Endoscopic Evacuation of Putaminal Hemorrhage Using the Trans-Middle Temporal Gyrus Approach: Technical Notes and Case Presentations.

BACKGROUND: The development of minimally invasive endoscopic neurosurgery has enabled widespread application of endoscopic surgery via the ipsilateral transfrontal approach for putaminal hematoma evacuation. However, this approach is unsuitable for putaminal hematomas that extend into the temporal lobe. We adopted the endoscopic trans-middle temporal gyrus approach, instead of the conventional surgical approach, for the management of these complicated cases and determined its safety and feasibility. METHODS: Twenty patients with putaminal hemorrhage underwent surgical treatment at the Shinshu University Hospital between January 2016 and May 2021. Of these, two patients with left putaminal hemorrhage that extended into the temporal lobe underwent surgical treatment using the endoscopic trans-middle temporal gyrus approach. The procedure entailed the use of a thinner transparent sheath to reduce the technique's invasiveness, a navigation system to determine the location of the middle temporal gyrus and the sheath's trajectory, and an endoscope with a 4K camera for higher image quality and utility. The sylvian fissure was compressed superiorly using our novel "port retraction technique" (i.e., by tilting the transparent sheath superiorly) to avoid damage to the middle cerebral artery and Wernicke's area. RESULTS: The endoscopic trans-middle temporal gyrus approach allowed sufficient hematoma evacuation and hemostasis under endoscopic observation without any surgical complexities or complications. The postoperative course was uneventful in both patients. CONCLUSION: The endoscopic trans-middle temporal gyrus approach for putaminal hematoma evacuation helps avoid damage to normal brain tissue, which could result from the wide range of motion of the conventional technique, particularly when the hemorrhage extends to the temporal lobe.

The efficacy of a visiting surgical service versus that of a hospital-based surgical service in providing endoscopic endonasal surgery to remove nonfunctioning pituitary adenomas in rural communities.

PURPOSE: To satisfy the increasing demand for endoscopic endonasal approach (EEA) to treat pituitary tumors, especially in rural areas, the "mobile EEA" system, a visiting surgical service, has been established We report this unique system for maintaining community healthcare and evaluate the surgical results of mobile EEA. METHODS: A retrospectively acquired database of 225 consecutive cases of EEA at Shinshu University Hospital (i.e., "home EEA") and its affiliated hospitals (i.e., "away EEA") between May 2018 and May 2022 was reviewed. A total of 105 consecutive patients who fulfilled the criterion of a diagnosis of new-onset nonfunctioning pituitary adenoma (PA) were included. Clinical characteristics and postoperative clinical outcomes were statistically compared between the home EEA and away EEA groups to assess the presence of a home advantage and/or an away disadvantage. RESULTS: Patients were stratified into two cohorts: patients treated at our hospital (home EEA: n = 41 [39.0%]) and those treated in the visiting surgical service at an affiliated hospital (away EEA: n = 64 [61.0%]). Postoperative clinical outcomes, such as the extent of tumor resection (p = 0.39), operation time (p = 0.80), visual function (p = 0.54), and occurrence of surgical complications (p = 0.53), were comparable between the groups. There were no visiting surgical service-related adverse events or accidents caused by physicians' driving to away hospitals. CONCLUSION: Pituitary surgeries performed via the mobile EEA system for nonfunctioning PAs may help maintain local community healthcare. Furthermore, this system can also contribute to the efficient training of surgeons by the same experienced pituitary surgeon using the same protocol.

Surgical Trapping of a Cavernous Carotid Aneurysm Causing Carotid Cavernous Fistula After Flow Diverter Placement: Technical Note and Literature Review.

BACKGROUND: Flow diverter (FD) treatment is a promising therapeutic strategy for intracranial aneurysms such as cavernous carotid aneurysms (CCAs). Direct cavernous carotid fistula (CCF) caused by delayed rupture of FD-treated CCAs has been reported, and endovascular therapy has been used in the literature. Surgical treatment is warranted for patients who have failed or are ineligible for endovascular treatment. However, no studies have evaluated surgical treatment to date. Here, this paper presents the first case of direct CCF due to delayed rupture of an FD-treated CCA managed with surgical internal carotid artery (ICA) trapping with bypass revascularization, in which the intracranial ICA with FD placement was successfully occluded with aneurysm clips. METHODS: A 63-year-old man with a diagnosis of large symptomatic left CCA underwent FD treatment. The FD was deployed from the supraclinoid segment of the ICA distal to the ophthalmic artery to the petrous segment of the ICA. Since angiography 7 months after the FD placement showed progressive direct CCF, left superficial temporal artery-middle cerebral artery bypass followed by ICA trapping was performed. RESULTS: The intracranial ICA proximal to the ophthalmic artery where the FD was placed was successfully occluded using two aneurysm clips. The postoperative course was uneventful. Follow-up angiography 8 months after the surgery confirmed complete obliteration of the direct CCF and CCA. CONCLUSIONS: The intracranial artery in which the FD was deployed was successfully occluded with two aneurysm clips. ICA trapping can be a feasible and useful therapeutic option to treat direct CCF caused by FD-treated CCAs.

Superficial temporal artery aneurysm with segmental arterial mediolysis: a case report.

Segmental arterial mediolysis (SAM) is a rare non-arteriosclerotic and non-inflammatory vascular disease. Superficial temporal artery (STA) aneurysms are usually associated with trauma, surgery, and hair transplantation. Spontaneous aneurysms of the STA are uncommon, but an STA aneurysm caused by SAM is rare. We report a 70-year-old woman with a spontaneous aneurysm of the STA. The mass in the left parietal region was pulsatile and gradually enlarged in size without any history of head trauma. The mass was successfully removed by surgery and was proved histopathologically to be a true aneurysm with SAM.

A preliminary study of the diagnostic efficacy and safety of the novel boring biopsy for brain lesions.

Existing methods for biopsy of intraparenchymal brain lesions, including stereotactic biopsy and open block biopsy, have advantages and disadvantages. We propose a novel biopsy method, called "boring biopsy," which aims to overcome the drawbacks of each conventional method. This method is less invasive and allows obtaining continuous specimens of sufficient volume. We aimed to assess the feasibility and efficacy of using boring biopsy for intraparenchymal brain lesions. We included 26 consecutive patients who underwent boring biopsy for intraparenchymal lesions. Columnar continuous specimens from the surface of the normal brain tissue to the tumor margin and the center of the lesion were obtained using the boring biopsy method. We used a catheter introducer with original modifications to create a cylindrical biopsy tool for surgery. Columnar continuous specimens were successfully obtained. Histopathological diagnosis was based on cellular changes and differentiation from normal tissues to the core of the lesion and established in all cases. No permanent deficits, major adverse outcomes, or deaths were observed. This novel technique may improve diagnostic accuracy and reduce invasiveness associated with brain biopsy. This method may become the next standard procedure, particularly in some cases where histological evaluation is paramount, and conventional biopsy methods are not suitable.

Dural sac restenosis due to regeneration of the resected C1 lamina in a patient with Chiari malformation: a case report and literature review.

Although foramen magnum decompression (FMD) is effective for the treatment of Chiari malformation type I (CM1), reoperations may be required in cases of insufficient decompression. We encountered a patient who experienced restenosis due to regeneration of resected C1 laminae and required reoperation after FMD.We present the case of a 14-year-old boy with symptomatic CM1 and syringomyelia who underwent FMD with outer dura layer incision and C1 laminectomy. He experienced gait disturbance, hyperesthesia, and hyperhidrosis, which did not improve after the surgery. He experienced recurrence of the stenosis at the age of 16 years, for which he underwent resection of the regenerated C1 arch and duraplasty. His symptoms gradually resolved after the second surgery.The recurrence might have been caused by regeneration of the C1 laminae. Bone regeneration rarely necessitates reoperation. Frequent follow-up is important after decompression surgery for Chiari malformation in young patients.

Intraoperative Image-Guided Surgery for Gliomas in the Smart Cyber Operating Theater (SCOT): A Preliminary Clinical Application.

BACKGROUND: Various devices exist for glioma image-guided surgery to improve tumor resection. These devices work as stand-alone units, making the flow of operative information complicated and disjointed. A novel networked operating room, the Smart Cyber Operating Theater (SCOT), has been developed, integrating stand-alone medical devices using the OPeLiNK communication interface. We report and evaluate the impact of SCOT for glioma surgery and our initial experiences. METHODS: Patients with gliomas who underwent tumor resection in SCOT between July 2018 and June 2021 were retrospectively reviewed. Various types of intraoperative information were integrated, managed, and shared with the surgical strategy desk using OPeLiNK. Patients' demographics, tumor characteristics, treatment details, and outcomes were obtained. The impact of the SCOT system was evaluated. RESULTS: Twenty-seven patients, with a mean age of 48.6 years (range, 13-88 years), met the inclusion criteria. We successfully completed all the surgical procedures using SCOT. The mean operation time was 420.6 minutes (range, 225-667 minutes).Gross total resection was accomplished in 13 patients (48.1%), subtotal resection in 4 (14.8%), and partial resection in 10 (37.0%). The main surgeon in the operating room and other neurosurgeons at the strategy desk shared and discussed the information in real time during the procedures. CONCLUSIONS: The use of SCOT was shown to be safe and feasible in glioma surgery. This study suggests that SCOT may improve surgical outcomes and educational impact by sharing information in real time with the strategy desk.

Endoscopic diving technique for surgery of brain abscess.

BACKGROUND: Recent advances in neuroendoscopic surgery have led to the minimally invasive treatment of brain abscesses using various endoscopy techniques. The endoscopic diving technique (EDT) involving the formation of fluid lenses to improve the visibility of the endoscope has been reported to be useful in the endoscopic endonasal approach (EEA) for pituitary and midline cranial base lesions. Here, we report a case of brain abscess treated endoscopically using EDT in cylinder surgery. CLINICAL PRESENTATION: A 29-year-old man with 11q trisomy syndrome developed a fever and progressive right hemiparesis was observed. A diagnosis of a brain abscess was made based on neuroradiological imaging, and endoscopic irrigation and drainage with EDT via a transparent endoscopic sheath were performed, which provided a clear operative field and allowed satisfactory irrigation without bacterial contamination. The bacterium identified by PCR was Streptococcus intermedius, and antibiotic therapy was administered. Postoperatively, his symptoms gradually improved. CONCLUSION: This is the first technical case report describing the clinical experience of EDT in brain abscess surgery. EDT may be a useful technique not only in EEA but also in cylinder surgery for brain abscesses.

Genetic associations of single nucleotide polymorphisms in the l-DOPA receptor (GPR143) gene with severity of nicotine dependence in Japanese individuals, and attenuation of nicotine reinforcement in Gpr143 gene-deficient mice.

l-3,4-dihydroxyphenylalanine (l-DOPA) is a candidate neurotransmitter. l-DOPA is released by nicotine through nicotinic receptors. Recently, G-protein coupled receptor GPR143, was identified as a receptor for l-DOPA. In this study, genetic association studies between GPR143 genetic polymorphisms and smoking behaviors revealed that the single-nucleotide polymorphism rs6640499, in the GPR143 gene, was associated with traits of smoking behaviors in Japanese individuals. In Gpr143 gene-deficient mice, nicotine-induced hypolocomotion and rewarding effect were attenuated compared to those in wild-type mice. Our findings suggest the involvement of GPR143 in the smoking behaviors.

Predictability of human pharmacokinetics of drugs that undergo hepatic organic anion transporting polypeptide (OATP)-mediated transport using single-species allometric scaling in chimeric mice with humanized liver: integration with hepatic drug metabolism.

We previously reported a prediction method for human pharmacokinetics (PK) using single species allometric scaling (SSS) and the complex Dedrick plot in chimeric mice with humanized liver to predict the total clearance (CLt), distribution volumes in steady state (Vdss) and plasma concentration-time profiles of several drugs metabolized by cytochrome P450 (P450) and non-P450 enzymes. In the present study, we examined eight compounds (bosentan, cerivastatin, fluvastatin, pitavastatin, pravastatin, repaglinide, rosuvastatin, valsartan) as typical organic anion transporting polypeptide (OATP) substrates and six compounds metabolized by P450 and non-P450 enzymes to evaluate the predictability of CLt, Vdss and plasma concentration-time profiles after intravenous administration to chimeric mice. The predicted CLt and Vdss of drugs that undergo OATP-mediated uptake and P450/non-P450-mediated metabolism reflected the observed data from humans within a threefold error range. We also examined the possibility of predicting plasma concentration-time profiles of drugs that undergo OATP-mediated uptake using the complex Dedrick plot in chimeric mice. Most profiles could be superimposed with observed profiles from humans within a two- to threefold error range. PK prediction using SSS and the complex Dedrick plot in chimeric mice can be useful for evaluating drugs that undergo both OATP-mediated uptake and P450/non-P450-mediated metabolism.

O controle estatal em saúde e segurança no trabalho e a auditoria do Programa de Controle Médico de Saúde Ocupacional / State control in health and safety at work and the audit of the Control Program Occupational Health Medical

Para diminuir os danos sociais decorrentes dos riscos inerentes ao trabalho, os Estados criam normas que obrigam o empregador a controlar a saúde ocupacional dos trabalhadores. No Brasil, estas ações devem estar dispostas no Programa de Controle Médico de Saúde Ocupacional, segundo obriga a Norma Regulamentadora nº 07. Para garantir o cumprimento desta norma, tanto o Estado quanto o empregador podem auditar o Programa de Controle Médico de Saúde Ocupacional (PCMSO). O objetivo foi verificar a aplicabilidade desta auditoria dentro do modelo brasileiro de controle estatal em saúde ocupacional. Para isso, foi feita uma revisão narrativa da literatura. Os resultados indicaram que as normas, punitivas e reparadoras, e a fiscalização, pontual e repressora, falham tanto em reduzir os gastos com doenças relacionadas ao trabalho quanto em estimular o cumprimento voluntário da lei. Indicaram também que as ações de controle estatal atuais (aumento do número de fiscais, flexibilização da alíquota do seguro acidente de trabalho e a fiscalização programática) seguem o modelo de controle adotado por diversos países desenvolvidos. No entanto, ao contrário destes países, o Brasil ainda não possui incentivos à adoção de Sistemas de Gestão em Saúde e Segurança no Trabalho, os quais por sua vez devem contemplar uma auditoria do PCMSO, cujos resultados podem ser usados tanto pela empresa para melhorar a gestão da saúde ocupacional quanto pelo Estado incentivar a adoção dos Sistemas de Gestão em Saúde e Segurança no Trabalho e para reduzir os gastos com acidentes e doenças relacionadas ao trabalho.

To reduce the social consequences of the risks inherent in the work, the States shall establish rules, which require the employer to control the occupational health of workers. In Brazil, these actions are to be arranged in the Medical Control Program of Occupational Health in accord to which requires Regulatory Standard 07. To ensure compliance with this standard, both State and the employer can audit the Programa de Controle Médico de Saúde Ocupacional (PCMSO ? Occupational Health Medical Control Program). The objective of this study was to verify the applicability of this audit within the Brazilian model of state control in occupational health and propose criteria for its realization. For this it was made a narrative review of the literature. The results indicated that the rules, punitive and remedial, and supervision, timely and repressive, fail both in reduce spending on work-related diseases as well as to encourage voluntary compliance. They also indicated that the current state control measures (increase in tax, easing of workers' compensation insurance rate and programmatic oversight) follow the control model adopted by many developed countries. However, unlike these countries, Brazil yet does not have incentives for adoption of Management Systems Health and Safety at Work, that should include an audit of PCMSO, with results may be used both by the company to improve their occupational health management as the State to encouraging the adoption of Occupational Health and Security Management Systems to reduce spending on work-related accidents and diseases.

Dysphagia progression and swallowing management in Parkinson's disease: an observational study / Progressão e tratamento da disfagia na doença de Parkinson: estudo observacional

Introduction: Dysphagia is relatively common in individuals with neurological disorders. Objective: To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. Methods: It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. Results: During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. Conclusion: The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series. .

Introdução: A disfagia é frequente em indivíduos com distúrbios neurológicos. Objetivo: Descrever o tratamento da disfagia e investigar fatores associados à deglutição em uma série de casos com doença de Parkinson. Método: Trata-se de um estudo longitudinal com 24 pacientes acompanhados por um período de cinco anos (2006-2011). Todos foram submetidos à videoendoscopia da deglutição, classificação de acordo com a Functional Oral Intake Scale (FOIS) e receberam orientações sobre o tratamento da deglutição a cada três meses. As orientações do tratamento da deglutição compreenderam exercícios para a melhora da deglutição. Os testes Qui-quadrado, Kruskal-Wallis e Fisher foram utilizados para investigar associação entre o estado da deglutição e variáveis clínicas. Resultados: Durante o acompanhamento, dez pacientes melhoraram, cinco mantiveram e nove pioraram a funcionalidade da deglutição. Uma mediana de dez meses foi observada até a me-lhora na deglutição ser obtida. Foi observada uma mediana de 33 meses de acompanhamento até a piora na deglutição. As manobras mais frequentemente indicadas na terapia foram: queixo para baixo, mudança na consistência e no efeito do bolo, exercícios para força e mobilidade de língua, deglutições múltiplas e exercícios vocais. Conclusão: O tratamento da disfagia foi caracterizado por avaliações trimestrais da deglutição com indicação de manobras compensatórias e reabilitadoras. Nesta casuística não foram identificados fatores associados às mudanças na funcionalidade da deglutição. .

Higher risk of complications in odynophagia-associated dysphagia in amyotrophic lateral sclerosis.

OBJECTIVE: This investigation aimed to identify associated factors with dysphagia severity in amyotrophic lateral sclerosis (ALS). METHOD: We performed a cross-sectional study of 49 patients with ALS. All patients underwent fiberoptic endoscopy evaluation of swallowing and answered a verbal questionnaire about swallowing complaints. The patients were divided into groups according to dysphagia severity. RESULTS: Among the factors analyzed, only odynophagia was associated with moderate or severe dysphagia. CONCLUSION: Odynophagia was associated with moderate and severe dysphagia in ALS and suggests a high risk of pulmonary and nutritional complications.

Higher risk of complications in odynophagia-associated dysphagia in amyotrophic lateral sclerosis / Disfagia associada a odinofagia na esclerose lateral amiotrofica pode sugerir maior risco para complicacoes pulmonares e nutricionais

Objective This investigation aimed to identify associated factors with dysphagia severity in amyotrophic lateral sclerosis (ALS). Method We performed a cross-sectional study of 49 patients with ALS. All patients underwent fiberoptic endoscopy evaluation of swallowing and answered a verbal questionnaire about swallowing complaints. The patients were divided into groups according to dysphagia severity. Results Among the factors analyzed, only odynophagia was associated with moderate or severe dysphagia. Conclusion Odynophagia was associated with moderate and severe dysphagia in ALS and suggests a high risk of pulmonary and nutritional complications. .

Objetivo Identificar fatores associados com a gravidade da disfagia na esclerose lateral amiotrófica (ELA). Método Estudo transversal incluindo 49 sujeitos com esclerose lateral amiotrófica. Todos foram submetidos à videoendoscopia da deglutição e responderam a um questionário sobre queixas de deglutição. Foram divididos em grupos de acordo com a gravidade da disfagia. Resultados Dentre os fatores estudados, apenas a odinofagia foi significantemente associada à disfagia moderada ou grave. Conclusão A odinofagia foi associada à disfagia moderada ou grave na ELA e sua presença sugere maior risco para complicações pulmonares e nutricionais. .

Evaluation of crystallization behavior on the surface of nifedipine solid dispersion powder using inverse gas chromatography.

PURPOSE: To investigate crystallization behavior on the surface of amorphous solid dispersion powder using inverse gas chromatography (IGC) and to predict the physical stability at temperatures below the glass transition temperature (T (g)). METHODS: Amorphous solid dispersion powder was prepared by melt-quenching of a mixture of crystalline nifedipine and polyvinylpyrrolidon (PVP) K-30. IGC was conducted by injecting undecane (probe gas) and methane (reference gas) repeatedly to the solid dispersion at temperatures below T (g). Surface crystallization was evaluated by the retention volume change of undecane based on the observation that the surface of the solid dispersion with crystallized nifedipine gives an increased retention volume. RESULTS: On applying the retention volume change to the Hancock-Sharp equation, surface crystallization was found to follow a two-dimensional growth of nuclei mechanism. Estimation of the crystallization rates at temperatures far below T (g) using the Avrami-Erofeev equation and Arrhenius equation showed that, to maintain its quality for at least three years, the solid dispersion should be stored at -20°C (T (g) - 65°C). CONCLUSIONS: IGC can be used to evaluate crystallization behavior on the surface of a solid dispersion powder, and, unlike traditional techniques, can also predict the stability of the solid dispersion based on the surface crystallization behavior.

Management of dysphagia in Parkinson's disease and amyotrophic lateral sclerosis / Gerenciamento da disfagia na doença de Parkinson e na esclerose lateral amiotrófica

PURPOSE: To describe swallowing management in patients with amyotrophic lateral sclerosis (ALS) and Parkinson' disease (PD), to investigate whether physiopathology determines the choice of therapeutic approaches, and to investigate whether the disease duration modifies the therapeutic approaches. METHODS: This is a long-term study comprising 24 patients with idiopathic PD and 27 patients with ALS. The patients were followed-up in a dysphagia outpatient clinic between 2006 and 2011. The patients underwent clinic evaluation and Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale, and therapeutic intervention every 3 months. The swallowing management was based on orientation about the adequate food consistency and volume, besides the necessary maneuvers or exercises to improve swallowing functionality. An exploratory analysis of data was used to investigate associations between the groups of disease (PD or ALS) and clinic aspects and to know about the association between the groups of diseases and the application of maneuver or exercises over the follow-up. RESULTS: The most frequent recommended maneuvers in PD were bolus effect (83.3%), bolus consistency (79.2%), and swallowing frequency (79%). To patients with ALS, the bolus consistency (92%) and the bolus effect (74.1%) were more recommended. Strengthening-tongue (p=0.01), tongue control (p=0.05), and vocal exercises (p<0.001) were significantly more recommended in PD than in ALS. CONCLUSION: Compensatory and sensorial maneuvers are more recommended to rehabilitee program in both diseases. The physiopathology of the diseases determined the choice of therapeutic approaches. The disease duration of the patients did not interfere directly in the therapeutic approaches.

OBJETIVO: Descrever o gerenciamento da disfagia na doença de Parkinson (DP) e na Esclerose Amiotrófica Lateral (ELA) e verificar se as características fisipatológicas das doenças determinam a escolha das abordagens terapêuticas para disfagia, além de investigar se a duração da doença modifica estas abordagens. MÉTODOS: Trata-se de um estudo longitudinal com 24 pacientes diagnosticados com DP e 27 pacientes com ELA. Os pacientes foram acompanhados em um ambulatório de disfagia entre os anos de 2006 e 2011. Todos foram submetidos à avaliação clínica e nasofibroscópica de deglutição, classificação pela Functional Oral Intake Scale e intervenção terapêutica a cada três meses. O programa de gerenciamento da disfagia baseou-se na orientação sobre a adequada consistência e volume para alimentação, além de manobras ou exercícios necessários para melhorar a funcionalidade da deglutição. Foi utilizada uma análise exploratória dos dados para investigar a associação entre os grupos de doença (DP ou ELA) e aspectos clínicos, além de verificar associação entre os grupos de doenças e a indicação das manobras e exercícios em um seguimento longitudinal. RESULTADOS: As manobras e estratégias mais indicadas para DP foram: modificações quanto às características do bolo alimentar (83,3%), modificações na consistência do bolo alimentar (79,2%) e deglutições múltiplas (79%). Para ELA, as mais indicadas foram modificações na consitência (92%) e nas características do bolo alimentar (74,1%). Em comparação com a ELA, para DP foram mais indicados exercícios para força e controle de língua (p=0,01 e 0,05) e exercícios vocais (p<0,001). CONCLUSÃO: As manobras compensatórias e sensoriais são as mais indicadas em ambas as doenças. As características fisiopatológicas das doenças determinaram a escolha das abordagens terapêuticas. O tempo de doença dos pacientes não inteferiu diretamente nas abordagens terapêuticas.

Efetividade de um programa de aprimoramento vocal para professores / Effectiveness of a vocal improvement program for teachers

OBJETIVO: analisar parâmetros fonoarticulatórios de professores, pré e pós-programa de aprimoramento vocal. MÉTODO: um programa de aprimoramento vocal foi oferecido numa escola estadual do município de Campinas, São Paulo, Brasil. Treze professores aceitaram participar do programa. Devido ao critério de exclusão, apenas cinco foram selecionados para as análises. Os sujeitos foram previamente submetidos à avaliação laringológica. Foram realizados 12 encontros semanais de 1 hora e 30 minutos na própria escola. No primeiro e no último encontro os sujeitos gravaram três "frases-veículo". As gravações foram submetidas à análise perceptivo-auditiva (para avaliação do pitch, da modulação e da articulação) e acústica (para avaliação da freqüência fundamental, da extensão de freqüência e dos dois primeiros formantes). Os dados foram submetidos à análise estatística. RESULTADOS: mesmo com o pequeno número de sujeitos, os resultados do presente estudo, revelaram ampliação significante da extensão de freqüência, indicando maior uso deste recurso expressivo pós-aprimoramento, além do aumento estatisticamente significante de F1 nas vogais /i/ e /u/ pós-intervenção, sugerindo melhora no ajuste articulatório. CONCLUSÕES: não foram observadas modificações no pitch, modulação e articulação avaliados por meio da análise perceptivo-auditiva, bem como da freqüência fundamental pós-intervenção.

PURPOSE: to analyze and correlate teachers' vocal and articulation parameters in a pre and post vocal improvement program. METHOD: a vocal improvement program was offered to a fundamental education state school, located in Campinas, São Paulo, Brazil. Thirteen teachers agreed to take part in the program, however, due to the exclusion criterion, only five "subjects" were selected for the analysis. Teachers were previously submitted to a laryngologist evaluation. Twelve weekly meetings of one and a half hour each were held in the school. In the first and the last meetings, the teachers made a three sentence-vehicle recording, which were submitted to a perceptual evaluation (pitch, modulation and articulation) and an acoustic analysis (fundamental frequency, the frequency length and two first formants' assessment). Data were submitted to statistic analysis. RESULTS: even with a small number of subjects, the results of this study, suggest significant expansion in the frequency extension and a statistically significant increase of F1 in the post-intervention vowels / i / and / u /. CONCLUSIONS: there were no changes in pitch, modulation and articulation measured through perceptual analysis, and fundamental post-intervention frequency.

PET imaging-based evaluation of hepatobiliary transport in humans with (15R)-11C-TIC-Me.

UNLABELLED: It is well accepted that drug transporters play a pivotal role in hepatobiliary excretion of anionic drugs, in which drug-drug interactions and genetic polymorphisms are known to cause variations. However, PET probes for in vivo functional characterization of these transporters have not been established yet. We used PET to investigate hepatic uptake and subsequent canalicular efflux of (11)C-labeled (15R)-16-m-tolyl-17,18,19,20-tetranorisocarbacyclin methyl ester [(15R)-(11)C-TIC-Me)] in healthy subjects. METHODS: Serial PET scans of the abdominal region in healthy male subjects were obtained with or without the organic anion-transporting polypeptide (OATP) inhibitor rifampicin after intravenous injection of (15R)-(11)C-TIC-Me as a radiotracer. Venous blood samples and PET images were obtained at frequent intervals up to 30 min after administration of the PET tracer. Dynamic imaging data were evaluated by integration plots of data collected for 2-10 min and for 10-30 min after tracer administration for the determination of tissue uptake clearance and biliary efflux clearance, respectively. RESULTS: After rapid hydrolysis in blood, the acid form-(11)C-labeled (15R)-16-m-tolyl-17,18,19,20-tetranorisocarbacyclin [(15R)-(11)C-TIC]-accumulated in the liver (37% of the dose by 17 min), and the radioactivity was then excreted into the bile (6.2% by 30 min). Rifampicin (600 mg by mouth), a potent OATP inhibitor, significantly reduced the radioactivity excreted into the bile (by 44%) by inhibiting both uptake (by 45%) and subsequent canalicular efflux (by 62%). (15R)-(11)C-TIC is an in vitro substrate of OATP1B1 and OATP1B3, and clinically relevant concentrations of rifampicin inhibited uptake by OATP1B1 and OATP1B3. These results demonstrated that in humans, (15R)-(11)C-TIC-associated radioactivity is excreted into the bile by organic anion transport systems. CONCLUSION: We demonstrated that PET image analysis with (15R)-(11)C-TIC-Me is useful for investigating variations in OATP function in the human hepatobiliary transport system.

Prevalência de neutropenia étnica benigna entre os trabalhadores de um hospital público no município de São Paulo / Benign ethnic neutropenia among public hospital employees in São Paulo

JUSTIFICATIVA E OBJETIVOS: Neutropenia étnica benigna é uma condição caracterizada por uma redução da contagem dos neutrófilos abaixo de 1.500 mm³ na circulação sanguínea, estando ausentes as causas secundárias, adquiridas ou congênitas. Ocorre,principalmente, em populações negras e seus descendentes, não apresentando problemas recorrentes de infecção. Diversos estudos realizados em outros Países, em que a etnia negra é importante na composição populacional, como no Brasil, mostram a importância do conhecimento da neutropenia étnica. O objetivo deste estudofoi investigar a prevalência de neutropenia étnica benigna, no meio de uma população trabalhadora, aparentemente saudável, realizado em um hospital de grande porte.MÉTODO: Trata-se de um estudo transversal, envolvendo 347 voluntários,que estavam dentro dos critérios de inclusão do estudo.RESULTADOS: Os dados deste estudo demonstraram entre os trabalhadores estudados, nove (2,59%) entraram nos critérios diagnósticos para neutropenia étnica benigna. Relativamente em relação aos brancos participantes, os negros, pardos e amarelos apresentaram menor contagem de neutrófilos.CONCLUSÃO: Levando-se em consideração o aspecto racial, este estudo mostrou que pessoas negras e seus descendentes podem apresentar diminuição na contagem de neutrófilos, sem predisposição a infecções.(AU)

BACKGROUND AND OBJECTIVES: Benign ethnic neutropeniais a condition characterized by a neutrophil count reduction under 1.500 mm³ in blood circulation, with absence of acquired or congenital secondary causes. It occurs mainly among afro populations or their descendants not presenting problems with recurrent infections. Different papers performed in other countries, in which the Black ethnicity is important in the population composition, such as in Brazil, discuss the importance of knowing about ethnic neutropenia. The aim of this paper was to investigate the prevalence of benign ethnic neutropeniain an apparently healthy working population of a large hospital.METHOD: This transversal study comprised 347 volunteers whomet the study inclusion criteria.RESULTS: According to this paper, nine (2.59%) among the studied employees met the diagnostic criteria for benign ethnic neutropenia.Relatively in relation to Caucasian participants, Black, Brownand Yellow people presented a lower neutrophil count.CONCLUSION: Considering the racial aspect, this study showedthat afro people and their descendants may present a neutrophilcount reduction, without predisposition to infections.(AU)