The Usefulness of Multi Voice Evaluation for Measuring Voice Recovery After Endolaryngeal Phonomicrosurgery in Patients with Vocal Fold Polyps.

OBJECTIVES: The purpose of this study was to the usefulness of a five-variable model predicting perceived voice severity and incorporating acoustic analysis based on cepstral analysis and self-reported questionnaires, for measuring voice recovery after endolaryngeal phonomicrosurgery in patients with vocal fold polyps. METHODS: In this study, 72 patients with vocal fold polyps were included. Two voice evaluations, including acoustic analysis, self-reported questionnaires, and auditory perceptual assessments for each patient, were implemented before and after endolaryngeal phonomicrosurgery. Using these evaluations, we compared the mean values of the perceptual evaluation of voice, acoustic analysis parameters, self-reported questionnaires, and the five-variable model estimated severity pre- and post-endolaryngeal phonomicrosurgery. RESULTS: Various parameters related to acoustic analysis, self-reported questionnaires, and auditory perceptual assessments were useful for measuring voice recovery after endolaryngeal phonomicrosurgery. In particular, a five-variable model incorporating spectral/cepstral analyses and self-reported questionnaires was able to effectively track voice changes after endolaryngeal phonomicrosurgery. CONCLUSION: We verified that most of the variables and the five-variable model were useful for measuring voice recovery in patients with vocal polyps after endolaryngeal phonomicrosurgery.

Clinical implications of placenta-derived angiogenic/anti-angiogenic biomarkers in pre-eclampsia.

Pre-eclampsia (PE) is a devastating systemic disease which results in maternal hypertension with multi-organ failure due to angiogenic imbalance, characterized by lack of circulating pro-angiogenic factors and excess of anti-angiogenic factors. These factors are crucial for understanding the pathophysiology of PE since they serve as a critical link from placental dysfunction to the clinical syndrome of systemic endothelial dysfunction in the disease. Moreover, utilizing these angiogenic/anti-angiogenic biomarkers can be helpful in risk stratifying and the early detection of PE, which allows for timely intervention to improve maternal and neonatal outcomes. In this review, we summarize updated perspectives of the angiogenic imbalance in PE with detailed characterization of key factors involved in the pathogenesis and how the developed biomarkers can be used in clinical settings as diagnostic tools and as possible therapeutic targets of PE.

Colon-targeted delivery of solubilized bisacodyl by doubly enteric-coated multiple-unit tablet.

A doubly enteric-coated multiple-unit tablet (DET) of bisacodyl (BD) was formulated to selectively deliver the stimulant laxative to the large intestine. Solubilized BD in surfactants was adsorbed into the porous carrier and primarily coated with different combinations of pH-sensitive polymers (Eudragit S and Eudragit L) and time-dependent release polymer (Eudragit RS). BD-loaded granules were compressed into tablets and coated again with pH-sensitive polymers (Eudragit S:Eudragit L=1:1). The multiple-unit tablet was optimized with respect to the granular coating compositions (Eudragit S:Eudragit L:Eudragit RS=5:1:4) and coating level (12.5%), and coating level on the tablet (25%), by evaluating in vitro release profile in continuous dissolution medium. Drug release from the optimized tablet was effectively retarded in the simulated gastric and small intestinal fluids (below 7%), but profound drug liberation was attained in the colonic fluid (over 50%). On the other hand, drug release from the marketed product (Dulcolax®, Boehringer Ingelheim Pharma), a reference drug, in the gastric and small intestinal fluids was reached to 30%, while that in the colonic fluid was only 7%. In an in vivo efficacy study in loperamide-induced constipated rabbits, a remarkable recovery in fecal secretion was observed in the DET-treated group 24h post-dosing, compared to vehicle-treated (p<0.05) and the marketed product-treated groups (p<0.05). Moreover, pharmacokinetic evaluation in the constipated rabbits revealed that the DET system significantly lowered the systemic exposure compared with the marketed product (p<0.05), by hindering drug release in the upper intestine, a preferential absorption site. Therefore, the novel colon-targeted delivery system may be an alternative for boosting pharmacological responses in the colon, while diminishing the intestinal irritation and/or systemic adverse effect of the stimulant laxative.

Comparison of two MR grading systems for correlation between grade of cervical neural foraminal stenosis and clinical manifestations.

OBJECTIVE: To compare the reliability of two recently reported MR grading systems of cervical neural foraminal stenosis (CNFS) and their correlation with clinical manifestations. METHODS: We evaluated 188 patients (male : female = 80 : 108; mean age of 41 years) who visited our institution and underwent oblique sagittal MRI of the cervical spine. Two radiologists evaluated the MRI findings for the presence and grade of CNFS at the narrowest point, with the grading systems (Park, Kim and mKim systems) suggested by Park et al and Kim et al. More than one positive neurologic sign and more than one neurologic clinical symptom was considered a positive neurologic manifestation of each foraminal stenosis. Interobserver agreement between the two readers was analyzed using kappa statistics. Non-parametric correlation analysis (Spearman's correlation) was used to evaluate the correlation coefficients (R) to assess the relationship between CNFS grade and clinical manifestations. RESULTS: Both the Park and mKim systems demonstrated a relatively high correlation (R = 0.714-0.764) between the CNFS grade and clinical manifestation, while the Kim system yielded a moderate correlation (by Reader 2). The Park and mKim systems demonstrated higher correlation values at the level of C6-7 than C4-5, while the Kim system showed no difference in correlation at the cervical spine level. CONCLUSION: Both the Park and mKim systems provide a reliable, reproducible CNFS diagnosis, while the Kim system has a slightly inferior reliability. The Park and mKim systems had a similar, relatively high clinical correlation. ADVANCES IN KNOWLEDGE: Grades 2 and 3 of the Park system and Grade 2 in the Kim and mKim systems exhibited a similar clinical significance. Patients with a grade of 0 (using each system) consistently exhibit negative neurologic manifestation.

Comparison of oblique coronal images in knee of three-dimensional isotropic T2-weighted turbo spin echo MRI versus two-dimensional fast spin echo T2-weighted sequences for evaluation of posterior cruciate ligament injury.

OBJECTIVE: To compare image quality between three-dimensional volume isotropic turbo spin echo acquisition (3D VISTA) with the posterior cruciate ligament (PCL) view and two-dimensional (2D) fast spin echo (FSE) for evaluation of PCL injury. METHODS: This retrospective study included 60 patients with clinical suspicion of PCL injury who underwent both 2D FSE and 3D VISTA of the knee between January 2015 and December 2015. The diagnostic performance of each oblique coronal view and the combined images was evaluated for sensitivity, specificity and accuracy for diagnosing a PCL tear. The arthroscopically confirmed diagnoses were used as the reference standard. Data were analyzed using the McNemar test. RESULTS: The mean contrast-to-noise ratio was significantly higher for 3D VISTA than for 2D FSE. The two imaging modalities did not differ significantly in anatomical identification ability, with the exception of margin sharpness, which was inferior for 3D VISTA with Reader 2 (p = 0.038). When we classified the diagnoses of PCL injury as normal or abnormal, there were no significant differences in sensitivity, specificity or accuracy between the PCL view of 3D VISTA and 2D FSE images (p > 0.05). CONCLUSION: 3D VISTA had a superior contrast-to-noise ratio than 2D FSE and similar image quality in the evaluation of the PCL. The PCL view of 3D VISTA has the same diagnostic ability as 2D FSE in the diagnosis of PCL injury and can thus replace 2D FSE. Advances in knowledge: The oblique coronal view 3D VISTA MRI has similar diagnostic ability to 2D FSE in the diagnosis of PCL injury, and therefore 3D VISTA image can replace 2D FSE.

Usefulness of oblique coronal magnetic resonance images of the knee after posterior cruciate ligament reconstruction.

OBJECTIVE:: To know the usefulness of the oblique coronal view of the posterior cruciate ligament (PCL) in the evaluation of the graft normal anatomy and the diagnostic accuracy of combining the PCL view with orthogonal views for the evaluation of PCL graft failure or impingement after reconstruction procedures. METHODS:: This retrospective study included 54 patients who underwent PCL-view MRI after PCL reconstruction surgery. Anatomic identification of graft failure and impingement was scored by two radiologists. The ability to diagnose PCL graft failure with the PCL view, orthogonal view or combined PCL/orthogonal views was evaluated by calculating the sensitivity, specificity and accuracy. RESULTS:: The entire width discrimination scores and margin sharpness scores for the PCL view were significantly higher than those for the orthogonal view for both readers. The specificities and accuracies for the PCL view and the combined PCL/orthogonal views were higher than those for the orthogonal view alone, but these differences were not statistically significant. CONCLUSION:: The PCL view provided a better anatomic evaluation than the orthogonal view with regard to the entire width evaluation and margin sharpness evaluation of the PCL graft. The combined view of orthogonal and PCL views was slightly more sensitive and accurate, but not significantly so, in the diagnoses of graft failure and impingement. ADVANCES IN KNOWLEDGE:: The PCL view provided a better anatomic evaluation than the orthogonal view with regard to the entire width evaluation and margin sharpness evaluation of the PCL graft. The PCL view was slightly more sensitive and accurate, but not significantly so, in the diagnoses of graft failure and impingement.

The Thiol Reductase Activity of YUCCA6 Mediates Delayed Leaf Senescence by Regulating Genes Involved in Auxin Redistribution.

Auxin, a phytohormone that affects almost every aspect of plant growth and development, is biosynthesized from tryptophan via the tryptamine, indole-3-acetamide, indole-3-pyruvic acid, and indole-3-acetaldoxime pathways. YUCCAs (YUCs), flavin monooxygenase enzymes, catalyze the conversion of indole-3-pyruvic acid (IPA) to the auxin (indole acetic acid). Arabidopsis thaliana YUC6 also exhibits thiol-reductase and chaperone activity in vitro; these activities require the highly conserved Cys-85 and are essential for scavenging of toxic reactive oxygen species (ROS) in the drought tolerance response. Here, we examined whether the YUC6 thiol reductase activity also participates in the delay in senescence observed in YUC6-overexpressing (YUC6-OX) plants. YUC6 overexpression delays leaf senescence in natural and dark-induced senescence conditions by reducing the expression of SENESCENCE-ASSOCIATED GENE 12 (SAG12). ROS accumulation normally occurs during senescence, but was not observed in the leaves of YUC6-OX plants; however, ROS accumulation was observed in YUC6-OX(C85S) plants, which overexpress a mutant YUC6 that lacks thiol reductase activity. We also found that YUC6-OX plants, but not YUC6-OX(C85S) plants, show upregulation of three genes encoding NADPH-dependent thioredoxin reductases (NTRA, NTRB, and NTRC), and GAMMA-GLUTAMYLCYSTEINE SYNTHETASE 1 (GSH1), encoding an enzyme involved in redox signaling. We further determined that excess ROS accumulation caused by methyl viologen treatment or decreased glutathione levels caused by buthionine sulfoximine treatment can decrease the levels of auxin efflux proteins such as PIN2-4. The expression of PINs is also reduced in YUC6-OX plants. These findings suggest that the thiol reductase activity of YUC6 may play an essential role in delaying senescence via the activation of genes involved in redox signaling and auxin availability.

Usefulness of the fast spin-echo three-point Dixon (mDixon) image of the knee joint on 3.0-T MRI: comparison with conventional fast spin-echo T2 weighted image.

OBJECTIVE: To compare the quality of two different imaging methods, three-point Dixon (mDixon) and fast spin-echo (FSE) T2 weighted image (T2WI) [and fat suppression (FS) T2WI], and to assess the utility of mDixon for the imaging of knee joint pathology. METHODS: This retrospective study included 66 patients who underwent both mDixon and FSE T2WI (and FS T2WI) of the knee joint. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the two sequences at the articular cartilage and ligament were measured. Two radiologists independently evaluated the anatomic identification score and diagnostic performances of the two sequences. RESULTS: The mean SNRs and CNRs of the patellar cartilage, femoral cartilage and anterior cruciate ligament (ACL) were significantly higher on T2WI and FS T2WI than on mDixon imaging, with the exception of the mean SNR of ACL on in-phase images. Most of the anatomic identification scores did not show significant differences, except for inferiorities of the in-phase mDixon in the evaluation of the cruciate ligament. There were no significant differences in sensitivity, specificity and accuracy between mDixon and T2WI regarding diagnostic performance. CONCLUSION: mDixon images have equivalent anatomic identification ability with the exception of cruciate ligament delineation on in-phase images and have a diagnostic performance comparable with that of FSE T2WI for meniscal, cartilage and ligament injuries of the knee joint. There would be a net saving in time, if mDixon was the only sequence used. ADVANCES IN KNOWLEDGE: The mDixon images have equivalent anatomic identification abilities, with the exception of cruciate ligament delineation on in-phase images and have a diagnostic performance comparable with that of FSE T2WI for meniscal, cartilage and ligament injuries of the knee joint.

The usefulness of the three-dimensional enhanced T1 high-resolution isotropic volume excitation MR in the evaluation of shoulder pathology: comparison with two-dimensional enhanced T1 fat saturation MR.

OBJECTIVE: To evaluate the diagnostic accuracy of three-dimensional (3D) enhanced T1 high-resolution isotropic volume excitation (eTHRIVE) shoulder MR for variable shoulder pathology such as rotator cuff tear, labral injury and synovial pathology in comparison with two-dimensional enhanced fast spin echo T1 fat saturation (2D T1 FS) sequences MR. METHODS: This retrospective study included 86 patients who underwent MRI of the shoulder using eTHRIVE technique. Two radiologists evaluated anatomic identification of the supraspinatus, glenoid labrum and acromioclavicular joint (AC joint) on routine MRI sequences (2D T1 FS) and compared them with the reformatted eTHRIVE images. Subjective scoring of the images was performed with a four-point scale that rated the degree of discrimination of the shape of the supraspinatus, glenoid labrum and AC joint. The diagnostic accuracy of eTHRIVE compared with routine MR images was evaluated in terms of rotator cuff pathology, labral pathology and synovial pathology. RESULTS: Anatomic identification scores of the supraspinatus tendon and labrum were significantly lower for eTHRIVE than for 2D T1 FS. There were no significant differences between eTHRIVE and 2D T1 FS in anatomic identification of the AC joint. There were no significant differences between eTHRIVE and 2D T1 FS in diagnosing the three disease categories. CONCLUSION: eTHRIVE had comparable diagnostic accuracy to 2D T1 FS imaging in the evaluation of rotator cuff tears, labral injury and synovial pathology, but anatomic identification was inferior to that of 2D T1 FS. ADVANCES IN KNOWLEDGE: The accuracy of 3D eTHRIVE imaging is comparable to that of 2D T1 FS for the diagnosis of rotator cuff tears, labral injury and synovial pathology.