Search

It was observed in [Sm.sub.2][TM.sub.17] magnets that decreasing Fe content did not strongly affect room temperature coercivity but led to a significantly higher coercivity at high temperatures; increasing Sm content resulted in much lower room temperature coercivity but substantially higher coercivity at high temperatures; increasing Cu content led to higher coercivity at all temperatures. In this paper, the effects of Fe, Sm, and Cu on coercivity are explained by using the temperature dependence of magnetocrystalline anisotropy of the 2:17 cell phase and 1:5 cell boundary phase. In order to explain complex temperature dependence of coercivity, thermal activation of domain walls must be taken into account. It is believed that the energy necessary for domain walls to overcome the energy barrier between the 1:5 cell boundary phase and 2:17 cell phase can be acquired not only from the magnetic field, but also from thermal energy [k.sub.B]T. This concept may apply to all magnetic materials in which domain wall motion is involved during magnetization and demagnetization processes. Index Terms--Domain wall motion, high temperature magnetic performance, rare earth permanent magnets, Sm-Co based permanent magnets, thermal activation.

The effect of z value on the high temperature performance of Sm[([Co.sub.0.795][Fe.sub.0.09][Cu.sub.0.09][Zr.sub.0.025]).sub.z] with effective z = 7.14 - 8.10 was studied up to 600 [degrees] C. It was observed that the intrinsic coercivity ([sub.M][H.sub.c]) was very sensitive to the z value, especially when the temperature was lower than 550 [degrees] C. Peak values of [sub.M][H.sub.c] were observed in the [sub.M][H.sub.c] - z curves. As the temperature rose, this peak shifted toward lower values of z. It was observed in this study that a new magnet with the composition of Sm[([Co.sub.0.795][Fe.sub.0.09][Cu.sub.0.09][Zr.sub.0.025]).sub.7.26] showed maximum energy product more than 20 times higher than the best conventional high temperature 2:17 magnet in a dynamic characterization at 400 [degrees] C. The new magnets with low z values and low Fe (high Co) content also displayed excellent long-term stability at 500 [degrees] C. Index Terms--Dynamic characterization, high temperature magnetic performance, rare earth permanent magnets, Sm-Co based permanent magnets.

Investigation of thermal stability at 300-550 [degrees] C for the newly developed Sm[([Co.sub.w][Fe.sub.v][Cu.sub.x][Zr.sub.y]).sub.z] high temperature magnets is reported in this paper. Three factors are responsible for the irreversible losses at high temperatures. One factor is the loss associated with a nonlinear induction demagnetization curve. This results in significant loss when the magnet is exposed to temperatures higher than the maximum use temperature [T.sub.M]. Another factor is the surface oxidation, which is more severe with increasing temperature and time at high temperature. Surface oxidation can be reduced by coating with a high temperature ceramic coating. The third factor is the result of metallurgical changes in the magnets. This loss is relatively small in the new magnets, which actually is [is less than] 2% after 360 hours at 550 [degrees] C. The experiment confirms that coated magnets with [T.sub.M] up to 550 [degrees] C can be expected to have considerable life expectancy and relatively low losses at the intended [T.sub.M]. Index Terms--High temperature applications, irreversible losses, linear demagnetization curve, surface oxidation, Sm-TM rare earth magnets, thermal stability.

New sintered Sm-Co based permanent magnet materials have been developed to meet the high-temperature ([is greater than or equal to] 400 [degrees] C) application requirement of advanced power systems. A magnet of [Sm([Co.sub.bal][Fe.sub.0.09][Cu.sub.0.09][Zr.sub.0.03]).sub.7.69] shows an intrinsic coercivity ([sub.M][H.sub.c]) approaching 13 kOe and an energy product of 14 MGOe at 400 [degrees] C. Its second-quadrant induction demagnetization curve is a straight line at temperatures to 500 [degrees] C. Magnets with improved temperature coefficient of MI-It have been obtained by reducing the Fe content and increasing the Sm content. An abnormal and complex temperature dependence of [sub.M][H.sub.c] was observed in sintered [Sm([Co.sub.bal][Fe.sub.0.09][Cu.sub.0.09][Zr.sub.0.03]).sub.7.69]. Upon heating, the [sub.M][H.sub.c] first reached a minimum of 4.4 kOe at 150 [degrees] C and then gradually increased to a maximum of 7.5 kOe at 500 [degrees] C. Index Terms--High temperature applications, rare earth permanent magnets, Sm-Co based permanent magnets, temperature coefficient of coercivity.

A new approach for calculating the temperature coefficients of magnetic parameters is proposed in order to more accurately describe high temperature characteristics of magnetic materials. Using this new approach, the 'true' (or instantaneous) temperature coefficient of any magnetic parameter at a specific temperature can be determined and a plot of temperature coefficient vs. temperature can be obtained. This new type of plot is a very useful tool to present temperature characteristics of a magnetic parameter. Data of temperature coefficient as a function of temperature for magnetization, intrinsic coercivity, and maximum energy product are given for several types of rare earth permanent magnets. By applying the same approach, the temperature coefficients of heavy rare earth substituted magnets are calculated for ([Sm.sub.1-x][Gd.sub.x])[Co.sub.5] and [([Sm.sub.1-x][Gd.sub.x]).sub.2][TM.sub.17] systems with 0 [is less than or equal to] x [is less than or equal to] 1. Index Terms--High temperature characteristics, rare earth permanent magnets, temperature coefficient.

This article reports our investigation on the behavior of some heavy and light rare earth-cobalt magnets at high temperatures. Magnetic properties and the temperature coefficients of magnetization, α, over a wide temperature range have been studied for various magnets, which include RE(Co[sub 0.74]Fe[sub 0.14]Cu[sub 0.09]Zr[sub 0.03])[sub 7.4] for RE = Er, Dy, Tm, Ho, and Tb, as well as RE(Co[sub 0.68]Fe[sub 0.22]Cu[sub 0.07]Zr[sub 0.03])[sub 7.4] for RE = Sm, Ho, and Gd. The results show that the temperature for magnetization peak is 480 °C for the Er-Co magnet, and 370 °C for the Ho-Co magnet. Our research indicates that there is good potential for making temperature compensated, high temperature magnets with Ho, Er, Gd, or combinations of these rare earths to satisfy certain applications. The Tm-Co magnet does not show the typical characteristic shown by other heavy rare earth cobalt magnets, which is a positive a at points above room temperature. However, Tm-Co shows a small and near constant negative a value, which may be useful for some applications. Magnetic properties and the temperature dependence for temperature compensated magnets with high coercivity are also reported in this article, which have the composition of Sm[sub 0.6]RE[sub 0.4](Co,Fe,Cu,Zr)[sub 7.4] with RE = Er, Ho, Tm, Dy, and Tb. [ABSTRACT FROM AUTHOR]

In search of high-temperature permanent magnet materials, sintered Sm–Co-based magnets with abnormal temperature dependence of intrinsic coercivity have been obtained. These magnets have small negative, or near-zero, or large positive temperature coefficients of intrinsic coercivity. A model of coercivity mechanism has been proposed to explain this abnormal temperature dependence. According to this model, the coercivity in 2:17-type permanent magnets is controlled by two conflicting mechanisms. The first mechanism is thermal activation, which leads to decreased coercivity with increasing temperature. The second mechanism can be explained by a pinning process in which increasing temperature may result in an increased difference of crystalline anisotropy between the 2:17 cell phase and 1:5 cell boundary phase and, in turn, a higher coercivity at high temperature. © 2000 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the incidence of subglottic stenosis in children undergoing endotracheal intubation.Methods:Children in the paediatric intensive care unit of a tertiary care hospital were considered eligible for inclusion if they received endotracheal intubation for more than 24 hours. After extubation, children underwent flexible fibre-optic nasolaryngoscopy. Based on this first evaluation, they were divided into two groups: ‘acute normal’, with mild laryngeal alterations or normal findings; and ‘acute alterations’, with moderate to severe laryngeal alterations. Further laryngoscopic follow up (7–10 days later) was undertaken for those children in the acute normal group who developed symptoms during follow up (after discharge from the intensive care unit), and for all children in the acute alterations group. Children were then classified into two final groups: ‘normal final examination’, with no chronic changes; and ‘subglottic stenosis’.Results:We included 123 children. The incidence of subglottic stenosis was 11.38 per cent (95 per cent confidence interval, 6.63–17.94 per cent). All the children who developed subglottic stenosis had had moderate to severe alterations immediately after extubation.Conclusion:This incidence of subglottic stenosis is quite high and needs further investigation to identify risk factors. [ABSTRACT FROM PUBLISHER]

Presents a study which explained the effects of iron, samarium, and copper on coercivity by using the temperature dependence of magnetocrystalline anisotropy of the 2: 17 cell phase and 1: 5 cell boundary phase. Effects of changing iron, samarium, and copper content on element concentrations in the cellular microstructure; Abnormal temperature dependence of coercivity and domain wall motion in ferromagnetic materials.

Evaluates the protein sources for finishing steers. Comparison of urea and soybean meal as supplemental protein sources; Interaction between roughage source and supplemental protein in finishing diets based on dry-rolled corn.

Objectives: To evaluate the bacterial microbiome found in tracheostomy cannulas of a group of children diagnosed with glossoptosis secondary to Robin Sequence (RS), and its clinical implications., Methods: Pediatric patients were enrolled in the study at the time of the cannula change in the hospital. During this procedure, the removed cannula was collected and stored for amplicon sequencing of 16s rRNA. DNA extraction was performed using DNeasy PowerBiofilm Kit (QIAGEN® ‒ Cat nº 24000-50) while sequencing was performed with the S5 (Ion S5™ System, Thermo Fisher Scientific), following Brazilian Microbiome Project (BMP) protocol., Results: All 12 patients included in the study were using tracheostomy uncuffed cannulas of the same brand, had tracheostomy performed for over 1-year and had used the removed cannula for approximately 3-months. Most abundant genera found were Aggregatibacter, Pseudomonas, Haemophilus, Neisseria, Staphylococcus, Fusobacterium, Moraxella, Streptococcus, Alloiococcus, and Capnocytophaga. Individual microbiome of each individual was highly variable, not correlating to any particular clinical characteristic., Conclusion: The microbiome of tracheostomy cannulas is highly variable, even among patients with similar clinical characteristics, making it challenging to determine a standard for normality., (Copyright © 2022 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction  Among the potential diseases that present altered salivary flow and activity is Sjögren syndrome. Sialendoscopy seems to be an important therapeutic option. Objective  To compare the results obtained with sialendoscopy for improving salivary flow measured by scintigraphy in patients with primary Sjögren syndrome to those obtained with other intraglandular washing solutions. Methods  Patients from our institution's rheumatology clinic diagnosed with primary Sjögren syndrome underwent parotid scintigraphy prior to the sialendoscopy procedure. During the sialendoscopy procedure, one of the parotid glands was randomized to receive a wash with saline while the other was washed with a corticosteroid solution. After 1 month, a new scintigraphy examination of the parotid glands was performed to observe the salivary flow for comparison. Results  A total of 13 female patients with mean age of 53.38 years (range, 27-76 years) were included in this study. After sialendoscopy, 10 patients (76.92%) were observed to have improvement in salivary excretion with radiopharmaceutical during scintigraphy. When analyzing each gland that was treated separately (26 glands), after sialendoscopy, improvement was observed in 18 glands (69.23%), 8 treated with dexamethasone and 10 with saline solution in the wash. There was no improvement in 8 glands (30.77%). Conclusion  This study demonstrates that sialendoscopy is as an important tool to improve salivary flow measured by scintigraphy in patients with primary Sjogren syndrome, increasing salivary excretion through dilation and consequent unblocking of the ducts. These data suggest that there is no statistically significant difference between intraductal washing solutions using saline or dexamethasone solution., Competing Interests: Conflict of Interests The authors have no conflict of interests to declare., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ).)

Objective: To assess the accuracy of stridor in comparison to endoscopic examination for diagnosis of pediatric post-intubation subglottic stenosis., Method: Children who required endotracheal intubation for >24h were included in this prospective cohort study. Children were monitored daily and underwent flexible fiberoptic laryngoscopy after extubation. Those with moderate-to-severe abnormalities underwent another examination 7-10 days later. If lesions persisted or symptoms developed, laryngoscopy under general anesthesia was performed. Patients were assessed daily for stridor after extubation., Results: A total of 187 children were included. The incidence of post-extubation stridor was 44.38%. Stridor had a sensitivity of 77.78% (95% confidence interval [95% CI]: 51.9-92.6) and specificity of 59.18% (95% CI: 51.3-66.6) in detecting subglottic stenosis. The positive predictive value was 16.87% (95% CI: 9.8-27.1), and the negative predictive value was 96.15% (95% CI: 89.9-98.8). Stridor persisting longer than 72h or starting more than 72h post-extubation had a sensitivity of 66.67% (95% CI: 41.2-85.6), specificity of 89.1% (95% CI: 83.1-93.2), positive predictive value of 40.0% (95% CI: 23.2-59.3), and negative predictive value of 96.07% (95% CI: 91.3-98.4). The area under the receiver operating characteristic (ROC) curve was 0.78 (95% CI: 0.65-0.91)., Conclusions: Absence of stridor was appropriate to rule out post-intubation subglottic stenosis. The specificity of this criterion improved when stridor persisted longer than 72h or started more than 72h post-extubation. Thus, endoscopy under general anesthesia can be used to confirm subglottic stenosis only in patients who develop or persist with stridor for more than 72h following extubation., (Copyright © 2018. Published by Elsevier Editora Ltda.)

Purpose: To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis., Methods: Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts., Results: The sample comprised 38 pediatric patients aged 0-5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever., Conclusion: When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.

Introduction: The optimal surgical technique for the management of patients with Robin Sequence (RS) has not been established. One of the most commonly used surgical techniques, mandibular distraction osteogenesis (MDO), is still controversial because of its potential risks and the lack of clear evidence of its efficacy., Objectives: To assess variations in airway patency, clinical symptoms, and polysomnographic parameters in children with RS who underwent MDO., Methods: In this prospective cohort study, 38 patients with RS were evaluated before and after MDO. Symptom severity was classified using a grading scale for RS clinical manifestations. Patients underwent flexible fiberoptic laryngoscopy, and the images were classified by a blinded examiner using two validated grading scales for airway obstruction. Patients not requiring ventilatory support underwent a polysomnography., Results: Patients' symptoms significantly improved after MDO, as shown by a decreased score in the grading scale for RS clinical manifestations (preoperative score of 2.20 vs. postoperative score of 0.81; P < 0.001). The two endoscopic grading scales also showed a statistically significant postoperative improvement in airway obstruction (first scale: preoperative score of 1.56 vs. postoperative score of 0.92; second scale: preoperative score of 2.19 vs. postoperative score of 1.16; P < 0.001 for both). Moreover, there was a statistically significant variation in the following polysomnographic parameters evaluated pre- and postoperatively: apnea-hypopnea index, total sleep time, oxygen desaturation nadir, and oxygen desaturation index (P < 0.05)., Conclusions: MDO seems to be an effective surgical option for children, as shown by postoperative improvements in clinical symptoms, endoscopic grading scales, and polysomnographic parameters., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: To evaluate the association of polysomnographic parameters with clinical symptom severity in Robin sequence (RS) patients., Methods: All patients diagnosed as presenting with RS at Hospital de Clínicas de Porto Alegre from October 2012 to June 2016 were enrolled. They were classified as isolated RS, RS-plus, and syndromic RS. Polysomnography (PSG) was performed, except for those patients in need of respiratory support. Symptom severity was evaluated as defined by the Cole et al., Classification: Ordinal OR (for the chance of increase in one grade on the clinical severity scale) and R 2 (determination coefficient from ordinal logistic regression) were computed from data analysis., Results: A total of 80 participants were enrolled in the study. Fifty-five of these were able to undergo polysomnography. Worsening of the studied PSG parameters was associated with increase in clinical severity grading, as follows: desaturation index (OR 1.27; 95% CI; 1.07-1.51; R 2  = 19.8%; p = 0.006); apnea/hypopnea Index (OR 1.13; 95% CI; 1.01-1.26; R 2  = 12.5%; p = 0.02); sleep mean oxygen saturation (OR 0.16; 95% CI; 0.05-0.52; R 2  = 22.6%; p = 0.002); oxygen saturation nadir (OR 0.73; 95% CI; 0.56-0.96; R 2  = 10.0%; p = 0.02); percentage of time with oxygen saturation <90% (OR 9.49; 95% CI; 1.63-55.31, R 2  = 37.6%; p = 0.012); and percentage of time presenting with obstruction (OR 2.5; 95% CI; 1.31-4.76; R 2  = 25.1%; p = 0.006)., Conclusions: Polysomnography parameters were associated with severity of clinical manifestations in patients with RS. Oxyhemoglobin saturation-based parameters had surprisingly significant R 2 values. Therefore, those parameters, which have traditionally been undervalued in other clinical settings, should also be assessed in the polysomnographic evaluation of RS patients., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Introduction: Although culturally food and physical activity restriction are part of the routine postoperative care of many Brazilian surgeons, current evidences from other countries support no such recommendations., Objective: To determine whether dietary and physical restriction effectively lead to a decrease on postoperative complications of adenotonsillectomy in children when compared to no restriction., Methods: We have designed a randomized clinical trial comparing two intervention: no specific counseling on diet or activity (Group A), and restriction recommendations on diet and physical activities (Group B). Caregivers completed a questionnaire on observed pain, diet and activity patterns, and medications administered. Parameters were compared at the 3rd and at the 7th postoperative day between intervention groups., Results: We have enrolled a total of 95 patients, 50 in Group A and 45 in Group B. Fourteen patients were lost to follow up. Eventually, 41 patients in group A and 40 in Group B were available for final analysis. Mean age in months (A=79.5; SD=33.9/B=81.1; SD=32.6) and sex (A=58% male; B=64.4% male) were equivalent between groups. Pain, evaluated through visual analog scale in the 3rd (A=2.0; IQR 1-6/B=4.5; IQR 2-6; p=0.18) and in the 7th (A=1.0; IQR 1.0-4.5/B=2.0; IQR 1.0-4.7; p=0.29) postoperative days, was not different between groups, as was the amount of analgesics administered. Dietary and physical activity patterns also showed no statistically significant differences between groups., Conclusion: Dietary and activity restriction after adenotonsillectomy does not seem to affect patients' recovery. Such information may impact considerably on the social aspects that involve a tonsillectomy, reducing the working days lost by parents and accelerating the return of children to school., (Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objectives/hypothesis: To assess the performance of endoscopic grading systems of glossoptosis in identifying severe clinical manifestations in children with Robin sequence (RS)., Study Design: Nested cohort cross-sectional study., Methods: All RS patients diagnosed at Hospital Clinics of Porto Alegre from October 2012 to June 2016 were enrolled in this cohort. Patients underwent sleep endoscopy and were classified according to Yellon (Y) and de Sousa et al. (S) scales. Symptom severity evaluation was performed as defined by Cole et al. The outcome of interest was Cole's clinical classification grade 3., Results: Eighty patients were eligible for analysis. Sensitivity (Y: 56.2%, S: 28.1%, P < .001) and specificity (Y: 85.4%, S: 93.8%, P = .038) in identifying severe clinical symptoms patients (i.e., Cole grade 3) were statistically different between Y and S classifications. A low but significant overall correlation was observed for both Y (rho = 0.372, P < .001) and S (rho = 0.439, P < .001) classifications when compared with Cole classification. Diagnostic odds ratio (DOR) for Y (DOR: 7.53, 95% confidence interval [CI]: 4.15-10.90) and S (DOR: 5.87, 95% CI: 1.86-9.87) were equivalent (P = .92). Also, receiver operating characteristic curves area under the curve were not significantly different between them. The positive likelihood ratio was 3.86 (95% CI: 1.82-8.16) and 4.50 (95% CI: 1.32-15.36) for Y and S, respectively., Conclusions: Y and S grading systems showed a low sensitivity and moderate to high specificity in detecting patients with severe clinical manifestations. Correlation between Y/S and Cole et al. grading were also considered low. Development of a more discriminative anatomic grading system is still needed for this specific disorder., Level of Evidence: 2b. Laryngoscope, 128:502-508, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications., Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates., Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015., Results: 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001)., Conclusion: Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities., (Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To identify the effects of laryngeal surgical treatment in the voice of transgender women, especially on the fundamental frequency (f0)., Study Design: We performed a systematic review in PubMed and Scopus in July 2016, covering the period between 2005 and 2016., Methods: Inclusion criteria were studies in English or Portuguese about the laryngeal surgical treatment in transgender women, featuring experimental design, title, year of publication, country of origin, journal of publication, participants, intervention, results. For the meta-analysis, only studies that had control group were selected. Exclusion criteria were articles that mentioned the use of surgical techniques but did not use the procedure in research, animal studies, studies of revision, and postmortem studies., Results: Four hundred and twenty-three articles were identified in the initial search; 94 were selected for analysis by two referees, independently. After applying all the selection criteria, five studies remained in the meta-analysis. The surgical procedures that were identified included laryngoplasty with or without thyrohyoid approximation, Wendler glottoplasty, cricothyroid approximation, laser glottoplasty reduction and the vocal fold shortening and retrodisplacement of anterior commissure. There was no significant difference between the experimental group and the control group in relation to f0., Conclusion: No randomized clinical trials and prospective cohort studies are available, and a small number of retrospective cohort and case-control studies of surgical techniques reveal an increase in the f0. The evidence produced is not conclusive regarding which surgical technique would be better for vocal treatment of transgender women., Level of Evidence: NA Laryngoscope, 127:2596-2603, 2017., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

Maxillary hypoplasia (MH) is a rare cause of respiratory dysfunction in infants and may occur in association with genetic abnormalities or as an isolated condition. It is included in the differential diagnosis of congenital nasal obstruction. This paper seeks to report a case series of infants with MH, discuss methods for its diagnosis, and compare computed tomography (CT) measurements of nasal cavities of infants with MH and without craniomaxillofacial abnormalities. The therapeutic approach in each patient is also described. All infants with MH admitted to a tertiary hospital between 2012 and 2015 were included. Baseline nasal endoscopy was performed at bedside. The width of the infants' nasal cavities was measured by a radiologist with experience in CT scanning of facial bones. Control patients were infants of matched sex and similar age who underwent head CT scanning for various reasons. Overall, 8 infants with MH and 8 controls were assessed. All nasal cavity dimensions of infants with MH were significantly smaller than those of control subjects. The authors conclude that the diagnosis of MH should be considered in infants with nasal obstruction and nasal cavity narrowing at nasal endoscopy.

The objective of this study is to determine the incidence of post-extubation acute laryngeal lesions in a pediatric intensive care unit (PICU) and potential risk factors. Children, aged 28 days to 5 years, admitted to the PICU who required endotracheal intubation for at least 24 h were enrolled. Exclusion criteria were a previous intubation, history of laryngeal disease, current or past tracheostomy, the presence of craniofacial malformations and patients considered on palliative care. All patients underwent flexible fiber-optic laryngoscopy (FFL) not later than 8 h after extubation. A blinded researcher identified and classified laryngeal lesions based on recorded media. 231 children were enrolled between November 2005 and December 2015. At FFL examination, 102 children (44.15%) presented moderate to severe laryngeal lesions. On a multivariable analysis, we found that for each additional day with repositioning of the endotracheal tube, there was an increase of 7.3% (RR 95% CI 1.012-1.137; P = 0.018) on the baseline risk of developing moderate to severe acute laryngeal lesions. Furthermore, for each additional dose of sedation per day of intubation, there was also an increase of 3.5% on the same baseline risk (RR 95% CI 1.001-1.070; P = 0.041). The amount of tube repositioning episodes and the need for extra doses of sedation (as a proxy for possible agitation) were found to be associated with acute laryngeal lesions. Adequate sedation and minimized tube repositioning should be pursued to possibly prevent the development of post-extubation airway compromise.

Objective: To analyze the level of sedation in intubated children as a risk factor for the development of subglottic stenosis., Methods: All patients between 30 days and 5 years of age who required endotracheal intubation in the pediatric intensive care unit between 2013 and 2014 were included in this prospective study. They were monitored daily and COMFORT-B scores were obtained. Flexible fiber-optic laryngoscopy was performed within eight hours of extubation, and repeated seven to ten days later if the first examination showed moderate to severe laryngeal injuries. If these lesions persisted and/or if the child developed symptoms in the follow-up period, microlaryngoscopy under general anesthesia was performed to evaluate for subglottic stenosis., Results: The study included 36 children. Incidence of subglottic stenosis was 11.1%. Children with subglottic stenosis had a higher percentage of COMFORT-B scores between 23 and 30 (undersedated) than those who did not develop subglottic stenosis (15.8% vs. 3.65%, p=0.004)., Conclusion: Children who developed subglottic stenosis were less sedated than children who did not develop subglottic stenosis., (Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: Systematically search literature for flexible fiberoptic laryngoscopy (FFL) use in Robin Sequence (RS) patients, in diverse clinical scenarios., Data Sources: Pubmed, LILACS and SCIELO., Review Methods: Systematic review using a sensitive search strategy focused on RS patients and FFL., Results: There were 48 full text articles included in this systematic review. No summary meta-analytic measurement could be calculated due to heterogeneity of interventions and outcomes. FFL approaches were grouped in five topics, as follows: Endoscopic classification: no evidence on superiority of awake over light sedation and correlation of grading scales with symptom severity. Airway abnormalities: high incidence of concomitant lesions besides glossoptosis. Swallowing evaluation: no validation against fluoroscopy (gold standard) yet. Intubation aid for mechanical ventilation: ultra-thin bronchoscopes improve success rates of intubation. Treatment outcome monitoring: no consensus on ideal parameters to be checked., Conclusion: Some applications have their roles already well established in the management of RS patients, like the evaluation of glossoptosis and associated lesions and as an intubation assistance tool, while others need to be the subject of further research, like the exact method of evaluation, its association with clinical manifestations, its role in swallowing investigation and as a postoperative success predictor., (Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Objective: To investigate the accuracy of clinical evaluation of swallowing in a sample of children with laryngomalacia or glossoptosis and describe the prevalence of dysphagia in each of these diseases, as well as characterize the swallow response to speech and language therapy interventions., Study Design: Children aged 1 month to 11 years receiving care at the Department of Otolaryngology, Hospital de Clínicas de Porto Alegre, Brazil, were evaluated in a cross-sectional design. Evaluation of swallowing was performed at two time points by two blinded speech-language pathologists, one responsible for clinical evaluation and the other for videofluoroscopic study. The protocols employed were based on the instruments proposed by DeMatteo et al. (DeMatteo C, Matovich D, Hjartarson A. Comparison of clinical and videofluoroscopic evaluation of children with feeding and swallowing difficulties. Dev Med Child Neurol 2005;47:149-157.)., Results: The study sample consisted of 29 patients: 10 patients with laryngomalacia and 19 patients with glossoptosis. The sensitivity of clinical evaluation did not exceed 50% in any of the evaluations, but specificity reached 100% in some cases, using thickened liquids. The prevalence of dysphagia was 100%, and the use of thickened liquids significantly reduced tracheal aspiration., Conclusions: Dysphagia was highly prevalent in this sample. The sensitivity of clinical evaluation to detect laryngeal penetration and tracheal aspiration was low, as the majority of aspiration events were silent. The videofluoroscopic study is important in order to determine a safest method to feed the patient. Pediatr Pulmonol. 2017;52:41-47. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Objectives: The aim of the study was to verify the answers to the transsexual voice questionnaire for male-to-female transsexual (TVQ MtF ) people given to individuals who participated in the Gender Identity Program (PROTIG) at the Hospital de Clínicas de Porto Alegre, Brazil, in relation to some of their demographic characteristics, visual-perceptual evaluations of the face, laryngeal prominence, and auditoryperceptual judgments of voice., Methods: In this cross-sectional study, 47 transsexual women aged between 18 and 50 responded to the (TVQ MtF ). The demographic data and perceptual ratings were selected from the PROTIG database., Results: Among all participants, 55.32% had completed secondary education, and 72.34% had not undergone a sex reassignment surgery; 4.2% of subjects did not use hormones, 23.40% had undergone speech therapy, the average number of years of experience in the female role was 13.98 years, and the participants had been definitively cross-dressing for 5-34 years. Most of the participants had low scores on the (TVQ MtF ), and significant differences in the total score were observed in accordance with age (higher scores were observed among those <30 years and ≥40 years old) and visual-perceptual evaluations of the face (higher scores were observed in the individual evaluated with masculine face). There were no significant correlations between the total score obtained by the participants and the other demographic variables., Conclusions: Although most of the participants had low scores on the (TVQ MtF ), some individuals were still experiencing distress due to being perceived as being of the opposite sex or were dissatisfied with their voices., (Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)