Indigo Carmine Chromoendoscopy for the Diagnosis of Minor Structural Alterations of the Vocal Fold Cover. A New Application for the Technique.

INTRODUCTION: Minor structural alterations (MSA) of the laryngeal mucosa are entities involving epithelial vocal cord covering modifications. Among differentiated structural alterations of the vocal cords are sulcus vocalis, epidermoid cysts, micro diaphragms, mucosal bridges, and vasculodysgenesis. While many of these MSA are evident and can be easily visible using conventional endoscopic methods, diagnosis can be difficult even with the help of stroboscopy. MSA can often go unnoticed and may be associated with polyps, cysts or vascular alterations. Its impact on the voice could be significant. In many cases, direct suspension laryngoscopy under general anesthesia is necessary to obtain a definitive diagnosis. OBJECTIVES: The purpose of this article is to describe a new diagnostic endoscopic method that uses contrast dyes, such as indigo carmine, for the detection of MSA of the vocal fold mucosal covering. MATERIAL AND METHODS: This research work uses the contrast dye Indigo Carmine as an endoscopic tissue stain, which is applied to the mucosal surface of the vocal cords under local anesthesia in the office or under general anesthesia in the operating room. The dye fills the interstices, highlighting irregularities such as depressions and elevations in architecture. RESULTS: Our study involved performing indigo carmine chromoendoscopy procedures on patients suspected of having vocal fold MSA-type sulcus vocalis, mucosal bridge, or bag-type sulcus. We identified cases where this technique is useful for diagnosing previously undetected alterations, shedding light on dysphonia "without an apparent cause." CONCLUSIONS: Indigo carmine chromoendoscopy is a useful technique for detecting MSA of the mucosal surface of the vocal folds. It has the potential to diagnose MSA in patients where current in-office endoscopic techniques are insufficient.

Nitrogen Sources and Iron Availability Affect Pigment Biosynthesis and Nutrient Consumption in Anabaena sp. UTEX 2576.

Anabaena sp. UTEX 2576 metabolizes multiple nitrogen (N) sources and is deemed a biotechnological platform for chemical production. Cyanobacteria have been identified as prolific producers of biofertilizers, biopolymers, biofuels, and other bioactive compounds. Here, we analyze the effect of different N-sources and Fe availability on the bioproduction of phycobiliproteins and ß-carotene. We characterize nutrient demand in modified BG11 media, including data on CO2 fixation rates, N-source consumption, and mineral utilization (e.g., phosphorus (P), and 11 metallic elements). Results suggest that non-diazotrophic cultures grow up to 60% faster than diazotrophic cells, resulting in 20% higher CO2-fixation rates. While the production of ß-carotene was maximum in medium with NaNO3, Fe starvation increased the cellular abundance of C-phycocyanin and allophycocyanin by at least 22%. Compared to cells metabolizing NaNO3 and N2, cultures adapted to urea media increased their P, calcium and manganese demands by at least 72%, 97% and 76%, respectively. Variations on pigmentation and nutrient uptake were attributed to changes in phycocyanobilin biosynthesis, light-induced oxidation of carotenoids, and urea-promoted peroxidation. This work presents insights into developing optimal Anabaena culture for efficient operations of bioproduction and wastewater bioremediation with cyanobacteria.

High Radiofrequency Surgery and Chromoendoscopy: A Novel Surgical Technique for the Treatment of Respiratory Papillomatosis.

Recurrent Respiratory Papillomatosis is a highly recurrent and residual disease. The use of indigo-carmine chromoendoscopy increases the early detection of nonvisible disease and reduces the possibility of leaving residual lesions. The best chances of papillomatosis being eradicated depend upon a surgical shallow epitheliolysis approach applied to patients who have never been surgically damaged before. We developed a novel surgical technique based upon the use of a time controlled High Radiofrequency (HRF) energy output. We applied a three-step bloodless HRF-surgical technique, that is, epitheliolysis, angiolysis and peeling without the aid of adjunct therapies. It acts according to differences in the water density of the tissues. We use it to remove the epithelial viral reservoir thus preserving subepithelial layers. For this purpose, we designed and manufactured a custom-made HRF electrodes set for office and O.R. use. From 2005 to 2018, 39 patients (100%) with recurrent respiratory papillomatosis participated in the present prospective work. Twenty-five (64,10%) achieved complete postsurgical remission, 6 (15,38%) were lost to follow up, and 8 (20,51%) present partial remissions. Thirty-six patients had laryngeal papillomatosis. Follow-up was possible in 30 of the 36 patients with laryngeal papillomatosis with a success remission rate of 83,33% (25 of 30). Eleven of those 36 (30,55%) entered this study without previous surgical treatment and 9 of 11 (81,81%) were cured. Indigo-carmine chromoendoscopy, a visualization solution for papillomatosis detection, together with a bloodless HRF-surgical technique proved to be effective tools to eradicate papillomatosis. Voice restoration to normal or near normal levels was achieved in all patients.

The transfer of Crel contextual control (same, opposite, less than, more than) through equivalence relations.

According to Relational Frame Theory (RFT) Crel denotes a contextual stimulus that controls a particular type of relational response (sameness, opposition, comparative, temporal, hierarchical etc.) in a given situation. Previous studies suggest that contextual functions may be indirectly acquired via transfer of function. The present study investigated the transfer of Crel contextual control through equivalence relations. Experiment 1 evaluated the transfer of Crel contextual functions for relational responses based on sameness and opposition. Experiment 2 extended these findings by evaluating transfer of function using comparative Crel stimuli. Both experiments followed a similar sequence of phases. First, abstract forms were established as Crel stimuli via multiple exemplar training (Phase 1). The contextual cues were then applied to establish arbitrary relations among nonsense words and to test derived relations (Phase 2). After that, equivalence relations involving the original Crel stimuli and other abstract forms were trained and tested (Phase 3). Transfer of function was evaluated by replacing the directly established Crel stimuli with their equivalent stimuli in the former experimental tasks (Phases 1 and 2). Results from both experiments suggest that Crel contextual control may be extended via equivalence relations, allowing other arbitrarily related stimuli to indirectly acquire Crel functions and regulate behavior by evoking appropriate relational responses in the presence of both previously known and novel stimuli.

Sialadenitis after radioiodine therapy. Analysis of factors that influence the response to medical treatment.

OBJECTIVES: To assess the incidence of 131I-induced sialadenitis (SD) in patients with differentiated thyroid cancer (DTC), to analyze clinical and other factors related to metabolic radiotherapy that may predict the lack of response to conventional medical therapy (CMT), and to determine the effectiveness of intraductal steroid instillation in patients failing CMT. MATERIAL AND METHODS: Fifty-two patients with DTC, 45 females (86.5%) and 7 males (13.5%) with a mean age of 44.21±13.3 years (r=17-74) who received ablation therapy with 131I after total thyroidectomy. Patients with diseases and/or medication causing xerostomia were excluded. Patients underwent salivary gland scintigraphy with 99Tc (10mCi). RESULTS: Eighteen patients (34.62%) had SD and received antibiotics, antispasmodics, and oral steroids for 15 days. They were divided into two groups: responders to medical therapy (n=12, age 44.3±14.4 years, 2 men [17%], 10 women [83%], cumulative dose 225±167.1 mCi) and non-responders to medical treatment, who underwent steroid instillation into the Stensen's duct (n=6 [33%], 2 men [33%], 4 women [67%], age 50±13.8 years, cumulative dose 138.3±61.7 mCi). Scintigraphy showed damage to the parotid and submaxillary glands. CONCLUSION: Incidence of 131I-induced sialadenitis was similar to that reported by other authors. Age, mean cumulative dose of 131I, and involvement of parotid and submaxillary glands did not condition response to CMT; however, male sex was a conditioning factor. Symptom persistence for more than 15 days makes instillation into the Stensen's duct advisable. This is an effective and safe method to avoid surgical excision of salivary glands.

Chromoendoscopy associated with endoscopic laryngeal surgery: a new technique for treating recurrent respiratory papillomatosis.

OUTLINE: Chromoendoscopy is a dye enhancement technique that uses epithelial tissue dyeing for assessing any changes in it by determining its characteristics and eventually to improving mucosal lesions detection at endoscopy. Currently with the addition of a joint use of rigid endoscopes and video systems at surgery, visualization of the larynx and trachea areas significantly improved with wide angle viewing. However, in certain diseases, such as laryngeal papillomatosis, certain conditions were overlooked by these approaches and with the likelihood of postoperative early relapse. With the addition of chromoendoscopy to endoscopic laryngeal surgery, we were able to increase the ability to recognize intraoperatively inconspicuous lesions, improve lesion limit visualization, observe in detail their surfaces, and determine as well the existence of residual lesion if any after surgical removal. OBJECTIVES: To prove the helpfulness of chromoendoscopy in otolaryngology as an innovative diagnostic technique associated with laryngeal endoscopical surgery. MATERIALS AND METHODS: The present study uses contrast dyeing agents such as indigo carmine as endoscopic tissue staining and, incidentally, which is the most widely used detection method in gastroenterology. The dye fills the interstices, highlighting irregularities, such as depressions and elevations in architecture. RESULTS: This diagnostic enhancing technique was used with six patients who presented recurrent laryngeal papillomatosis. We committed ourselves to get the most out of the intraoperative diagnostic yield and reduce the relapse likelihoods in all cases. CONCLUSION: Chromoendoscopy joined with endoscopic laryngeal surgery is an excellent intraoperative diagnostic approach in the management of laryngeal invasive conditions such as laryngeal papillomatosis.

Evaluation of an adolescent hospital-based injury prevention program.

BACKGROUND: IMPACT (Impaired Minds Produce Actions Causing Trauma) is an adolescent, hospital-based program aimed to prevent injuries and their consequences caused by alcohol or drug impairment and other high-risk behaviors. The overall objective of this evaluation was to determine the effect of the program on students' knowledge and behavior regarding drinking and driving, over time. METHODS: A randomized control trial between students randomly selected to attend IMPACT and those not selected served as a control group. Students completed a questionnaire before the program and at three posttime periods (1 week, 1 month, and 6 months). Panel data models were used to analyze the effects of the experiment on students' knowledge of alcohol and crash issues and negative driving behaviors (no seat belt, driving while using a cell phone, involved in conversation, eating, annoyed with other drivers, and drowsy). Descriptive statistics and logistic regression models were used to analyze the effect of IMPACT on students' influence on friends and family about road safety. RESULTS: This study consisted of 269 students (129 IMPACT; 140 control) with an overall response rate of 84% (range, 99% presurvey to 71% at 6 months). The IMPACT group had a 57%, 38%, and 43% increase in the number of correct answers on alcohol and crash issues during the three time periods, respectively (p < 0.05). Students in the IMPACT group would try to influence friends and family to improve their road safety twice as often as 1-week postprogram (odds ratio 1.94, confidence interval 1.07, 3.53). The models did not suggest that the program had an effect on negative driving behaviors. Men and students who drove more frequently had worse driving behavior. CONCLUSIONS: Our evaluation demonstrates that the IMPACT program had a statistically significant, positive effect on students' knowledge of alcohol and crash issues that was sustained over time. IMPACT had an initial effect on students' behaviors in terms of peer influence toward improving road safety (i.e., buckling up, not drinking, and driving) 1 week after the program, but this effect diminished after 1 month. Other negative driving behaviors had low prevalence at baseline and were not further influenced by the program.