Fold Edge Research Articles

PECULIARITIES OF THE COURSE AND TREATMENT OF ACUTE INFECTIOUS RHINOSINUSITIS IN VOICE-SPEAKING PROFESSIONALS

Numerous scientific studies are dedicated to the study of the morphological structure of the vocal cords and the diagnostic criteria of their lesions. The purpose of the work: the study of changes in the quality of the voice and the condition of the vocal cords in persons of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness.Research material and methods. The examination data of 24 patients (16 women and 8 men) of voice-speaking professions who were treated for acute viral or bacterial rhinosinusitis and continued to work (had voice strain) during the illness were analyzed. For each patient, a phoniatric patient study card was filled out, in which passport data was noted, including profession, patient complaints, data on life history, disease history and objective examination of ENT organs: pharyngoscopy, rhinoscopy, otoscopy, indirect laryngoscopy, which was performed with the help of 700 or 900 rigid endoscope. Research results. The analysis of the examination data of 24 patients (16 women and 8 men) of voice professionals who were treated for acute viral or bacterial rhinosinusitis and continued to work (had vocal strain) during the illness showed that during the control examination of the data of the patients for 7-10 days since the beginning of treatment, indirect laryngoscopy and stroboscopy revealed: hemorrhage in one fold - 3 cases, prenodular thickening of the edges of the vocal folds - 8 cases. The mobility of the folds was preserved in all patients, but during phonation, a gap formed between the folds in 19 patients, which was accompanied by hypertonus of the vestibular folds in 3 cases. During stroboscopy of this group of patients, vocal fold asynchrony was detected in 21 cases. The PMF was shortened in 21 patients and was 12 + 1.3 s (norm – 16s), and in men – 16 + 1.5 s (norm – 21s). Conclusions. In the treatment of patients of voice-speaking professions with acute viral or bacterial rhinosinusitis, changes in the vocal folds are observed, with possible hypertonus.

Deep Learning-Based Analysis of Glottal Attack and Offset Times in Adductor Laryngeal Dystonia.

Diagnosis of adductor laryngeal dystonia (AdLD) is challenging as it mimics voice features of other voice disorders. This could lead to misdiagnosis (or delayed diagnosis) and ineffective treatments of AdLD. This paper develops automated measurements of glottal attack time (GAT) and glottal offset time (GOT) from high-speed videoendoscopy (HSV) in connected speech as objective measures that can potentially facilitate the diagnosis of this disorder in the future. HSV data were recorded from vocally normal adults and patients with AdLD during the reading of the "Rainbow Passage" and six CAPE-V (Consensus Auditory-Perceptual Evaluation of Voice) sentences. A deep learning framework was designed and trained to segment the glottal area and detect the vocal fold edges in the HSV dataset. This automated framework allowed us to automatically measure and quantify the GATs and GOTs for the participants. Accordingly, a comparison was held between the obtained measurements among vocally normal speakers and those with AdLD. The automated framework was successfully developed and able to accurately segment the glottal area/edges. The precise automated measurements of GAT and GOT revealed minor, nonsignificant differences compared to the results of manual analysis-showing a strong correlation between the measures by the automated and manual methods. The results showed significant differences in the GAT values between the vocally normal subjects and AdLD patients, with larger variability in both the GAT and GOT measures in the AdLD group. The developed automated approach for GAT and GOT measurement can be valuable in clinical practice. These quantitative measurements can be used as meaningful biomarkers of the impaired vocal function in AdLD and help its differential diagnosis in the future.

Machine learning-based segmentation of aerial LiDAR point cloud data on building roof

ABSTRACT Three-dimensional (3D) reconstruction of a building can be facilitated by correctly segmenting different feature points (e.g. in the form of boundary, fold edge, and planar points) over the building roof, and then, establishing relationships among the constructed feature lines and planar patches using the segmented points. Present machine learning-based segmentation approaches of Light Detection and Ranging (LiDAR) point cloud data are confined only to different object classes or semantic labelling. In the context of fine-grained feature point classification over the extracted building roof, machine learning approaches have not yet been explored. In this paper, after generating the ground truth data for the extracted building roofs from three different datasets, we apply machine learning methods to segment the roof point cloud based on seven different effective geometric features. The goal is not to semantically enhance the point cloud, but rather to facilitate the application of 3D building reconstruction algorithms, making them easier to use. The calculated F1-scores for each class confirm the competitive performances over the state-of-the-art techniques, which are more than 95% almost in each area of the used datasets.

Voice Outcomes Following Serial Office-Based Steroid Injections and Voice Therapy for Vocal Fold Scar

Previous studies indicate that certain voice outcomes can improve following a single office-based steroid injection with voice therapy for vocal fold scar. We evaluated voice outcomes after a series of three timed office-based steroid injections with voice therapy. Retrospective case series with chart review. Academic medical center. We evaluated pre-and postprocedural patient-reported, perceptual, acoustic, aerodynamic, and videostroboscopic parameters. We evaluated 23 patients who underwent three office-based dexamethasone injections into the superficial lamina propria one month apart. All patients pursued voice therapy. Voice Handicap Index (n=19; P= .030) decreased after injection series. Total GRBAS score (grade, roughness, breathiness, asthenia, strain) decreased (n=23; P=0.001). Dysphonia severity index score improved (n=20; P=0.041). Phonation threshold pressure did not decrease significantly (n=22; P=0.536). Videostroboscopic parameters of vocal fold edge (P=0.023), right mucosal wave (P=0.023) improved or normalized after injection series. Glottic closure (P=0.134) did not improve. Series of three office-based steroid injections combined with voice therapy for vocal fold scar does not appear to provide further benefit than one injection. Despite lack of improvements of PTP and other parameters, injection series is likewise unlikely to worsen dysphonia. A partially negative study provides value in investigation of less invasive treatment alternatives for a disorder that is challenging to treat. Future studies exploring effects of voice therapy alone without other intervention and consideration of sham injection versus steroid injection are warranted.

Односторонний парез гортани: особенности клинической картины и сложности диагностики

The article presents the experience of the phoniatric department of the Saint Petersburg Institute of Ear, Throat, Nose, and Speech in the management of patients with unilateral vocal fold paresis. Variants of the clinical picture of the disease that complicate the compensation of the phonatory, respiratory, and protective functions of the larynx have been studied. The most common clinical picture of unilateral laryngeal paresis is the presence of complaints of hoarseness, diplophonia, inspiratory dyspnea during physical activity, aspiration. However, complaints about the voice may be absent, or they may be presented in the form of an aphonia. Patients may not complain of shortness of breath, or inspiratory stridor appears with minimal physical activity, snoring with episodes of apnea, laryngospasm attacks. The article presents cases of rare manifestations of paresis associated with the phenomena of hypotension and hypotrophy of the laryngeal muscles. These include the weakening of the tension of the medial edge of the vocal fold, thinning of the vocal fold, contouring of the vocal process of the arytenoid cartilage, lower location of the paralyzed vocal fold relative to healthy, rotation of the arytenoid cartilage, rotation of the epiglottis, and others. Compensatory mechanisms of phonation are described. Possible difficulties in diagnosing laryngeal paresis based on video laryngoscopy data, including hypomobility of the vocal fold, as well as options for simulating paresis due to neoplasms and post-traumatic changes in the larynx are considered.

Hc-transgelin is a novel matrix protein gene involved in the shell biomineralization of triangle sail mussel (Hyriopsis cumingii)

In triangle sail mussel (Hyriopsis cumingii), shell biomineralization is a complicated process that involves multiple gene products. Shell matrix proteins are involved in the formation of the organic framework and play an important role in the regulation of calcium carbonate deposition. In this study, A new shell matrix protein gene Hc-transgelin was identified in H. cumingii. The full-length cDNA of Hc-transgelin was 1200 bp, including a 501 bp open reading frame, which encoded 166 amino acids. Hc-transgelin is rich in lysine, it accounts for 11.40% of the protein. The predicted transgelin protein contained a conserved calmodulin homologous domain. A tissue-specific expression assay indicated that Hc-transgelin exhibited significantly highest expression in the mantle. Furthermore, Hc-transgelin in situ hybridization detected positive signals at the edge of the mantle outer fold, where nacre and prismatic layer biomineralization occur. An RNA interference assay showed that the shape of aragonite flakes in nacre changed and their growth was inhibited, and cracks appeared in the prismatic layer organic sheath when the expression of Hc-transgelin was suppressed. In a shell repair assay, a higher expression of Hc-transgelin appeared from day 12 to day 25 when the nacre accumulated quickly. These findings indicate that Hc-transgelin may be involved in the formation of aragonite flakes in the nacre and play a role in the formation of the organic sheath in the prismatic layer of the shell. This study provides new insights into the role of the Hc-transgelin gene and also contributes to the molecular understanding of mollusk shell formation.

Stratifying Presbylarynx: Characterization of its Three Types

To describe the clinical characteristics of each type of glottal configuration proposed in a classification that allows stratifying presbylarynx into three types: Type 0: there is no significant morphological alteration in glottal configuration. Type 1: two or more of the following endoscopic signs are present: atrophic vocal folds, vocal fold bowing, prominence of vocal processes, supraglottal hyperactivity, decreased amplitude (vocal fold edge stiffness without evidence of vocal post-traumatic scar), and tremor of laryngeal structures. Type 2: elderly patients with type 1 plus glottal insufficiency. Prospective, observational, and cross-sectional study. Data regarding age, gender, type of glottal configuration, self-assessment regarding vocal complaints, as well as acoustic and audio-perceptive examination were collected. The study population included 306 subjects (180 females), and the mean age was 73.85. Type 0 was the most frequent (61%). A statistically significant association was found between type 0 and female subjects, as well as type 2 and male subjects. The mean age of the patients with type 0 was statistically lower than the mean age of the patients with type 1 or type 2. The mean score of self-assessment questionnaires of patients with type 2 was statistically higher than the mean score registered for patients with type 0 and type 1. The mean score of Jitter, Shimmer, and HNR in type 2 were statistically higher than in type 0 or type 1 (P < 0.05). The mean score of Maximum Phonation Time in type 2 was statistically lower than in type 0 or 1 (P < 0.001). Based on vocal complaints, 115 subjects (38%) had presbyphonia (46 males; 69 females), and the mean age was 75.97 years (SD=6.98; range 65 - 97). Among subjects without presbyphonia (n=191), type 0 was the most frequent (84%), followed by type 1 (15%) and type 2 (1%). Among subjects with presbyphonia (n=115), type 1 was the most frequent (58%), followed by type 0 (23%) and type 2 (19%). This study presented the clinical characterization of a classification that allows stratifying endoscopic laryngeal signs in elderly patients with presbyphonia. We believe this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.

Study of the factors influencing load displacement curve of energy absorbing device by area division simulation

A pre folded energy absorbing device, which is the key device of energy absorption anti impact for roadway support, is tested by quasi-static compression and simulated. The energy absorbing device is divided into zones, and the influence of the area on the load displacement curve of the energy absorbing device is studied according to the area. It is found that the error of numerical simulation is within 5%, indicating that the finite element modeling procedure is appropriate for the problem analyzed here. The device crushes following the pre folded origami pattern in a stable progressive. The device was divided into four areas: the upper and lower opening region of the concave surface four corner parts; the other areas of opening regions; the middle fold edge; the surrounding four sides edge. Each area has effect on the first drop stage and the second rise stage of the load displacement curve. The middle fold edge area has an effect on the peak load value of load displacement curve. Four indicators of peak load, average load, load efficiency, and specific energy absorption were generated from the results of numerical simulation. The strength enhancement of corner region can ensure the energy absorbing device with low peak load and high mean crushing load. The other areas of opening regions affect the first descending and second ascending of the curve. The first rising stage bears the load from the middle edge.

Are Children with Cleft Palate at Increased Risk for Laryngeal Pathology?

To determine the prevalence of laryngeal pathology in children presenting with cleft palate with or without cleft lip (CP ± L) who underwent nasoendoscopy to assess palatal function. A secondary aim was to determine the relationship between patient demographics, resonance, articulation, and prevalence of laryngeal pathology in this population. Retrospective, observational cohort study Outpatient pediatric cranio-facial anomalies clinic Children ≤18 years of age presenting with CP ± L (N = 215) who underwent nasoendoscopy, speech language pathology, plastic surgery, and otolaryngological evaluations between 2009 and 2020. Laryngeal diagnosis by pediatric otolaryngologists. 21.9% of children presented with laryngeal pathology. Diagnoses included benign vocal fold lesions and laryngeal edema sufficiently severe to alter vocal fold edge contour. Likelihood of laryngeal pathology increased by approximately 12% with every increase of 1 year in age ( P = .001, OR = 1.12). Children with laryngeal pathology were 50% more likely to have undergone palatal repair ( P &lt; .001, OR = 1.50). In addition, children with severely hypernasal resonance were 78% less likely to present with laryngeal pathology ( P =.046, OR = 0.22). This population is at increased risk for laryngeal pathologies as determined by nasoendoscopy. This finding underscores the importance of careful laryngeal imaging in assessing these children. Additional research is warranted to identify the mechanisms underlying the increased risk for morphological vocal fold changes.

A Deep Learning Approach for Quantifying Vocal Fold Dynamics During Connected Speech Using Laryngeal High-Speed Videoendoscopy.

Voice disorders are best assessed by examining vocal fold dynamics in connected speech. This can be achieved using flexible laryngeal high-speed videoendoscopy (HSV), which enables us to study vocal fold mechanics with high temporal details. Analysis of vocal fold vibration using HSV requires accurate segmentation of the vocal fold edges. This article presents an automated deep-learning scheme to segment the glottal area in HSV from which the glottal edges are derived during connected speech. Using a custom-built HSV system, data were obtained from a vocally healthy participant reciting the "Rainbow Passage." A deep neural network was designed for glottal area segmentation in the HSV data. A recently introduced hybrid approach by the authors was utilized as an automated labeling tool to train the network on a set of HSV frames, where the glottis region was automatically annotated during vocal fold vibrations. The network was then tested against manually segmented frames using different metrics, intersection over union (IoU), and Boundary F1 (BF) score, and its performance was assessed on various phonatory events on the HSV sequence. The designed network was successfully trained using the hybrid approach, without the need for manual labeling, and tested on the manually labeled data. The performance metrics showed a mean IoU of 0.82 and a mean BF score of 0.96. In addition, the evaluation assessment of the network's performance demonstrated an accurate segmentation of the glottal edges/area even during complex nonstationary phonatory events and when vocal folds were not vibrating, thus overcoming the limitations of the previous hybrid approach that could only be applied to the vibrating vocal folds. The introduced automated scheme guarantees accurate glottis representation in challenging color HSV data with lower image quality and excessive laryngeal maneuvers during all instances of connected speech. This facilitates the future development of HSV-based measures to assess the running vibratory characteristics of the vocal folds in speakers with and without voice disorder. https://doi.org/10.23641/asha.19798864.

Mechanisms of sound production in deer mice (Peromyscus spp.).

Rodent diversification is associated with a large diversity of species-specific social vocalizations generated by two distinct laryngeal sound production mechanisms: whistling and airflow-induced vocal fold vibration. Understanding the relative importance of each modality to context-dependent acoustic interactions requires comparative analyses among closely related species. In this study, we used light gas experiments, acoustic analyses and laryngeal morphometrics to identify the distribution of the two mechanisms among six species of deer mice (Peromyscus spp.). We found that high frequency vocalizations (simple and complex sweeps) produced in close-distance contexts were generated by a whistle mechanism. In contrast, lower frequency sustained vocalizations (SVs) used in longer distance communication were produced by airflow-induced vocal fold vibrations. Pup isolation calls, which resemble adult SVs, were also produced by airflow-induced vocal fold vibrations. Nonlinear phenomena (NLP) were common in adult SVs and pup isolation calls, suggesting irregular vocal fold vibration characteristics. Both vocal production mechanisms were facilitated by a characteristic laryngeal morphology, including a two-layered vocal fold lamina propria, small vocal membrane-like extensions on the free edge of the vocal fold, and a singular ventral laryngeal air pocket known as the ventral pouch. The size and composition of vocal folds (rather than total laryngeal size) appears to contribute to species-specific acoustic properties. Our findings suggest that dual modes of sound production are more widespread among rodents than previously appreciated. Additionally, the common occurrence of NLP highlights the nonlinearity of the vocal apparatus, whereby small changes in anatomy or physiology trigger large changes in behavior. Finally, consistency in mechanisms of sound production used by neonates and adults underscores the importance of considering vocal ontogeny in the diversification of species-specific acoustic signals.

Endoscopic signs of gastroesophageal reflux disease with different hiatal hernias types

A hiatal hernia occurs in 83–94 % of patients with gastroesophageal reflux disease (GERD). Difficulties in diagnosing endoscopic signs of gastroesophageal reflux with combination of the most common hiatal hernia types remain relevant. Untimely and inaccurate endoscopic interpretation of these pathological changes significantly reduces the effectiveness of treatment. The aim of the research was to study the endoscopic signs of gastroesophageal reflux disease with the most common hiatal hernia type I and type III. Materials and methods. The examination results of 153 patients with GERD and the most common hiatal hernia type I and type III at the stage of preparation for antireflux surgical treatment were analyzed. The age was 54.5 ± 11.3, there were 48 (31.4 %) men, 105 (68.6 %) women. In Group I – 85 patients with GERD and type I hiatal hernia, in Group II – 68 patients with GERD and type III hiatal hernia. A complete preoperative examination necessarily included endoscopy with chromoendoscopy (mainly NBI or FICE), biopsy from suspicious foci of the gastric mucosa and the lower third of the esophagus followed by histological analysis. Statistical processing and mathematical analysis of the obtained results were performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). For comparative analysis the arithmetic mean and standard deviation were calculated and presented as M ± s. Differences between groups were assessed using the sub-module “Difference tests” in the module “Basic statistics and tables”. Differences at P &lt; 0.05 were considered statistically significant. Results. In both groups, non-erosive forms of gastroesophageal reflux disease prevailed: 57 (67.1 %) and 39 (57.4 %) patients respectively. Both in Groups I and II, among the erosive forms there were mainly LA A stages of esophagitis – 20 (23.5 %) and 17 (25.0 %). СLE signs of the esophageal mucosa prevailed in Group I – 16 (18.8 %) patients, in Group II – 5 (7.4 %) patients. The proximal edges of the gastric folds, which are visualized in all patients, were considered the reference point for the true esophageal-gastric junction. Complicated course of GERD was noted in both groups of patients. Conclusions. Endoscopic signs of GERD with hiatal hernia type I or type III have characteristic features, the severity of which manifestation does not depend on the type. A reliable indicator of the true esophageal-gastric junction location is the proximal edge of the gastric folds. Complicated course of GERD occurs in both groups: Barrett’s esophagus and Schatzki’s ring predominate in the Group I, strictures and ulcers of the esophagus – in the Group II.

Epicanthus correction with a modified asymmetric Z-plasty

SummaryThe study aimed to explore the clinical efficacy of the modified asymmetric Z-plasty with a central axis from the point near the edge of the skin fold of the medial canthus to the point of the innermost palpebral edge of medial canthus for epicanthus correction. A total of 130 followed-up patients who received modified asymmetric Z-plasty for epicanthus correction in Hunan Provincial People's Hospital from January 2019 to December 2019 were included. All patients were followed up with at 1, 3, and 6 months after surgery, and the scarring and surgical outcomes were assessed. The results showed the surgical wounds were healing well, and the sutures were removed at 7 days postoperatively in all patients. At 6 months postoperatively, epicanthus correction was successful in all patients, the lacrimal caruncle was moderately exposed, the incision was not red, and there were no obvious prominent scars. Slightly prominent and uneven scars below the edge of the lower eyelid were observed in 3 patients. Among these 3 patients, 1 patient received no further treatment, and the outcomes were considered acceptable; the outcomes were improved in the remaining 2 patients after a single session of fractional laser treatment, and none of these patients received further surgery. In conclusion, the modified asymmetric Z-plasty with a central axis from the point near the edge of the skin fold of the medial canthus to the point of the innermost palpebral edge of medial canthus is relatively simple and provides good surgical results for epicanthus correction.

Computational Analysis of the Droplet-Stimulated Laryngeal Adductor Reflex in High-Speed Sequences.

The laryngeal adductor reflex (LAR) is an important protective mechanism of the airways. Its physiology is still not completely understood. The available methods for LAR evaluation offer limited reproducibility and/or rely on subjective interpretation. A new approach, termed Microdroplet Impulse Testing of the LAR (MIT-LAR), was recently introduced. Here, the LAR is elicited by a droplet and a laryngoscopic high-speed recording is acquired simultaneously. In the present work, image-processing algorithms for autonomous MIT-LAR sequence analysis were developed. This allowed the automated approximation of kinematic LAR parameters in humans. Development and testing of computational methods. Computational image processing enabled the autonomous estimation of the glottal area, the glottal angle, and the vocal fold edge distance in MIT-LAR sequences. A suitable analytical representation of these glottal parameters allowed the extraction of seven relevant LAR parameters. The obtained values were compared to the literature. A generalized logistic function showed the highest average goodness of fit among four different analytical approaches for each of the glottal parameters. Autonomous sequence analysis yielded bilateral LAR response latencies of (229 ± 116) ms and (182 ± 60) ms for cases of complete and incomplete glottal closure, respectively. The initial/average/maximum angular vocal fold adduction velocity was estimated at (157 ± 115) °s-1 /(891 ± 516) °s-1 /(929 ± 583) °s-1 and (88 ± 53) °s-1 /(421 ± 221) °s-1 /(520 ± 238) °s-1 for complete and incomplete glottal closure, respectively. The automated extraction of LAR parameters from laryngoscopic high-speed sequences can potentially increase the objectiveness of optical LAR characterization and reduce the associated workload. The proposed methods may thus be helpful for future research on this vital reflex. NA Laryngoscope, 132:2412-2419, 2022.

Habilitation for the Aging Avocational Singer

Habilitation for the Aging Avocational Singer Dann Mitton (bio) VOICE PEDAGOGY We are getting older. Nearly seven million Canadians are currently age 65 or older.1 More than two-fifths of U.S. Baby Boomers have already reached the de facto retirement age of 65; the first Gen Xers to cross this aging milestone will do so in 2030. By 2060, 94.7 million Americans are projected to be age 65 or older.2 Williamson reports that "the fastest growing segment of the population is in the over age 85 category."3 This means a steadily growing market segment for the informed voice teacher who understands and can address the needs of the aging singer. The purpose of this article is to curate some thoughts on voice pedagogy (listening, interventions, and resources) that can equip voice teachers to better support an aging singer clientele. It will identify aspects of the aging process that impact the singing voice, and touch on pedagogic interventions for six common challenges experienced by aging singers: onset, power, intonation, vibrato, noise, and vowel production. An in-depth discussion of serious age-related diseases such as Parkinson's, chronic illness, or vocal pathologies is outside the scope of this article. The assumption is that voice teachers understand and embrace their role as part of a greater voice care team that will include certified medical experts to whom one defers whenever issues of health and singing intersect. WHAT IS AGING? Aging is a complex process in which changes at the molecular, cellular, and organ levels result in a progressive and inevitable decrease in the body's ability to respond appropriately to disruptions.4 [Aging affects] accuracy, speed, endurance, stability, strength, coordination, breathing capacity, nerve conduction velocity, heart output, and kidney function. Muscle and neural tissues atrophy, and the chemicals responsible for nerve transmissions change. Ligaments atrophy, and cartilages turn to bone (including those in the larynx). Joints develop irregularities that interfere with smooth motion. The vocal folds themselves thin and deteriorate, losing their elastic and collagenous fibers. This makes them stiffer and thinner and may correlate with voice changes often noted with aging such as breathiness, slightly decreased volume, "thinning" of the voice, and loss of vocal efficiency … The vocal fold edge also becomes less smooth.5 The loss of muscle mass from aging is also known as sarcopenia. [End Page 347] Johnson and Brunssen correlate these widespread systemic changes to the following effects for the aging singer: loss of range (up and/or down); noise in the sound; breaks in the voice; "knerdly" sound and other compensatory effort; intonation; need to take a few more breaths; vibrato slower; warming up takes longer; unclear open vowels; slower coloratura; less ring and intensity in the sound; vocal fatigue; cramping in voice: ceiling; /h/ between notes; difficulty with soft singing and decrescendos; debilitating and compensatory efforts to make up for compromised function.6 Gerontologist Dr. Tracey Gendron questions the ethics of feeding the larger narrative of aging as a progressive decline.7 "Older age is a time that we can actually look forward to. People really just enjoy themselves more and are at peace with who they are. I would love for everyone to say their age at every year and celebrate it."8 Can one recapture youthful vigor? Exciting new research shows that it soon may be possible to undo the reduction in capillary density that accompanies aging. Capillaries are the vehicles through which oxygen off-loads from the blood to the muscle cells. The greater the density of capillaries, the faster the metabolism is excited.9 A 2018 study on aging mice successfully restored the number of blood capillaries and capillary density seen in younger mice, concomitantly restoring their ability to exercise rigorously as in youth.10 This is encouraging as we develop future therapies that can benefit humans. One manifest advantage enjoyed by the aging performing artist is life experience. Lived experience "allows older singers to bring a level of emotion to a performance that is not possible in youth."11 Another point of optimism is that aspects of the aging process respond very well to intervention. Physical decline does not take place uniformly among the...

The novel matrix protein hic7 of hyriopsis cumingii participates in the formation of the shell and pearl.

Shell matrix proteins have important roles in the biomineralization of shells. In this study, we isolated and identified a novel shell matrix protein gene, hic7, from the mussel Hyriopsis cumingii. The cDNA of hic7 was 459bp long, including a 240-bp open reading frame. It encoded a 79 amino acid-long protein, with amino acids 1-19 constituting the signal peptide. The resulting hic7 is rich in cysteine (16.5%). After removing the signal peptide, the molecular weight was 8.85kDa and the theoretical isoelectric point was 6.34, indicating that hic7 is a weakly acidic shell matrix protein. Hic7 is mainly expressed in the mantle tissue of H. cumingii. In situ hybridization showed hic7 signals at the edge and dorsal region of the mantle outer fold, indicating that it is related to the formation of the prismatic and nacreous layer of the shell. RNA interference indicated that when hic7 was inhibited by 80%, the crystal morphology of the prism and nacre layers of the shell were irregular and disordered. In addition, the expression of hic7 during the early development of the pearl sac indicated that it has an important role in the transformation of calcium carbonate crystals from a disordered to an orderly deposition pattern. These results suggest that matrix protein hic7 take part in constructing the framework of crystal nucleation and regulating the calcium carbonate crystal morphology of the nacreous and prismatic layers of shells and pearls.

Multiple laser puncture for Reinke’s edema: surgical outcome and voice assessment

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;The two important principles in Reinke’s edema treatment are minimal intervention and superficial resection with evacuation the edema and preservation the medial edge of the vocal fold to improve the voice quality. The aim of this study was to evaluate a novel surgical technique in treatment of Reinke’s edema and its effect on subjective and quantitative voice characteristics. The study design was a prospective clinical series.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We evaluated 67 patients from 19 to 73 years (mean, 47.7 years) with Reinke’s edema. The patients were divided into 3 types, mild, moderate and sever. Clinical voice assessment was composed of stroboscopy, subjective voice evaluation (GRBAS hoarseness scale) and quantitative voice evaluation were evaluated pre- and postoperatively. All patients underwent endolaryngeal CO2 laser puncturing for treatment of Reinke’s edema.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;67 patients diagnosed as Reinke’s edema were classified by H. Yonekawa classification into three types. Type I 25 (37.3%) patients, type II 30 (44.8%), type III 12 (17.9%). Out of 67 patients, fifty two (77.6%) were smoker. In all the patients, the laryngostrobscopic findings showed an improvement of mucosal wave patterns with little vocal fold scaring. Significant vocal improvement was also noted in subjective and objective voice assessments.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The laser puncture technique is safe, effective and less invasive to treat Reinke’s edema with significant improvement in vocal performance after surgery.&lt;/p&gt;

Contour detection and salient feature line regularization for printed circuit board in point clouds based on geometric primitives

Effective extraction of the printed circuit board (PCB)’s key contour feature line is of great significance in the optoelectronic industry, especially for defect detection and accurate dimensional measurement. Here, we develop a method to convert the fold edge points into boundary points and then extract the salient contour feature lines of the PCB. The method is performed directly on the real PCB point cloud, and no image processing or 3D reconstruction is required. Our approach involves three key steps: point cloud preprocessing, feature point detection, and contour feature line regularization. Firstly, the PCB point cloud’s preprocessing is completed using the k-d tree and pass-through filtering algorithms. Secondly, through the least-median-of-squares (LMS) and the Euclidean-Clustering-Based-on-Gaussian-Mapping (ECGM), the fold edge points are converted into boundary points. Then, the contour feature points are identified by angle criterion between lines formed by the query point with respect to its neighboring points. Finally, the feature points are regularized by the self-pruning B-spline curve based on squared distance minimization (SDM). Compared with the other methods, our approach extracts more salient contour points and fewer redundant points. Experiments on real test data also suggest that this method has good potential in extracting feature lines, which ensures accuracy and strong applicability.

Subglottic Mucosal Flap: Endoscopic Single-Stage Reconstruction for Anterior Glottic Stenosis.

Anterior glottic stenosis (AGS) results from surgical intervention, carcinoma, papillomatosis, congenital, or idiopathic causes. It may be present as elastic web or fibrotic scar. It impairs vocal function and glottic airway. Reconstructive options include resection and placement of a keel or glottic web-based mucosal flaps to prevent restenosis. These methods may not be sufficient for reconstructing a thick anterior scar and may require multiple interventions. The aim of the study was to describe the anterior subglottic mucosal flap (ASGMF), a one-stage, keel-free technique for AGS repair. A retrospective cohort. Patients with AGS were operated using the ASGMF between 2017 and 2020. The stenotic segment was excised, and then an ASGMF was developed. A unilateral oblique incision was performed to allow rotation and advancement of the flap toward the contralateral vocal fold. The flap was sutured to the mucosal edge of the vocal fold to create mucosal continuity and prevent restenosis. Vocal fold length ratio (VFLR), which is between the free part and the total vocal fold length, as well as stroboscopic measures, were calculated before and after surgery. Twelve patients were enrolled. Etiologies were iatrogenic, dysplasia, papillomatosis, carcinoma, and congenital. Average VFLR improved from 0.33 to 0.87 (P-value < .0001). Median amplitude and mucosal wave propagation improved from 12.3% and 9.5% to 28.6% and 22.7%, respectively (P-values=.0278, .0385). Phase symmetry improved from 24.5% to 60.9% (P-value=.0413). No complications were encountered. ASGMF for AGS is an effective surgical procedure, allowing for one stage, keel-free reconstruction of the anterior commissure. ASGMF can significantly elongate the free portion of the vocal folds and improve vibratory function. 4 Laryngoscope, 132:612-618, 2022.

Effects of Sulcus Vocalis Depth on Phonation in Three-Dimensional Fluid-Structure Interaction Laryngeal Models.

Sulcus vocalis is an indentation parallel to the edge of vocal fold, which may extend into the cover and ligament layer of the vocal fold or deeper. The effects of sulcus vocalis depth d on phonation and the vocal cord vibrations are investigated in this study. The three-dimensional laryngeal models were established for healthy vocal folds (0 mm) and different types of sulcus vocalis with the typical depth of 1 mm, 2 mm, and 3 mm. These models with fluid-structure interaction (FSI) are computed numerically by sequential coupling method, which includes an immersed boundary method (IBM) for modelling the glottal airflow, a finite-element method (FEM) for modelling vocal fold tissue. The results show that a deeper sulcus vocalis in the cover layer decreases the vibrating frequency of vocal folds and expands the prephonatory glottal half-width which increases the phonation threshold pressure. The larger sulcus vocalis depth makes vocal folds difficult to vibrate and phonate. The effects of sulcus vocalis depth suggest that the feature such as phonation threshold pressure could assist in the detection of healthy vocal folds and different types of sulcus vocalis.