Automated detection of glottic laryngeal carcinoma in laryngoscopic images from a multicentre database using a convolutional neural network.

OBJECTIVE: Little is known about the efficacy of using artificial intelligence (AI) to identify laryngeal carcinoma from images of vocal lesions taken in different hospitals with multiple laryngoscope systems. This multicentre study aimed to establish an AI system and provide a reliable auxiliary tool to screen for laryngeal carcinoma. STUDY DESIGN: Multicentre case-control study. SETTING: Six tertiary care centres. PARTICIPANTS: Laryngoscopy images were collected from 2179 patients with vocal fold lesions. OUTCOME MEASURES: An automatic detection system of laryngeal carcinoma was established and used to distinguish malignant and benign vocal lesions in 2179 laryngoscopy images acquired from 6 hospitals with 5 types of laryngoscopy systems. Pathological examination was the gold standard for identifying malignant and benign vocal lesions. RESULTS: Out of 89 cases in the malignant group, the classifier was able to correctly identify laryngeal carcinoma in 66 patients (74.16%, sensitivity). Out of 640 cases in the benign group, the classifier was able to accurately assess the laryngeal lesion in 503 cases (78.59%, specificity). Furthermore, the region-based convolutional neural network (R-CNN) classifier achieved an overall accuracy of 78.05%, with a 95.63% negative predictive value and a 32.51% positive predictive value for the testing data set. CONCLUSION: This automatic diagnostic system has the potential to assist clinical laryngeal carcinoma diagnosis which may improve and standardise the diagnostic capacity of laryngologists using different laryngoscopes.

A Novel Acoustic Evaluation Method for the Diagnosis of Adductor Spasmodic Dysphonia.

INTRODUCTION: Adductor spasmodic dysphonia (ADSD) is characterized by involuntary laryngeal muscle spasms. Due to the lack of a quantitative evaluation method, most measurements have demonstrated difficulty in validity and reliability for diagnosing ADSD. This study aimed to establish a novel indicator for ADSD and determine its diagnostic effects. METHODS: We investigated 98 voice samples from 49 patients with ADSD and 49 healthy subjects. A sustained vowel was recorded by a high-definition audio recorder. Voice samples underwent regular acoustic evaluation and a novel global dimension method. Global dimension (GD), Jitter, Shimmer, HNR, Frequency shift, and CPPS were measured for both groups. RESULTS: Statistical analysis revealed that the global dimension method effectively differentiated ADSD patients from healthy subjects (P<0.001, D'>0.8). Subsequent multiclass receiver operating characteristic analysis demonstrated that GD possessed the most significant classification accuracy (AUC = 0.988) compared with other acoustic parameters. CONCLUSION: GD was an effective metric for objective differentiation between ADSD patients and healthy subjects. This metric could assist clinicians in the diagnosis of ADSD patients.

Treatment of Uremic Tumoral Calcinosis in Maintenance Hemodialysis Patients.

BACKGROUND/AIMS: Uremic tumoral calcinosis (UTC) is a rare disease with metastatic tissue calcification in maintenance hemodialysis (HD) patients. However, limited data are available on the treatment of UTC in HD patients. This article mainly discusses the diagnostic findings and efficacy of treatment on HD patients with UTC. METHODS: A retrospective analysis was conducted based on the data of 13 cases of UTC, including their clinical features, biochemical indicators, imaging findings, diagnosis, therapeutic methods, and follow-up results. Parathyroidectomy (PTX) or drug treatment was determined based on intact parathyroid hormone (iPTH) levels and clinical symptoms. RESULTS: All 13 patients were diagnosed as UTC definitely by imaging examination. The predominant areas involved were the buttocks (4 cases, 30.77%), shoulders (4 cases, 30.77%), and elbows (3 cases, 23.08%). Based on the levels of iPTH, cases were categorized into 2 different groups: PTX treatment group was associated with high levels of iPTH, while drug treatment group (lanthanum carbonate or sevelamer with sodium thiosulfate) was associated with lower iPTH levels. After PTX treatment, there was a significant decrease in serum iPTH, calcium (Ca), phosphate (P), and alkaline phosphatase levels (p < 0.05). In drug treatment group, the serum p levels were decreased significantly, along with a finding that hemoglobin levels were increased (p < 0.05). All the UTC had lessened or even disappeared after 4-6 months treatment. CONCLUSIONS: Although most UTC patients have an increased iPTH, a small number had lower iPTH levels. Based on iPTH levels and clinical symptoms, the patients were treated with PTX or drug therapy. With proper treatment, UTC disappeared without the need for surgery to remove calcinosis tissue.

A Retrospective Study of The Prognostic Significance of Preoperative Plasma Fibrinogen, Mean Platelet Volume, and the Neutrophil-to-Lymphocyte Ratio in Patients with Laryngeal Squamous Cell Carcinoma.

BACKGROUND This study aimed to evaluate the prognostic significance of plasma fibrinogen, serum albumin, the mean platelet volume (MPV), and the neutrophil-to-lymphocyte ratio (NLR) in patients with laryngeal squamous cell carcinoma (LSCC) who underwent surgical resection. MATERIAL AND METHODS A retrospective study included 110 patients with LSCC who underwent surgical resection between January 2008 to June 2015. Clinicopathologic and demographic data were recorded. Preoperative levels of plasma fibrinogen, serum albumin, MPV, and NLR were measured, and all patients underwent postoperative follow-up. The Kaplan-Meier method was used to determine the impact of these factors on overall survival (OS) and disease-free survival (DFS). RESULTS Preoperative hyperfibrinogenemia was significantly correlated with clinical stage, T stage, and tumor location in patients with LSCC (P<0.05). Serum albumin, MPV, and NLR were significantly correlated with the clinical stage and the T stage (P<0.05). The OS and DFS were significantly reduced in patients with hyperfibrinogenemia compared with patients with plasma fibrinogen <4 g/dL (P<0.05). Serum albumin of 35 g/L was not significantly correlated with OS (P>0.05). Patients with an MPV <9.5 fL had a significantly longer OS compared with patients with an MPV ≥9.5 fL (P=0.026). The DFS of patients with an NLR <2.22 was significantly longer than for those with an NLR ≥2.22. CONCLUSIONS Preoperative hyperfibrinogenemia, increased MPV and NLR were associated with reduced prognosis in patients with LSCC.

Soluble Urokinase Plasminogen Activator Receptor is Associated with Coronary Artery Calcification and Cardiovascular Disease in Patients Undergoing Hemodialysis.

BACKGROUND/AIMS: Cardiovascular disease (CVD) is an important cause of morbidity and mortality in hemodialysis patients. Vascular calcification is thought to play an important role in causing CVD. Soluble urokinase plasminogen activator receptor (suPAR) is a biomarker strongly predictive of cardiovascular outcomes in the pathogenesis of diabetic patients with renal disease treated with hemodialysis. We investigated the relationship between suPAR and coronary artery calcification (CAC) in patients undergoing maintenance hemodialysis. METHODS: A total of 99 adult hemodialysis patients were enrolled in this study. Plasma samples were analyzed for suPAR with an enzyme-linked immunosorbent assay and the CAC score was determined with multidetector computed tomography. The occurrence of cardiovascular events and all-cause mortality during follow-up were recorded from January 1, 2010 to June 1, 2016. RESULTS: In 99 patients treated with maintenance hemodialysis, 91 (91.9%) had varying degrees of CAC, and suPAR correlated positively with the CAC score in a Spearman analysis. In a mean follow-up period of 33 months, 36 patients (36.4%) experienced at least one cardiovascular event. When the quartiles of suPAR concentrations were used as the cutoff points for a subgroup analysis, the incidence of CVD and all-cause mortality was much higher in the higher quartiles of suPAR. In a univariate Cox regression analysis, high suPAR was a risk factor for CVD and all-cause mortality. CONCLUSION: suPAR is associated with the CAC score and is a risk factor for new-onset CVD in patients undergoing hemodialysis.

Supracricoid partial laryngectomy cricohyoidoepiglottopexy (SCPL-CHEP) versus vertical partial laryngectomy for the treatment of glottic carcinoma.

The study aimed to compare the survival rate and functional outcome of supracricoid partial laryngectomy cricohyoidoepiglottopexy (SCPL-CHEP) and vertical partial laryngectomy (VPL) in the treatment of glottic carcinoma. Thirty-nine patients underwent SCPL-CHEP and 45 patients underwent VPL between 2002 and 2007. Post-operative clinical staging were performed according to the UICC staging criteria (2002). The primary endpoints were survival time and recurrence rate. The secondary endpoints were the laryngeal functions including pronunciation, swallowing, and respiration. Overall, the estimated mean survival time was 75.6 months. There was no significant difference in survival times between the two groups (P = 0.496). The SCPL-CHEP group had a significantly lower post-operative local recurrence rate than VPL group (2.6 vs. 17.8 %, P = 0.033). Significantly longer nasogastric tube removal (22 vs. 14 days, P < 0.001) and tracheostomy decannulation (38.5 vs. 15 days, P < 0.001) times in SCPL-CHEP group was observed with the VPL group, respectively. Significantly higher aspiration rates were observed at 3, 6, and 12 months in the SCPL-CHEP group compared with the VPL group (P < 0.001, P < 0.001, P < 0.05, respectively). Although the survival rate was not significantly different between the two groups, the local regional control rate and organ preservation in the supracricoid partial laryngectomy cricohyoidoepiglottopexy group was better than those observed in the vertical partial laryngectomy group.

Change of Phonation in Canines Without Vocal Fold Paralysis After Vocal Processes Resection.

The effects of the vocal processes resection on phonation in an animal without vocal fold paralysis have not been clarified. The present study used an in vivo animal model with vocal processes resection and excised larynges phonation model to investigate the effects of the vocal processes resection on phonation. Six months after resection of bilateral vocal fold processes, glottal airflow, subglottal air pressure, acoustic signals, and ultra-high-speed video images were recorded in the excised larynges phonation model of canine. Glottal aerodynamic parameters were estimated by calculation of subglottal pressure and glottal flow. Histological analyses of the scarred were assessed for wound healing completion. In the vocal processes resection group, fundamental frequency(F0) and vocal intensity decreased, and the Jitter and Shimmer increased significantly. The phonation threshold power(PTW) of the vocal processes resection was significantly higher than controls. The vibratory amplitude of the vocal fold posterior and visual vocal fold vibration length increased. Expression of collagen I-III in scarred tissue samples in vocal process resection was similar to controlling soft tissue specimens around vocal process cartilage, and collagen fiber formed matured thick bundles. The results suggest that the F0, voice quality, and vocal intensity significantly decreased after complete wound healing of vocal processes resection in canines without vocal folds paralysis. The higher PTW and posterior scarred vocal vibration may be the dynamic reasons.

Long non­coding RNA HCG18 facilitates the progression of laryngeal and hypopharyngeal squamous cell carcinoma by upregulating FGFR1 via miR­133b.

It has been reported that long non­coding RNA HLA complex group 18 (HCG18) is involved in the progression of cancer, acting as an oncogenic gene. The aim of the present study was to investigate the mechanism underlying the action of HCG18 in laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC). The expression levels of HCG18, microRNA (miR)­133b and fibroblast growth factor receptor 1 (FGFR1) in LHSCC tissues and transfected LHSCC cells were evaluated by reverse transcription­quantitative PCR or immunohistochemistry. The viability, migration and invasion of transfected LHSCC cells were detected by Cell Counting Kit­8, wound healing and Transwell assays, respectively. The targeting relationships of HCG18, miR­133b and FGFR1 were predicted by bioinformatics analysis and confirmed using a dual­luciferase reporter assay. Moreover, the expression levels of FGFR1, phosphorylated (p)­PI3K, PI3K, p­AKT, AKT, p53, Bax and Bcl­2 in transfected LHSCC cells were measured by western blotting. It was found that the expression levels of HCG18 and FGFR1 were upregulated, but those of miR­133b were downregulated in LHSCC tissues. Short hairpin RNA (sh) HCG18 and miR­133b mimic inhibited LHSCC cell viability, while enhancing miR­133b expression. HCG18 could competitively bind with miR­133b. Moreover, the miR­133b inhibitor promoted cell viability, migration, invasion and the expression levels of Bcl­2, p­PI3K and p­AKT, but inhibited the expression levels of p53 and Bax, which were abrogated by shHCG18. miR­133b could competitively bind with FGFR1, and the miR­133b mimic decreased the expression level of FGFR1 in transfected LHSCC cells. shFGFR1 promoted the expression levels of p53 and Bax, while inhibiting viability, migration, invasion and Bcl­2, p­PI3K and p­AKT expression in LHSCC cells. In conclusion, the current results indicated that HCG18 facilitated the progression of LHSCC by upregulating FGFR1 via miR­133b. The present study evaluated the mechanism with regards to the action of HCG18 in LHSCC, and these experimental results may provide novel evidence for targeted therapy of LHSCC.

Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma.

Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.

Cephalometric craniofacial features of patients with Sagliker syndrome: a primary analysis of our experience.

BACKGROUND: Sagliker syndrome (SS) is characterized by a severe uglifying facial appearance resulting from untreated or inadequately treated secondary hyperparathyroidism (SHPT). To date, the craniofacial morphology of patients with SS has yet to be analyzed. The present research sought to cephalometrically evaluate the craniofacial features of patients with SS and to perform an in-depth analysis of their serum biochemical parameters, with the aim of furthering the theoretical basis for the early diagnosis and prevention of SS. METHODS: A retrospective chart review of 9 patients who fulfilled the diagnostic criteria for SS were included in this study, and their serum biochemical parameters were collected. After subjecting standard lateral cephalometric radiographic images to correction for distortions caused by magnification followed by digitization, we conducted a cephalometric analysis. Student's two-tailed t tests or Mann-Whitney U tests were used to analyze the data. Thirty-three patients with patients with SHPT alone were also included as controls. RESULTS: The lower anterior facial height (ANS-ME) and total anterior facial height (N-Me) measurements of patients with SS were significantly increased compared to those of the controls. The angles between the Frankfort horizontal, palatal, and occlusal planes and the mandibular plane, were greater in the SS group than in the control group, as was the gonial angle. Patients with SS also exhibited a significantly larger maxillary protrusion angle and relative position of the maxilla to the mandible. Most patients with SS had class II malocclusion, whereas most of the controls exhibited normal occlusion. Soft tissue largely followed the same pattern as craniofacial changes. Our investigation also showed that among patients with SHPT, female sex, longer duration of dialysis, and higher serum levels of alkaline phosphatase and intact parathyroid hormone were associated with development to SS. CONCLUSIONS: Patients with SS show facial and biochemical differences compared to patients with SHPT. Female sex, long dialysis duration, and high serum levels of intact parathyroid hormone and alkaline phosphatase may be potential risk factors for SS.

Acoustic and Perceptual Analyses of Adductor Spasmodic Dysphonia in Mandarin-speaking Chinese.

OBJECTIVE: The objective of this study was to examine the perceptual structure and acoustic characteristics of speech of patients with adductor spasmodic dysphonia (ADSD) in Mandarin. STUDY DESIGN: Case-Control Study MATERIALS AND METHODS: For the estimation of dysphonia level, perceptual and acoustic analysis were used for patients with ADSD (N = 20) and the control group (N = 20) that are Mandarin-Chinese speakers. For both subgroups, a sustained vowel and connected speech samples were obtained. The difference of perceptual and acoustic parameters between the two subgroups was assessed and analyzed. RESULTS: For acoustic assessment, the percentage of phonatory breaks (PBs) of connected reading and the percentage of aperiodic segments and frequency shifts (FS) of vowel and reading in patients with ADSD were significantly worse than controls, the mean harmonics-to-noise ratio and the fundamental frequency standard deviation of vowel as well. For perceptual evaluation, the rating of speech and vowel in patients with ADSD are significantly higher than controls. The percentage of aberrant acoustic events (PB, frequency shift, and aperiodic segment) and the fundamental frequency standard deviation and mean harmonics-to-noise ratio were significantly correlated with the perceptual rating in the vowel and reading productions. CONCLUSIONS: The perceptual and acoustic parameters of connected vowel and reading in patients with ADSD are worse than those in normal controls, and could validly and reliably estimate dysphonia of ADSD in Mandarin-speaking Chinese.

Experimentally induced phonation increases matrix metalloproteinase-1 gene expression in normal rabbit vocal fold.

OBJECTIVES: An in vivo rabbit model was used to study the effect of 3 hours of experimentally induced phonation on messenger RNA expression of the normal vocal fold. STUDY DESIGN: Prospective; animal model. SUBJECTS AND METHODS: Ten rabbits received experimental phonation for 3 hours, followed by 1 hour of recovery. A separate group of 5 rabbits served as no-phonation controls. We measured messenger RNA expression of matrix metalloproteinase-1, MMP-9, and interleukin-1beta using real-time reverse-transcribed polymerase chain reaction. Gene expression ratios from phonation and control animals were assessed with the Mann-Whitney U test. RESULTS: Phonation (77 +/- 3 dB; 429 +/- 141 Hz) resulted in increased matrix metalloproteinase-1 gene expression from rabbits receiving experimental phonation compared with controls, and a nonsignificant increase in matrix metalloproteinase-9 and interleukin-1beta gene expression. CONCLUSION: Matrix metalloproteinases play a role in maintaining tissue homeostasis. Investigation of cellular responses to experimental phonation may provide insight into how matrix metalloproteinases and other extracellular matrices contribute to maintenance of the vocal fold and development of pathology.

Survival in Vivo Canine Phonation Model Without Stimulation.

OBJECTIVES: We describe a survival nonstimulated in vivo canine phonation model using distending laryngoscope, cramp frame, and constant humidified glottal airflow to elicit phonation. METHODS: Five beagle dogs were involved in this study. One cuffed endotracheal tube was placed below the glottis through the tracheotomy and delivered humidified airflow to the glottis. Arytenoids approximation was maintained using a clamp under the distending laryngoscope. Acoustic and aerodynamic parameters were measured using synchronous signal collection system and analysis software. Vocal oscillation also was examined using stroboscope laryngeal imaging. RESULTS: For the nonstimulated in vivo phonation animal, the sound intensity and fundamental frequency were 78.3 ± 6.8 dB and 127.6 ± 29.2 Hz in the first experiment and 82.9 ± 6.6 dB and 175.2 ± 4.4 Hz 4 weeks later. The aerodynamic analysis revealed the mean subglottal phonation threshold pressure (PTP) and phonation threshold flow (PTF) were 8.5 ± 4.0 cmH20 and 683.0 ± 356.4 mL/s in the first experiment and 16.1 ± 8.6 cmH20 and 384.8.0 ± 230.6 mL/s in the second experiment 4 weeks later. Stroboscope image revealed sustained vocal vibration during great airflow delivery to glottis in the phonation animal model. CONCLUSIONS: We developed a survival nonstimulated in vivo phonation canine model that allows the study of long-term animal phonation study as its own control.

Serum parathyroid hormone and alkaline phosphatase as predictors of calcium requirements after total parathyroidectomy for hypocalcemia in secondary hyperparathyroidism.

BACKGROUND: To prevent hypocalcemia, this study examined the efficiency of a calcium supplement formula guided by predicted calcium requirement in patients with renal failure after parathyroidectomy with autotransplantation. METHODS: In the first phase, a protocol was followed whereby intravenous calcium gluconate was repeatedly titrated based on serum calcium levels in 22 patients with parathyroidectomy with autotransplantation. In the second phase, the first equation protocol was applied in 74 patients with parathyroidectomy with autotransplantation and revised. RESULTS: There is a significant correlation between the postoperative amount of calcium requirement and preoperative serum alkaline phosphatase level (r = 0.442; P < .001) and parathyroid hormone level (PTH; r = 0.889; P < .001). For prediction of insufficient calcium supplement, the cutoff point of PTH and alkaline phosphatase level values were calculated by receiver operating characteristic (ROC) curve analysis and modified equations were developed by regression analysis. CONCLUSION: The preoperative PTH and alkaline phosphatase levels can predict postoperative calcium requirements, such that equations of calcium supplement allow the management of hypocalcemia efficiently in patients on dialysis after parathyroidectomy with autotransplantation.

The Mandarin Version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and Its Reliability.

Purpose: The purpose of this study is to develop the Mandarin version of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and evaluate its reliability compared with the Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS). Method: The Mandarin version of the CAPE-V tool was translated from the validated English version with phonemic adaptations, content adjustment, and scale modification. Sixty dysphonic, 20 normal, and 20 repeated voice samples were included in this study. Ten of these were used for preassessment training; the remaining 90 were evaluated using the Mandarin CAPE-V and GRBAS for comparison of their interrater and intrarater reliabilities. Results: Intrarater reliability was measured by Pearson r for the CAPE-V and Spearman rho for the GRBAS. Average CAPE-V Pearson r ranged from 0.80 for strain to 0.91 for overall severity, compared with average GRBAS Spearman rho of 0.83 for strain to 0.89 for asthenia. Interrater reliability was measured by an intraclass coefficient (ICC). Average CAPE-V ICCs ranged from .57 for pitch to .81 for overall severity, compared with average GRBAS ICCs of .60 for asthenia to .83 for grade. Conclusions: The Mandarin CAPE-V addresses some limits of the English version. It also demonstrates good intrarater and interrater reliability, comparable to those of GRBAS.

Reliability and validity of the Chinese pediatric voice handicap index.

OBJECTIVES: To evaluate the reliability and validity of the Chinese version of pediatric voice handicap index (pVHI). MATERIAL AND METHODS: The original English version-pVHI was translated into Chinese. Parents of 52 children with voice dysphonia and 43 children with no history or symptoms of voice problems were asked to fill the Chinese pVHI questionnaires twice with an interval of 2 weeks. GRB (Grade, Roughness, Breathiness) scale was used for perceptual assessment by two otolaryngologists and one speech pathologist for each child's voice. The internal consistency was assessed using Cronbach's alpha coefficient. Pearson's correlation coefficient was used to evaluate the test-retest reliability. The Kendall's coefficient of concordance W was used to assess the consistency of GRB scores of 3 voice specialists. The nonparametric Mann-Whitney test was used to assess the differences between the dysphonia group and controls. The correlation between pVHI and GRB scores were assessed using Pearson's correlation coefficient. RESULTS: The internal consistency of total score and three subscales scores of Chinese pVHI were 0.788-0.944. The test-retest reliability was 0.631-0.887(P < .001). The pVHI scores of control group significantly were lower than the pathological group (P = .000). The GRB scores of 3 voice specialists have an excellent consistency (W = 0.694-0.807, P = .000). The pVHI scores positively correlated with GRB assessment (P < .01). CONCLUSIONS: The Chinese version of pVHI had a good reliability and validity. It can be applicable and useful supplementary tool for evaluating parents' perception of their children's dysphonia.

Clinical predictor of postoperative hyperkalemia after parathyroidectomy in patients with hemodialysis.

OBJECTIVE: Hyperkalaemia is one of the most common reasons for patients requiring emergency treatment. This study is to investigate the risk factors of postoperative hyperkalemia in renal failure patients undergoing parathyroidectomy with autotransplantation (PTXa). METHODS: One hundred and eight patients [ 54 men and 54 women; age, 45.1 ±â€¯11.1 years (mean ±â€¯SD)] with secondary hyperparathyroidism undergoing parathyroidectomy with autotransplantation were involved in this study. Laboratory chemistries (hemoglobin, fasting blood glucose, serum calcium level, alkaline phosphatase, phosphorus, parathyroid hormone) were measured before surgery. Serum potassium level was obtained before surgery and at 0 h after surgery. RESULTS: Serum potassium level increased in 108 patients after surgery (P < 0.05). Sixteen patients (14.8%) potassium levels rose more than 6.0 mmol/L after parathyroidectomy with autotransplantation. Age and preoperative serum potassium level were significantly negative correlated with postoperative serum potassium level. Correlation analysis and receiver operating characteristic curve method confirmed that use of the preoperative serum potassium level was the primary predictor of postoperative hyperkalemia. The cutoff point for preoperative serum potassium level was 4.40 mmol/L, according to the Youden index of the receiver operating characteristic curve. CONCLUSIONS: Preoperative serum potassium increased after parathyroidectomy with autotransplantation in patients with secondary hyperparathyroidism. The preoperative serum potassium level could help the surgeon to predict postoperative hyperkalemia in case of emergency dialysis following surgery.

[A study on vowel duration and word length of adductor spasmodic dysphonia].

OBJECTIVE: To understand the vowel duration and statement reading of the adductor spasmodic dysphonia (ADSD) patients compared with their normal controls, and provide ideas for clinical diagnosis and treatment. METHOD: Twenty-nine ADSD patients were included in the research, with 31 normal controls. All subjects filled in form voice handicap index (VHI) by themselves. Maximum phonetic time (MPT) and maximum loudness phonetic time(MLPT) were tested on /a/ sound for all patients. Also, all the patients were required to read aloud a standard mandarin assay named , duration were measured with Praat5. 0 software after sounds were collected. A one-way t-test was performed to compare spasmodic group with control group on VHI, MPT, MLPT and duration for reading standard sentences. Pearson/Spearman correlation was tested. Result: The VHI of the 29 ADSD patients is 89±12, and their normal controls 15±16, indicating that the VHI in ADSD group is significantly higher than in the control group(P<0. 01). The MPT of the ADSD group is(16. 9±9. 8 s), and the control group is (25. 3±10.0)s, indicating that MPT in the ADSD group is significantly shorter than the control group(P<0. 01). The MLPT of the ADSD group is (15.7±7. 6)s, and the control group is (26. 5±11. 4)s, indicating that MLPT in the ADSD group is significantly shorter than the control group (P<0. 01). The duration of standard sentence reading of the ADSD group is (55.0±14. 2)s, and the control group is (37. 8±4. 8)s, indicating that the duration of standard sentence reading in the ADSD group is significantly longer than the control group (P<0. 01). Correlation analysis showed that MPT and MLPT are related within the ADSD group(r=0. 697,P< 0.01), other indexes being tested have no significant correlations. CONCLUSION: The voice disorder condition of the ADSD patients is significantly worse than normal people. Their pronunciations on continuous vowels are not lasting compared with normal people. In the meantime, their ability to read sentences is worse than normal people, needing longer time to complete the reading task. There is a significant correlation between MLPT and MPT, which can be used as an alternative to MPT.

[Observation of the dysphonia severity index in evaluating curative effect of vocal cord polyp surgery].

OBJECTIVE: To investigate the applicability of the eysphonia severity index (DSI) in evaluating effects of surgery between before and after groups of vocal polyp patients. METHODS: Analyses of measurement data pre and pro-surgery of 70 vocal polyp patients and 35 no voice disorders volunteers (control group). The voice quality was measured subjectively with the voice handicap index (VHI), the GRBAS and fiber electronic laryngoscopy. Measures of maximum phonation time (MPT), shimmer and jitter were obtained for each subject by using DiVAS 2.30 (XION, Germany). The DiVAS 2.30 had spotanenously calculate the scores of DSI. Using SPSS 17.0 to find the differences of DSI scores among the three groups by one-way ANOVA variance analysis. And finding out of the correlation with DSI scores and VHI scores, GRBAS, MPT, jitter and shimmer. RESULTS: DSI improved significantly after surgery in the vocal polyps group (mean difference DSI -2.92 and 1.87, respectively) and also in the control group (mean difference DSI -2.92 and 2.30, respectively). However, no significant difference between the control group and the after surgery group. By using Pearson correlation analysis, this study observed a strong correlation between the DSI scores and the VHI scores, the values of GRBAS, shimmer (P < 0.01). CONCLUSIONS: DSI is an effective and high accuracy multi-parameter system for evaluation of vocal cord polyp patients as an independent assessment of dysphonia. DSI also can be used in evaluation of the effects of the vocal polyps surgery.

[Stimuli phrases of adductor spasmodic dysphonia phonatory break in mandarin Chinese].

OBJECTIVE: To investigate the characteristics of adductor spasmodic dysphonia phonatory break in mandarin Chinese and select the stimuli phrases. METHOD: Thirty-eight patients with adductor spasmodic dysphonia were involved in this study. Standard phrase " fù mu xin" and a speech corpus in mandarin Chinese with 229 syllables covering all vowel and constant of mandarin Chinese were selected. Every patient read the phrases above twice in normal speed and comfortable voice. Two auditory perpetual speech pathologists marked phonatory break syllables respectively. The frequency of phonatory break syllables and their located phrases were calculated, rated and described. The phrases including the most phonatory break syllables were selected as stimuli phrases, the phonatory break frequency of which was also higher than that of standard phrase "fù mu xin". RESULT: Phonatory break happened in the reading of all patients. The average number of phonatory break syllables was 14 (3-33). Phonatroy break occurred when saying 177 (77.3%) syllables in the speech corpus. The syllables "guo, rén, zang, diàn, che, gè, guan, a, ba, ne, de" broke in 23.1%-41.0% patients. These syllables belonged to the phrases "ping guo, huo che, shì de, ni shì gè hao rén, wo mén shì you zong shì ba qin shì nong dé hen zang, wo mén nà bian you wang qiú yùn dong chang, can guan, jiu ba hé yi gè miàn bao dìan, ta shì duo me kang kai a,wo ying gai zài xìn li xie yi xie shén me ne?". Thirty-seven patients (97.3%) had phonatory break in above mentioned words. Ratios of these words phonatory break also were more than "fù mu xin". CONCLUSION: Adductor spasmodic dysphonic patients exhibited different degrees of phonatory break in mandarine Chinese. The phrases" shì de, ping guo, huo che, ni shì gè hao rén, wo mén nà bian you wang qiú yùn dong chang, can guan, jiu ba hé yi gè miàn bao dìan, ta shì duo me kang kai a" were recommended as stimuli phrases for adductor spasmodic dysphonia evaluation.