Laryngeal Cartilage Research Articles

Weights of tensor, abductor and adductor muscles of the human larynx

The intrinsic muscles of the larynx interconnect the laryngeal cartilages and help in their mobility. Three muscles cricothyroid tensor of vocal cord, supplied by external laryngeal nerve. Posterior cricoarytenoid abductor of vocal cord, Lateral cricoarytenoid adductor of vocal cord both these muscles are supplied by recurrent laryngeal nerve. This study is important in various clinical laryngeal palsies.A good understanding of the anatomy and the knowledge of laryngeal muscles is important.Aim of the present study was to measure the weight of cricothyroid (Tensor), posterior cricoarytenoid (Abductor) and lateral cricoarytenoid (Adductor) muscles. Proposal of practical use of data on the basis of this study.Fifty laryngeal preparations from adult cadavers of Western India were assessed. Sections were prepared via dissection and the removed muscles weighed& statistical analysis was done.The mean weight of the cricothyroid on right side was 309.68±102.94 on left side was 332.81±116.7. The mean weight of the posterior cricotarytenoid on right side was 230.01±60.93 on left side was 231.06±61.35.The mean weight of the lateral cricotarytenoid on right side was 60.56±24.10 on left side was 63.48±19.67.Wide individual variation in weight of the muscles was observed. The Average weight of thecricothyroid muscle (tensor) was more than the Posterior cricoarytenoid (abductor) & Lateral cricoarytenoid muscle (adductor). The Average weight of the Posterior cricoarytenoid (abductor) was more as compared to Lateral cricoarytenoid muscle (adductor).

A SYSTEMATIC REVIEW: FORENSIC AGE ESTIMATION BY MAGNETIC RESONANCE IMAGING

The purpose of the study: analysis of published data on the possibility of using MRI of the knee to register the status of its development and predict the biological age of children, adolescents and young people. Material and methods. The research protocol was compiled and registered in PROSPERO (registration number in the prospective register of systematic reviews - CRD42022344779, 2022). The databases Scopus, Pubmed Web of Science were used. Time period: 1985-2021 Language of publications: English, Russian. Keywords used (search bar): (("age estimation") OR ("age determination")) AND (knee). Results. In the course of this study, out of the total number of articles (400), 15 articles were eventually selected and studied in detail. The differences in the author's methods of staging age-related changes in the epiphyseal line of the examined bones, the technical characteristics of MRI devices, research protocols, the specialty of researchers and their work experience were established. There are also differences that can lead to a high risk of bias and limit the practical study of MRI of the knee joint in the forensic medical assessment of age. Conclusion. Radiographic examination of laryngeal cartilage and assessment of laryngeal ossification can be used as an Express method of preliminary age diagnostics for identification of the unknown person.

3D printed sodium alginate/gelatin/tannic acid/calcium chloride scaffolds laden bone marrow mesenchymal stem cells to repair defective thyroid cartilage plate.

Due to the absence of blood vessels, cartilage exhibits extremely limited self-repair capacity. Currently, repairing laryngeal cartilage defects, resulting from conditions such as laryngeal tumors, injury, and congenital structural abnormalities, remains a significant challenge in the Department of Otolaryngology, Head and Neck Surgery. Previous research has often focused on enhancing the mechanical properties of synthetic materials. However, their low biological activity and weak cell adhesion necessitate compensatory measures. This study aims to capitalize on the advantages of natural materials in cartilage tissue engineering. Sodium alginate, gelatin, tannic acid, and calcium chloride were utilized to prepare bioinks through cross-linking for application in 3D printing cartilage scaffolds. Bone marrow mesenchymal stem cells with multidirectional differentiation potential were chosen as seed cells, with appropriate growth factors incorporated to promote their differentiation into cartilage during in vitro culture. The scaffold laden cells was subsequently implanted into rabbit thyroid cartilage plate defects at the appropriate time. HE staining, toluidine blue staining, Masson staining, and collagen type II staining were employed to assess cartilage defect repair at 4, 8, and 12 weeks, respectively. Results demonstrated that scaffolds made from natural materials could emulate the mechanical properties of fresh cartilage with commendable biocompatibility. Stained sections further confirmed the efficacy of the composite hydrogel scaffolds identified in this study in promoting rabbit thyroid cartilage plate restoration. In summary, this study successfully fabricated a natural material scaffold for rabbit laryngeal cartilage tissue engineering, thereby furnishing a new idea and experience for the clinical application of laryngeal cartilage defect reconstruction.

Clinical characteristics of 6 cases of relapsing polychondritis in children with airway involvement

Objective: To investigate the pathogenesis, clinical signs and diagnosing procedures of relapsing polychondritis(RP) in children with airway involvement. Methods: The medical history, clinical symptoms, physical examination, electronic laryngoscopy and imaging findings of six patients were retrospectively analyzed. The patients diagnosed as relapsing polychondritis with involving the airway from January 2018 to December 2021 were in our hospital. The clinical features of the 6 cases were summarized. Results: All 6 patients were male, ranging in age from 8 years 1 month to 14 years 1 month, with a median age of 12.04 years. Stridor and dyspnea were observed in all patients, with hoarseness in 2 patients and frequently nocturnal dyspnea during sleep in 2 patients. Initially, all children were diagnosed as laryngitis or laryngotracheitis, and were treated symptomatically with glucocorticoids and aerosol inhalation. Immunosuppressants and targeted therapy with biologics were given after patients diagnosed as RP. All patients were ultimately required tracheostomy. The time from the onset of airway symptoms to tracheostomy ranged from 1 month to 27 months. Two children had a history of endotracheal intubation prior to tracheostomy. All 6 patients underwent electronic laryngoscopy, revealing involvement of the laryngeal and subglottic mucosa and cartilage structures, which showed gradual improvement with medical therapy. Computed tomography (CT) of the trachea with three-dimensional reconstruction was performed in all patients, demonstrating moderate to severe subglottic stenosis. Two patients exhibited complete airway obstruction at the C4-C6 cervical level. Three children underwent suspension laryngoscopy under general anesthesia and endotracheal mucosal biopsy.Of the 6 children, 3 presented with nasal tip collapse or saddle nose, 2 had auricular cartilage changed, and 1 had scleralinvolvement. One patient underwent PET-CT scanning, which revealed tracheal collapse, diffuse increase in FDG(Flurodeoxyglucose)metabolism with increased FDG uptake in the nasal alar regions. All children were followed up for 2-3 years, 1 child died, while the remaining five continued to receive medical treatment. Conclusions: Relapsing polychondritis with airway involvement has an insidious onset and is difficult to diagnose. The airway stenosisresulting from RP is always severe and necessitating tracheotomy to maintain airway patency in the majority of cases.The treatment coursef or RP is prolonged, requiring long-term tracheostomy tube placement.

THE USING OF VIRTOPSIA IN FORENSIC MEDICAL EXAMINATION OF HANGING (literature review)

Background. For the third decade in a row, forensic medical expertise in the world has been introducing and developing the use of virtopsia as a virtual alternative to traditional examination of corpse. It is believed that the combination of postmortem computed tomography (PMCT), postmortem magnetic resonance imaging (PMRI) 3D surface scanning and postmortem angiography is sufficient to replace the traditional autopsy with a virtual one. Yjwever, the practical experience of using virtopsia has revealed both its positive aspects and disadvantages that should be taken into account when using in practice. Aim: to study the peculiarities of the use of virtopsia in forensic medical examinations of corpses in general and in cases where the cause of death was mechanical asphyxia due to hanging. Material and methods: systematic review of electronic databases of medical and biological publications, bibliographic, analytical. Results. Virtopsia can be useful in cases of identification by dental status, in case of damage of the bones of the skull and in the diagnosis of craniocerebral injuries. Analysis of the role of PMCT in trauma and diagnostic features showed that the presumed cause of death as a result of trauma was proven in approximately 30% of cases. The properties of PMCT make it possible to use it in cases of drawing, in the examination of gunshot injuries to detect skeletal injuries in high-energy trauma and it can be used as a tool for selecting individual parts of the body for further detailed autopsy and reconstruction of the cause of events and finding the cause of death. In addition, it is advisable to use postmortem PMRI for the radiological assessment of gunshot wounds. Postmortem CT angiography is particularly useful for identifying vascular involvement and coronary death. During virtopsia signs of mechanical asphyxia, fractures of the hyoid bone, larynx or thyroid cartilage and intramuscular hemorrhages were revealed which can be used as an adjunct to the autopsy. A combined approach with radiological methods demonstrates the utility of a multidisciplinary approach to significantly reduce the number of unidentified injuries. Conclusion. Analysis of the literature suggests that both postmortem PMCT and PMRI have become widely used, but forensic medical examination of corpse is the gold standard for diagnosing injuries and determining of the cause of death yet. In cases of mechanical asphyxia due to hanging, it is advisable to use PMCT to detect injuries to the hyoid bone and cartilage of the larynx, and using PMRI to detect hemorrhages in the soft tissues of the neck. Detection of specific signs of perpetuity of neck tissue injury during mechanical asphyxia with the help of PMCT allows to improve the diagnosis of hanging by applying innovative technologies and using a multidisciplinary approach.

Recurrent equine laryngeal alteration associated with compression of nerves in the infra-auricular region similar to Eagle Syndrome in humans

A mare presented headshaking, along with signs of problems in the upper respiratory tract. After a detailed clinical examination, an endoscopic examination was performed and an asymmetry was found to the left of the laryngeal cartilages. Searching for a probable etiology for the endoscopic finding, an ultrasound examination was performed in the infra-auricular region (parotid region) bilaterally and comparatively. The ultrasound examination showed a deviation (on the left side) of the nerve bundle corresponding to the deviation of the cartilages and soft palate, from which we associated the findings with the clinical presentation by the mare and concluded that it was the cause of the problem. Comparing this case, specifically, with Eagle Syndrome in humans, the aforementioned findings were very similar to the syndrome in humans.

The clinical treatment of laryngotracheal rupture injury

Objective:To investigate the therapeutic effect of laryngotracheal rupture injury and management of related complications. Methods:A retrospective analysis was conducted on 10 patients with laryngotracheal rupture injury caused by trauma, admitted between October 2014 and October 2022. Results:Anti-shock treatment, local debridement, tracheal-cricoid cartilage or tracheal-tracheal anastomosis, laryngeal cartilage reduction and fixation, local transposition flaps repair and phase-Ⅱ airway reconstruction were performed respectively on 10 patients. Nine patients underwent operations of tracheal-cricoid cartilage or tracheal-tracheal anastomosis, with five of these were performed by cartilage broken reduction and fixation, placed with intraluminal stents of iodoform gauze fingerstalls for （8.2±1.6） days. Tracheal reconstruction surgery was performed on 2 cases during phase-Ⅱ and both were placed with T-shaped silicone tube to support for 3 months. Two cases required tracheoesophageal fistula surgical repair, and vocal cord suturing was conducted for three vocal fold injuries. Anti-shock treatment was given to one emergency case and closed thoracic drainage treatment was given to another one. We removed the tracheal cannula from 10 patients after surgery and one case was diagnosed with Ⅰ-level swallowing function of sub-water test. All cases recovered to take food per-orally. Conclusion:Maintenance of circulation and respiration functions is the major target during early treatment of laryngotracheal rupture. It should strive to complete the reconstruction of airway structure on phase-Ⅰ, among which end-to-end anastomosis to reconstruct airway and broken laryngeal cartilage reduction and fixation are the vital methods for airway structure reconstruction to achieve good results. It is suggested that the reconstruction of trachea and esophagus structures should be performed simultaneously to patients with tracheoesophageal fistula.

Thyroid cartilage infiltration in advanced laryngeal cancer: prognostic implications and predictive modelling.

Detection of laryngeal cartilage invasion is of great importance in staging of laryngeal squamous cell carcinoma (LSCC). The role of prognosticators in locally advanced laryngeal cancer are still widely debated. This study aimed to assess the impact of volume of thyroid cartilage infiltration, as well as other histopathologic variables, on patient survival. We retrospectively analysed 74 patients affected by pT4 LSCC and treated with total laryngectomy between 2005 and 2021 at the Department of Otorhinolaryngology - Head and Neck Surgery of the University of Brescia, Italy. We considered as potential prognosticators histological grade, perineural (PNI) and lympho-vascular invasion (LVI), thyroid cartilage infiltration, and pTN staging. Pre-operative CT or MRI were analysed to quantify the volume of cartilage infiltration using 3D Slicer software. The 1-, 3-, and 5-year disease free survivals (DFS) were 76%, 66%, and 64%, respectively. Using machine learning models, we found that the volume of thyroid cartilage infiltration had high correlation with DFS. Patients with a higher volume (>670 mm3) of infiltration had a worse prognosis compared to those with a lower volume. Our study confirms the essential role of LVI as prognosticator in advanced LSCC and, more innovatively, highlights the volume of thyroid cartilage infiltration as another promising prognostic factor.

A large, locally aggressive giant cell tumour arising from the laryngeal cartilage: A Rare Case Report

Giant cell tumour is a growth predominantly found in long bones of the body. Giant cell tumour has a rare occurrence in the head and neck. A case of a 31 year old male with no known comorbidities at the ENT Department, Shifa International Hospital, Islamabad presented with anterior neck swelling and hoarseness of voice. Patient was diagnosed as having Giant Cell Tumour of Larynx (GTCL) proven on FNA cytology and post-operative biopsy. GCTL is an uncommon entity with only 45 reported cases in the world. Key Words: Giant Cell Tumor, Laryngeal Cancer, Thyroid Cartilage, Laryngectomy.

Revisiting the "Puffed Cheek" Technique: Advantages, Fallacies, and Potential Solutions.

The "puffed cheek" technique is routinely performed during CT neck studies in patients with suspected oral cavity cancers. The insufflation of air within the oral vestibule helps in the detection of small buccal mucosal lesions, with better delineation of lesion origin, depth, and extent of spread. The pitfalls associated with this technique are often underrecognized and poorly understood. They can mimic actual lesions, forfeiting the technique's primary purpose. This review provides an overview of the puffed cheek technique and its associated pitfalls. These pitfalls include pneumoparotid, soft palate elevation that resembles a nasopharyngeal mass, various tongue displacements or distortions that obscure tongue lesions or mimic them, sublingual gland herniation, an apparent exacerbation of the airway edema, vocal cord adduction that hinders glottic evaluation, and false indications of osteochondronecrosis in laryngeal cartilage. Most stem from a common underlying mechanism of unintentional Valsalva maneuver engaged in by the patient while trying to perform a puffed cheek, creating a closed air column under positive pressure with resultant surrounding soft-tissue displacement. These pitfalls can thus be avoided by instructing the patient to maintain continuous nasal breathing while puffing out their cheek during image acquisition, preventing the formation of the closed air column. Keywords: CT, Head/Neck © RSNA, 2024.

CT and MR anatomy of the larynx and hypopharynx.

Imaging of the larynx and hypopharynx is frequently requested to assess the extent of neoplasms beyond the field of view of endoscopic evaluation. The combination of optical and cross-sectional imaging allows tumors to be classified according to AJCC/UICC guidelines. A thorough understanding of laryngeal and hypopharyngeal anatomy is crucial to guide the radiological eye along the possible pathways of the spread of diseases and to guide differential diagnoses. Computed tomography (CT) has been the first cross-sectional imaging technique used to evaluate the larynx and hypopharynx; its spatial resolution combined with volumetric capability and the use of injectable contrast medium made CT the working horse in the assessment of neoplastic and inflammatory diseases. In the last two decades, magnetic resonance (MR) supported CT in the most challenging cases, when the optimal contrast resolution due to the multisequence portfolio is needed to assess the neoplastic involvement of laryngeal cartilages, paraglottic space(s), and extra laryngeal spread. The aim of this paper is to give a comprehensive radiological overview of larynx and hypopharynx complex anatomy, combining in vivo images, anatomical sections, and images of ex vivo specimens.

Prostate-Specific Membrane Antigen PET/CT Detection of Prostate Cancer Metastasis to Thyroid and Cricoid Cartilages.

Prostate-specific membrane antigen (PSMA) PET/CT has revolutionized the imaging of prostate cancer. Historically, prostate cancer metastasis to thyroid and cricoid cartilages was thought to be exceedingly rare, with only a few reported cases in the literature. Prostate cancer metastasis to the laryngeal cartilages was detected in 4 of 221 patients who underwent imaging with 18 F-PSMA (Pylarify) or 68 Ga-PSMA (Illuccix) PET/CT for initial staging of high-risk prostate cancer or restaging evaluation in the setting of biochemical recurrence from April 2022 through October 2023. The increased sensitivity and specificity of PSMA PET/CT allow for the detection of previously occult metastatic disease.

Discrepancy between clinical and pathological staging of laryngeal carcinoma: a dilemma to be solved

ObjectivesThe aim of this study was to investigate the degree of discrepancy between the clinical and pathological staging of laryngeal carcinoma, and the potential impact of this discrepancy on the outcomes and prognosis.MethodsThis study was conducted on 127 patients who underwent total laryngectomy over five years (October 2016–October 2021). Data collected from pretherapeutic clinical staging regarding the extent of the tumor affection of different laryngeal subsites was compared to the postsurgical pathological assessment.ResultsOverall, 12 out of 127 patients (9.4%) in the current study, were clinically over-staged from T3 to T4 due to radiological diagnosis of tumor infiltration of laryngeal cartilages that proved pathologically to be free of tumor. Additionally, discordance in the N stage was found in 12.6% (n = 16). However, stage discrepancy did not have a significant impact on the prognosis and survival.ConclusionDiscordance between clinical and pathological TNM staging of laryngeal carcinoma may affect the decision making and the choice of the treatment options. Some improvement can be probably achieved with advancements and higher accuracy of the preoperative diagnostic tools.

Development of the hyolaryngeal architecture in horseshoe bats: insights into the evolution of the pulse generation for laryngeal echolocation

BackgroundThe hyolaryngeal apparatus generates biosonar pulses in the laryngeally echolocating bats. The cartilage and muscles comprising the hyolarynx of laryngeally echolocating bats are morphologically modified compared to those of non-bat mammals, as represented by the hypertrophied intrinsic laryngeal muscle. Despite its crucial contribution to laryngeal echolocation, how the development of the hyolarynx in bats differs from that of other mammals is poorly documented. The genus Rhinolophus is one of the most sophisticated laryngeal echolocators, with the highest pulse frequency in bats. The present study provides the first detailed description of the three-dimensional anatomy and development of the skeleton, cartilage, muscle, and innervation patterns of the hyolaryngeal apparatus in two species of rhinolophid bats using micro-computed tomography images and serial tissue sections and compares them with those of laboratory mice. Furthermore, we measured the peak frequency of the echolocation pulse in active juvenile and adult individuals to correspond to echolocation pulses with hyolaryngeal morphology at each postnatal stage.ResultsWe found that the sagittal crests of the cricoid cartilage separated the dorsal cricoarytenoid muscle in horseshoe bats, indicating that this unique morphology may be required to reinforce the repeated closure movement of the glottis during biosonar pulse emission. We also found that the cricothyroid muscle is ventrally hypertrophied throughout ontogeny, and that the cranial laryngeal nerve has a novel branch supplying the hypertrophied region of this muscle. Our bioacoustic analyses revealed that the peak frequency shows negative allometry against skull growth, and that the volumetric growth of all laryngeal cartilages is correlated with the pulse peak frequency.ConclusionsThe unique patterns of muscle and innervation revealed in this study appear to have been obtained concomitantly with the acquisition of tracheal chambers in rhinolophids and hipposiderids, improving sound intensity during laryngeal echolocation. In addition, significant protrusion of the sagittal crest of the cricoid cartilage and the separated dorsal cricoarytenoid muscle may contribute to the sophisticated biosonar in this laryngeally echolocating lineage. Furthermore, our bioacoustic data suggested that the mineralization of these cartilages underpins the ontogeny of echolocation pulse generation. The results of the present study provide crucial insights into how the anatomy and development of the hyolaryngeal apparatus shape the acoustic diversity in bats.

Postnatal changes in thyroid cartilage shape and cartilage matrix composition are not synchronized in Mus musculus.

The study was conducted to quantify laryngeal cartilage matrix composition and to investigate its relationship with cartilage shape in a mouse model. A sample of 30 mice (CD-1 mouse, Mus musculus) from five age groups (postnatal Days 2, 21, 90, 365, and 720) were used. Three-dimensional mouse laryngeal thyroid cartilage reconstructions were generated from contrast-enhanced micro-computed tomography (CT) image stacks. Cartilage matrix composition was estimated as Hounsfield units (HU). HU were determined by overlaying 3D reconstructions as masks on micro-CT image stacks and then measuring the attenuation. Cartilage shape was quantified with landmarks placed on the surface of the thyroid cartilage. Shape differences between the five age groups were analyzed using geometric morphometrics and multiparametric analysis of landmarks. The relationship between HU and shape was investigated with correlational analyses. Among five age groups, HU became higher in older animals. The shape of the thyroid cartilage changes with age throughout the entire life of a mouse. The changes in shape were not synchronized with changes in cartilage matrix composition. The thyroid cartilage of young and old M. musculus larynx showed a homogenous mineralization pattern. High-resolution contrast-enhanced micro-CT imaging makes the mouse larynx accessible for analysis of genetic and environmental factors affecting shape and matrix composition.

Effect of amniotic membrane/collagen scaffolds on laryngeal cartilage repair.

Laryngeal cartilage defects are a major problem that greatly impacts structural integrity and function. Cartilage repair is also a challenging issue. This study evaluated the efficacy of a collagen scaffold enveloped by amniotic membrane (AM/C) on laryngeal cartilage repair. Experimental animal study. Fourteen Dutch rabbits were enrolled in the study. A 5 mm cartilage defect was created in the right and left thyroid lamina. The animals were divided into two groups randomly. Group 1 collagen scaffolds and group 2 AM/C were applied to the right side defects. Left side defects were not repaired, serving as control. Histologic evaluation was done 45 and 90 days following collagen and AM/C application with criteria of tissue and cell morphology, lacuna formation, vascularization, and inflammation. Significant improvement in cartilage repair was observed in the AM/C side compared to the control side in all histologic criteria after 45 days (p<.05). After 90 days, cartilage repair improved in cell morphology, lacuna formation, and inflammation significantly (p<.05). The combination of amniotic membrane and collagen scaffolds provides a promising treatment modality for improving the repair of laryngeal cartilage defects. NA.

Laryngeal cartilage calcifications on lateral cephalometric radiographs

The aim of this study was to determine the influence of age and gender on the incidence of calcification in laryngeal cartilage diagnosed on lateral cephalometric radiographs routinely taken for orthodontic diagnosis. The lateral cephalometric radiographs of 957 patients who met the study criteria were analyzed from among the 1000 lateral radiographs originally collected. The images were evaluated independently by two investigators. Given the dichotomous dependent variable (calcification or no calcification), a mixed logistic regression model was used to test how age and gender affected calcification. The effect of age and gender reliably determined the likelihood of laryngeal cartilage calcification. The greatest differences in the degree of calcification by gender were found at ages 20–25 years. The degree of calcification increased with age, reaching 100% in women at age 30 and in men at age 50. In women, the degree of calcification was higher than in men from the age of 13 years and levelled off at the age of 50 years. The interrater agreement was strong k = 0.97, z = 30.0, p < .001. Calcification can be detected by orthodontists trained in lateral cephalogram analysis and can be used as a screening or diagnostic tool to detect calcified areas in the larynx.

New progress in diagnosis and treatment of congenital laryngomalacia in infants

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.

Squid cartilage type II collagen accelerates osteoporotic fractures healing through regulating homocysteine mediated EGF and FBN1 signals

Osteoporosis fracture (OPF) is a serious social public health concern in humans. Type II collagen from squid cartilage (SCII) has been proven to promote the healing process in normal fracture mice, however, the effect and mechanism of SCII to improve osteoporosis fracture remain unknown. In this study, type II collagen was obtained from squid laryngeal cartilage, and the effects of SCII on OPF were investigated in mice that experienced bilateral ovariectomy and open tibial fracture surgery after oral administration. The results showed that SCII supplementation significantly decreased the serum TNF-α, increased aggrecan levels on the 5 d, and elevated the serum TGF-β and Col10α levels on 13 d after fracture. Notably, H&E staining exhibited an obvious chondrocyte proliferation on 5 d, and a specific promotion of chondrocyte hypertrophic differentiation and mineralization in the SCII group on 13 d. These findings suggested that SCII promoted osteoporosis fracture healing by enhancing the proliferation and hypertrophy of chondrocyte. Mechanically, SCII supplementation significantly reduced homocysteine levels through down-regulating TMAO production and bile acid levels and activated the EGF/AKT/CylinD1 and TGFβ/Smad1/5/8 pathways, thereby recovering the delay of chondrocyte proliferation and hypertrophy in OPF mice. This study investigated the effects of SCII on osteoporosis fracture healing for the first time and provided a new theoretical basis and options for the high-value application of squid cartilage.

A Novel Low-Cost, Open-Source, Three-Dimensionally Printed Thyroplasty Simulator

Training of surgical procedures on awake patients, such as medialization thyroplasty, poses challenges to educators and trainees. Three-dimensionally (3D)-printed simulators provide opportunity to practice in low-stakes settings. We present the first 3D-printed thyroplasty simulator incorporating a cartilaginous framework, endolaryngeal soft tissue housed in a 3D-printed manikin with endoscopic visualization. Male and female laryngeal cartilages and endolarynx molds were 3D printed from an existing open-source design. Cartilage models were made of heat-treated polylactic acid (HTPLA), a material chosen for its thermal stability, allowing drilling. They were combined with molded silicone endolarynges modeling glottic insufficiency. Larynges were set in a 3D-printed head-and-neck manikin with an attached borescope for internal visualization similar to distal chip laryngoscopy. Eight laryngologists evaluated the simulator by drilling a thyroplasty window, inserting an implant for medialization, and rating the model using a modified Michigan Standard Simulation Experience Scale (1=strongly disagree, 5=strongly agree). The model was well rated in educational value (mean 4.7, standard deviation [SD] 0.3), fidelity (mean 3.8, SD 0.2), and overall value (mean 4.8, SD 0.5). Qualitative assessment concluded the model was anatomically realistic and that HTPLA was a good approximation of the density and texture of thyroid cartilage. The materials for one larynx cost $4.09. This high-fidelity 3D-printed simulator demonstrates educational value for thyroplasty training. The low-cost, open-source design has broad implications for universal access to this simulator platform.