Lakeshore General Hospital

Auditory feedback allows individuals to monitor their vocal characteristics and adjust to maintain optimal voice quality. One type of auditory stimulation for conversational voice training/therapy is pure tone stimulation. This technique presents binaural auditory stimuli consisting of pure tones separated by half-step intervals to modify the fundamental frequency of the speaking voice and expand the vocal range. This study aimed to characterize detectable changes in voice production following the application of pure tone stimulation (PTS) among speakers with and without voice disorders. Data from thirty-nine participants (28 individuals with voice disorders and 11 individuals with normal voices) were analyzed for this study. All participants engaged in binaural PTS exercises. Participants recorded a sustained vowel /a/ before and after the PTS exercises. Multiple acoustic voice parameters were extracted from the sustained vowel samples (fundamental frequency, pitch strength, harmonics-to-noise ratio, and smoothed cepstral peak prominence). Additionally, a visual analogue scale (VAS) interpretation of narrowband (NB) spectrograms was conducted to assess voice quality. Statistically significant increases in fundamental frequency were found after the PTS exercises, except for males in the normal voices group. Pitch strength increased after the PTS, regardless of gender. Participants also demonstrated an increase in the harmonics-to-noise ratio. VAS ratings of NB spectrograms indicated improvement in voice quality following the program. Voice changes after performing PTS suggest voice quality improvement, as measured by acoustic analysis of vowel production and qualitative assessment of NB spectrograms among participants with and without voice disorders.

The PA:A as a marker of acute exacerbations of COPD (AECOPD) was validated using research CT scans. Automation and validation using ‘real-world’ community-acquired CTs would facilitate uptake into clinical practice. We aimed to validate the reproducibility of the PA:A in a community practice-based study with raters (R) of varying levels of expertise and a semi-automated software (SlicerCIP, chestimagingplatform.org) against a thoracic radiologist (gold standard). Randomly selected CTs from a community practice database were anonymized. Two medical students (R1, R2) and a gynecologist (R3) performed between 4 and 3 consecutive randomized, blinded measures of the PA:A (trials). A general and a thoracic radiologist each performed 1 trial. R2 performed a Slicer-assisted trial. 33 CTs (18 contrast, 15 non-contrast) from 6 subjects (4 COPD, 1 asthma, 1 PH, 1M:5F, age 67 mean years(±16SD), PA:A ratio 0.86(±0.11)). Results are shown in Table1. <fig><object-id>erj;64/suppl_68/PA1657/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> The PA:A of ‘real-world’ CTs exhibit excellent intra- and inter-rater agreement and reproducibility between radiologists matching those of research CTs. With experience, clinicians obtain similar results. While Slicer-assisted performance is less than expert radiologist and trained clinician, it is better than untrained clinician. Whether the PA:A of ‘real-world’ CTs will be equally predictive for AECOPD as that of research CT scans remains to be determined.

Purpose To determine if proton (1H) MRI-derived specific ventilation is responsive to bronchodilator (BD) therapy and associated with clinical biomarkers of type 2 airway inflammation and airways dysfunction in severe asthma. Materials and Methods In this prospective study, 27 participants with severe asthma (mean age, 52 years ± 9 [SD]; 17 female, 10 male) and seven healthy controls (mean age, 47 years ± 16; five female, two male), recruited between 2018 and 2021, underwent same-day spirometry, respiratory oscillometry, and tidal breathing 1H MRI. Participants with severe asthma underwent all assessments before and after BD therapy, and type 2 airway inflammatory biomarkers were determined (blood eosinophil count, sputum eosinophil percentage, sputum eosinophil-free granules, and fraction of exhaled nitric oxide) to generate a cumulative type 2 biomarker score. Specific ventilation was derived from tidal breathing 1H MRI and its response to BD therapy, and relationships with biomarkers of type 2 airway inflammation and airway dysfunction were evaluated. Results Mean MRI specific ventilation improved with BD inhalation (from 0.07 ± 0.04 to 0.11 ± 0.04, P < .001). Post-BD MRI specific ventilation (P = .046) and post-BD change in MRI specific ventilation (P = .006) were greater in participants with asthma with type 2 low biomarkers compared with participants with type 2 high biomarkers of airway inflammation. Post-BD change in MRI specific ventilation was correlated with change in forced expiratory volume in 1 second (r = 0.40, P = .04), resistance at 5 Hz (r = -0.50, P = .01), resistance at 19 Hz (r = -0.42, P = .01), reactance area (r = -0.54, P < .01), and reactance at 5 Hz (r = 0.48, P = .01). Conclusion Specific ventilation evaluated with tidal breathing 1H MRI was responsive to BD therapy and was associated with clinical biomarkers of airways disease in participants with severe asthma. Keywords: MRI, Severe Asthma, Ventilation, Type 2 Inflammation Supplemental material is available for this article. © RSNA, 2023 See also the commentary by Moore and Chandarana in this issue.

To investigate the relationship of throat pain and dysphonia. Prospective cohort study. Forty-five subjects presenting with hyoid bone syndrome (HBS) and dysphonia were asked to rate their pain on a numerical rating scale and complete the 10-item Voice-Related Quality of Life (V-RQOL) questionnaire prior to and at 1-week follow-up after treatment with triamcinolone injection into the attachments to the affected greater cornu(s). Wilcoxon signed-rank tests were applied to evaluate if the overall V-RQOL scores, the physical functioning (PF) and social-emotional (SE) domain scores, and pain scores changed significantly after treatment. To evaluate how change in perceived pain affected V-RQOL, the differences in the V-RQOL, PF, and SE domain scores, and in pain scores were calculated for each subject. Three linear models were fit to the response variables, ΔV-RQOL, ΔPF, and ΔSE, using ΔPain as a predicting variable. V-RQOL, PF, and SE domain scores, and pain scores all improved significantly with treatment. A bigger decrease in the pain score led to a bigger increase in V-RQOL and domain scores, with slopes varying between -1.1 and -1.4. The PF domain scores showed the greatest improvement with decrease in pain scores. Effective treatment of HBS led to improvement in patients' voice complaints, suggesting that throat pain may have a direct effect on voice. This may be related to compensatory perilaryngeal adjustments patients make when speaking with a "guarding" effect when they have throat pain. IV (Cohort study) Laryngoscope, 131:E2303-E2308, 2021.

The aims of this study are to evaluate the sensitivity of FDG PET/CT for detection of soft tissue and osseous sarcomas on the basis of FDG avidity. We retrospectively evaluated 212 consecutive patients with known soft tissue or osseous sarcoma who had undergone a FDG PET/CT study for the initial staging or assessment of recurrence of disease. The maximum standardized uptake value (SUVmax) of each primary and/or most intense metastatic lesion was measured and compared with the histological data provided in the final pathological reports. An SUVmax of 2.5 or greater was considered positive for our analysis. Sufficient histopathological data were available for 160 soft tissue sarcomas and 52 osseous sarcomas. FDG PET/CT detected 93.9% of all sarcomas with a sensitivity of 93.7% for soft tissue sarcomas and 94.6% for osseous sarcomas. The sensitivities of the most common sarcoma histologies were 100% for leiomyosarcomas, 94.7% for osteosarcomas, 100% for Ewing's sarcomas, 88.9% for liposarcomas, 80.0% for synovial sarcomas, 100% for gastrointestinal stromal tumors, 87.5% for malignant peripheral nerve sheath tumors, 100% for fibroblastic and myoblastic sarcomas, and 100% for malignant fibrohistiocytic tumors. The receiver-operating characteristic curve revealed an area under the curve of 94% for the discrimination of low-grade and high-grade sarcomas imaged for initial staging by FDG PET/CT. The combined metabolic and morphological information of FDG PET/CT imaging allows high sensitivity for the detection of various sarcomas and accurate discrimination between newly diagnosed low-grade and high-grade sarcomas.

Il y avait près de 160 000 familles monoparentales au Québec au recensement de 1976, ce qui représente 10,3% du total des familles. Ce texte donne une description de leurs principales caractéristiques démographiques et socio-économiques : l’âge, le sexe, l’état matrimonial, la scolarité, l’activité et le revenu du chef de famille y sont abordés. La conclusion est que la famille monoparentale a à sa tête une femme d’environ 48 ans, généralement veuve mais de plus en plus souvent divorcée, célibataire ou séparée, travaillant peu à l’extérieur, peu scolarisée et ayant peu de revenus.