Structural, thermal, electronic, vibrational, magnetic, and cytotoxic properties of chloro(glycinato-N,O)(1,10-phenanthroline-N,N')­copper(II) trihydrate coordination complex.

Chloro(glycinato-N,O)(1,10-phenanthroline-N,N')­copper(II) trihydrate complex was synthesized through the slow evaporation method. The crystal's structural, thermal, magnetic, and vibrational properties were obtained by X-ray powder diffraction (XRPD), thermal analyses, magnetization, Raman, and Fourier-transform infrared (FT-IR) spectroscopy. XRPD results showed that the crystalline complex belongs to a monoclinic system (P21/n). Thermal analyses revealed that around 333 K, the material undergoes a thermodynamically irreversible process. Magnetic data showed a paramagnetic behavior with weak ferromagnetic interactions. Moreover, all the Raman- and infrared-active bands were assigned from computational calculations based on the density functional theory (DFT) to analyze intra-molecular vibrational modes. In addition, the cytotoxic assay on colorectal cancer cells was performed to evaluate the antitumor activity of this ternary compound. Therefore, the antineoplastic activity of [Cu(1,10-phenanthroline)(glycine)Cl]•3H2O complex in HCT-116 cells was confirmed, showing a potent cytotoxic effect.

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

OBJECTIVES/HYPOTHESIS: This study aimed to describe the videolaryngostroboscopic (VLS) findings in a cohort of patients with isolated paresis of laryngeal adduction and identify predictive variables that may be related to voice recovery. STUDY DESIGN: Chart review and VLS analysis of dysphonic patients diagnosed with isolated paresis of laryngeal adduction by laryngeal electromyography (LEMG). METHODS: Demographic, clinical, VLS, and LEMG findings were analyzed according to the outcome of dysphonia. RESULTS: There were 17 patients, 12 males (70.6%), mean age of 46.6 years, with median dysphonia duration of 4 months (range, 1-60 months) included in the study. In all patients, gross movement of both vocal folds were normal. Laryngoscopy showed limited adduction of the ipsilateral ventricular fold, contralateral interarytenoid region deviation, and vocal fold atrophy in 100%, 94.1%, and 76.5% of patients, respectively. VLS findings included: impairment of glottic closure (94.1%), phase asymmetry (94.1%), and reduced mucosal wave on the affected side (76.5%). Predictors of good voice outcome were sudden onset (P = .012), duration of dysphonia on presentation shorter than 5 months (P = .005), and absence of polyphasic potentials on LEMG (P = .041). CONCLUSIONS: Findings on VLS as described suggest isolated paresis of laryngeal adduction and should warrant indication of LEMG for definite diagnosis. Voice improvement may be related to clinical and LEMG findings. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:919-925, 2019.

Correlation of the Dysphonia Severity Index (DSI), Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), and Gender in Brazilians With and Without Voice Disorders.

OBJECTIVES: This study aims to analyze the Dysphonia Severity Index (DSI) in Brazilians with or without voice disorders and investigate DSI's correlation with gender and auditory-perceptual evaluation data obtained via the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol. STUDY DESIGN: A total of 66 Brazilian adults from both genders participated in the study, including 24 patients with dysphonia confirmed on laryngeal examination (dysphonic group [DG]) and 42 volunteers without voice or hearing complaints and without auditory-perceptual voice disorders (nondysphonic group [NDG]). METHODS: The vocal tasks included in CAPE-V and DSI were performed and recorded. Data were analyzed by means of the independent t test, the Mann-Whitney U test, and Pearson correlation at the 5% significance level. RESULTS: Differences were found in the mean DSI values between the DG and the NDG. Differences were also found in all DSI items between the groups, except for the highest frequency parameter. In the DG, a moderate negative correlation was detected between overall dysphonia severity (CAPE-V) and DSI value, and between breathiness and DSI value, and a weak negative correlation was detected between DSI value and roughness. In the NDG, the maximum phonation time was higher among males. In both groups, the highest frequency parameter was higher among females. CONCLUSIONS: The DSI discriminated among Brazilians with or without voice disorders. A correlation was found between some aspects of the DSI and the CAPE-V but not between DSI and gender.

Cutaneous Application of Silicone Wafers Containing Carbon Microcoils: Efficacy in Relieving Chronic Muscle Tension and Pain.

BACKGROUND: Chronic musculoskeletal pain is highly prevalent worldwide. PRIMARY STUDY OBJECTIVE: The aim of this study was to evaluate the efficacy of Helical(®) microcoils, a new, noninvasive treatment for chronic musculoskeletal pain. DESIGN: This was a prospective, observational study. SETTING: The study was conducted at the main author's private clinic, in São Paulo, Brazil. PARTICIPANTS: We evaluated 20 physicians, from 2 different hospitals, who suffered from chronic musculoskeletal pain and volunteered to participate in the study. INTERVENTION: The Helical(®) microcoils were applied to the skin over the affected areas. Before and after the intervention, the physician-patients completed questionnaires and a visual analog scale. PRIMARY OUTCOME MEASURES: We quantified postintervention improvement or worsening of pain and muscle tension. RESULTS: Significant improvements in pain and muscle tension were observed in 95% of the physician-patients evaluated. The only side effect reported was mild pruritus at the application site, which occurred in 5 of the 20 cases. CONCLUSION: The use of Helical microcoils was found to be safe and efficacious in relieving muscle tension and pain.

Individually customized implants for laryngoplasty--are they possible?

OBJECTIVE: To standardize the design of individually fitted implants based on computed tomographic (CT) images for use in medialization laryngoplasty without intraoperative voice monitoring. STUDY DESIGN: Prospective tomographic and anatomical experimental study of 10 human cadaveric larynges. METHODS: CT scans of 10 excised human larynges were analyzed to define the shape and size of ideal implants for medialization laryngoplasty. Silicone implants were designed according to CT parameters and used in simulated laryngoplasties in the laryngeal specimens. The efficacy of each implant in providing adequate medialization of the vocal fold was evaluated. RESULTS: Diverse shapes and sizes of implants were obtained, reflecting variations in laryngeal anatomy. The implants enabled regular medialization of the entire extent of the free border of the vocal fold, including its posterior aspect. Medialization was considered adequate in all cases. CONCLUSIONS: This method proved to be a simple and efficient way to design individualized implants for medialization laryngoplasty, regardless of the size and shape of the larynx. LEVEL OF EVIDENCE: Not available.

Collagen type I, collagen type III, and versican in vocal fold lamina propria.

OBJECTIVE: To analyze the distributions of collagen type I, collagen type III, and versican in the lamina propria of the human vocal fold. DESIGN: Cross-sectional analysis of cadaveric vocal folds of adult human larynges. SETTING: Academic tertiary referral center. SUBJECTS: Larynges harvested at autopsy from 10 adult men and 10 adult women. MAIN OUTCOME MEASURES: Immunohistochemical reactions were performed using antihuman monoclonal antibodies to analyze the expression of collagen type I, collagen type III, and versican. RESULTS: Collagen type I density was lower in the intermediate layer compared with the superficial and deep layers of vocal folds. Collagen type III density was lower in the intermediate layer compared with the deep layer. Versican density was lower in the superficial layer compared with the intermediate and deep layers. Versican density was lower in the lamina propria of women compared with men; this difference was noted in the superficial layer only. There was a positive correlation between collagen type III and versican densities within the lamina propria. CONCLUSION: Collagen type I, collagen type III, and versican are distributed differently within the lamina propria layers of the adult vocal folds.

The relationship between tongue trill performance duration and vocal changes in dysphonic women.

OBJECTIVE: To assess the relationship between tongue trill performance duration and auditory perception and acoustic changes in dysphonic women. STUDY DESIGN: Prospective clinical study, with intrasubject comparison. METHODS: Twenty-seven women who had vocal nodules were in the experimental group (EG) (tongue trills), and 10 were also in the control group (CG) (placebo exercises). The voices were recorded before and after experimental and placebo exercises at the first (m1), third (m3), fifth (m5), and seventh (m7) minutes of performance. These recordings were randomized, and the auditory perception analysis was carried out by three judges trained in voice analysis. Individual recordings were analyzed using the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol, the randomized pairs of recordings were compared, and the better voice was chosen. VoxMetria software (CTS, Parana, Brazil, www.ctsinformatica.com.br) was used to assess the acoustic. RESULTS: In the EG, the CAPE-V results showed a predominance of vocal improvement, statistically proven, at m5 of tongue trill exercise, with the best overall rating, the least roughness and breathiness, and increase in pitch level. At m7, strain was significantly higher. In the paired comparison analysis, voices at m5 were considered the best of all moments. There was an increase of the F(0) and glottal-to-noise excitation after m3 and a decrease in noise as in m1. In the CG, vocal changes were discrete compared with those in the EG. CONCLUSION: Tongue trill performance duration interfered with the vocal response of dysphonic women, with positive response predominance at m5. At m7, there was an increase of vocal tension and a drop in vocal quality.

A model bismuth oxide intergranular thin film in a ZnO twist grain boundary.

The electronic properties of a model bismuth oxide intergranular film in ZnO were investigated using density functional plane wave calculations. It was found that oxygen excess plays a fundamental role in the appearance of electrical activity. The introduction by oxygen interstitials or zinc vacancies results in depletion of the charge in deep gap states introduced by the bismuth impurities. This makes the boundary less metallic and promotes the formation of acceptor states localized to the boundary core, resulting in Schottky barrier enhancement. The results indicate that the origin of electrical activity in thin intergranular bismuth oxide films is probably not distinct from that in decorated ZnO boundaries.

The presence of a vocal ligament in fetuses: a histochemical and ultrastructural study.

Although it is currently believed that the vocal ligament of humans undergoes considerable development postnatally, there is no consensus as to the age at which it first emerges. In the newborn infant, the lamina propria has been described as containing a sparse collection of relatively unorganized fibres. In this study we obtained larynges from autopsy of human fetuses aged 7-9 months and used light and electron microscopy to study the collagenous and elastic system fibres in the lamina propria of the vocal fold. Collagen fibres were viewed using the Picrosirius polarization method and elastic system fibres were stained using Weigert's resorcin-fuchsin after oxidation with oxone. The histochemical and electron microscopic observations were consistent, showing collagen populations with an asymmetric distribution across different compartments of the lamina propria. In the central region, the collagen appeared as thin, weakly birefringent, greenish fibres when viewed using the Picrosirius polarization method, whereas the superficial and deep regions contained thick collagen fibres that displayed a strong red or yellow birefringence. These findings suggest that the thin fibres in the central region consist mainly of type III collagen, whereas type I collagen predominates in the superficial and deep regions, as has been reported in studies of adult vocal folds. Similarly, elastic system fibres showed a differential distribution throughout the lamina propria. Their distribution pattern was complementary to that of collagen fibres, with a much greater density of elastic fibres apparent in the central region than in the superficial and deep regions. This distribution of collagen and elastic fibres in the fetal vocal fold mirrors that classically described for the adult vocal ligament, suggesting that a vocal ligament has already begun to develop by the time of birth. The apparently high level of organization of connective tissue components in the newborn is in contrast to current hypotheses that argue that the mechanical stimuli of phonation are essential to the determination of the layered structure of the lamina propria and suggests that genetic factors may play a more significant role in the development of the vocal ligament than previously believed.

T-shaped microsuture: a new suture technique for laryngeal microsurgery.

UNLABELLED: To describe a new suture technique for laryngeal microsurgery and to test its applicability in human cadaver larynges. The new technique was experimentally tested in freshly excised human larynges fixed to a larynx holder appropriate for the simulation of laryngeal microsurgery. A mucosal flap was created in the vocal fold for the fabrication of a pocket for subepithelial fat implantation, and the wound edges were then brought together and sutured using the proposed technique. The time necessary for suture was measured with a stopwatch for five successive sutures performed by one of the surgeons. The presence or absence of mucosal rupture was determined for five sutures performed by two surgeons, for a total of 10 sutures. The sutures were performed without the help of an assistant, with no laceration of the mucosa being observed in any of the attempts, and within a relatively short period of time even without previous training. The sutures performed permitted the implanted fat to remain stable under the mucosal flap. CONCLUSIONS: the new suture technique is an easy procedure, which can be performed by a single surgeon under microscopic vision, with a low risk of tissue rupture. The technique does not markedly prolong the duration of surgery and a single suture thread can be used for the fabrication of more than one stitch.

Morphometric study on the anatomy of the fetal cricoid cartilage and comparison between its inner diameter and endotracheal tube sizes.

OBJECTIVES: The high incidence of respiratory disorders is one of the main problems in perinatal medical care. With the increased use of intubation, the incidence of laryngeal injury causing stenosis has also increased. The principal constriction point in the infant's larynx is the midcricoid area. We sought to provide detailed morphometric data on the anatomy of the cricoid cartilage and its relationship with growth and body characteristics of fetuses at 5 to 9 months of gestational age. METHODS: Nineteen larynges obtained from 17 stillborn infants and 2 newborn infants ranging in gestational age from 5 to 9 months were studied. Measurements of the cricoid cartilage were made with a millimeter-graded caliper. RESULTS: Weight was the variable most correlated with cricoid measurements. The cricoid lumen configuration showed an almost elliptic shape and did not change with gestational age. The mean inner subglottic cricoid area was 19.27 +/- 9.62 mm2 and was related to weight and body surface area. Cricoid growth was more pronounced at the outer portion of the cartilage. CONCLUSIONS: The cricoid lumen configuration was elliptic, and its mean area was smaller than that of available endotracheal tubes. This lumen area was most influenced by weight and height.

Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Disarrangement of collagen fibers in Reinke's edema.

OBJECTIVE/HYPOTHESIS: To describe the arrangement of collagen fibers in the superficial layer of the lamina propria of the vocal folds with Reinke' edema. STUDY DESIGN: Cross sectional analysis of the lamina propria of the vocal folds with Reinke's edema (RE). METHOD: The picrosirius polarization method was used to study the arrangement of collagen fiber. Findings of collagen disarrangement were categorized semiquantitatively and correlated with RE severity, age, cigarette smoking and duration of dysphonia. RESULTS: Analysis of 20 specimens of vocal folds with RE showed that the intertwined network of collagen fibers resembling a wicker-basket normally observed in vocal folds was disarranged in RE. The collagen fibers were loosely arranged, fragmented and intermixed with varying amounts of myxoid stroma. Moderate and large areas of disarrangement (90% of cases) predominated. Collagen fiber arrangement in the region underneath the epithelium was better preserved when compared with fibers in the deeper region of the superficial layer of the lamina propria. There was a statistical difference in collagen disarrangement between grade II and grade III severity (P = .007) that appeared to be due to the large areas of disarrangement observed in 73% of patients with grade III severity and in 44% of grade II severity. Age was the only variable correlated with collagen fiber disarrangement (r = 0.47, P = .037). CONCLUSION: Our findings suggest that the flexible framework which maintains the uniformity of the lamina propria was lost in RE caused by the disarrangement of the collagen fibers.

Amiloidose com múltiplos focos em trato aéreo-digestivo superior: relato de caso e revisão de literatura / Multiple-sited amyloidosis in the upper aerodigestive tract: case report and literature review

Há na literatura inúmeras descrições de amiloidose limitada à laringe, sendo que esta afecção corresponde a cerca de 1 por cento dos tumores benignos da laringe. Entretanto, há somente três relatos de amiloidose acometendo a região do anel de Waldeyer. Descreveremos um raro caso de amiloidose em que há acometimento de sítios distintos do trato aéreo-digestivo superior: pilar amigdaliano, rinofaringe, supraglote e glote, sem continuidade aparente do tecido amilóide. Abordaremos, também, o seguimento pós-operatório com uma disfagia grave.

There are some reports of localized amyloidosis in the larynx, an entity that corresponds to one percent of all benign tumors of this region. However, there are only two cases of amyloidosis in the Waldeyer's ring 6, 13, 14. We hereby describe a rare case of amyloidosis in areas not associated with the upper aero-digestive tract: tonsil pillar, rhinopharynx, supraglottis and glottis, without visible continuity of amyloid tissue. We will also discuss post-operative follow up with severe dysphagia.

Age of child, more than HPV type, is associated with clinical course in recurrent respiratory papillomatosis.

BACKGROUND: RRP is a devastating disease in which papillomas in the airway cause hoarseness and breathing difficulty. The disease is caused by human papillomavirus (HPV) 6 or 11 and is very variable. Patients undergo multiple surgeries to maintain a patent airway and in order to communicate vocally. Several small studies have been published in which most have noted that HPV 11 is associated with a more aggressive course. METHODOLOGY/PRINCIPAL FINDINGS: Papilloma biopsies were taken from patients undergoing surgical treatment of RRP and were subjected to HPV typing. 118 patients with juvenile-onset RRP with at least 1 year of clinical data and infected with a single HPV type were analyzed. HPV 11 was encountered in 40% of the patients. By our definition, most of the patients in the sample (81%) had run an aggressive course. The odds of a patient with HPV 11 running an aggressive course were 3.9 times higher than that of patients with HPV 6 (Fisher's exact p = 0.017). However, clinical course was more closely associated with age of the patient (at diagnosis and at the time of the current surgery) than with HPV type. Patients with HPV 11 were diagnosed at a younger age (2.4y) than were those with HPV 6 (3.4y) (p = 0.014). Both by multiple linear regression and by multiple logistic regression HPV type was only weakly associated with metrics of disease course when simultaneously accounting for age. CONCLUSIONS/SIGNIFICANCE ABSTRACT: The course of RRP is variable and a quarter of the variability can be accounted for by the age of the patient. HPV 11 is more closely associated with a younger age at diagnosis than it is associated with an aggressive clinical course. These data suggest that there are factors other than HPV type and age of the patient that determine disease course.

Granuloma de processo vocal: caracterização clínica, tratamento e evolução / Vocal process granuloma: clinical characterization, treatment and evolution

O granuloma de processo vocal é uma doença cuja etiopatogenia não é bem definida. Assim, o tratamento clínico e cirúrgico não é padronizado e os resultados terapêuticos variam de acordo com o serviço. OBJETIVO: Objetivando caracterizar os pacientes com granuloma de processo vocal tratados em nosso serviço, a abordagem terapêutica utilizada e a evolução clínica. MATERIAL E MÉTODO: realizamos um estudo retrospectivo pela análise de seus prontuários. Encontramos maior incidência de granuloma de processo vocal em homens, exceto em casos associados à intubação laríngea. RESULTADO: O fator etiopatogênico associado mais freqüente foi o refluxo laringo-faríngeo (RLF), seguido de intubação laríngea e abuso vocal. O tratamento clínico com inibidor de bomba de prótons (IBP), corticosteróide tópico e fonoterapia foi suficiente para remissão da lesão em 48,6 por cento dos casos. A cirurgia para remoção do granuloma associada ao tratamento clínico foi eficaz em cerca de 90 por cento dos casos. Recidivas tardias (após um ano) foram observadas em cinco pacientes, sugerindo que o controle dos fatores etiopatogênicos associados deve ser mantido por tempo prolongado.