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Purpose Endometrial cancer is the most common gynecological malignancy. The helicase RIG-I, a part of the innate immune system, and EFTUD2, a splicing factor which can upregulate RIG-I expression, are shown to influence tumor growth and disease progression in several malignancies. For endometrial cancer, an immunogenic cancer, data about RIG-I and EFTUD2 are still missing. The aim of this study was to examine the expression of RIG-I and EFTUD2 in endometrial cancer. Methods 225 specimen of endometrial cancer were immunohistochemically stained for RIG-I and EFTUD2. The results were correlated to clinicopathological data, overall survival (OS) and progression-free survival (PFS). Results High RIG-I expression correlated with advanced tumor stages (FIGO: p = 0.027; pT: p = 0.010) and worse survival rates (OS: p = 0.009; PFS: p = 0.022). High EFTUD2 expression correlated to worse survival rates (OS: p = 0.026; PFS: p Conclusion Our data suggest that the expression of RIG-I and EFTUD2 correlates with survival data, which makes both a possible therapeutic target in the future.

ZusammenfassungDer Übersichtsartikel beinhaltet eine Zusammenstellung seltener Erkrankungen von Larynx, Trachea und Schilddrüse. Im Speziellen werden angeborene Fehlbildungen, seltene Formen der entzündlichen Larynxerkrankungen, gutartige und bösartige epitheliale sowie nicht-epitheliale Tumoren, laryngeale und tracheale Manifestationen von Allgemeinerkrankungen und schließlich seltene Erkrankungen der Schilddrüse besprochen. Die einzelnen Kapitel beinhalten eine Übersicht über die Datenlage in der Literatur, das jeweilige klinische Erscheinungsbild, wichtige Stichpunkte zur Diagnostik und zur Therapie und eine abschließende Stellungnahme zur Prognose der Erkrankung. Des Weiteren finden sich Hinweise zu Studienregistern und Selbsthilfegruppen.

European archives of oto-rhino-laryngology and head & neck 279(1), 293-298 (2022). doi:10.1007/s00405-021-07067-y, Published by Springer, Berlin ; Heidelberg

The platelet-activating factor receptor (PAFR) and its ligand (PAF) are important inflammatory mediators that are overexpressed in ovarian cancer. The receptor is an important player in ovarian cancer development. In this study, we aimed to evaluate the prognostic value of PAFR in epithelial ovarian cancer (EOC) and the potential use of its antagonist, Rupatadine as an experimental treatment. Tissue microarrays of ovarian cancer patients, most markedly those with a non-mucinous subtype, immunohistochemically overexpressed PAFR. Elevated cytoplasmic PAFR expression was found to significantly and independently impair patients’ overall and recurrence-free survival (OS: median 83.48 vs. 155.03 months; p=0.022; RFS: median 164.46 vs. 78.03 months; p=0.015). In vitro, especially the serous ovarian cancer subtypes displayed an elevated PAFR gene and protein expression. siRNA knockdown of PAFR decreased cell proliferation significantly, thus confirming the receptor's protumorigenic effect on ovarian cancer cells. The clinically approved PAFR antagonist Rupatadine effectively inhibited in vitro cell proliferation and migration of ovarian cancer cells. PAFR is a prognostic marker in ovarian cancer patients and its inhibition through Rupatadine may have important therapeutic implications in the therapy of ovarian cancer patients.

Purpose Flexible endoscopic evaluation of swallowing (FEES®) is a standard diagnostic tool in dysphagia. The combination of FEES® and narrow band light (narrow band imaging; NBI) provides a more precise and detailed investigation method. So far, this technique could only be performed with the NBI illumination. The new version of the “professional image enhancement technique” (PIET) provides another image enhancing system. This study investigates the eligibility of PIET in the FEES® procedure. Methods Both techniques, NBI and PIET, were compared using a target system. Furthermore, the image enhancement during FEES® was performed and recorded with the two systems during daily routine. Results Performing an image enhancement during FEES® is possible with both systems PIET and NBI. On the target system, the contrast of the PIET showed a brighter and a more detailed picture. In dysphagia patients, no difference between PIET and NBI was detected. Conclusions PIET proved to be non-inferior to NBI during image enhancement FEES®. So far, image enhancement FEES® was exclusively connected to NBI. With the PIET system, an alternative endoscopy technology is available for certain indications.

In light of the superior analgesia and opioid sparing effects provided by transversus abdominis plane (TAP) blocks, numerous new techniques and applications have evolved. However, TAP blocks are still underutilized in the critical care setting, and PubMed‑listed reports on the relevance of TAP integrity for TAP block efficacy are lacking. Here, we report bilateral TAP blocks delivering quick, potent and durable pain relief to a patient with open abdomen (OA) after prior management with opioids and epidural anesthesia had failed. Extending TAP block application to OA patients even in the post‑operative setting might hence reduce opioid consumption and quicken reconvalescence.

Purpose The surface store governs the rainwater partition, e.g., water storage and evaporation on paved surfaces, especially for low-intensity and low-sum rain events, which account for the greatest part of the total rainfall in a temperate climate city like Berlin, Germany. The surface store S is a fixed value, dependent on surface relief and pore system characteristics. Contrary, in this study, the surface storage was assumed to depend also on the rain intensity, thus being variable from event to event. Materials and methods The surface store filling dynamics for dense (DP), porous (PP), and highly infiltrative (IP) paving materials were studied in a rainfall simulator. Irrigation intensities p ranged from 0.016 to 0.1 mm min−1 which represent the 25 to 88% quantiles of the rain event distribution in Berlin, Germany (1961 to 1990). Results and discussion Three surface stores can be separated: storage until initial runoff, Sf, at maximum filling, Sm, and for steady-state runoff, Seq—all of them can be regarded as effective stores depending on the aim of its use. The equilibrium store varies from 0.2 to 3 mm for DP, PP, and IP for the investigated rainfall intensities. Conclusions For all pavers, the surface store depends on rainfall intensity, which was shown experimentally and confirmed by numerical simulation of the infiltration. We introduce a simple and robust method to describe Sf, Sm = f(p) for different pavers. Pavers can evaporate a multiple of their surface store per day, depending on the rainfall distribution, which implicates the need for high temporal resolutions in urban hydrology modeling. Pavers can evaporate a multiple of their surface store per day, depending on the rainfall distribution. That implicates the need for high temporal resolutions in urban hydrology modeling.

General methodology of Life Cycle Assessment that will be used to assess the environmental evaluation of each case study. This includes the description of the used methods and tools, as well as information that applies for all studied systems. The document also comprises the methodological approach, the interpretation concept and specific assumptions for the innovative production strategies assessed within the CS of Circular Agronomics. All studied systems are described in detail and a brief overview over the further steps of the environmental assessment, including data collection and calculations is given.

Kurzfassung Um im ruinösen Wettbewerb der Containerschifffahrt zu bestehen, suchen Reedereien und Logistikdienstleister nach neuen Geschäftsmodellen, die durch den Einsatz digitaler Technologien ermöglicht werden. Hierfür wurde ein Modell entwickelt, welches Unternehmen ermöglicht, neue Anwendungsszenarien und Geschäftsmodell-Innovationen im bestehenden Umfeld der Containerlogistik zu entwickeln und am Markt zu etablieren. Der vorliegende Beitrag zeigt die aktuellen Marktgegebenheiten in der Containerlogistik und gibt einen Ausblick darüber, wie die vierte industrielle Revolution den Container der Zukunft prägen wird.

ZusammenfassungDie totale Laryngektomie stellt nach wie vor ein Standardverfahren zur Therapie fortgeschrittener Larynx- und Hypopharynxkarzinome dar. Der Verlust des stimmbildenden Organs schränkt die Lebensqualität der Betroffenen maßgeblich ein. Die am häufigsten eingesetzte Technik zur Stimmrehabilitation ist die tracheoösophageale Punktion mit Einsatz eines Stimmventils. Zu den chirurgischen Verfahren der Stimmrehabilitation gehört unter anderem die Larynxrekonstruktion mit einem Unterarmlappen. Im Rahmen dieser monozentrischen retrospektiven Analyse wurden Patienten betrachtet, die zwischen 2006 und 2015 nach totaler Laryngektomie mit einer solchen sogenannten Laryngoplastik versorgt wurden. Fokus der Untersuchung lag auf der Beurteilung von funktionellen Langzeitergebnissen und Komplikationen. Insgesamt konnten 39 Patienten in die Studie eingeschlossen werden, von denen bei 77 % eine dauerhafte Phonation über das Transplantat möglich war, bei 62 % sogar fingerfrei. Nach Ausschluss adjuvant bestrahlter Patienten lag die Rate der erfolgreichen Stimmrehabilitation bei 91 % (20 / 22). Das postoperative Halshämatom war mit 15 % die häufigste Frühkomplikation, Lappennekrosen traten nicht auf. Die häufigste Spätkomplikation war die Stenosierung des Laryngoplastiklumens, welche in der Regel als Folge einer Radiatio auftrat. Im Vergleich zu Daten aus der Literatur ist die Rate erfolgreich stimmrehabilitierter Patienten annähernd gleichwertig zur Versorgung mit einem Stimmventil, allerdings mit qualitativ besseren Ergebnissen. Komplikationen, die durch das Stimmventil bedingt sind und in seltenen Fällen schwerwiegend sein können, treten bei Laryngoplastikpatienten nicht auf. Die lebenslange Notwendigkeit zum regelmäßigen Stimmventilwechsel entfällt. Bei korrekter Indikationsstellung ist die Laryngoplastik eine suffiziente Methode zur Stimmrehabilitation nach Laryngektomie.

Objectives: • To ensure that knowledge developed during the project is properly captured and dissemination is effectively targeted and carried out systematically • To promote a continuous knowledge exchange and transfer for project outcomes with interested stakeholders beyond the consortium • To formulate fact based policy recommendations that stimulate the transition towards a circular economy • To create public awareness concerning the need for a circular economy and the actions required to move towards its realisation

Wet compression molding (WCM) provides large-scale production potential for continuously fiber-reinforced structural components due to simultaneous infiltration and draping during molding (viscous draping). Experimental and theoretical investigations proved strong mutual dependencies between resin progression and textile draping. Significant cavity pressures only develop towards the end of the tool stroke, when the cavity is almost filled with resin and fibers. Therefore, the resin’s impact on the draping behavior (intra-ply and interface behavior) is of great relevance, since it represents a large share of the draping process. This study extends the work presented by Huttl et al. [1] with experimental interface tests on dry and infiltrated woven fabrics, which confirm rate-, pressure- and viscosity-dependent tangential contact behavior within the viscous draping stage. Furthermore, experimental results for the ply-ply interface are utilized to parametrizes a contact model, which is subsequently applied to assess and evaluate the process relevance on part level by means of FE forming simulation. Although a relatively simple geometry has been investigated, numerical results show a significant impact of the infiltration-depended tangential contact formulation on part level. Beyond that, an investigation of the ply-ply contact state (pressure or tension) reveal that transversal pressure is only predominate towards the end of the tool stroke. Consequently, contact characterization and parametrization should also include tests at low transversal pressure.

The surface store governs the rainwater partition, e.g., water storage and evaporation on paved surfaces, especially for low-intensity and low-sum rain events, which account for the greatest part of the total rainfall in a temperate climate city like Berlin, Germany. The surface store S is a fixed value, dependent on surface relief and pore system characteristics. Contrary, in this study, the surface storage was assumed to depend also on the rain intensity, thus being variable from event to event. The surface store filling dynamics for dense (DP), porous (PP), and highly infiltrative (IP) paving materials were studied in a rainfall simulator. Irrigation intensities p ranged from 0.016 to 0.1 mm min−1 which represent the 25 to 88% quantiles of the rain event distribution in Berlin, Germany (1961 to 1990). Three surface stores can be separated: storage until initial runoff, Sf, at maximum filling, Sm, and for steady-state runoff, Seq—all of them can be regarded as effective stores depending on the aim of its use. The equilibrium store varies from 0.2 to 3 mm for DP, PP, and IP for the investigated rainfall intensities. For all pavers, the surface store depends on rainfall intensity, which was shown experimentally and confirmed by numerical simulation of the infiltration. We introduce a simple and robust method to describe Sf, Sm = f(p) for different pavers. Pavers can evaporate a multiple of their surface store per day, depending on the rainfall distribution, which implicates the need for high temporal resolutions in urban hydrology modeling. Pavers can evaporate a multiple of their surface store per day, depending on the rainfall distribution. That implicates the need for high temporal resolutions in urban hydrology modeling.

Hintergrund: Im Rahmen der Transition von Mann zu Frau ist die Stimmtherapie ein wichtiger Bestandteil einer ganzheitlichen Therapie. Die Therapie besteht aus konservativ logopadischen und operativen Ansatzen, es existieren allerdings keine einheitlichen Standards. Neben der Sprechstimmlage wird die Geschlechtswahrnehmung von vielen Faktoren wie Formantfrequenzen, Intonation, Prosodie und Verhaltensmerkmalen beeinflusst. Material und Methoden: Bei 21 transsexuellen Patientinnen nach operativer Stimmerhohung wird ein eigenes Addendum zu etablierten Fragebogen wie dem Voice Handicap Index (VHI) und dem Fragebogen zur Lebenszufriedenheit (FLZ) eingefuhrt. Es wird ein neuer Therapiealgorithmus hergeleitet. Dieser ist unabhangig von der gewahlten Operationsmethode einsetzbar. Ergebnisse: Durch die Stimmerhohungsoperation ist das Selbstbewusstsein der Patientinnen stark gestiegen. Identifikationsprobleme aufgrund der veranderten Stimme traten nicht auf. Trotz der erhohten Stimme sind einige Patientinnen mit ihrer Stimme subjektiv nicht zufrieden. Schlussfolgerungen: Durch die stimmerhohende Operation wird die Sprechstimmlage als einziger Parameter verandert. Fur einen weiblicheren Stimmklang sollte logopadische Therapie als notige Voraussetzung vor der Indikationsstellung operativer Masnahmen stehen. Hierbei kann neben der Stimmlage auch an den anderen Parametern der Geschlechtszuordnung gearbeitet werden. Kann durch logopadische Therapie ein zufriedenstellend weiblicher Stimmklang erreicht werden, ist eine Operation nicht indiziert.

Recent developments and innovations in the field of P recovery and recycling from municipal sewage sludge claim to provide a sustainable and more efficient alternative to the traditional sludge valorization in agriculture. The method of life cycle assessment (LCA) offers a detailed analysis of the potential environmental impacts associated with different technologies, but it needs to be based on sound definitions and validated input data, not only for the specific technologies but also for the methodological framework. Since the relevant ISO standards 14040/44 provide methodological guidance without specifically fixed definitions, the application of LCA leaves a lot of potential for interpretation of results. Within the European research project P-REX, a methodological framework was developed to assess various available technologies for P recovery from sewage sludge, sludge liquor or incineration ash. Decisive definitions are the setting of adequate system boundaries and functional unit, the selection of LCA indicators and their interpretation. The following chapter discusses important definitions of the LCA methodology and provides recommendations towards a consolidated approach for future LCA studies in the field of P recovery from sewage sludge.

Kreislaufwirtschaft fur Nahrstoffe! Wie transformiert man „buzz words“ in die Praxis? Noch immer bleiben sowohl Phosphorruckgewinnungs- bzw. Recyclingpotentiale

Einleitung: Als haufigste Ursache der traumatischen Trommelfellperforation ist die Anwendung von Wattestabchen zur Gehorgangsreinigung bekannt. Weitere Ursachen sind beschrieben, ausfuhrliche statistische Aussagen von einem groseren nationalen Patientenkollektiv liegen in der Literatur allerdings nicht vor. Als Therapie hat sich das Auskrempeln der Perforationsrander mit anschliesender Schienung sowie einer Gehorgangstamponade bewahrt. Methoden und Ergebnisse: In der vorliegenden Arbeit wurden retrospektiv die Dokumentationen der Klinik und Poliklinik fur Hals-, Nasen und Ohrenkrankheiten, plastische und asthetische Operationen der Universitat Wurzburg von Patienten mit einer traumatischen Trommelfellperforation aus den Jahren 2005–2010 untersucht. Bei den 238 Patienten zahlten neben Wattestabchen (19,3%) hauptsachlich Schlage mit der flachen Hand (37,4%), aber auch Wasserturmsprunge (13,0%), zu den haufigsten traumatischen Ursachen. In der vorliegenden Studie werden die Atiologie sowie die Ergebnisse nach Trommelfellschienungen mit Silikon- oder Papierschienen dargestellt. Die Perforationsverschlussraten liegen abhangig vom verwendeten Schienungsmaterial (Papierschiene, Silikonfolie) zwischen 71,9 und 81,8%. Eine wichtige Rolle spielt neben dem Heilungsverlauf auch die aus subjektiver Horminderung, Otalgien oder Ohrgerauschen bestehende Gesamtzufriedenheit des Patienten. Schlussfolgerung: Haufigste nationale Ursache einer traumatischen Trommelfellperforation in Deutschland ist der Schlag auf das Ohr. Die Therapie der Wahl ist die Auskrempelung und Schienung des Trommelfells. Ein Unterschied zwischen Silikon- oder Papierschienung konnte nicht gesehen werden. Dies ist die erste Studie eines groseren nationalen Patientenkollektivs zur Atiologie der traumatischen Trommelfellperforation.

Purpose: Targeted next-generation sequencing provides a remarkable opportunity to identify variants in known disease genes, particularly in extremely heterogeneous disorders such as nonsyndromic hearing loss. The present study attempts to shed light on the complexity of hearing impairment. Methods: Using one of two next-generation sequencing panels containing either 80 or 129 deafness genes, we screened 30 individuals with nonsyndromic hearing loss (from 23 unrelated families) and analyzed 9 normal-hearing controls. Results: Overall, we found an average of 3.7 variants (in 80 genes) with deleterious prediction outcome, including a number of novel variants, in individuals with nonsyndromic hearing loss and 1.4 in controls. By next-generation sequencing alone, 12 of 23 (52%) probands were diagnosed with monogenic forms of nonsyndromic hearing loss; one individual displayed a DNA sequence mutation together with a microdeletion. Two (9%) probands have Usher syndrome. In the undiagnosed individuals (10/23; 43%) we detected a significant enrichment of potentially pathogenic variants as compared to controls. Conclusion: Next-generation sequencing combined with microarrays provides the diagnosis for approximately half of the GJB2 mutation–negative individuals. Usher syndrome was found to be more frequent in the study cohort than anticipated. The conditions in a proportion of individuals with nonsyndromic hearing loss, particularly in the undiagnosed group, may have been caused or modified by an accumulation of unfavorable variants across multiple genes.

Increasing attention has been directed toward assessing mutational fallout of stereocilin (STRC), the gene underlying DFNB16. A major challenge is due to a closely linked pseudogene with 99.6% coding sequence identity. In 94 GJB2/GJB6-mutation negative individuals with non-syndromic sensorineural hearing loss (NSHL), we identified two homozygous and six heterozygous deletions, encompassing the STRC region by microarray and/or quantitative polymerase chain reaction (qPCR) analysis. To detect smaller mutations, we developed a Sanger sequencing method for pseudogene exclusion. Three heterozygous deletion carriers exhibited hemizygous mutations predicted as negatively impacting the protein. In 30 NSHL individuals without deletion, we detected one with compound heterozygous and two with heterozygous pathogenic mutations. Of 36 total patients undergoing STRC sequencing, two showed the c.3893A>G variant in conjunction with a heterozygous deletion or mutation and three exhibited the variant in a heterozygous state. Although this variant affects a highly conserved amino acid and is predicted as deleterious, comparable minor allele frequencies (MAFs) (around 10%) in NSHL individuals and controls and homozygous variant carriers without NSHL argue against its pathogenicity. Collectively, six (6%) of 94 NSHL individuals were diagnosed with homozygous or compound heterozygous mutations causing DFNB16 and five (5%) as heterozygous mutation carriers. Besides GJB2/GJB6 (DFNB1), STRC is a major contributor to congenital hearing impairment.

Die Fahigkeit Sprachsignale in lauter Umgebung wahrzunehmen und zu verstehen gehort zu den erstaunlichsten Eigenschaften des auditorischen Systems. Patienten mit einer Horstorung beklagen ein reduziertes Sprachverstandnis im Umgebungslarm. Zur qualitativen Erfassung des Sprachverstandnis von Erwachsenen und Schulkindern im Storschall werden standardisierte Testverfahren wie der HSM-Test, der OLSA oder der OlKiSa verwendet. Fur die Kinderaudiometrie von Kindergarten- und Vorschulkindern existieren jedoch bis heute wenig vergleichbare Sprachtests zur Anwendung im Storschall. Das Ziel dieser Arbeit war die Evalua­tion und Standardisierung des neu entwickelten Wurzburger Kindersprachtest im Storlarm. Es wurden 24 normal horende Kinder im Alter von 5 bis 9 Jahren mit dem Test IV des Wurzburger Kindersprachtests – 3 Listen zu je 20 zweisilbige Worter – untersucht. Als Storgerausch diente das Wurzburger Rauschen, das durch eine zeitversetzte 32-fache Uberlagerung des Sprachmaterials generiert wurde. Fur jedes Kind gelang es, bei einem Sprachpegel von 60 dB SPL, die Sprachverstandlichkeitsschwelle (SRT) in Abhangigkeit zum Signalrauschabstand (SNR) zu bestimmen. Sie betrug im Durchschnitt −8,3 dB SNR; −7,7 dB SNR fur die Liste 1, −9,2 dB SNR fur die Liste 2 und −8,1 dB SNR fur die Liste 3. Die Ergebnisse zeigen, dass der Wurzburger Kindersprachtest geeignet ist, das individuelle Sprachverstandnis eines Kindes im Storlarm zu bestimmen. Die SRT betrug im Durchschnitt −8,3 dB SNR. Dieses Ergebnis ist vergleichbar mit bislang publizierten Daten. Als ursachlich fur die Streubreite der SRT-Werte sind interindividuelle Unterschiede der Probanden zu nennen, wie Motivation, Konzentration und Stand der Sprachentwicklung des Kindes. Alle 3 Listen des Wurzburger Kindersprachtest waren in den Ergebnissen Vergleichbar.

In the aftermath of the adoption of the Sustainable Development Goals (SDGs) and the Paris Agreement (COP21) by virtually all United Nations, producing more with less is imperative. In this context, phosphorus processing, despite its high efficiency compared to other steps in the value chain, needs to be revisited by science and industry. During processing, phosphorus is lost to phosphogypsum, disposed of in stacks globally piling up to 3–4 billion tons and growing by about 200 million tons per year, or directly discharged to the sea. Eutrophication, acidification, and long-term pollution are the environmental impacts of both practices. Economic and regulatory framework conditions determine whether the industry continues wasting phosphorus, pursues efficiency improvements or stops operations altogether. While reviewing current industrial practice and potentials for increasing processing efficiency with lower impact, the article addresses potentially conflicting goals of low energy and material use as well as Life Cycle Assessment (LCA) as a tool for evaluating the relative impacts of improvement strategies. Finally, options by which corporations could pro-actively and credibly demonstrate phosphorus stewardship as well as options by which policy makers could enforce improvement without impairing business locations are discussed.

Adoptive T cell transfer (ACT) is currently under investigation for the treatment of metastatic cancer. Recent evidence suggests that the coinhibitory PD-1-PD-L1 axis plays a major role in ACT failure. We hypothesized that a new fusion receptor reverting PD-1-mediated inhibition into CD28 costimulation may break peripheral tolerance.Different PD-1-CD28 fusion receptor constructs were created and retrovirally transduced into primary T cell receptor transgenic murine CD8(+) T cells specific for ovalbumin (OT-1). Cytokine release, proliferation, cytotoxicity, and tumor recognition were analyzed in vitro. Antitumor efficacy and mode of action were investigated in mice bearing subcutaneous tumors induced with the pancreatic carcinoma cell line Panc02 expressing the model antigen ovalbumin (Panc-OVA). For antitumoral efficacy, six to eight mice per group were used. All statistical tests are two-sided.Transduction of the PD-1-CD28 receptor constructs mediated enhanced cytokine release, T cell proliferation, and T cell-induced lysis of target tumor cells. The PD-1-CD28 receptor function was dependent on two of the CD28-signaling motifs and IFN-γ release. Treatment of mice with established Panc-OVA tumors with fusion receptor-transduced OT-1 T cells mediated complete tumor regression. Mice rejecting the tumor were protected upon subsequent rechallenge with either ovalbumin-positive or -negative tumors, indicative of a memory response and epitope spreading in nine of 11 mice vs none of the six naïve mice (P.001). Treatment efficacy was associated with accumulation of IFN-γ-producing T cells and an increased ratio of CD8(+) T cells to immunosuppressive myeloid-derived suppressor cells in the tumors.Transduction of T cells with this new PD-1-CD28 receptor has the potential of breaking the PD-1-PD-L1-immunosuppressive axis in ACT.

Summary Objectives The present study reports objective and subjective voice results of Wendler's glottoplasty modified by Hagen. Study design This is an outcomes research study. Methods A total of 21 patients underwent Wendler's glottoplasty modified by Hagen. Parameters in the follow-up session were laryngoscopy, voice range profile, Voice Handicap Index, Life Satisfaction Questionnaire, and a visual analog scale for individual satisfaction with the voice. Results The fundamental frequency was elevated into the typical female fundamental frequency range. Furthermore, an elevation of the lower frequency limit was shown without a reduction of the frequency range. About one third of the population feels affected by the restricted dynamic range. This change of the vocal pitch is seen as part of the voice feminization by some of the patients. The Dysphonia Severity Index as a marker for voice quality was unchanged. Subjective satisfaction with the voice showed a strong correlation with the individual elevation of the pitch. Conclusion Wendler's glottoplasty modified by Hagen is an effective and low-risk method of raising the vocal pitch of male-to-female transgender persons. However, elevated Scores of the Voice Handicap Index indicated that in everyday life, transgender persons continue to feel handicapped because of their voice. Another indicator for the lack of social acceptance and integration is the reduced general life satisfaction in the Life Satisfaction Questionnaire especially in the domain “friends, acquaintances, relatives.” Therefore, a better multidisciplinary therapy concept for voice feminization is necessary.

To determine (1) levels on fibrous tissue and bony growth around the ceramic receiver-stimulator of cochlear implants in situ and (2) if these ceramic receiver-stimulators can withstand a tractive force of 5 N without displacing.During revision surgery, we measured the extent of the fibrous tissue and bone growth around the receiver-stimulators in 13 subjects. After completely exposing the receiver-stimulator, we measured the tractive force it could withstand without displacing. The tractive force was gradually increased until either displacement or a force of approximately 5.5 N was reached.In 6 out of 10 subjects the receiver-stimulator did not displace when up to 5 N of tractive force was applied. Three subjects could not be evaluated. Statistical analysis was not possible due to the small sample size; however, we found no correlation between the degree of bone growth around the receiver-stimulator and (1) the length of time the implants remained in situ before revision or (2) the tractive force a receiver-stimulator could withstand without displacing. Discussion As bone growth around the receiver-stimulator is often limited, even years after implantation, it might therefore only play a minor role in preventing displacement. In contrast, fibrous tissue encapsulation of the implant bed of the receiver-stimulator may be the key stabilizing factor. In any case, when completely exposed, the 6 out of 10 receiver-stimulators could still withstand a tractive force of 5 N (calculated force generated by magnetic resonance imaging (MRI) with 1.5 T) without displacing.During MRI, it is strongly recommended to secure ceramic receiver-stimulators with an external pressure bandage in order to minimize risk and possible user discomfort.