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The purpose of this study is twofold: (1) to determine the feasibility of optical coherence tomography (OCT) to differentiate normal and diseased tissue of the neck region intraoperatively and (2) to evaluate how accurately a cohort of test subjects can identify various tissue types when shown a sample set of OCT images. In this in vivo, prospective, single institutional study, an OCT imaging system (Niris, Imalux, Cleveland, OH) was used to image parathyroid, thyroid, lymph node, and fat tissue in 76 patients during neck surgery. Biopsies were performed for comparison of OCT images with histology in select cases (n = 20). Finally, a group of either surgeons or scientists familiar with OCT (n = 17) were shown a sample of OCT images and asked to identify the tissue. A total of 437 OCT images were analyzed, and characteristic features of each tissue type were identified. OCT demonstrated distinct differences in structural architecture and signal intensity that allows differentiation between thyroid and parathyroid tissues, lymph nodes, and fat. OCT images were also compared with histology with good correlation. There was no difference in correctly identifying OCT-imaged tissue type between surgeons and scientists. This study is the first in vivo OCT imaging study to evaluate both normal and diseased tissues that may be encountered during neck surgery. OCT has the potential to become a valuable intraoperative tool to differentiate diseased and normal thyroid tissue intraoperatively to obtain an "optical biopsy" in real time without fixation, staining, or tissue resection.

Purpose: In this study, we investigated how the direction and timing of a perturbation in voice pitch auditory feedback during phrasal production modulated the magnitude and latency of the pitch-shift reflex as well as the scaling of acoustic production of anticipatory intonation targets for phrasal prominence and boundary. Method: Brief pitch auditory feedback perturbations (±200 cents for 200-ms duration) were applied during the production of a target phrase on the first or the second word of the phrase. To replicate previous work, we first measured the magnitude and latency of the pitch-shift reflex as a function of the direction and timing of the perturbation within the phrase. As a novel approach, we also measured the adjustment in the production of the phrase-final prominent word as a function of perturbation direction and timing by extracting the acoustic correlates of pitch, loudness, and duration. Results: The pitch-shift reflex was greater in magnitude after perturbations on the first word of the phrase, replicating the results from Mandarin speakers in an American English-speaking population. Additionally, the production of the phrase-final prominent word was acoustically enhanced (lengthened vowel duration and increased intensity and fundamental frequency) after perturbations earlier in the phrase, but more so after perturbations on the first word in the phrase. Conclusion: The timing of the pitch perturbation within the phrase modulated both the magnitude of the pitch-shift reflex and the production of the prominent word, supporting our hypothesis that speakers use auditory feedback to correct for immediate production errors and to scale anticipatory intonation targets during phrasal production.

ObjectivesTo present our experience using the first commercially available optical coherence tomography (OCT) device for use in the head, neck, and upper aerodigestive tract and to determine the feasibility and efficacy of this system in comparison with our previous experience using other research OCT systems.MethodsUsing the Niris OCT imaging system (Imalux, Cleveland, OH), we obtained OCT images of benign and premalignant laryngeal disease in 33 patients undergoing surgical head and neck endoscopy. This imaging system has a spatial depth resolution of 10 to 20 mum and a depth scanning range of 2.2 mm, obtaining images of 200 x 200 pixels at a maximum frame rate of 0.7 Hz. The scanning mechanism of the device is located at the distal end of a flexible probe that is placed in contact or near-contact with the area of interest. The tip of the probe was inserted through a rigid laryngoscope, and still images were obtained.ResultsOCT images of arytenoids, aryepiglottic folds, piriform sinus, epiglottis, and true and false vocal cords were obtained. In patients whose OCT images were taken from normal tissue, the normal microstructures were clearly identified, as well as disruption of the latter in malignant pathologies.ConclusionsThe device can easily be incorporated into the operating room and requires minimal set-up and staff to operate. OCT imaging with this device potentially offers an efficient, quick, and reliable imaging modality in guiding surgical biopsies, intraoperative decision making, and therapeutic options of various laryngeal pathologies and premalignant disease.

Objectives: To describe the current and promising new applications of Optical Coherence Tomography (OCT) as a helpful tool when imaging the different sites in the head and neck. We used the OCT Niris system, which is the first commercially available OCT device for applications outside the field of ophthalmology. Methods: OCT images were obtained of normal, benign, premalignant and malignant lesions in different areas of the head and neck. The OCT imaging system has a tissue penetration depth of approximately 1-2mm, a scanning range of 2mm and a spatial depth resolution of approximately 10-20μm. Imaging was performed using a flexible probe in two different settings, the outpatient clinic and the operating room. Results: High-resolution cross-sectional images from the larynx were obtained with the patient awake, without the need for general anesthesia, under direct visualization with a flexible fiberoptic endoscope. The OCT probe was inserted through the nasal cavity and placed in slight contact with the laryngeal tissue. In the ears, cholesteatoma was differentiated from inflamed middle ear mucosa by the different hyperintensity. In the neck, normal as well as different pathologies of the thyroid were identified. Conclusions: This system is non invasive and easy to incorporate into the operating room setting as well as the outpatient clinic. It requires minimal set-up and only one person is required to operate the system. OCT has the distinctive capability to obtain highresolution images, and the microanatomy of different sites can be observed. OCT technology has the potential to offer a quick, efficient and reliable imaging method to help the surgeon not only in the operating room but also in the clinical setting to guide surgical biopsies and aid in clinical decision making of different head and neck pathologies, especially those arising form the larynx. © 2010 Copyright SPIE - The International Society for Optical Engineering.

Objectives: To determine the feasibility and accuracy of the Niris Optical Coherence Tomography (OCT) system in imaging of the mucosal abnormalities of the head and neck. The Niris system is the first commercially available OCT device for applications outside ophthalmology. Methods: We obtained OCT images of benign, premalignant and malignant lesions throughout the head and neck, using the Niris OCT imaging system (Imalux, Cleveland, OH). This imaging system has a tissue penetration depth of approximately l-2mm, a scanning range of 2mm and a spatial depth resolution of approximately 10-20μm. Imaging was performed in the outpatient setting and in the operating room using a flexible probe. Results: High-resolution cross-sectional images from the oral cavity, nasal cavity, ears and larynx showed distinct layers and structures such as mucosa layer, basal membrane and lamina propria, were clearly identified. In the pathology images disruption of the basal membrane was clearly shown. Device set-up took approximately 5 minutes and the image acquisition was rapid. The system can be operated by the person performing the exam. Conclusions: The Niris system is non invasive and easy to incorporate into the operating room and the clinic. It requires minimal set-up and requires only one person to operate. The unique ability of the OCT offers high-resolution images showing the microanatomy of different sites. OCT imaging with the Niris device potentially offers an efficient, quick and reliable imaging modality in guiding surgical biopsies, intra-operative decision making, and therapeutic options for different otolaryngologic pathologies and premalignant disease. © 2009 SPIE.

Meniscus injuries are common and a major cause of long‐term joint degeneration and disability. Current treatment options are limited, so novel regenerative therapies or tissue engineering strategies are urgently needed. The development of new therapies is hindered by a lack of knowledge regarding the cellular biology of the meniscus and a lack of well‐established methods for studying meniscus cells in vitro. The goals of this study were to (1) establish baseline expression profiles and dedifferentiation patterns of inner and outer zone primary meniscus cells, and (2) evaluate the utility of poly(ethylene glycol) diacrylate (PEGDA) and gelatin methacrylate (GelMA) polymer hydrogels to reverse dedifferentiation trends for long‐term meniscus cell culture. Using reverse transcription‐quantitative polymerase chain reaction, we measured expression levels of putative meniscus phenotype marker genes in freshly isolated meniscus tissue, tissue explant culture, and monolayer culture of inner and outer zone meniscus cells from porcine knees to establish baseline dedifferentiation characteristics, and then compared these expression levels to PEGDA/GelMA embedded passaged meniscus cells. COL1A1 showed robust upregulation, while CHAD, CILP, and COMP showed downregulation with monolayer culture. Expression levels of COL2A1, ACAN, and SOX9 were surprisingly similar between inner and outer zone tissue and were found to be less sensitive as markers of dedifferentiation. When embedded in PEGDA/GelMA hydrogels, expression levels of meniscus cell phenotype genes were significantly modulated by varying the ratio of polymer components, allowing these materials to be tuned for phenotype restoration, meniscus cell culture, and tissue engineering applications. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that voice fundamental frequency (fo), or pitch, relies on auditory feedback to monitor and correct for errors in production. When voice-pitch auditory feedback is unexpectedly perturbed, individuals typically produce a compensatory change in fo that opposes the direction of the pitch-perturbation. Studies comparing steady vowel vocalizations and speech tasks have demonstrated task-dependent modulation of the compensatory response, but the effects of planning to volitionally change fo during active vocalization have yet to be explored. Ten musicians and ten non-musicians were asked to perform two vocal tasks. Both tasks started off at a conversational fo. In one task, pitch-shifted feedback was presented when the participants were planning to hold fo constant (steady fo), and in the other, feedback was shifted while participants were in the planning stage prior to raising fo (raised fo) from a steady state. Acoustical analyses of fo were performed to measure the peak magnitude and latency of both the compensatory response as well as the voluntary fo change. Results showed that planning to change pitch modulates the mechanisms controlling feedback-based error correction of fo, and musicality affects how individuals incorporate modulations in auditory feedback with the feedforward plans to increase voice fo. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that voice fundamental frequency (fo), or pitch, relies on auditory feedback to monitor and correct for errors in production. When voice-pitch auditory feedback is unexpectedly perturbed, individuals typically produce a compensatory change in fo that opposes the direction of the pitch-perturbation. Studies comparing steady vowel vocalizations and speech tasks have demonstrated task-dependent modulation of the compensatory response, but the effects of planning to volitionally change fo during active vocalization have yet to be explored. Ten musicians and ten non-musicians were asked to perform two vocal tasks. Both tasks started off at a conversational fo. In one task, pitch-shifted feedback was presented when the participants were planning to hold fo constant (steady fo), and in the other, feedback was shifted while participants were in the planning stage prior to raising fo (raised fo) from a steady state. Acoustical analyses of fo were performed to measure the peak magnitude and latency of both the compensatory response as well as the voluntary fo change. Results showed that planning to change pitch modulates the mechanisms controlling feedback-based error correction of fo, and musicality affects how individuals incorporate modulations in auditory feedback with the feedforward plans to increase voice fo. [ABSTRACT FROM AUTHOR]

Background: Lateral epicondylitis is a common cause of elbow pain that is generally self-limiting. For patients who have persistent symptoms refractory to conservative treatment, there is still no clear consensus on the most favorable treatment modality. The purpose of this systematic review was to synthesize the available literature regarding both nonoperative and operative treatment modalities for recalcitrant lateral epicondylitis (RLE) to provide insight into the efficacy of treatment options., Methods: A systematic review was performed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, where the PubMed, MEDLINE/Ovid, CINAHL, Cochrane, and Scopus databases were queried to identify studies evaluating treatment options for RLE., Results: A total of 27 studies with 1,958 patients were included. Of the reviewed studies, there were a wide variety of treatments including platelet-rich plasma injections, percutaneous tenotomies, and various arthroscopic and open procedures., Conclusion: There are a wide variety of treatment modalities available for RLE that have promising efficacy in the short, medium, and long terms. A comprehensive approach combining evidence-based and patient-centered care is critical for effective management of refractory symptoms., Level of Evidence: Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/B128)., (Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)

Objective: Free tissue transfer to the skull base provides a watertight seal to prevent CSF leakage and donor tissue tailored to the individual defect., Study Design and Setting: Retrospective chart review of 38 patients who underwent free tissue transfer to the skull base between November 1995 and October 2005 at an academic, tertiary referral center., Results: There were 23 male and 15 female patients (average age, 58.1 years) with skull base defects resulting from oncologic resection or head trauma most frequently. Donor sites included the radial forearm (25), rectus abdominis (12), latissimus dorsi (4), anterolateral thigh, scapula, serratus anterior, and ulna (1 each). Seven patients required a second free tissue transfer indicated for flap death (3), partial flap necrosis (2), pneumocephalus (1), or tumor recurrence (1). Two patients died in the immediate postoperative period., Conclusions: Free tissue transfer is a robust option in the repair of post-surgical and post-traumatic skull base defects.