomical abnormalities (9.6%). An interarterial course occurred in 86.5%, an intramural course in 62.8% and symptoms in 85.9%. The operations included coronary unroofing (56.4%), reimplantation (19.2%), coronary bypass graft (15.4%) and other (9.0%). Two patients with preoperative cardiac failure died postoperatively (1.3%). All survivors were discharged home in good clinical condition. At a median follow-up of 2 years (interquartile range 1-5, 88.5% complete), there were 3 deaths (2.2%), 9 reinterventions in 8 patients (5 interventional, 3 surgical); 91.2% are in New York Heart Association functional class CONCLUSIONS: Surgical repair of anomalous aortic origin of coronary arteries is effective and has few complications. Unroofing and coronary reimplantation are safe and are the most common procedures. The occurrence of late adverse events is not negligible, and long-term surveillance is mandatory. Most young athletes can return to an unrestrained lifestyle.Peer reviewe

Anomalous aortic origin of coronary arteries : Early results on clinical management from an international multicenter study

Background: Anomalous aortic origin of coronary arteries (AAOCA) is a rare abnormality, whose optimal management is still undefined. We describe early outcomes in patients treated with different management strategies. Methods: This is a retrospective clinicalmulticenter study including patients with AAOCA, undergoing or not surgical treatment. Patients with isolated high coronary take off and associated major congenital heart disease were excluded. Preoperative, intraoperative, anatomical and postoperative data were retrieved from a common database. Results: Among 217 patients, 156 underwent Surgical repair (median age 39 years, IQR: 15-53), while 61 were Medical (median age 15 years, IQR: 8-52), inwhomAAOCA was incidentally diagnosed during screening or clinical evaluations. Surgical patients were more often symptomatic when compared to medical ones (87.2% vs 44.3%, p b 0.001). Coronary unroofing was the most frequent procedure (56.4%). Operative mortality was 1.3% (2 patients with preoperative severe heart failure). At a median follow up of 18 months (range 0.1-23 years), 89.9% of survivors are in NYHA Conclusions: Surgery for AAOCA is safe andwith low morbidity. When compared to Medical patients, who remain on exercise restriction and medical therapy, surgical patients have a benefit in terms of symptoms and return to normal life. Since the long term-risk of sudden cardiac death is still unknown, we currently recommend accurate long term surveillance in all patients with AAOCA. (C) 2019 The Authors. Published by Elsevier B.V.Peer reviewe

Alveolar surfactant phosphatidylglycerol, disaturated phosphatidylcholine, and SP-B kinetics in infants and adults with stable isotopes tracers, and H+V-ATPase activity in B1 subunit knockout mice

Alveolar surfactant is the key physiological structure that every mammal utilizes to live while breathing air. It is a mixture of proteins and lipids that lines the external part of the alveoli and allows a water-based organism to use air as source of oxygen. Disorders in surfactant’s metabolism are known to be involved in life-threatening diseases like the acute respiratory distress syndrome and cystic fibrosis. In this thesis we describe the kinetics of two main surfactant’s phospholipids (phosphatidylglycerol and disaturated-phosphatidylcholine) and of its specific protein B, in vivo in humans, all obtained with stable isotopes infusion protocols in children (phospholipids) and adults (protein SP-B). In the last part we tried to use the model of renal intercalated cells to approach the role of pH in the secretion of surfactant.Il surfattante alveolare è la struttura fisiologica che viene utilizzata da ogni mammifero per vivere e respirare in atmosfera. Si tratta di un complesso di proteine e lipidi che si trova nella parte esterna degli alveoli, dove svolge la sua funzione fisiologica permettendo lo scambio gassoso tra organismo (principalmente acquoso) e aria. Alterazioni del metabolismo del surfattante sono note in numerose e gravi malattie, come la sindrome da distress respiratorio e la fibrosi cistica. In questa tesi sono descritte le cinetiche di due principali fosfolipidi (fosfatidilglicerolo e fosfatidilcolina disatura) e di una proteina specifica del surfattante (SP-B), misurati in vivo nell’uomo attraverso l’infusione di isotopi stabili. Nell’ultima parte è descritto il tentativo di utilizzare il modello delle cellule intercalate del rene per studiare il ruolo delle variazioni di pH nella secrezione del surfattante

Alveolar surfactant phosphatidylglycerol, disaturated phosphatidylcholine, and SP-B kinetics in infants and adults with stable isotopes tracers, and H+V-ATPase activity in B1 subunit knockout mice

Alveolar surfactant is the key physiological structure that every mammal utilizes to live while breathing air. It is a mixture of proteins and lipids that lines the external part of the alveoli and allows a water-based organism to use air as source of oxygen. Disorders in surfactant’s metabolism are known to be involved in life-threatening diseases like the acute respiratory distress syndrome and cystic fibrosis. In this thesis we describe the kinetics of two main surfactant’s phospholipids (phosphatidylglycerol and disaturated-phosphatidylcholine) and of its specific protein B, in vivo in humans, all obtained with stable isotopes infusion protocols in children (phospholipids) and adults (protein SP-B). In the last part we tried to use the model of renal intercalated cells to approach the role of pH in the secretion of surfactant.Il surfattante alveolare è la struttura fisiologica che viene utilizzata da ogni mammifero per vivere e respirare in atmosfera. Si tratta di un complesso di proteine e lipidi che si trova nella parte esterna degli alveoli, dove svolge la sua funzione fisiologica permettendo lo scambio gassoso tra organismo (principalmente acquoso) e aria. Alterazioni del metabolismo del surfattante sono note in numerose e gravi malattie, come la sindrome da distress respiratorio e la fibrosi cistica. In questa tesi sono descritte le cinetiche di due principali fosfolipidi (fosfatidilglicerolo e fosfatidilcolina disatura) e di una proteina specifica del surfattante (SP-B), misurati in vivo nell’uomo attraverso l’infusione di isotopi stabili. Nell’ultima parte è descritto il tentativo di utilizzare il modello delle cellule intercalate del rene per studiare il ruolo delle variazioni di pH nella secrezione del surfattante

PORTRAYING BRONCHOALVEOLAR LAVAGE IN COVID19-ASSOCIATED ACUTE RESPIRATORY DISTRESS SYNDROME: FOCUS ON CELLULAR COMPONENTS, CYTOKINE PROFILE, AND CONCOMITANT INFECTIONS

Raw data and code (in R) used for the analysi

Data from: Lung vascular-epithelial changes in patients undergoing tumour resection after SARS-CoV-2 infection: a retrospective comparative study

Data from: Lung vascular-epithelial changes in patients undergoing tumour resection after SARS-CoV-2 infection: a retrospective comparative stud