Use of surface electromyography in phonation studies: an integrative review

INTRODUCTION: Surface electromyography has been used to assess the extrinsic laryngeal muscles during chewing and swallowing, but there have been few studies assessing these muscles during phonation. OBJECTIVE: To investigate the current state of knowledge regarding the use of surface electromyography for evaluation of the electrical activity of the extrinsic muscles of the larynx during phonation by means of an integrative review. METHOD: We searched for articles and other papers in the PubMed, Medline/Bireme, and Scielo databases that were published between 1980 and 2012, by using the following descriptors: surface electromyography and voice, surface electromyography and phonation, and surface electromyography and dysphonia. The articles were selectedon the basis ofinclusion and exclusion criteria. DATA SYNTHESIS: This was carried out with a cross critical matrix. We selected 27 papers,i.e., 24 articles and 3 theses. The studies differed methodologically with regards to sample size and investigation techniques, making it difficult to compare them, but showed differences in electrical activity between the studied groups (dysphonicsubjects, non-dysphonicsubjects, singers, and others). CONCLUSION: Electromyography has clinical applicability when technical precautions with respect to application and analysis are obeyed. However, it is necessary to adopt a universal system of assessment tasks and related measurement techniques to allow comparisons between studies

Preferência de lado mastigatório e simetria facial em laringectomizados totais: estudo clínico e eletromiográfico

OBJETIVO: observar se existe relação entre a preferência do lado mastigatório, antropometria facial e atividade elétrica do músculo masseter em laringectomizados totais. MÉTODOS: a coleta de dados, realizada no setor de Fonoaudiologia do Hospital de Câncer de Pernambuco (HCP), contou com a participação de quinze voluntários laringectomizados totais do gênero masculino e idade média de 64 anos. Foi realizada aferição das distâncias entre os pontos antropométricos faciais ex e ch nas hemifaces dos voluntários e posteriormente executado exame eletromiográfico dos músculos masseteres, bilateralmente, nos momentos de máxima intercuspidação habitual (MIH), mastigações unilaterais direita e esquerda e durante mastigação habitual. Realizou-se filmagem durante a mastigação habitual para identificação do lado de preferência mastigatória. RESULTADOS: os indivíduos cuja preferência mastigatória foi do lado direito, apresentaram o lado esquerdo da face com maior medida (72,37mm); já os indivíduos cuja preferência mastigatória foi do lado esquerdo, apresentaram maior medida da face do lado direito (68,85mm). Quando a mastigação apresentou-se unilateral direita a atividade elétrica do masseter direito atingiu média de 123,57% enquanto o masseter esquerdo alcançou média igual a 84,85% de atividade em relação à MIH (p = 0,016). CONCLUSÃO: em laringectomizados as medidas antropométricas faciais correlacionam-se com o lado de preferência de mastigação e os valores eletromiográficos dos masseteres durante a mastigação

Contributions of neuroimaging in singing voice studies: a systematic review

ABSTRACT It is assumed that singing is a highly complex activity, which requires the activation and interconnection of sensorimotor areas. The aim of the current research was to present the evidence from neuroimaging studies in the performance of the motor and sensory system in the process of singing. Research articles on the characteristics of human singing analyzed by neuroimaging, which were published between 1990 and 2016, and indexed and listed in databases such as PubMed, BIREME, Lilacs, Web of Science, Scopus, and EBSCO were chosen for this systematic review. A total of 9 articles, employing magnetoencephalography, functional magnetic resonance imaging, positron emission tomography, and electrocorticography were chosen. These neuroimaging approaches enabled the identification of a neural network interconnecting the spoken and singing voice, to identify, modulate, and correct pitch. This network changed with the singer's training, variations in melodic structure and harmonized singing, amusia, and the relationship among the brain areas that are responsible for speech, singing, and the persistence of musicality. Since knowledge of the neural networks that control singing is still scarce, the use of neuroimaging methods to elucidate these pathways should be a focus of future research

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research