Compensatory articulations in a case of congenital aglossia

This paper examines the articulatory and phonatory strategies used by a German female born without a tongue. Analysis concentrates on the phonetic correlates of dorsal plosives. The speaker uses two main strategies. In word list material, closure for initial /k, g/ is produced using a combination of the uvula, floor of the mouth and adduction of the glossopalatal arches. In other environments, closure is made at the glottis. The glottal strategy is shown to be consistently different from the junctural glottalization used at vowel onset.     

Evaluation of an end-tidal portable ETCO2 colorimetric breath indicator (COLIBRI)

Evaluation of tube position is important after in-hospital and prehospital emergency intubation. Colorimetric breath indicators are devices for immediate control of tube positioning by showing a color change according to end-tidal CO2 (ETCO2) concentrations. We hypothesized that colorimetric breath indicators can yield reliable results for confirmation of tube position. The aim of this study was to evaluate the effectiveness and safety of a new colorimetric breath indicator (Colibri, ICOR AB, Bromma, Sweden) in 147 patients during general anesthesia, in critically ill patients, during transport to in-hospital interventions, and in a study design after insertion of a second tube into the esophagus in long-term ventilated patients. The Colibri was attached between the respective airway and ventilatory tubing. Seventy-three patients were investigated during general anesthesia, 39 patients were observed during long-term ventilation with an average duration of 33 hours, in 15 patients during transport to an intervention for up to 4 hours, and in 20 long-term ventilated patients at the medical intensive-care unit after insertion of a second tube intentionally into the esophagus with the help of a laryngoscope. The Colibri worked well in all groups investigated and showed no false results in the group with tubes inserted into the trachea and esophagus. Data suggest that the Colibri might serve as a valuable tool for evaluating and controlling tube position. This device is independent of power supply or electronic equipment, portable, small, and immediately ready for use.     

Respiratory compliance and resistance in mechanically ventilated patients with acute respiratory failure

The purpose of this study was noninvasive assessment of respiratory compliance and resistance in mechanically ventilated patients with acute respiratory failure (ARF). To this end, flow, change in lung volume, and airway pressure were measured at the proximal tip of the endotracheal tubes in twenty nine critically ill unselected patients. Eleven had acute exacerbation of chronic obstructive pulmonary disease (COPD), 8 had adult respiratory distress syndrome (ARDS) and 10 had ARF of various etiologies. Static compliance (Cst,rs), intrinsic PEEP (PEEPi), as well as minimum and maximum resistance (Rrs,min and Rrs,max, respectively) were obtained with end-inspiratory and end-expiratory airway occlusions. We found that: (1) PEEPi was present in all patients with COPD (up to 11.4 cmH₂O) and it was not uncommon in patients with ARF without history of chronic airway disease (up to 4.1 cmH₂O). (2) Without correction for PEEPi average Cst,rs was not significantly different between ARDS and COPD patients, whereas the average corrected compliance was significantly lower in ARDS patients. (3) Substantial frequency-dependence of resistance was exhibited not only by COPD patients, but also by ARDS patients.A preliminary report was presented at the joint meeting SEP-SEPCR, Paris, September 3rd, 1986.Currently on sabbatical leave from the University of Cincinnaty     

Molecular-level HLA mismatch is associated with rejection and worsened graft survival in heart transplant recipients – a retrospective study

The aim was to evaluate the association of molecular-level human leukocyte antigen (HLA) mismatching with post-transplant graft survival, rejection, and cardiac allograft vasculopathy (CAV). We retrospectively analyzed all primary cardiac transplant recipients between 01/1984-06/2016. 1167 patients fulfilled inclusion criteria and had HLA typing information available. In 312 donor-recipient pairs, typing at serological split antigen level was available. We used the Epitope MisMatch Algorithm to calculate the number of amino acid differences in antibody-verified HLA eplets (amino acid mismatch load (AAMM)) between donor and recipient. Patients with a higher HLA-DR AAMM load had inferior 1-year graft survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 1.01–1.28). The HLA-AB AAMM load showed no impact on graft survival. In the subgroup with available split-level information, we observed an inferior graft survival for a higher HLA-DR AAMM load 3 months after transplantation (HR, 1.22; 95% CI, 1.04–1.44) and a higher risk for rejection for an increasing HLA-AB (HR, 1.70; 95% CI, 1.29–2.24) and HLA-DR (HR, 1.32; 95% CI, 1.09–1.61) AAMM load. No impact on the development of CAV was found. Molecular-level HLA mismatch analysis could serve as a tool for risk stratification after heart transplantation and might take us one step further into precision medicine.     

Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience

Background contextWound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.PurposeTo assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT.Study designRetrospective study.Patient sampleOne hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.Outcome measuresPostoperative incidence of wound infection and dehiscence.MethodsAll adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.ResultsOne hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).ConclusionsRoutine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.