The Influence of Voice Training on Vocal Learners' Supraglottal Activities and Aerodynamic Evaluation

OBJECTIVE

Among music majors with only 18 months of training, supraglottal activities and aerodynamic parameters were studied to facilitate understanding of the influence of voice training on characteristics of voice production.

METHODS

Twenty-three students at the Xiamen Music School were examined over the course of 18 months of singing training. Only 17 students completed all data collection sessions. All students had no previous voice training and were confirmed to be without organic voice disorders by a laryngologist but did present with supraglottal compression. Strobolaryngoscopy and aerodynamic assessment were performed every 6 months. Using the laryngoscopic images, anterior-posterior (A-P) compression and medial-lateral compression were analyzed. Aerodynamic assessment was carried out to measure maximum phonation time, phonation threshold flow, glottal resistance, subglottal pressure, phonation threshold pressure, and vocal efficiency. From these measurements, the mean was calculated along with a measurement of reliability. One-way ANOVA with Bonferroni post hoc test was used to evaluate the results between subjects at different time points. Kendall's W test was completed to assure consistency between and within laryngologists.

RESULTS

Referring to the Strobolaryngoscopy Evaluation Rating Form, 4 of the 17 students had decreased A-P compression scores in the second measurement compared to the first (from 2.24 ± 0.20 to 2.12 ± 0.17, P = 0.100). After completion of the program, 6 of the 17 students' anterior-posterior compression scores further improved from the second measurement (from 2.12 ± 0.17 to 1.71 ± 0.17, P = 0.600). The A-P compression scores showed a gradual downward trend and was overall statistically significant (P = 0.004). In addition, there was an improvement of maximum phonation time (P​ ​= 0.016).

CONCLUSION

Professional voice training can improve the supraglottal activities and maximum phonation time. These parameters have potential to be used for voice training evaluation and screening.

[Analysis of vocal fold movement characteristics in patients with laryngeal neurogenic injury]

Objective:To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury. Methods:A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically. Results:The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group（P<0.05）, the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group（47.70%） was significantly greater than that in unilateral vocal fold paralysis group（12.27%）. There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group（P<0.05）. The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group（50.00%） was higher than that in recurrent laryngeal nerve paralysis group（9.32%） and vagal nerve paralysis group（9.00%）. The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant（P<0.05）.There was no significant difference in glottic closure among the three groups（P<0.05）. Conclusion:Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.

Exploring the Role of Opera Voice Quality Exercise in the Voice Therapy

OBJECTIVE

There are very diverse approaches for voice therapy, and the application of voice quality used in vocal arts in voice therapy can also be seen. However, there is little research on the application of opera voice quality in voice therapy. This study explored the applications of our Opera Voice Quality Exercise in the field of voice therapy and investigated the impacts of this exercise on pitch, intensity, voice quality, and vocal ability.

METHODS

Sixty-two healthy subjects, defined as those with no discomfort in their voice and no appearance of organic lesions on the larynx via stroboscopic laryngoscopy were included in the study. The subjects were randomly divided into an experimental group of 31 subjects and a control group of 31 subjects. The experimental group received a voice health education and weekly coaching sessions of Opera Voice Quality Exercise, whereas the subjects in the control group only had the former. The acoustic and aerodynamic parameters were evaluated before and after the experimental interventions.

RESULTS

When producing [a] at comfortable speech pitch and intensity, the experimental group compared to the control group showed statistically significant improvement (P < 0.05) in the irregularity component (IC) parameter for males. When producing [a] at loudest intensity at a higher pitch in the normal speech pitch range, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in sound pressure level (SPL) as well as improvements (P < 0.05) in shimmer and IC parameters for males. There was a statistically significant increase (P < 0.05) in SPL for females. During continuous speech, the experimental group compared to the control group showed statistically significant increase (P < 0.01) in SPLmax (maximum sound pressure level) for both males and females. There was a statistically significant increase in highest pitch (P < 0.01) and lowest pitch (P < 0.05) for males.

CONCLUSION

Regardless of gender, there is the greatest impact of Opera Voice Quality Exercise on phonation intensity. Furthermore, for males, this exercise causes the voice quality to be improved and the speech pitch to raise. Therefore, there may be applications of Opera Voice Quality Exercise in voice problems with weak voice such as nonorganic hypofunctional dysphonia, vocal fold paresis and paralysis, and voice problems related to Parkinson and age.

A Meta-analysis of PPIs Plus Alginate Versus PPIs Alone for the Treatment of GERD

OBJECTIVE

To systematically evaluate the clinical efficacy and safety of proton-pump inhibitors (PPIs) combined with alginate versus PPIs alone in the treatment of gastroesophageal reflux disease (GERD).

METHODS

Randomised Controlled Trials (RCTs) of PPIs combined with alginate and PPIs alone for the treatment of GERD in PubMed, Embase, and The Cochrane Library were searched and screened, and the risk assessment of bias and statistical analysis were performed using Rev Man 5.4 software.

RESULTS

A total of four RCTs (608 patients) were included. Before and after treatment, the change of heartburn score in the experimental group increased compared with the control group, but the difference was not statistically significant [Standard Mean Difference (SMD)= -0.29, 95%CI (-0.78, 0.19), P > 0.05]; The change of HRDQ heartburn score increased, but the difference was not statistically significant [SMD= -0.40, 95%CI (-1.04, 0.24), P > 0.05]; The number of days without heartburn during the 28-day treatment period increased, but the difference was not statistically significant [OR= 1.16, 95%CI (0.37, 3.61), P > 0.05]; The amount of reflux score increased, but the difference was not statistically significant [SMD= -0.30, 95%CI (-0.71, 0.11), P > 0.05]; The amount of change in HRDQ regurgitation score increased, but the difference was not statistically significant [SMD= -0.05，95%CI （- 1.57，0.17）， P > 0.05]； There was no statistically significant difference in adverse events with treatment [OR= 0.93, 95%CI (0.58, 1.47), P > 0.05].

CONCLUSION

In the treatment of GERD, the efficacy of PPIs combined with alginate is improved compared with PPIs alone, but there is no significant difference, and alginate does not increase the occurrence of adverse events in PPIs treatment. In the future, more subdivisions of GERD subtypes and more high-quality studies are needed to further improve the treatment strategy of GERD-related diseases.

Vocal Vibration Opening Onset Position Abnormality in Patients With Adductor Spasmodic Dystonia by Using High-Speed Endoscopy

OBJECTIVE

To analyze vocal fold vibration onset in patients with adductor laryngeal dystonia (ADLD) by analyzing vocal vibration opening onset position (VVOOP).

STUDY DESIGN

Case-control study SETTING: A voice center.

METHODS

Eleven patients with ADLD diagnosed in our voice center were enrolled in the ADLD group. Eleven healthy subjects matched by exact age and gender to the ADLD patients were selected as the control group. All subjects underwent laryngeal high-speed video endoscopy. VVOOP and its change were assessed by two otolaryngologists. The multiline video kymography was used to analyze the open quotient (OQ) and standard deviation of OQ.

RESULTS

VVOOP had more than one position in 54.6% (6/11) of the patients with ADLD, which was higher than the control group (P < 0.05). VVOOP appeared in the front of the vocal fold in 54.6% (6/11) of patients with ADLD and in the back of the vocal fold in 81.8% (9/11) of patients with ADLD. VVOOP can be abnormal in 90.9% (10/11) of patients with ADLD, and the rate of VVOOP abnormality was higher than that of the control group (P < 0.05). Of 11, 6 (54.6%) patients with ADLD had a variable VVOOP; the variability rate of VVOOP was higher than that in the control group (P < 0.05). OQ and OQ standard deviation in the ADLD group were significantly greater than in the control group (P < 0.05).

CONCLUSIONS

In patients with ADLD, vocal fold vibration was irregular, and VVOOP was abnormal and had a variable position and could reflect variability of the vocal vibration.

LEVEL OF EVIDENCE

Level 4.

A 4-Week Straw Phonation in Water Exercise Program for Aging-Related Vocal Fold Atrophy

PURPOSE

This study evaluated the efficacy of a 4-week straw phonation in water (SPW) exercise program on aging-related vocal fold atrophy (VFA), with a secondary objective to examine the immediate effects of SPW exercises.

METHOD

Thirty-eight older adults aged 60 years and above formally diagnosed with aging-related VFA were randomly assigned into an experimental group undergoing SPW exercises with an 8-cm depth of straw submersion into water for 4 weeks plus vocal hygiene practice (n = 20), and a control group with only vocal hygiene practice (n = 18). Outcome measures included laryngeal endoscopic measures of glottal gap, auditory-perceptual ratings of voice quality, acoustic measures, aerodynamic measures, and standardized self-assessment questionnaire scores. An additional round of acoustic and aerodynamic assessment following 20 min of SPW exercises was conducted to examine the immediate effects.

RESULTS

Significant improvements in normalized glottal gap area, perceptual rating of breathiness, smoothed cepstral peak prominence, harmonics-to-noise ratio (HNR), mean oral airflow, subglottal pressure and laryngeal airway resistance at comfortable loudness, Voice-related Quality of Life scores, and Chinese Vocal Fatigue Index Factor 3 scores were observed in the experimental group relative to the control group. There were also significant immediate effects for HNR, mean oral airflow, subglottal pressure, and laryngeal airway resistance.

CONCLUSIONS

These findings suggested significant immediate improvements in vocal function following SPW exercises, with additional significant improvements in vocal function as well as significant improvements in quality of life following the 4-week SPW exercise program. Further studies with more long-term follow-up are recommended to better understand the efficacy of SPW exercises with deep levels of straw submersion into water as an effective clinical option for the management of hypofunctional dysphonia associated with aging-related VFA.

Mandarin Chinese version of the Aging Voice Index

Objectives

This study developed the Mandarin Chinese version of the Aging Voice Index (AVI), with preliminary validation of the scale for potential clinical applications.

Study Design

Scale development.

Methods

The experimental procedure involved: (1) cross-cultural adaptation of the original AVI into the Mandarin Chinese version (CAVI); (2) evaluation by expert panel; (3) back translation; (4) pilot testing; (5) development of the final CAVI; (6) scale validation with 68 older adults of 60-89 years old (29 females and 39 males), 34 with voice disorders and 34 age-matched with normal voice. Internal consistency reliability, test-retest reliability, content validity, criterion-related validity, and discriminatory ability (diagnostic accuracy) of the CAVI were evaluated.

Results

There were high internal consistency (Cronbach's alpha = 0.9733), high test-retest reliability (intraclass correlation coefficient = 0.9578, p < 0.01), high content validity (content validity index = 0.9710), high criterion-related validity (Pearson's r = 0.9439, p < 0.01 between CAVI and Voice Handicap Index-10; r = 0.8070, p < 0.01 between CAVI and voice-related quality of life [V-RQOL]), and significant difference in CAVI scores between the two groups with huge effect size (t(34.69) = -11.59, Cohen's d = 2.81, p < 0.001). Receiver operating characteristic analysis revealed a high diagnostic accuracy of the CAVI, with an area under the curve of 0.9974 (p < 0.001) and a cut-off score of 12.0 with 100% sensitivity and 97.1% specificity.

Conclusion

Our findings suggested that the CAVI could be a reliable and valid standardized self-assessment questionnaire tool for clinical evaluation of the impact of voice problems specifically for Mandarin-speaking older adults. Further studies should explore a full-scale validation of the CAVI for being a standard clinical tool, including for older adults in Mainland China.

Level of evidence

3b (case-control study).

Dynamic CT Study on the Morphology and the Motor Ability of Unilateral Vocal Fold Paralysis

OBJECTIVE

To investigate the morphological changes and motor functions of the larynx in unilateral vocal fold paralysis by using dynamic three-dimensional CT, and to explore the differences between vocal fold paralysis with different nerves involved.

METHODS

Twenty-five patients with unilateral vocal fold paralysis and 10 healthy subjects were selected as the paralytic group and the normal group, respectively. Ten dynamic sequence images of laryngeal movement from inhalation to phonation were reviewed, and the glottic morphology at the coronal position, the minimum glottic area at the horizontal position, and the overall activity of the two groups were compared. The 25 patients with unilateral vocal fold paralysis were divided into the thyroarytenoid (TA) muscle group, the TA and posterior cricoarytenoid (PCA) (TA + PCA) muscle group, and the PCA muscle group. The coronal and horizontal parameters of the three types were compared as noted above and the dynamic parameter changes were also compared between the groups.

RESULTS

The height and thickness of bilateral vocal cords, the minimum glottic area, and the whole glottic activity were different in the paralysis group and were significantly different from those of the normal group (P < 0.05). The value of the glottic gap ratio and its decrease rate in the TA + PCA group was smaller than those in the TA and PCA group, and the glottic gap ratio was the largest in the PCA group.

CONCLUSION

Dynamic CT can provide a qualitative evaluation of laryngeal morphology and quantitative evaluation of motor function in vocal fold paralysis.

LEVEL OF EVIDENCE: 4

"Double-edged sword" effect of reactive oxygen species (ROS) in tumor development and carcinogenesis

Reactive oxygen species (ROS) are small reactive molecules produced by cellular metabolism and regulate various physiological and pathological functions. Many studies have shown that ROS plays an essential role in the proliferation and inhibition of tumor cells. Different concentrations of ROS can have a "double-edged sword" effect on the occurrence and development of tumors. A certain concentration of ROS can activate growth-promoting signals, enhance the proliferation and invasion of tumor cells, and cause damage to biomacromolecules such as proteins and nucleic acids. However, ROS can enhance the body's antitumor signal at higher levels by initiating oxidative stress-induced apoptosis and autophagy in tumor cells. This review analyzes ROS's unique bidirectional regulation mechanism on tumor cells, focusing on the key signaling pathways and regulatory factors that ROS affect the occurrence and development of tumors and providing ideas for an in-depth understanding of the mechanism of ROS action and its clinical application.

To Explore the Changes and Differences of Microstructure of Vocal Fold in Vocal Fold Paralysis and Cricoarytenoid Joint Dislocation by Diffusion Tensor Imaging

OBJECTIVE

The diffusion characteristics of water molecules were measured in the vocal folds of canines exhibiting unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation. These characteristics were used in conjunction with a histological examination of the microstructural changes of vocal fold muscle fibers to explore the feasibility of diffusion tensor imaging (DTI) in distinguishing unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation as well as evaluating microstructural changes.

METHODS

Ten beagles were randomly divided into three groups: four in the unilateral vocal fold paralysis group, four in the unilateral cricoarytenoid joint dislocation group, and two in the normal group. Unilateral recurrent laryngeal nerve resection was performed in the vocal fold paralysis group. Unilateral cricoarytenoid joint dislocation surgery was performed in the dislocation group. No intervention was performed in the normal group. Four months postintervention, the larynges were excised and put into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning, followed by an analysis of diffusion parameters among the different groups for statistical significance. After MRI scanning, the vocal folds were cut into sections, stained with hematoxylin and eosin, and scanned digitally. The mean cross-sectional area of muscle fibers, and the mean diameter of muscle fibers in the vocal folds were calculated by target detection and extraction technology. Mean values of each measurement were used to compare the differences among the three groups. Pearson correlation analysis was performed on the DTI parameters and the results from histological section extraction.

RESULTS

The paralysis group had significantly higher Fractional Anisotropy (FA) compared to the dislocation group and normal group (P = 0.004). The paralysis group also had a significantly lower Tensor Trace value compared to the dislocation group and normal group (P = 0.000). The average cross-sectional area of vocal fold muscle fibers in the paralysis group was significantly smaller than the dislocation group and normal group (P = 0.000). Pearson correlation analysis yielded values of, r = -0.785, P = 0.01 between the average cross-sectional area of vocal muscle fibers and FA, and values of r = 0.881, P = 0.00 between Tensor Trace and the average cross-sectional area of vocal muscle.

CONCLUSION

FA and Tensor Trace can be used as effective parameters to reflect the changes of microstructure in vocal fold paralysis and cricoarytenoid joint dislocation. DTI is an objective and quantitative method to effectively evaluate unilateral vocal fold paralysis and unilateral cricoarytenoid joint dislocation, also capable of noninvasively evaluating vocal fold muscle fiber microstructure.

Increased 18F-FDG Uptake in the Posterior Region of Contralateral Vocal Folds in Beagle Dogs With Unilateral Vocal Fold Immobility Disorders

OBJECTIVE

To explore the glycolytic metabolism of contralateral vocal fold compensation by examining the glycolytic metabolism of the posterior region of vocal folds in beagles with unilateral vocal fold immobility disorders and its correlation with acoustic parameters.

STUDY DESIGN

Prospective animal study.

SETTING

Department of Voice METHODS: Ten adult beagles were divided randomly into three groups: a unilateral cricoarytenoid joint dislocation (UCAJD) group (n = 4), a unilateral vocal fold paralysis (UVFP) group (n = 4), and a control group (n = 2). Positron emission tomography-computed tomography (PET/CT) scans of larynx and recordings of vocalizations were collected 4 months after the operations. The maximum standardized uptake values (SUVmax) of 18F-FDG within each posterior region of the vocal folds were obtained from PET/CT and voice recordings were analyzed for acoustic parameters F0, jitter, shimmer, and loudness using PRAAT.

RESULTS

In both UCAJD and UVFP groups, a significant increase of SUVmax was observed in the contralateral vocal fold relative to the impaired fold (P < 0.05). The SUVmax values of the contralateral vocal folds and the SUVmax values of the impaired vocal folds in the UCAJD, UVFP, and control groups were both found to be significantly different (P < 0.05). The SUVmax of the contralateral vocal fold may exhibit a potentially negative correlation with jitter and shimmer, with R2 values of 0.42 and 0.26 and P values of 0.03 and 0.11, respectively.

CONCLUSION

UCAJD and UVFP can cause enhanced glycolytic metabolism of the contralateral vocal fold relative to the impaired vocal fold. The SUVmax of the contralateral vocal fold may be positively correlated with acoustic quality.

Using Diffusion Tensor Imaging to Explore the Changes in the Microstructure of Canine Vocal Fold Scar Tissue

OBJECTIVE

To apply diffusion tensor imaging (DTI) in measurement of the diffusion characteristics of water molecules in vocal fold scar tissue, combined with the analysis of textural characteristics of collagen fibers in the cover layer of the vocal folds to explore the feasibility of DTI in the qualitative and quantitative diagnosis of vocal fold scars and the evaluation of microstructural changes of vocal fold scar tissue.

METHODS

A unilateral injury was created using micro-cup forceps in the left vocal fold of six beagles. The contralateral normal vocal fold was used as a self-control. Five months postinjury, the larynges were excised and placed into a magnetic resonance imaging (MRI) system (9.4T BioSpec MRI, Bruker, German) for scanning and extraction of the diffusion parameters, fractional anisotropy (FA) and tensor trace in the anterior, middle, and posterior portions of the vocal fold cover layer. These parameters were then analyzed for statistical significance between the scarred vocal fold and the normal vocal fold. After MRI scanning, the tissue of the vocal folds was divided into anterior, middle, and posterior parts for sectioning and staining with hematoxylin and eosin, and samples were subsequently digitally scanned for texture analysis. The irregularity parameters, energy, contrast, correlation, and homogeneity, of collagen fibers of the vocal folds and the mean gray value of collagen fibers were calculated by the gray-level co-occurrence matrix (GLCM) texture analysis method. The differences in the mean value of the two sides of the vocal fold were compared. In addition, Pearson correlation analysis was performed between DTI parameters and irregularity parameters.

RESULTS

The FA of the left vocal fold cover layer was significantly lower compared to the self-control group (P = 0.0366), and the tensor trace value on the left vocal fold cover layer was significantly higher compared to the self-control group (P = 0.0353). The FA was significantly higher in the anterior part of the right vocal fold cover layer compared to the middle and posterior parts of the same side (P = 0.0352), and the tensor trace was significantly lower in the anterior part of the right vocal fold cover layer compared to the middle and posterior parts of the same side (P = 0.0298). There were no significant differences in FA and tensor trace between the middle and posterior parts of the vocal fold cover layer. The mean gray value of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0219), the energy of the left vocal fold cover layer was significantly smaller than that of the right vocal fold cover layer (P < 0.0001), the contrast of the left vocal folds cover layer was significantly larger than that of the right vocal fold cover layer (P = 0.0002), the correlation of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0002), and the homogeneity of the left vocal folds cover layer was significantly smaller than the right vocal fold cover layer (P = 0.0003). Pearson correlation analysis yielded values of r = 0.926, P = 0.000 between the FA and mean gray value; r = -0.918, P = 0.000 between FA and energy; r = -0.924, P = 0.000 between the FA and homogeneity, r = -0.949, P = 0.000 between tensor trace and mean gray value; r = 0.893, P = 0.000 between the tensor trace and energy; and r = 0.929, P = 0.000 between the tensor trace and homogeneity.

CONCLUSION

FA and tensor trace can be used as effective parameters to reflect microstructural changes in vocal fold scars. DTI is an objective and quantitative method of analyzing vocal fold scarring, and it noninvasively evaluates the microstructure of vocal fold collagen fibers.

Exploring the Clinical Characteristics of Superior Laryngeal Nerve Injury

OBJECTIVES

To observe the cases of superior laryngeal nerve injury along with summarizing and analyzing its clinical characteristics.

METHODS

A total of 14 patients with unilateral superior laryngeal nerve injury (SLN) diagnosed by laryngeal electromyography (LEMG) in our department from 2018 to 2020 were collected as SLN injury group. A total of 14 healthy subjects with normal laryngeal electromyography were recruited as normal group matched by age and sex. The etiology and LEMG of the SLN injury group were analyzed, and the video stroboscopic manifestations of SLN injury group and normal group were compared to see the characteristic video stroboscopic manifestations of SLN injury.

RESULTS

The most common causes of SLN injury were surgery and idiopathic etiology. Compared with normal group, the most frequent video stroboscopic manifestations of SLN injury group were vocal fold dyskinesia. Abnormal video stroboscopic manifestations occurred in normal group except larynx deviation, epiglottic petiole deviation, and dyskinesia. There was a significant difference between the two groups in various abnormal video stroboscopic manifestations (P < 0.05). Time limit widening was the most common manifestation of LEMG.

CONCLUSIONS

Vocal fold dyskinesia was a prominent finding in SLN injury, laryngeal deviation and epiglottic petiole deviation were relative specific signs of SLN injury. Vocal fold bowing combined with shortening will contribute to the diagnosis of SLN injury. There were no specific diagnostic signs for SLN injury, clinicians need further LEMG for a firm diagnosis.

Glottic Insufficiency in the Vertical Plane in Patients With Unknown-Source Unilateral Vocal Fold Hypomobility

OBJECTIVE

To observe the laryngeal CT and strobe laryngoscopy signs of unilateral vocal fold hypomobility (UVFHM) in patients with well-closed glottises in the horizontal plane.

METHODS

A retrospective analysis was performed on 18 subjects with well-closed glottises in the horizontal plane using strobe laryngoscopy, 9 patients diagnosed with unilateral vocal fold hypomobility with an unknown etiology were enrolled in the UVFHM group, and 9 healthy matched subjects with symmetrical bilateral vocal fold movement were enrolled in the control group. Vertical plane distances of bilateral vocal folds and three-dimensional structural parameters of vocal folds were measured through laryngeal CT. Glottic insufficiency in the vertical plane and reflux findings scores (RFS) were assessed under laryngeal CT and strobe laryngoscopy. Reflux symptom index (RSI) were collected. SPSS25.0 software was used for statistical analysis.

RESULTS

The height differences in vertical plane and thicknesses of bilateral vocal folds in the UVFHM group were larger than those in the control (P < 0.05), while the length, width and subglottic convergence angle of the vocal folds were not statistically significant between the two groups (P > 0.05). In the UVFHM group, laryngeal CT showed that 77.78% of patients (7/9) had glottic insufficiency in the vertical plane, with height differences ranging from 0.3 to 1.9 mm and a mean of 0.76mm. However, strobe laryngoscopy showed that 33.33% (3/9) had glottic insufficiency in the vertical plane. The proportion of patients with glottic insufficiency in vertical plane in the UVFHM group was significantly higher than that in the control group (P < 0.05). RSI and RFS scores of the UVFHM group were higher than those of the control group (P < 0.05).

CONCLUSION

Glottic insufficiency in the vertical plane often occurred in patients with UVFHM with an unknown cause of hoarseness, so the presence of glottic insufficiency in the vertical plane should be considered when hoarseness is detected by clinicians. Laryngeal dynamic CT can enhance the diagnostic rate compared to strobe laryngoscopy. Unexplained UVFHM patients have higher RSI and RFS compared to control subjects, warranting further research about the relationship between UVFHM and laryngopharyngeal reflux.

The Effects of Hard Voice Onset on Objective Voice Function in Patients With Laryngopharyngeal Reflux

OBJECTIVE

Laryngopharyngeal reflux (LPR) causes laryngopharyngeal hypersensitivity and laryngeal muscle hyperfunction, which may result in hard voice onset in patients with LPR. The purpose of this study is to examine the incidence of hard voice onset in patients with LPR and the effects of hard voice onset on objective voice function in patients with LPR.

METHODS

Forty patients with confirmed LPR were enrolled in the LPR group, and 40 healthy subjects were enrolled in the non-LPR group. Subjects underwent laryngeal high-speed videoendoscopy, and the presence or absence of hard voice onset in each subject was determined by two experienced laryngologists based on whether glottal closure was complete or incomplete before vocal fold vibration. Based on the results, the subjects with LPR were divided into a hard voice onset group and a non-hard voice onset group. The voice onset time (VOT) was measured and compared between the hard and non-hard voice onset groups within the LPR group. Laryngeal aerodynamic assessment was also carried out on the LPR group, and subglottal pressure, phonation threshold pressure (PTP), glottal resistance, and mean flow rate were measured. The voice acoustic signals of subjects were additionally analyzed in the LPR group, and the fundamental frequency, jitter, shimmer, and noise-harmony ratio were determined. The kappa statistic, chi-square test and independent-samples t test in SPSS were used for statistical analysis.

RESULTS

The two laryngologists had substantial inter-rater consistency on the evaluation of hard voice onset and non-hard voice onset, with a kappa statistic of 0.71. In the LPR group, 42.5% of patients had hard voice onset (17/40), significantly more than in the non-LPR group (8/40, 20%) (P < 0.05). The VOT in the LPR group was significantly longer than in the non-LPR group (P < 0.05). Within the LPR group, the VOT, PTP and shimmer were significantly greater in the hard voice onset group than in the non-hard voice onset group (all P < 0.05). The other laryngeal aerodynamic parameters and acoustic parameters were not significantly different between the hard voice onset group and the non-hard voice onset group (P > 0.05).

CONCLUSION

Changes in vocal production may occur in LPR patients, causing them to be more susceptible to hard voice onset. The patients with hard voice onset require longer VOT and greater PTP to initiate phonation.

Effects of Cryopreservation on Acrosin Activity and DNA Damage of Russian Sturgeon (Acipenser gueldenstaedtii) Semen

BACKGROUND

Cryopreservation of sturgeon sperm can be successful, but there can be a decrease in sperm viability and the reasons are not clear.

OBJECTIVE

To investigate variations in the acrosin activity and the DNA integrity of Acipenser gueldenstaedtii semen during cryopreservation at -196ºC.

MATERIALS AND METHODS

Fish semen samples were randomly divided into three groups: [1] fresh control; [2] native semen diluted 1:1 with 23.4 mM sucrose + 0.25 mM KCl + 30 mM Tris (pH 8.0) and the addition of 10% methanol as cryoprotectant; and [3] semen without any diluents or cryoprotectants. Acrosin activity and DNA damage (COMET assay) were assessed.

RESULTS

The average acrosin activity fell to 61% and 27% of the control for cryoprotected and non-cryoprotected semen after cryopreservation. The differences among the three groups were significant (P<0.05). We also observed that various indexes of DNA damage (L-tail; tail DNA, tail momentum, olive tail momentum) were higher in semen that had been frozen.

CONCLUSION

Although cryopreservation of semen induces decreased acrosin activity and increased DNA damage, cryoprotectants can protect the semen during cryopreservation.

The Influence of Voice Training on Vocal Learner's Objective Acoustic Voice Components

OBJECTIVE

Acoustic parameters of voice were studied in music majors throughout 18 months of training to understand the influence of voice training on voice.

METHODS

Twenty-three students from Xiamen Music School between 12 and 15 years old were enrolled. Acoustic examination was performed three times- every 6 months for 18 months. Various traditional acoustic parameters were measured, including dysphonia severity index (DSI), jitter, and D-value of vocal range. Nonlinear dynamic measures were also measured, including diffusive chaos to construct voice type component profiles (VTCPs), spectrum convergence ratio, and nonlinear energy difference ratio. The results were analyzed by multivariate analysis of variance.

RESULTS

Over the study duration, there was an improvement of DSI (P = 0.002), and D-value of vocal range (P = 0.000). Among nonlinear parameters, only voice type component data demonstrated significant changes during the study duration. Both Voice Type Component 1(VTC1) and VTC3 values differed from Time 1 to Time 2 as well as from Time 1 to Time 3. The proportion of VTC1 in samples generally decreased, while VTC3, representative of aperiodicity, increased. Both nonlinear energy difference ratio and spectrum convergence ratio exhibited no significant changes throughout the study.

CONCLUSION

Professional voice training can improve DSI and D-value of vocal range in singers' voices. These parameters have potential to be used for voice training evaluation and screening. Many nonlinear parameters did not detect differences in the healthy voices studied, but VTCPs created using intrinsic dimension present a valuable new method, visualizing increases in aperiodicity of the speaking voices after professional voice training.

An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China

PURPOSE

Using the Reflux Symptom Index (RSI), this nationwide study aimed to investigate the incidence, diagnostic status, risk factors, and common symptoms of adult laryngopharyngeal reflux disease (LPRD) at otorhinolaryngology-head and neck surgery (OHNS) clinics in China.

METHODS

This multicenter cross-sectional survey began at the different institutions ranged from July to October 2017, and the duration was 12 months. A total of 90,440 eligible patients were finally enrolled from 72 medical institutions in China. All these patients completed the questionnaire based on RSI. In this study, LPRD was defined as RSI > 13.

RESULTS

There were 9182 with LPRD among the 90,440 eligible participants (10.15%). However, only 1294 had a history of LPRD diagnosis among those with LPRD (14.09%). There were regional differences in the frequency of LPRD (P < 0.001). The proportions of patients with LPRD in males (vs. females), middle- and old-aged patients (vs. young), with current smoking history (vs. no smoking), and current drinking history (vs. no drinking) were significantly higher (all P < 0.001). Middle and old age, current smoking, and drinking history were independent predictors of LPRD (all P < 0.001, OR 1.240, 1.261, and 1.481, respectively). "Sensations of something stuck in throat or a lump in throat", "clearing throat", and "excess throat mucus or postnasal drip" were the most frequent clinical symptoms in patients with LPRD.

CONCLUSIONS

LPRD has a high incidence at the OHNS clinics in China. However, the diagnostic status of this disease is not optimistic. Older age, smoking, and drinking history were risk factors for LPRD.

Spatial Motion of Arytenoid Cartilage Using Dynamic Computed Tomography Combined with Euler Angles

OBJECTIVE

To investigate the feasibility of dynamic computed tomography in recording and describing the spatial motion characteristics of the arytenoid cartilage.

METHODS

Dynamic computed tomography recorded the real-time motion trajectory of the arytenoid cartilage during inspiration and phonation. A stationary coordinate system was established with the cricoid cartilage as a reference and a motion coordinate system was established using the movement of the arytenoid cartilage. The Euler angles of the arytenoid cartilage movement were calculated by transformation of the two coordinate systems, and the spatial motion characteristics of the arytenoid cartilage were quantitatively studied.

RESULTS

Displacement of the cricoid cartilage was primarily inferior during inspiration. During phonation, the displacement was mainly superior. When the glottis closed, the superior displacement was about 5-8 mm within 0.56 s. During inspiration, the arytenoid cartilage was displaced superiorly approximately 1-2 mm each 0.56 s. The rotation angle was subtle with slight rotation around the XYZ axis, with a range of 5-10 degrees. During phonation, the displacement of the arytenoid cartilage was mainly inferior (about 4-6 mm), anterior (about 2-4 mm) and medial (about 1-2 mm). The motion of the arytenoid cartilage mainly consisted of medial rolling, and there was an alternating movement of anterior-posterior tilting. The arytenoid cartilage rolled medially (about 20-40 degrees within 0.56 s), accompanied by anterior-posterior tilting (about 15-20 degrees within 0.56 s).

CONCLUSION

Dynamic computed tomography recordings of arytenoid cartilage movement can be combined with Euler transformations as a tool to study the spatial characteristics of laryngeal structures during phonation.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:E646-E653, 2020.

Compensatory Movement of Contralateral Vocal Folds in Patients With Unilateral Vocal Fold Paralysis

OBJECTIVES

Previous studies of subjects with unilateral vocal fold paralysis (UVFP) as observed in a positron emission tomography-computed tomography (PET-CT) examination have demonstrated false positive results in the contralateral cricoarytenoid, in which the metabolism may be higher. This area may also be the site of contralateral compensatory movement in these patients. In this study, we compared the adduction speed of the contralateral vocal folds in patients with UVFP and in healthy subjects as measured by the stroboscopic laryngoscope frame rate. This study aimed to explore the contralateral compensatory movement of the vocal folds in subjects with UVFP.

METHODS

(1) We collected visual data from 14 patients with UVFP and 14 healthy subjects through a stroboscopic laryngoscope. These subjects were divided into a vocal fold paralysis group and a control group, and we analyzed the excessive adduction of the contralateral vocal folds in the vocal fold paralysis group by examining vocal fold movement speed (pixels/s) as featured in a stroboscopic laryngoscope video. (2) We analyzed the uptake of 18-FDG in the posterior vocal fold from positron emission tomography-computed tomography imaging from four subjects with UVFP and 12 healthy subjects. An independent sample t test and a χ² test were used to compare data.

RESULTS

Four subjects with UVFP had a higher metabolic rate in the contralateral cricoarytenoid joints, with a significant difference between the two groups, P < 0.05. Fifty percent of the cases of contralateral adduction of the vocal folds in the subjects with UVFP adducted past the midline, with a significant difference between the two groups, P < 0.05. The contralateral adduction of the vocal folds in subjects with UVFP had shorter video frames and higher adduction speed than the control group, and the difference was statistically significant, P < 0.05. There were fewer vocal fold abduction video frames and higher abduction speed of the healthy side of the vocal fold in subjects with UVFP than the control group, but there was no statistically significant difference, P > 0.05.

CONCLUSION

Subjects with UVFP exhibited faster adduction compensation in the contralateral vocal folds, and the contralateral cricoarytenoid joint's metabolism in subjects with UVFP was higher. These data may help clarify the diagnostic criteria for laryngeal nerve damage.

Evaluation of Diffusional Characteristics and Microstructure in Unilateral Vocal Fold Paralysis Using Diffusion Tensor Imaging

OBJECTIVE

To investigate the value of diffusion tensor imaging (DTI) in the evaluation of vocal fold tissue microstructure after recurrent laryngeal nerve (RLN) injury.

METHODS

Six canines were divided into 2 groups: a unilateral vocal fold paralysis group (n = 4) and a control group (n = 2). The RLN was cut in the unilateral vocal fold paralysis group, and no intervention was applied in the control group. After 4 months, the canines' larynges were removed and placed in a small animal magnetic resonance imaging (MRI) system (9.4T BioSpec MRI; Bruker, Germany). After scanning, the vocal folds were isolated, sectioned, and stained. The slides were then analyzed for the cross-sectional area and muscle fiber density through feature extraction technology. Pearson correlation analysis was performed on the DTI scan and histological section extraction results.

RESULTS

In the vocal fold muscle layer, the fractional anisotropy (FA) of the unilateral RLN injury group was higher than that of the control group, and the Tensor Trace was lower than that of the control group. This difference was statistically significant, P < .05. In the lamina propria, the FA of the unilateral RLN injury group was lower than that of the control group, P > .05, and the Tensor Trace was lower than that of the control group, P < .05. The muscle fiber cross-sectional area of the RLN injury group was significantly smaller than the control group with statistical significance, P < .05, and the density of muscle fibers was lower, P < .05. The correlation coefficient between FA and the cross-sectional area was -0.838, P = .002, and .726; P = .017 between Tensor Trace and the cross-sectional area.

CONCLUSION

Diffusion tensor imaging is an effective method to assess the changes in the microstructure of atrophic vocal fold muscle tissue after RLN injury.

The Mandarin Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Its Reliability

PURPOSE

The purpose of this study is to develop the Mandarin version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and evaluate its reliability compared with the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS).

METHOD

The Mandarin version of the CAPE-V tool was translated from the validated English version with phonemic adaptations, content adjustment, and scale modification. Sixty dysphonic, 20 normal, and 20 repeated voice samples were included in this study. Ten of these were used for preassessment training; the remaining 90 were evaluated using the Mandarin CAPE-V and GRBAS for comparison of their interrater and intrarater reliabilities.

RESULTS

Intrarater reliability was measured by Pearson r for the CAPE-V and Spearman rho for the GRBAS. Average CAPE-V Pearson r ranged from 0.80 for strain to 0.91 for overall severity, compared with average GRBAS Spearman rho of 0.83 for strain to 0.89 for asthenia. Interrater reliability was measured by an intraclass coefficient (ICC). Average CAPE-V ICCs ranged from .57 for pitch to .81 for overall severity, compared with average GRBAS ICCs of .60 for asthenia to .83 for grade.

CONCLUSIONS

The Mandarin CAPE-V addresses some limits of the English version. It also demonstrates good intrarater and interrater reliability, comparable to those of GRBAS.

Association of fish and long-chain omega-3 fatty acids intakes with total and cause-specific mortality: prospective analysis of 421 309 individuals

BACKGROUND

Prevailing dietary guidelines recommend regular fish consumption. However, the associations of fish and long-chain omega-3 polyunsaturated fatty acids (LCn-3 PUFAs) intakes with mortality remain unclear.

OBJECTIVES

To examine the associations of fish and LCn-3 PUFAs intakes with total and cause-specific mortality.

METHODS

A total of 240 729 men and 180 580 women from NIH-AARP Diet and Health Study were prospectively followed-up for 16 years. Dietary intakes were assessed using a validated NIH Diet History Questionnaire.

RESULTS

A total of 54 230 men and 30 882 women died during 6.07 million person-years of follow-up. Higher fish and LCn-3 PUFAs intakes were significantly associated with lower total mortality (P < 0.0001). Comparing the highest with lowest quintiles of fish intake, men had 9% (95% confidence interval, 6-11%) lower total mortality, 10% (6-15%) lower cardiovascular disease (CVD) mortality, 6% (1-10%) lower cancer mortality, 20% (11-28%) lower respiratory disease mortality and 37% (17-53%) lower chronic liver disease mortality, while women had 8% (5-12%) lower total mortality, 10% (3-17%) lower CVD mortality and 38% (20-52%) lower Alzheimer's disease mortality. Fried fish consumption was not related to mortality in men whereas positively associated with mortality from all causes (P = 0.011), CVD and respiratory disease in women. LCn-3 PUFAs intake was associated with 15% and 18% lower CVD mortality in men and women across extreme quintiles, respectively.

CONCLUSION

Consumption of fish and LCn-3 PUFAs was robustly associated with lower mortality from major causes. Our findings support current guidelines for fish consumption while advice on non-frying preparation methods is needed.

Study on Normal Laryngeal Electromyography of Thyroarytenoid Muscle, Cricothyroid Muscle, and Posterior Cricoarytenoid Muscle

OBJECTIVE

The aim of this study was to investigate the physiological activity of intrinsic laryngeal muscle under different functional states of larynx by measuring the normal laryngeal electromyography parameters.

METHODS

Laryngeal electromyography (EMG) was performed in 112 patients with unilateral vocal cord movement disorder. The duration and amplitude of the motor unit potential (MUP) of the thyroarytenoid muscle (TA), posterior cricoarytenoid muscle (PCA), and cricothyroid muscle (CT) were measured when patients were asked to make a deep inspiration and phonate /i/. The normal side of the patients' vocal chords was used as the research object.

RESULTS

(1) The motor unit potential of TA, CT, and PCA were measured when inspiration and phonating /i/. Waveforms were normal. (2) There were significant differences in duration of TA between inspiration and phonating /i/ in comfortable tone. (3) When comparing the duration and amplitude of any 2 of TA, CT, and PCA during inspiration and phonating /i/, there were significant differences in duration between CT and PCA when phonating /i/ only. There were no significant differences in any other comparisons.

CONCLUSIONS

Under either deep inspiration or pronunciation, the TA, CT, and PCA muscles were activated. The TA may play a major role in phonating. The PCA may play a major role in the action of deep inspiration.

Properties of oscillatory neuronal activity in the basal ganglia and thalamus in patients with Parkinson's disease

Background

The cardinal features of Parkinson’s disease (PD) are bradykinesia, rigidity and rest tremor. Abnormal activity in the basal ganglia is predicted to underlie the mechanism of motor symptoms. This study aims to characterize properties of oscillatory activity in the basal ganglia and motor thalamus in patients with PD.

Methods

Twenty-nine patients with PD who underwent bilateral or unilateral electrode implantation for subthalamic nucleus (STN) DBS (n = 11), unilateral pallidotomy (n = 9) and unilateral thalamotomy (n = 9) were studied. Microelectrode recordings in the STN, globus pallidus internus (GPi) and ventral oral posterior/ventral intermediate of thalamus (Vop/Vim) were performed. Electromyography of the contralateral limbs was recorded. Single unit characteristics including interspike intervals were analyzed. Spectral and coherence analyses were assessed. Mean spontaneous firing rate (MSFR) of neurons was calculated. Analysis of variance and X² test were performed.

Results

Of 76 STN neurons, 39.5% were 4–6 Hz band oscillatory neurons and 28.9% were β frequency band (βFB) oscillatory neurons. The MSFR was 44.2 ± 7.6 Hz. Of 62 GPi neurons, 37.1% were 4–6 Hz band oscillatory neurons and 27.4% were βFB neurons. The MSFR was 80.9 ± 9.6 Hz. Of 44 Vop neurons, 65.9% were 4–6 Hz band oscillatory neurons and 9% were βFB neurons. The MSFR was 24.4 ± 4.2 Hz. Of 30 Vim oscillatory neurons, 70% were 4–6 Hz band oscillatory neurons and 13.3% were βFB neurons. The MSFR was 30.3 ± 3.6 Hz. Further analysis indicated that proportion of βFB oscillatory neurons in STN and GPi was higher than that of similar neurons in the Vop and Vim (P < 0.05). Conversely, the proportion of 4–6 Hz band oscillatory neurons and tremor related neurons in the Vim and Vop was higher than that of STN and GPi (P < 0.05). The highest MSFR was for GPi oscillatory neurons whereas the lowest MSFR was for Vop oscillatory neurons (P < 0.005).

Conclusion

The alterations in neuronal activity in basal ganglia play a critical role in generation of parkinsonism. β oscillatory activity is more prominent in basal ganglia than in thalamus suggesting that the activity likely results from dopaminergic depletion. While both basal ganglia and thalamus have tremor activity, the thalamus appears to play a more important role in tremor production, and basal ganglia β oscillatory activity might be the trigger.

Establishment and Analysis of False Vocal Folds Hypertrophy Model in Excised Canine Larynges

OBJECTIVE

This study aimed to investigate the role of false vocal folds (FVFs) medialization in phonation and the acoustic impact of ventricular hypertrophy by establishing an FVF hypertrophy model.

STUDY DESIGN

A prospective in vitro experiment was carried out.

SETTING

The study was carried out using a pseudolung platform with high-speed camera in a soundproof room.

MATERIALS AND METHODS

Control, degree I, and degree II FVFs hypertrophy were simulated in 10 excised larynges via fructose injection of 0.1 mL for degree I and 0.25 mL for degree II. Mean flow rate (MFR), fundamental frequencies (F0), formants, and sound pressure level were measured with a subglottal pressure of 1.5 kPa and 2.5 kPa, respectively.

RESULTS

When the subglottal pressure was controlled at both at 1.5 kPa and at 2.5 kPa, the degree of FVF hypertrophy significantly influenced the distribution of the formants, F0, and MFR in excised canine larynges. Increasing the degree of hypertrophy was associated with a decrease in F0 and an increase in MFR. In degree II FVF hypertrophy models, the sound pressure level and the first formant were significantly higher (P < 0.05) than in normal models.

CONCLUSION

Hypertrophy of the FVFs has a significant influence on the distribution of sound energy and is associated with changes in sound quality.

The Effect of Vocal Fold Inferior Surface Hypertrophy on Voice Function in Excised Canine Larynges

OBJECTIVE

This study aimed to explore the changes in vocal fold inferior surface hypertrophy (VFISH) on vocal fold vibration by aerodynamic and acoustic analysis. The present study allows us to gain new insights into the subglottal convergence angle (SCA), which will change with VFISH.

STUDY DESIGN

The study is prospective, and designed for repeated measures with each excised canine larynx serving as own control.

SUBJECTS AND METHODS

Three degrees of VFISH, initial, mild, and severe, were simulated by injecting different doses of fructose injections into the inferior surface of the vocal folds of 10 excised canine larynges. Computed tomographic images of the larynx were gathered, and three-dimensional models of the airway and vocal folds were reconstructed using the Mimics software. The SCA was measured from the reconstructed models. Phonation threshold flow (PTF), phonation threshold pressure (PTP), and mean flow rate (MFR) were recorded directly in the excised canine larynx phonation setup. Glottal resistance (GR), sound pressure level (SPL), fundamental frequency (F0), and formants 1-4 (F1-4) were measured when subglottal pressure (P_sub) was at 1.5 kPa or 2.5 kPa, separately. Using ordinary one-way analysis of variance, we compared the aerodynamic outcomes and voice quality among the three groups of hypertrophy.

RESULTS

The SCA, PTP, and PTF increased with the degree of VFISH. When the P_sub was controlled at 1.5 kPa or 2.5 kPa, F0 also increased significantly with the degree of VFISH of the excised canine larynges. The MFR, GR, SPL, and F1-4 had little change between the three groups and were not significantly different.

CONCLUSION

The VFISH makes onset phonation more difficult, increases the SCA, and increases the F0 in sustained phonation.

Subthalamic oscillatory activity in parkinsonian patients with off-period dystonia

OBJECTIVES

The study was aimed to explore oscillatory activity in the subthalamic nucleus (STN) in Parkinson's disease (PD) with off-period dystonia, a type of levodopa-induced dyskinesias (LID).

METHODS

Eighteen patients with PD who underwent STN DBS were studied. Nine patients had dyskinesia defined as the LID group and nine patients who did not present any sign of dyskinesia were defined as the control group. Microelectrode recordings in the STN together with electromyogram (EMG) were recorded. Spectral and coherence analyses were performed to study the neuronal oscillations in relation to limb muscles.

RESULTS

Two hundred and fifteen neurons were identified. There were 39 neurons with tremor-frequency band (4-7 Hz) oscillation, 57 neurons with β-frequency band (12-30 Hz, β-FB) oscillation and 100 neurons without oscillation, and 19 neurons with very low-frequency band oscillation at a mean peak power of 1.2 ± 0.5 Hz (LFB). These LFB oscillatory neurons (n = 15) were frequently significantly coherent with EMG of off-period dystonia. Notably, 89% (n = 17) neurons with LFB oscillation were found in the patients in the off-dystonia group. The age at onset of PD, duration of PD, and levodopa equivalent dose daily consumption were statistically different between two groups (P < 0.05).

CONCLUSIONS

Subthalamic LFB oscillatory neurons seem to play an important role in the genesis of off-period dystonia in advanced PD. Clinical and demographic analyses confirmed that the earlier age at onset of PD, longer duration of PD, and levodopa exposure are important risk factors in the development of the type of LID.

Heavy-flavour and quarkonium production in the LHC era: from proton-proton to heavy-ion collisions

This report reviews the study of open heavy-flavour and quarkonium production in high-energy hadronic collisions, as tools to investigate fundamental aspects of Quantum Chromodynamics, from the proton and nucleus structure at high energy to deconfinement and the properties of the Quark-Gluon Plasma. Emphasis is given to the lessons learnt from LHC Run 1 results, which are reviewed in a global picture with the results from SPS and RHIC at lower energies, as well as to the questions to be addressed in the future. The report covers heavy flavour and quarkonium production in proton-proton, proton-nucleus and nucleus-nucleus collisions. This includes discussion of the effects of hot and cold strongly interacting matter, quarkonium photoproduction in nucleus-nucleus collisions and perspectives on the study of heavy flavour and quarkonium with upgrades of existing experiments and new experiments. The report results from the activity of the SaporeGravis network of the I3 Hadron Physics programme of the European Union 7[Formula: see text] Framework Programme.

[Acoustic analysis in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis]

OBJECTIVE

To analysis the acoustic characteristics in patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis, and evaluate the application value of acoustic analysis technique in these two diseases.

METHOD

The voice signals of sustained vowel /a/ were measured using the software MDVP in 50 healthy adults and 67 patients with unilateral vocal cord movement disorders. The acoustic parameters (jitter, shimmer, NHR and F₀) were analyzed. All patients were divided into arytenoid dislocation group (36 cases) and vocal fold paralysis group (31 cases) through the laryngeal electromyography. All groups were divided into male and female group again. The acoustic characteristics between the two experimental groups and normal control groups were observed and compared. Results were analyzed using Rank sum test.

RESULT

(1) In both male or female groups, there were significant differences in jitter and shimmer between two experimental group and control group. In both male or female groups, there were significant differences in NHR between arytenoid dislocation group and control group. There were no significant differences in NHR between vocal fold paralysis group and control group. Except for the male vocal fold paralysis group, there were significant differences in F between the other experimental groups and control groups. (2) In both male or female groups, there were no significant differences in jitter and shimmer between vocal fold paralysis group and arytenoid dislocation group. There were significant differences in NHR.

CONCLUSION

The acoustic parameters are effective parameters to measure the voice quality of patients with unilateral arytenoid dislocation and unilateral vocal fold paralysis. NHR is the most sensitive parameter in the distinction of vocal cord paralysis and arytenoid dislocation.

[Significance of certain experiments relevant to airflow parameters in assessment of voice function]

OBJECTIVE

To investigate the role of airflow parameters of some specific examinations in voice function assessment.

METHODS

The s/z ratio, pulmonary function and phonatory aerodynamic parameters were measured in subjects with benign vocal fold lesions and with normal voice. The effect of treatment in subjects with benign vocal fold lesions was evaluated with the phonatory aerodynamic parameters.

RESULTS

The value of s/z ratio in the disease group was higher than that in the normal group (P<0.05). The value of PEF was significantly different between the disease group and the normal group for male (P<0.05). MFR, MPT, PTF, SGP, PTP, VE were significantly different between the disease group and the normal group (P<0.05). MFR, MPT, PTF, SGP, PTP of the disease group after surgery for both sex were significantly different from before surgery (P<0.05). The disease group was subdivided into two groups through stroboscopic examination before and one month after surgery: the worse group (with some functional laryngeal abnormality, or organic abnormality except benign vocal fold lesion) and the better group. PTF, PTP, SGP, VE were significantly different between the worse group and the normal voice group. There was almost no significant difference for aerodynamic parameters between the better group and the normal voice group (P>0.05). There was no significant difference between the worse group after 8 weeks'voice training and the normal voice group (P>0.05).

CONCLUSIONS

s/z ratio, aerodynamic parameters (MFR, MPT, SGP, PTF, PTP, VE) are valuable for the diagnosis and assessment of the voice disorders. Aerodynamic parameters are sensitive to the change of glottal function during the treatment. Voice training can increase the glottal function of patients after laryngeal microsurgery.

Isosmotic points and their ecological significance for juvenile Chinese sturgeon Acipenser sinensis

Serum osmolality and ion concentrations were measured in juvenile Chinese sturgeon Acipenser sinensis at different salinities to determine the isosmotic point. Isosmotic and isoionic concentrations were calculated from the regressions for serum and ambient osmolality, with Na(+) , Cl(-) and K(+) as salinities 9·19, 8·17, 7·89 and 9·70, respectively. These values were consistent with the salinity of the habitat where juvenile A. sinensis occur in the Yangtze Estuary, suggesting that an isosmotic salinity is an important factor driving their habitat choice.

Effects of cryopreservation on motility characteristics and enzyme activity of sperm in a Chinese fish Nibea albiflora

BACKGROUND

Growing evidence suggests that among the causes which deteriorate qualitative and functional characteristics of sperm after freezing and thawing, there are those linked to decrease of sperm motility and release of various enzymes in the cells and seminal plasma.

OBJECTIVE

In the present study, the motility, fertilization and enzyme activity of sperm were analyzed after cryopreservation.

MATERIALS AND METHODS

Computer-assisted sperm motility analysis (CASA) was used to evaluate the effect of cryopreservation on sperm motility of Nibea albiflora.

RESULTS

The activities of total adenosine triphosphatase (ATPase), creatine kinase (CK), succinate dehydrogenase (SDH), lactate dehydrogenase (LDH), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px) and glutathione reductase (GR) in fresh and frozen seminal plasma and spermatozoa were measured respectively. Cryopreservation led to a decline in the percentage of motile sperm, moreover, other parameters of sperm motion, curvilinear and straight line velocities, linearity were changed observably (p < 0.05), the fertilizing capacity of post-thaw sperm was lower than that of the fresh sperm significantly. After cryopreservation, the activities of total ATPase, CK, SDH, LDH, SOD, CAT and GSH-Px increased in seminal plasma and decreased in spermatozoa respectively, but GR activity varied contrarily, GR activity dropped in seminal plasma and increased in spermatozoa.

CONCLUSION

Cryopreservation had significant effects on the motility characteristics, fertilization ability and enzyme activity of the sperm of Nibea albiflora.

Measurement of phonation threshold power in normal and disordered voice production

OBJECTIVES

Phonation threshold pressure (PTP) and phonation threshold flow (PTF) are useful aerodynamic parameters, but each is sensitive to different disorders. A single comprehensive aerodynamic parameter sensitive to a variety of disorders might be beneficial in quantitative voice assessment. We performed the first study of phonation threshold power (PTW) in human subjects.

METHODS

PTP and PTF were measured in 100 normal subjects, 19 subjects with vocal fold immobility, and 94 subjects with a benign mass lesion. PTW was calculated from these two parameters. In 41 subjects with a polyp, measurements were obtained before and after excision. Receiver operating characteristic (ROC) analysis was used to determine the ability of the three parameters to distinguish between controls and disordered groups.

RESULTS

The PTW (p < 0.001), PTP (p < 0.001), and PTF (p < 0.001) were different among the three groups. All parameters decreased after polyp excision. PTW had the highest area under the ROC curve for all analyses.

CONCLUSIONS

PTW is sensitive to the presence of mass lesions and vocal fold mobility disorders. Additionally, changes in PTW can be observed after excision of mass lesions. PTW could be a useful parameter to describe the aerodynamic inputs to voice production.

Differentiating arytenoid dislocation and recurrent laryngeal nerve paralysis by arytenoid movement in laryngoscopic video

OBJECTIVE

To present a new method of quantifying arytenoid movement during inspiration and determine if it can be used to distinguish arytenoid dislocation from vocal fold paralysis.

STUDY DESIGN

Case series with chart review.

SETTING

Retrospective study conducted in a university laboratory based on university hospital data.

SUBJECTS AND METHODS

Endoscopic videos from 8 patients with dislocation and 5 patients with vocal fold paralysis diagnosed by electromyography were included. Vector analysis measured cuneiform movement, an indirect measurement of arytenoid movement, during 1 inspiration. Measurements normalized and not normalized to vocal fold length were evaluated. Interrater reliability (2 raters) and intrarater reliability (1 rater performing the analysis twice) were evaluated using intraclass correlation coefficient (ICC) analysis. Raters were blinded to subject group during analysis.

RESULTS

Pixel-valued cuneiform movement was 81.16 ± 25.62 for dislocation and 30.22 ± 23.60 for paralysis (P = .019). Unitless cuneiform movement was 0.58 ± 0.17 for dislocation and 0.24 ± 0.18 for paralysis (P = .030). Interrater ICC was 0.942 for pixel-valued measurements and 0.962 for unitless measurements. Intrarater ICC was 0.909 for pixel-valued measurements and 0.881 for unitless measurements.

CONCLUSIONS

Both pixel-valued and unitless measures of arytenoid movement were significantly greater in arytenoid dislocation than vocal fold paralysis. Pixel-valued measurements were included to demonstrate the ability to make quantitative comparisons across subjects without precise knowledge of camera precision, provided position is approximately stable, as each measurement is inherently normalized by vocal tract length. Future studies will apply this new method of evaluating vocal fold immobility disorders on a larger scale and incorporate a more diverse group of etiologies.

Unilateral deep brain stimulation of the right globus pallidus internus in patients with Tourette's syndrome: two cases with outcomes after 1 year and a brief review of the literature

Tourette's syndrome is a complex neuropsychiatric disorder, characterized by tics. Bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) has been considered to be an effective treatment for refractory Tourette's syndrome. Postoperative outcomes are described after 12 months' follow-up in a 41-year-old male patient and a 22-year-old male patient with Tourette's syndrome, both of whom underwent unilateral electrode implantations into the right GPi for DBS. These patients were diagnosed with Tourette's syndrome in childhood and, despite long-term therapy with a range of antipsychotic medications, continued to experience disabling tics in adulthood. Improvements in tic severity of 58.5% and 53.1% were observed at 12 months in the older and younger patient, respectively; improvements were determined by the Yale Global Tic Severity Scale. Both patients also experienced reductions in tic frequency and reported improvements in their health-related quality of life. Improvements in tics were similar to previous reports involving patients who underwent bilateral GPi DBS. These cases suggest that unilateral DBS of the right GPi is effective and might be a viable surgical choice for some patients with Tourette's syndrome.

[The effect of hyalinized chorda tympani nerve canal in protection of mastoid segment of facial nerve in middle ear surgery]

OBJECTIVE

To investigate the effect of hyalinized chorda tympani nerve canal in mastoid segment to landmark facial nerve in middle ear surgery by means of observing the location relationship between hyalinized chorda tympani nerve canal and facial nerve.

METHOD

118 cases of cholesteatoma otitis media in our hospital undergoing tympanoplasty from 2008 to 2011 were retrospectively analyzed. In all the cases, the position of horizontal semicircular and fossa incus as well as the hyalinized chorda tympani nerve canal were used for landmark the height of facial ridge and vertical segment of facial nerve.

RESULT

The chorda tympani nerve of 99 patients were higher than the vertical segment of the facial nerve which were not exposed, and the vertical segment of the facial nerve in 9 patients, which were exposed, were 1-2 mm lower and 2-3 mm ahead or backward than the chorda tympani nerve. The horizontal semicircular and fossa incus were broken in 9 patients, of whom the vertical segments of the facial nerve were 1-2 mm lower and 2-3 mm ahead or backward than the chorda tympani nerve. The chorda tympani nerve of 1 patient were lower than the exposed vertical segment of facial nerve.

CONCLUSION

The hyalinized chorda tympani nerve canal in mastoid segment can landmark the positon of facial ridge, and it would be the complement to the traditional method of landmarking vertical segment of facial nerve, especially for those whose horizontal semicircular canal and fossa incus had been broken.

NUMERICAL METHODS FOR SOLVING THE MULTI-TERM TIME-FRACTIONAL WAVE-DIFFUSION EQUATION

In this paper, the multi-term time-fractional wave-diffusion equations are considered. The multi-term time fractional derivatives are defined in the Caputo sense, whose orders belong to the intervals [0,1], [1,2), [0,2), [0,3), [2,3) and [2,4), respectively. Some computationally effective numerical methods are proposed for simulating the multi-term time-fractional wave-diffusion equations. The numerical results demonstrate the effectiveness of theoretical analysis. These methods and techniques can also be extended to other kinds of the multi-term fractional time-space models with fractional Laplacian.

Changes in Spontaneous Dorsal Horn Potentials after Dorsal Root Entry Zone Lesioning in Patients with Pain after Brachial Plexus Avulsion

OBJECTIVES: This study investigated spontaneous dorsal horn potentials in patients with pain after brachial plexus avulsion and determined the effect of dorsal root entry zone (DREZ) lesioning on these potentials and on pain levels. METHODS: Electrospinography (ESG) recordings were undertaken in seven patients using a noninvasive electrocorticography strip electrode. Measurements were taken from the DREZ on the intact side of the spinal cord before lesioning of the injured DREZ and from the injured DREZ before and after lesioning. RESULTS: DREZ lesioning had a significant positive effect on pain at 12 months postoperatively. At 15.0 Hz, the mean ESG power from the injured DREZ before lesioning was significantly higher than that from the intact DREZ. In addition, the mean ESG power from the injured DREZ after successful DREZ lesioning was significantly lower than that from the intact DREZ and that from the injured DREZ before lesioning. CONCLUSIONS: The ESG power from the injured DREZ increases in patients with pain after brachial plexus avulsion compared with that of the intact DREZ; this increase is reduced by successful DREZ lesioning.

Endophytic colonisation of Bacillus subtilis in the roots of Robinia pseudoacacia L

The endophytic colonisation of Bacillus subtilis strain GXJM08, isolated from roots of Podocarpus imbricatus B1. Enum. P1. Jav., in roots of the leguminous plant Robinia pseudoacacia L. was investigated. Ultrastructure observations showed that B. subtilis caused morphological changes in the root hair and colonised the plant through infected root hairs. The structure of the infection thread was similar to that of rhizobia, but the structure of infected cells was different. B. subtilis is also different from rhizobia and plant pathogens in terms of the formation of a peribacteroid membrane and the mode of penetration through the host cell wall. Our results provide a basis for studying development of the mutualistic symbiotic relationship between B. subtilis and plants, and a basis for studying the mechanism of the B. subtilis-plant interaction.

Heavy metal contamination in soils and food crops around Dabaoshan mine in Guangdong, China: implication for human health

This study was designed to investigate heavy metal (Cu, Zn, Pb, and Cd) contamination levels of soils, vegetables, and rice grown in the vicinity of the Dabaoshan mine, south China. The concentration of Cu, Zn, Pb, and Cd in paddy soil exceeded the maximum allowable concentrations for Chinese agricultural soil. The heavy metal concentrations (mg kg(-1), dry weight basis) in vegetables ranged from 5.0 to 14.3 for Cu, 34.7 to 170 for Zn, 0.90 to 2.23 for Pb, and 0.45 to 4.1 for Cd. The concentrations of Pb and Cd in rice grain exceeded the maximum permissible limits in China. Dietary intake of Pb and Cd through the consumption of rice and certain vegetable exceeded the recommended dietary allowance levels. The status of heavy metal concentrations of food crops grown in the vicinity of Dabaoshan mine and their implications for human health should be further investigated.