Fold Width Research Articles

Precision-Targeted Injection Laryngoplasty and Longitudinal Biomaterial Effects Evaluation Using High-resolution Ultrasonography in a Rat Model.

Current laryngeal injection models rely on the transoral route and are suboptimal due to limited view, narrowed working space, and the need to sacrifice animals for investigation of the injectables. In the present study, a novel surgical model for laryngeal intervention therapy utilizing an ultra-high frequency ultrasound imaging system was proposed. Based on this system, we developed a systemic evaluation approach, from guidance of the injection process, documentation of the injection site of the material, to in vivo longitudinal follow-up on the augmentation and medialization effect by analyzing the ultrasonography data. In vivo animal study. Academic institution. Injection laryngoplasty with hyaluronic acid under ultrasonography guidance was performed on Sprague-Dawley rats one week after induced unilateral vocal paralysis. Ultrasonography was performed at preinjection, immediately postinjection, on Day 2, Day 7 and then weekly for 4 weeks to obtain measurements, including the glottic area, angle between bilateral folds, and vocal fold width ratio. Laryngoscopic and histologic studies were also performed. Unilateral injections to the paralyzed fold were successfully performed as demonstrated by ultrasonographic, laryngoscopic, and histologic studies. The width ratio was significantly increased after injection for 4 weeks, while the glottic airway area was unchanged. Here, a novel surgical model for laryngeal injection utilizing ultrasonography in rats was established. In addition to providing visual guidance for precise localization of the injection, robust documentation of the treatment effect was also demonstrated. This methodology could be beneficial for screening therapeutic agents for treatment of glottic insufficiency.

Intestinal histomorphology of silver catfish fed diets supplemented with Citrus x Aurantium essential oil

The aim of this study was to investigate the effects of dietary Citrus x aurantium essential oil (EOCA) on the growth and intestinal histomorphology of silver catfish (Rhamdia quelen) fingerlings. Five diets with different doses of EOCA (0.0, 0.25, 0.5, 1.0, and 2.0 mL/kg diet) were evaluated. At the end of 60 days, the growth performance was positively correlated with dietary EOCA supplementation. The results showed an increase in fold height in the middle intestine (MI) of fish fed the EOCA diet compared to the control group. In the anterior intestine (AI), the enterocyte height increased, while the goblet cell number decreased in all EOCA-supplemented diets. The goblet cell number in the MI and posterior intestine (PI) was higher with EOCA and lowest in the control group. Diets with EOCA did not affect the fold height in the PI. Similarly, to the AI, the fold width in PI increased in the 0.5 mL/kg treatment compared to the control group. These results revealed that dietary supplementation with EOCA, primarily at a dose of 0.5 mL EOCA/kg diet, promoted positive effects on the intestinal morphology of R. quelen, indicating that the use of EOCA extracted from sweet orange peel, a fruit residue, could be considered in fish diets.

Are the effects of Deoxynivalenol (DON) on performance, liver and gastrointestinal tract health of rainbow trout (Oncorhynchus mykiss) influenced by dietary composition?

This study investigated if dietary composition influences the effects of Deoxynivalenol (DON) on the health and performance of rainbow trout (Oncorhynchus mykiss). Four experimental diets (2 × 2 factorial design) were formulated which differed in 1) the diet composition; fishmeal (FM) versus soybean meal-based (SBM) and 2) the DON content of wheat; clean versus naturally contaminated wheat. Triplicate groups of n = 30 fish were assigned to each diet: (1) CON-FM; DON= 0 µg/kg feed; (2) DON-FM; DON= 1200 µg/kg feed; (3) CON-SBM; DON= 46 µg/kg feed; (4) DON-SBM; DON= 1300 µg/kg feed. The 8 week experiment was divided into two feeding periods: after 6 weeks of restrictive feeding, fish were fed ad libitum for 2 weeks. Influences on performance were evaluated by determining growth, protein and energy gain metrics, and on health parameters through the determination of histopathological changes in the liver and gastrointestinal tract (GIT). Restrictive feeding showed negative effects of DON and dietary composition on performance but did not show an interaction between DON and diet composition. Similarly, subsequent ad libitum feeding showed effects of DON and/or diet composition on growth, feed efficiency and body biometrics, but no interaction effects. These data confirmed the challenging nature of the SBM-based diet and previously noted negative effects of DON on performance. Only the histopathological assessment of mucosal fold width, enterocyte width and goblet cell density indicated significant interaction effects between DON and diet composition in the midgut. Yet, the differences were generally small and interaction effects were restricted to the midgut and not to the hindgut which is usually challenged by SBM. The combined information on growth performance and health suggests that DON challenges rainbow trout regardless of being fed a FM- or SBM-based diet, allowing more flexible formulations in the aquafeeds.

Effect of Schizochytrium limacinum supplementation to a low fish-meal diet on growth performance, lipid metabolism, apoptosis, autophagy and intestinal histology of Litopenaeus vannamei

In this experiment, we aimed to evaluate the relationship between the addition of Schizochytrium limacinum to low fish meal diets on growth performance, apoptosis, autophagy, lipid metabolism, and intestinal health of Lipenaeus vanamei. The diet containing 25% fish meal was used as a positive control (FM) and the other three diets contained 15% fish meal and were supplemented with 0, 0.3, and 0.6% S. Limacinum (LF, LFLD, LFHD). The shrimp (0.22 ± 0.00 g) were divided into four replicates of 40 shrimp per tank and fed four times daily to apparent satiation for 8 weeks. Results showed that the final weight (FBW) and weight gain rate (WGR) of shrimp fed FM and LFHD diets were significantly increased compared to those fed the LFLD diet (P<0.05), and there was no significant difference in survival rate (SR) and feed conversion rate (FCR) among the groups (P>0.05). Supplementation of S. Limacinum in low fish meal diets had no effects on shrimp body composition (P<0.05). There were significant differences (P<0.05) in low-density lipoprotein (LDL-C) glucose (GLU), triglycerides (TG), and total cholesterol (TC) in the hemolymph of shrimp fed the LF diet compared to those fed the LFLD and LFHD diets. HE staining and transmission electron microscopy (TEM) results showed that the microvilli height, mucosal folds height, mucosal folds width and muscle layer thickness in the intestine of shrimp fed the LF diet were significantly reduced compared to those fed the other three diets (P<0.05). Swelling of the endoplasmic reticulum and irregular mitochondria in the gut of shrimp fed the LF diet was also observed by TEM, and the endoplasmic reticulum and mitochondria of shrimp fed the LFHD diet returned to a healthy state. Hepatopancreas genes expression results were showed that the gene expression of 5′ -AMP-activated protein kinase (ampk), stearoyl-CoA desaturase (scd1), acetyl-CoA carboxylase 1 (acc1), and malonyl-CoA decarboxylase (mcd) of shrimp fed the LF diet was significantly increased compared to those fed the FM diet (P<0.05). The gene expression of sterol regulatory element-binding protein (srbep) and carnitine palmitoyl transferase 1 (cpt-1) of shrimp fed the LFLD diet was significantly increased compared to those fed the LF diet (P<0.05). The gene expression of acc1, mcd and scd1 of shrimp fed the LFHD diet was significantly reduced compared to those fed the LF diet (P<0.05). Results of genes expression associated with apoptosis in the hepatopancreas showed that the gene expression of B lymphocytoma-2 (bcl-2), BCL2 associated X apoptosis regulator (bax) and cysteinyl aspartate specific proteinase 8 (caspase 8) of shrimp fed the LF diet was significantly reduced compared to those fed the FM diet (P<0.05). The gene expression of bcl-2 of shrimp fed the LFHD diet was significantly reduced compared to those fed the LF diet (P<0.05). Genes related to autophagy in the hepatopancreas showed that the expression of autophagy-related protein 12 (atg 12), autophagy-related protein 13 (atg 13) and beclin1 of shrimp fed LF the diet was significantly reduced compared to those fed the FM diet (P<0.05). The gene expression of atg 12 and atg 13 of shrimp fed the LFHD diet was significantly increased compared to those fed the LF diet (P<0.05). In summary, reducing fish meal is detrimental to the growth performance and intestinal health of shrimp, and 0.6% S. Limacinum supplementation can improve the growth performance, promotes hepatopancreas lipid metabolism, reduces apoptosis, promotes autophagy and improve intestinal health of Litopenaeus vannamei.

Effects of Three Compound Attractants in Plant Protein Diets on Growth, Immunity, and Intestinal Morphology of Yellow River Carp Cyprinus carpio var

A feeding experiment was conducted to evaluate the effects of three compound attractants on the growth performance, immunity, and intestinal morphology of Yellow River (YR) carp. Five treatment groups were included in the feeding experiment. Group I consisted of a fishmeal-based diet (positive control), and group II was a plant protein diet (negative control). The compound attractants 1 ( 0.06 % dimethyl − beta − propiothetin DMPT + 0.22 % tangerine peel powder + 0.75 % yeast powder ), 2 ( 0.05 % garlic powder + 0.06 % DMPT + 0.75 % yeast powder ), and 3 ( 0.07 % sodium glutamate + 0.22 % tangerine peel powder + 0.34 % betaine ) were added to the plant protein diet, belonging to groups III, IV, and V, respectively. The three different compound attractants significantly improved the weight gain rate, special growth rate, and protein efficiency ratio of Yellow River (YR) carp ( P < 0.05 ) compared with the negative control, among which group III performed best. Similarly, group III had significantly higher serum lysozyme (LZM) and acid phosphatase (ACP) activities than the negative control, and groups III, IV, and V depicted significantly higher LZM activities in the liver and gill ( P < 0.05 ). Groups III, IV, and V revealed significantly higher superoxide dismutase (SOD), catalase (CAT), and total antioxidant capacity (T-AOC) activities in the serum and liver than the negative control ( P < 0.05 ), while the malondialdehyde (MDA) content was the opposite ( P < 0.05 ). Moreover, the height and width of the plica in the foregut and midgut and the thickness of the midgut muscle layer in group III were significantly higher than those in the negative control ( P < 0.05 ). Therefore, adding compound attractants in a plant protein diet can significantly enhance the total antioxidant and immune capacity, along with improved growth performance of YR carp. Similarly, compound attractants significantly elevated the height and width of the intestinal fold within the anterior and middle sections of the intestine, depicting that compound attractants promote intestinal digestion and absorption, thereby reducing intestinal injury. The results from the three experimental groups found that the compound attractants combined with 0.06% DMPT, 0.22% tangerine peel powder, and 0.75% yeast powder were more suitable for the basic plant protein diet of YR carp.

Framework for Indirect Spatial Calibration of the Horizontal Plane of Endoscopic Laryngeal Images

Calibrated horizontal-plane measurements from laryngeal images could contribute significantly to refining evidence-based practice and developing patient-specific models and precision-medicine approaches. Laser-projection endoscopes can address the need for direct calibrated measures; however, these systems are not widely available. This study presents the framework for an alternative indirect horizontal-plane calibration approach. A spatial attribute of a common object, a distinct characteristic that is maintained across images, may be used as a scale for the normalization of other spatial measurements. The outcome of this indirect approach could be used for absolute measurements (eg, in units of mm) or relative measurements (eg, percent change), depending on the information that is available from the common attribute. The required conditions of a common attribute for achieving a valid calibration outcome were studied. Three conditions were derived: registration accuracy of the common attribute, size consistency of the common attribute, and similarity in the vertical distance between the region of interest (ROI) (eg, vocal fold) and the common attribute. Any common attribute satisfying these three conditions was called proper and would result in a valid indirect calibration outcome. Three tests were presented for evaluating the properness of a common attribute. A data-driven statistical method was presented that can evaluate the registration accuracy of a common attribute. The second test used variation in calibrated lengths of a common attribute under different phonatory configurations for evaluating the size consistency condition. Finally, the effect of differences between vertical distances of the ROI and the common attribute was mathematically tested and quantified. The application of the proposed framework for indirect calibration was demonstrated using a pre existing dataset with a vocal fold as the ROI and four different common attributes (vocal fold length, vocal fold width, blood vessel on the vocal fold, and blood vessel on nearby tissue). The proposed registration-accuracy test was able to detect and eliminate instances of common attributes with low accuracies. The analysis suggested that among the studied four common attributes, the vocal fold length had the highest (ie, best) registration accuracy; however, the vocal fold length exhibited the lowest (ie, worst) size consistency. The analysis also suggested that, among the studied attributes, the vocal fold width offered the best trade-off among the three conditions and, hence, was a proper common attribute for calibrating spatial aspects of the vocal folds (length, displacement of edges, velocity, etc). Indirect calibration is a feasible alternative for calibration of laryngeal endoscopic images, given a proper common attribute is selected. Future work is needed to systematically evaluate the effects of various phonatory conditions on the characteristics of common attributes.

Objective Laryngoscopic Measures From Older Patients With Voice Complaints and Signs of Aging.

The purpose of this study was to use objective measures of glottal gap, bowing, and supraglottic compression from selected images of laryngoscopic examinations from adults over 60 years of age with voice complaints and signs of aging to test current hypotheses on whether degree of severity impacts treatment recommendations and potential follow-through with treatment. Records from 108 individuals 60 years or older with voice complaints and signs of aging were reviewed. Three objective measures (normalized glottal gap area [NGGA], total bowing index, and normalized true vocal fold width) were derived. Each measure was subsequently divided into three categories by severity: absence, small degree, or large degree. Nonparametric statistics tested associations between severity and treatment recommendations as well as potential follow-through. Noninvasive treatments (observation/voice therapy) were marginally associated with no glottal gap (p = .09). More invasive treatments (injection/bilateral thyroplasty) were associated with glottal gaps being present (p = .026), but bilateral thyroplasty recommendations were not significantly associated with the largest gaps. Treatment modalities were not characterized by specific severity categories for any of the objective measures. No significant differences were found for any of the three objective measures between those who followed through with recommended treatment and those who did not. Results demonstrated some support for current hypotheses on how degrees of severity of objective measures relate to treatment recommendations. Of the three measures, NGGA appears to be more informative regarding treatment recommendations and follow-through, but due to low power, larger sample sizes are needed to confirm clinical relevance.

Enlarged folds on endoscopic gastritis as a predictor for submucosal invasion of gastric cancers.

BACKGROUNDAccurate diagnosis of the depth of gastric cancer invasion is crucial in clinical practice. The diagnosis of gastric cancer depth is often made using endoscopic characteristics of the tumor and its margins; however, evaluating invasion depth based on endoscopic background gastritis remains unclear.AIMTo investigate predicting submucosal invasion using the endoscopy-based Kyoto classification of gastritis.METHODSPatients with gastric cancer detected on esophagogastroduodenoscopy at Toyoshima Endoscopy Clinic were enrolled. We analyzed the effects of patient and tumor characteristics, including age, sex, body mass index, surveillance endoscopy within 2 years, current Helicobacter pylori infection, the Kyoto classification, and Lauren’s tumor type, on submucosal tumor invasion and curative endoscopic resection. The Kyoto classification included atrophy, intestinal metaplasia, enlarged folds, nodularity, and diffuse redness. Atrophy was characterized by non-reddish and low mucosa. Intestinal metaplasia was detected as patchy whitish or grayish-white flat elevations, forming an irregular uneven surface. An enlarged fold referred to a fold width ≥ 5 mm in the greater curvature of the corpus. Nodularity was characterized by goosebump-like multiple nodules in the antrum. Diffuse redness was characterized by uniform reddish non-atrophic mucosa in the greater curvature of the corpus.RESULTSA total of 266 gastric cancer patients (mean age, 66.7 years; male sex, 58.6%; mean body mass index, 22.8 kg/m2) were enrolled. Ninety-three patients underwent esophagogastroduodenoscopy for surveillance within 2 years, and 140 had current Helicobacter pylori infection. The mean Kyoto score was 4.54. Fifty-eight cancers were diffuse-type, and 87 cancers had invaded the submucosa. Multivariate analysis revealed that low body mass index (odds ratio 0.88, P = 0.02), no surveillance esophagogastroduodenoscopy within 2 years (odds ratio 0.15, P < 0.001), endoscopic enlarged folds of gastritis (odds ratio 3.39, P = 0.001), and Lauren’s diffuse-type (odds ratio 5.09, P < 0.001) were independently associated with submucosal invasion. Similar results were obtained with curative endoscopic resection. Among cancer patients with enlarged folds, severely enlarged folds (width ≥ 10 mm) were more related to submucosal invasion than mildly enlarged folds (width 5-9 mm, P < 0.001).CONCLUSIONEnlarged folds of gastritis were associated with submucosal invasion. Endoscopic observation of background gastritis as well as the lesion itself may help diagnose the depth of cancer invasion.

Soy protein concentrate effects on gut microbiota structure and digestive physiology of Totoaba macdonaldi.

Examine the effect of soy protein concentrate (SPC) on allochthonous microbiota, hindgut integrity, and liver tissue of totoaba (Totoaba macdonaldi). Four diets were prepared: control diet (100% fishmeal) and experimental diets containing partial substitution of fishmeal by SPC (15%, 30% and 45% SPC). After 90days, samples of the hindgut contents were taken to determine the taxonomic composition of the allochthonous microbiota through sequencing of the V3-V4 region of the 16S rRNA gene. Simultaneously, liver and hindgut samples were collected for examination by histological approaches. The SPC modulated the richness and abundance of the accessory microbiota, of which the main operational taxonomic unit showed an increase corresponding to the Phylum Firmicutes (Bacillales and Lactobacillales). With the increase in SPC, a slight decrease in mucosal fold width, a decrease in goblet cells and a slight distortion of the villi in the hindgut were observed. In the liver, SPC was observed to influence hepatocytes morphology through irregular and enlarged nuclei. The study demonstrates that Proteobacteria dominated the allochthonous microbiota of subadult totoaba, regardless of the diet. However, the SPC modulated the accessory bacteria communities and caused slight effects on the liver and gut of fish. To our knowledge, this is the first study that analyses the effects of SPC on allochthonous microbiota of subadults T. macdonaldi through new generation techniques such as DNA sequencing for metagenomic analysis.

Application of dynamic CT scan in the three-dimensional dynamic morphology changes of laryngeal soft tissue in unilateral vocal fold paralysis patients

Objective: To explore the dynamic changes of three-dimensional morphology of laryngeal soft tissue and its clinical value in the unilateral vocal fold paralysis (UVFP) patients through dynamic CT scanning during the process from inspiration to phonation. Methods: From October 2017 to July 2019, a retrospective study was performed in 18 patients with UVFP (10 males and 8 females with the range of age from 29 to 75 years old) and 10 normal subjects (5 males and 5 females with the range of age from 25 to 58 years old) in Department of Voice-Otolaryngology Head and Neck Surgery, Section Two, Zhongshan Hospital Xiamen University. The laryngeal dynamic computed tomography (CT) of cine mode was performed. Ten dynamic sequence images of vocal folds movements were obtained during the process from inspiration to phonation. Based on the dynamic changes of glottic area and the displacement of cricoid cartilage. The above dynamic sequence images were divided into inspiratory phase and phonation phase as well as open phase and closed phase. The soft tissue parameters were measured respectively, including vocal folds length, width, thickness and subglottal convergence angle. Independent-sample t test was used to analyze between UVFP group and control group. Results: During the process from inspiration to phonation, the morphology of vocal folds in control group was relatively stable at inspiratory phase and closed phase in phonation. When open phase and closed phase of phonation were switching, the morphology of vocal folds changed obviously. The length of vocal folds became longer (1.19±0.10) mm, the width became wider (2.19±0.17) mm, the thickness became thinner (2.66±0.56) mm, and the subglottal convergence angle decreased (31.45±4.78)°. Compared with the controll group, in the open phase, the thickness and width of the vocal fold on affected side in the UVFP group were thinner (t=10.25, P<0.001) and wider (t=5.25, P<0.001).While in the closed phase, the subglottal convergence angle was larger (t=4.41, P=0.001).The width of the healthy side vocal fold in the UVFP was wider (t=2.54, P=0.026) than that in the control group. The differences in other parameters were not statistically significant. Conclusions: Dynamic laryngeal CT scanning provides a simple and non-invasive method for the objective and quantitative measurement of the dynamic changes of laryngeal morphology from inspiration to phonation. Compared with the control group, the characteristic dynamic changes among UVFP were observed during this particular process, which included changes of subglottal convergence angle and thickness of vocal muscle due to denervation. In addition, in UVFP group, the width of the vocal fold healthy side in the closed phase may be used to assess its compensatory function.

Bipedicled Vocal Fold Mucosal Flap: An Experimental Study

To determine the dimensions of mucosal defects that can be covered by a bipedicled vocal fold mucosal flap. We used 20 adults human larynges (10 of each gender) excised from cadavers, divided into 2 groups of 10 larynges (5 of each gender) each. In one group (the normal flap group), we created the largest possible bipedicled vocal fold mucosal flap and then quantified the dimensions of the largest defect that could be covered by displacing the flap medially. In the other group (the augmented flap group), the flap was augmented laterally with mucosa from the laryngeal ventricle and we determined whether the larger flap would effectively cover larger defects. The mean width of mucosal defect capable of being covered was 1.51 mm when the normal bipedicled flap was employed and was 1.67 mm when the augmented flap was applied. However, the difference was not statistically significant. We found that defect size correlated with vocal fold length, width and flap size in the normal flap group, whereas it correlated only with vocal fold length in the augmented flap group. The bipedicled flap is capable of covering larger defects in males. Enlargement of a bipedicled vocal fold mucosal flap with laryngeal ventricular mucosa does not necessarily translate to an increase in the size of defect that can be covered. On average, the flap should be 30% larger than the width of the defect. The statistical model for predicting the defect size based on the vocal fold length, vocal fold width, and flap size has excellent predictive quality when a normal flap is employed.

A 4-year Retrospective Review of the Presence and Pattern of Ventricular Hyperadduction Following Unilateral Vocal Fold Paralysis, Paresis, and Unilateral Cordectomy

The aim of our study was to determine the presence and pattern of ventricular hyperadduction (VH) following unilateral vocal fold (VF) paralysis/paresis and that following unilateral cordectomy (UC). The authors independently reviewed charts and flexible videostroboscopic recordings of 214 patients diagnosed with unilateral VF paralysis/paresis and those who had undergone UC from 2015 to 2018. The presence and pattern of VH was noted. VH was considered to be present when the false vocal fold (FVF) obliterated 50% or more of the true vocal fold width during phonation, with or without FVF vibration. The true vocal fold width was considered to be that which was visible on abduction of the VFs. Categorical variables were presented in numbers and percentages and qualitative variables were correlated using Chi-Square test. Odds ratio with 95% Confidence Interval was calculated. In 154 patients diagnosed as unilateral VF paralysis/paresis 85 patients had a VH pattern (55.19%) with contralateral VH observed in 74 (87.05%), ipsilateral VH observed in 6 (7.05%) and bilateral VH observed in five patients (5.88 %). The total number of patients of UC was 60 with 36 of these patients developing a VH (60%). Ipsilateral VH was observed in 28 of these 36 patients (77.77%), three patients developed contralateral VH (8.33%) and five patients developed bilateral VH (13.88%). Ipsilateral ventricular hyper-adduction following unilateral cordectomy in the group of patients that develop hyperadduction is a significant finding in our study suggesting possibility of unilateral central phonatory control of the FVF. Contralateral ventricular hyper-adduction following unilateral paralysis and paresis, in the group of patients that develop hyperadduction is a significant finding in our study and this finding resonates with previously published papers. A finding of unilateral VH may serve as a possible indicator of the occasionally challenging diagnosis of vocal fold paresis. Retrospective, Observational.

Volumetric measures of the paralyzed vocal fold using computerized tomography; its clinical implication

Objective To report the volumetric measures of the paralyzed vocal fold in patients undergoing injection laryngoplasty. Material and method All the medical records of patients with unilateral vocal fold paralysis who had high resolution computerized tomography scan of the neck and chest prior to injection laryngoplasty between October 2015 and May 2018 were included. Volumetric evaluation of the vocal folds was performed by measuring the vocal fold height using coronal images and the vocal fold length and width using axial images. Results A total of 21 patients divided into 13 males and 8 females were identified. The mean age was 56.66 ± 20.94 years. The mean volume of the paralyzed vocal fold was significantly smaller than that of the non-paralyzed vocal fold (p < .05). Similarly, the mean length and height of the paralyzed vocal folds were smaller than those of the non-paralyzed vocal folds (p < .05). Conclusion Volumetric measurements of the paralyzed vocal fold in comparison to the normal vocal fold in a group of 21 patients with unilateral vocal fold paralysis shows the presence of significant difference between the normal and affected site, and the presence of large inter-subject variation. Information on the volume difference between the two vocal folds may be used to better estimate the amount that needs to be injected in medialization procedures.

Penetration Profiles of a Class IV Therapeutic Laser and a Photobiomodulation Therapy Device in Equine Skin

Photobiomodulation therapy (PBMT) effects depend on the energy settings and laser penetration. We investigated the penetration time profiles of two different light therapy devices, at the dark and light skin regions in horses. Six light skin and six dark skin adult clinically healthy Arab and Quarter horses were used. A cutometer was used to measure the width of the skin fold from both sides of the cervical area, followed by three measurements of the thickness of the same skin fold by transversal and longitudinal ultrasonography (US). The depth of light penetration was compared based on the percentage of penetration versus power, between a portable PBMT device versus a class IV laser device. The laser mean power output was measured with an optical power meter system for 120 seconds after penetrating the skin. Skin width and laser penetration were compared among equipment by paired “t” test. There was no difference in the width of the skin fold between measurements acquired by the cutometer against either longitudinal or transversal US or between the US measurements at cervical versus metacarpus area. Light penetration was greater in both kinds of skins in the PBMT (0.01303 ± 0.00778) versus class IV laser (0.00122 ± SD 0.00070) (P < .001). The PBMT device provided a greater energy penetration than the class IV laser in unclipped light and dark skin, suggesting that the former may produce a better therapeutic effect. The color of the skin changes penetration profiles of PBMT.

Quantitative Measurement of the Three-dimensional Structure of the Vocal Folds and Its Application in Identifying the Type of Cricoarytenoid Joint Dislocation

The objective of this study was to quantitatively measure the three-dimensional (3D) structure of the vocal folds in normal subjects and in patients with different types of cricoarytenoid dislocation. We will analyze differences in parameters between the groups and also determine if any morphologic parameters possess utility in distinguishing the type and the degree of cricoarytenoid dislocation. This retrospective study was conducted using university hospital data. Subjects' larynges were scanned using dual-source computed tomography (CT). The normal subjects were divided into deep-inhalation and phonation groups, and patients with cricoarytenoid joint dislocation were divided into anterior-dislocation and posterior-dislocation groups. Membranous vocal fold length and width were measured directly on the thin-section CT images. Vocal fold and airway 3D models were constructed using Mimics software and used in combination to measure vocal fold thickness, subglottal convergence angle, and oblique angle of the vocal folds. The phonation group displayed a greater vocal fold width, greater oblique angle, thinner vocal folds, and a smaller subglottal convergence angle than those of the deep-inhalation group (P < 0.05). The anterior-dislocation group displayed a smaller oblique angle and subglottal convergence angle than the posterior-dislocation group (P < 0.05). The 3D structure of the vocal folds during deep inhalation and phonation can be accurately measured using dual-source CT and laryngeal 3D reconstruction. As the anterior-dislocation group yielded negative values for the oblique angle and the posterior-dislocation group yielded positive values, the oblique angle of the vocal folds may possess utility for distinguishing the type and for quantitatively determining the degree of cricoarytenoid dislocation.

54. Primary cutis verticis gyrata associated to chronic migraine treated with ultrasound guided onabotulinum injections. A case report

Cutis verticis gyrata (CVG), also known as “bulldog” scalp syndrome was originally described in 1837 by Jean-Louis-Marc Alibert. CVG is a descriptive term for a condition of the scalp manifesting as convoluted folds and furrows formed from thickened skin of the scalp resembling cerebriform pattern. In 1953 Polan and Butterworth classified CVG into two forms: primary and secondary. The primary form can be divided in essential and non-essential, where the essential form do not present other abnormality (while primary nonessential can be associated with other pathologies or a combination of this. In the primary essential form, the etiology is not known, and, though most of the cases seem sporadic, autosomal recessive and autosomal dominant inheritance with variable expression have been described. In the primary nonessential form, the pathogenesis (beside the genetic determination) may have an endocrinologic basis. In the secondary form, the etiology depends on the underlying process (eg,inflammatory, neoplastic). Our patient was a 25 year old caucasian male who presented for three years scalp skin redundancy, with deep cerebriform folds and wrinkles, located in frontoparietal regions He denied comorbidities. He referred fronto temporal headache often unilateral with casual trigeminal diffusion, described as chronic and burning pain with allodinia. For those he performed a 3T MRI of head with a 3D reconstraction of scalp that excluded abnormality of the brain lobes and essentially revealed thickened dermis and a slight increase in the volume of subcutaneous fat and irregularly distributed cutaneous folds characteristic of CVG. Because neurologist considered patient with CM and inadequate response or intolerance to previous two prophylactic treatments he was treated with pericranial injections of about 150 UI of BoNT-A with the proposal to repeat treatment every 3–4 months and the purpose to increase dose up to 200 U in case of no response. After 3 months unfortunately patient achieved minimal reduction of pain of about 20–30% in headache frequency and intensity and during the 3 months follow-up period. The first weeks after BonT-A treatment he reduced NSAIDs and analgesics consumption but unfortunately after first stage he preferred to avoid further botulinum injections due to mini invasive procedure on scalp. Primary essential cutis verticis gyrata firstly because is a cosmetic problem, but also because eventual pain symptoms and psychological repercussions are very important issues. In this case both pain relief and reduction of folds width could be beneficials and therefore we encouraged the patient to treat both CM and CVG with BonT-A Injections.

Treatment effectiveness for aging changes in the larynx.

To compare the effectiveness of injection augmentation and bilateral thyroplasty surgery in managing age-related changes of the larynx. Retrospective chart review of patients treated with bilateral thyroplasty and/or injection augmentation. We evaluated 22 patients before and after treatment using: 1) normalized glottal gap area and normalized true vocal fold width from endoscopic images; 2) patient self-rating questionnaires; and 3) acoustic and aerodynamic measures. Thyroplasty surgery resulted in 38% of patients demonstrating less bowing compared to 33% after injection, and 63% demonstrated less supraglottic activity compared to 43% after injection (P = 0.09). Change in mean Voice-Related Quality of Life (V-RQOL) scores was 25.5 after thyroplasty compared to -16.4 after injection (P < 0.05). Those exhibiting a greater than 20 change in V-RQOL after treatment were significantly more likely to report swallowing symptoms pretreatment. Patients postinjection did not rate themselves on any questionnaires as significantly better compared to pretreatment, whereas patients post-thyroplasty rated themselves as significantly improved on all questionnaires. Patients post-thyroplasty rated their voices as significantly closer to their best voice than patients postinjection. Likewise, 64% of patients who had thyroplasty surgery reported a significant treatment effect compared to 33% for injection augmentation. 4. Laryngoscope, 127:2572-2577, 2017.

Diagnosing Epiglottitis with Radiographs: Can we be More Objective?

Objective The classical radiographic signs in acute epiglottitis are qualitative. The purpose of our study was to identify objective radiographic parameters to aid diagnosis of acute epiglottitis in Chinese adults. Methods A case-control study of Chinese adult patients attending the accident and emergency department (AED) who were subsequently diagnosed to have acute epiglottitis from 1st January 2009 to 31st December 2013 in a public hospital in Hong Kong. Controls were one-to-one age- and sex-matched patients who attended the AED during the study period for orthopaedic problems with cervical spine radiographs taken. Cases and controls were retrieved from the hospital computer system and their radiographs were interpreted by two specialist radiologists with various pharyngeal and laryngeal parameters, including the dimensions of the third cervical vertebral body, epiglottis, aryepiglottic fold, hypopharynx, retropharyngeal soft tissue and retrotracheal soft tissue, measured and analysed. Sensitivity, specificity, positive and negative likelihood ratios were calculated for each of the parameters. Results Twenty-six patients and 26 age- and sex-matched controls were included in the study. Epiglottis width of 5.5 mm or more was found to be 96.2% sensitive and 100% specific in diagnosing acute epiglottitis. Positive and negative likelihood ratios were infinity and 0.04 respectively. Aryepiglottic fold width of 5.9 mm or more was 92.3% sensitive and 80.8% specific. Positive and negative likelihood ratios were 4.80 and 0.10 respectively. Conclusion The identified objective radiographic parameters should aid in the diagnosis of acute epiglottitis in Chinese adults. (Hong Kong j. emerg.med. 2016;23:168-175)

The Case Files

The Case Files

Custom Implants for Medialization Laryngoplasty: A Model That Considers Tissue Compression

Unilateral vocal fold paralysis can be treated with surgical medialization with a carved silastic implant. One challenge to this approach is anticipating the dimensions of the implant for adequate medialization. The purpose of this study was to develop a predictive model for implant design based on a patient's unique laryngeal anatomy and considering compression of the vocal fold. Retrospective chart review, prospective cadaver study, and prospective patient study. A retrospective chart review was performed on patients who received silastic medialization laryngoplasty with favorable outcome and who had preoperative computed tomography. Data including Voice Handicap Index, maximum phonation time, and implant dimensions were collected from medical records, and laryngeal measurements were taken from preoperative imaging. Measurements were taken from computed tomography scans of three cadavers who underwent laryngoplasty for this study. Tissue compression (TC) was calculated and analyzed. A model to predict successful implant dimensions was developed and applied prospectively in 16 patients. Eleven patients from the chart review and three cadavers were included. Of all laryngeal metrics, width of the vocal fold at maximal medialization was most strongly correlated to TC (r=0.728). Linear regression was performed (y=0.50x - 1.2, R(2)=0.53, P=0.005, F=12.39). Of the prospective patients, 15 of 16 demonstrated complete glottis closure with the premeasured silastic implant. Vocal fold compression by silastic implants is linearly correlated with vocal fold-width at maximal medialization. A predictive formula was generated to anticipate TC and was successful in designing custom implants for patients.