Stylohyoid Complex Syndrome Associated With Unilateral Vocal Cord Palsy: A Case Report.

Eagle's syndrome is a rare cause of cervicofacial pain and is due to abnormalities in the stylohyoid process, stylohyoid ligament or lesser cornu of the hyoid bone. Generally, patients affected by Eagle's syndrome present with pain in the lateral or upper neck, angle of the mandible, submandibular space and throat (exacerbated by head movements and/or mastication); foreign body sensation; headache and referred otalgia. A 66-year old gentleman presented with a 36-month history of recurrent pain localising mainly to the right angle of the mandible and radiating to the submandibular triangle. No pathological changes were noted on multiple ultrasound scans. Flexible nasendoscopy revealed a right vocal cord palsy. Initially, the CT scan revealed an abnormality in the stylohyoid complex, and the patient was managed conservatively. Subsequent three-dimensional CT scan noted significant worsening of the abnormality in the stylohyoid complex. Due to progressive nature of the patient's symptoms and progression of stylohyoid complex calcification noted on imaging, the patient was listed for surgery. He underwent partial styloidectomy and vocal cord injection for cord paralysis secondary to impingement on the vagal nerve by the stylohyoid complex. The patient recovered well and denies any ongoing stylalgia. Various cases of Eagle's syndrome have been managed successfully in a conservative manner. However, the authors of this case report suggest that patients with Eagle's syndrome should be monitored closely. A delay in surgical intervention can lead to complications such as complete ossification of the stylohyoid complex and impingement on surrounding structures. This, in turn, increases intra-operative complexity.

Enhanced thylakoid photoprotection can increase yield and canopy radiation use efficiency in rice.

High sunlight can raise plant growth rates but can potentially cause cellular damage. The likelihood of deleterious effects is lowered by a sophisticated set of photoprotective mechanisms, one of the most important being the controlled dissipation of energy from chlorophyll within photosystem II (PSII) measured as non-photochemical quenching (NPQ). Although ubiquitous, the role of NPQ in plant productivity remains uncertain because it momentarily reduces the quantum efficiency of photosynthesis. Here we used plants overexpressing the gene encoding a central regulator of NPQ, the protein PsbS, within a major crop species (rice)  to assess the effect of photoprotection at the whole canopy scale. We accounted for canopy light interception, to our knowledge for the first time in this context. We show that in comparison to wild-type plants, psbS overexpressors increased canopy radiation use efficiency and grain yield in fluctuating light, demonstrating that photoprotective mechanisms should be altered to improve rice crop productivity.

Complications of ventilation tube insertion in children with and without cleft palate: a nested case-control comparison.

IMPORTANCE: Optimizing hearing in patients with cleft lip and/or palate (CLP) by early recognition and management of otitis media with effusion is essential for speech development. Some evidence has suggested higher complication rates from ventilation tube (VT) insertion in patients with CLP and has led to a trend not to treat these patients surgically. However, studies have failed to match comparison groups for age and sex. OBJECTIVE: To compare complication rates from VT insertion in pediatric patients with and without CLP. DESIGN, SETTING, AND PARTICIPANTS: The study used a nested case-control design to evaluate 60 pediatric patients with CLP who underwent VT insertion at a children's hospital. The control group of age- and sex-matched patients was selected from a database of 2943 VT insertions. INTERVENTIONS: All patients were administered general anesthesia and underwent VT insertion by a pediatric otorhinolaryngology (ENT) team. MAIN OUTCOMES AND MEASURES: The primary outcomes were numbers of otorrhea complications. Secondarily, rates of attendance at an ENT clinic specifically for complications were evaluated. Finally, numbers of complications other than otorrhea were assessed but not statistically analyzed owing to the varied types and low numbers in each group. RESULTS: The control cohort had 151 documented cases of otorrhea compared with 121 in the CLP group (ratio 1.25:1); the difference between groups was not statistically significant (P = .52). There was no significant difference in mean ENT clinic visits per patient for complications between groups (0.80 in the CLP group, 0.78 for controls) (P = .66). Regarding complications other than otorrhea, the control group reported more than the CLP group (43 vs 25; ratio, 1.7:1). CONCLUSIONS AND RELEVANCE: Complication rates of VT placement among patients with CLP were not higher than those among patients without CLP. Therefore, treatment with VT insertion should be administered to patients with CLP under the same guidelines as for those without CLP. Indeed, there could be an argument for a shift in practice toward more aggressive treatment of patients with CLP, who are already vulnerable to speech and social developmental delay.

The paediatric voice clinic.

BACKGROUND: Prevalence of paediatric voice disorders has been reported as 6-9% in children of school age. The appropriate diagnosis and management of paediatric voice disorders is essential for progress in education and psychosocial development. This paper presents a review of a UK tertiary paediatric voice clinic experience of referral patterns, diagnosis, management and socioeconomic variations. METHODS: An audit of 195 consecutive appointments (154 were new patients) between October 2009 and September 2013 at a monthly paediatric voice clinic based at the Royal Hospital for Sick Children in Glasgow. RESULTS: Of the 154 new patients, 86 were male and 68 were female. The age at first clinic appointment shows a trimodal peak at ages 5, 8 and 11 years. General practitioners were the main referral source (46%). Vocal cord nodules accounted for 52% of diagnoses with a male predominance. Clinic attendance was most common from Scottish Index of Multiple Deprivation groups 1 (most deprived) and 5 (least deprived). Analysis of the muscle tension dysphonia group indicates that they are more likely to come from social groups 4 or 5 (69%) and an older age group (mean age 10.4 years). DISCUSSION: A dedicated paediatric voice clinic is the optimal method for assessment, diagnosis and management of these patients. Diagnosis is possible on the majority of the patients in clinic, with the predominant pathology being vocal cord nodules that receive speech and language therapy. Socioeconomic group appears to have an influence on paediatric voice particularly vocal cord nodules and muscle tension dysphonia.

Head drop syndrome secondary to multimodality treatments for head and neck cancer.

Five patients under follow-up for head and neck squamous cell carcinoma (SCC) at Southern General Hospital Glasgow presented with a fixed flexion deformity of the neck. These cases are characterized by the onset of severe weakness and atrophy of the neck extensor muscles and anterior fibrosis forcing the mandible to the chest wall. This causes considerable morbidity with communication, feeding, and appearance. This is a rare complication with no curative treatments that has not been reported previously by a UK center and is likely to become important with the increased use of multimodality treatments for head and neck SCC.

Neuromuscular and hormonal responses to a single session of whole body vibration exercise in healthy young men.

Whole body vibration (WBV) has been proposed as an alternative exercise stimulus to produce adaptive responses similar to resistance exercise. Few studies have analysed acute hormonal responses to WBV. Purpose To evaluate neuromuscular and hormonal responses to an acute bout of isometric half-squat exercise with and without superimposition of WBV. Methods Seven healthy males (22.3+/-2.7 years) performed 10 sets of half squat isometric exercise for 1 min with 1-min rest between sets. Two separate trials were conducted either with WBV [30 Hz; 3.5 g (1 g=9.81 m.s2)] or without vibration (Control). Salivary concentration of testosterone and cortisol was collected and maximal isometric unilateral knee extensions (MVC) were completed before, immediately after, 1, 2 and 24 h after treatment. Results Significant decreases in MVC were observed immediately after (229.4+/-53.2 Nm), 1 h (231.6+/-59.9 Nm), and 2 h (233.0+/-59.1 Nm) after WBV compared with baseline (252.7+/-56.4 Nm; P<0.05). No significant change in MVC was recorded in Control. Rate of torque development in the first 200 ms (RTD200 ms), and salivary testosterone and cortisol concentrations were unaffected in both conditions. However, there was a trend for change over time in cortisol (P=0.052), with an increase after WBV and decrease after Control. Conclusion A 10 min session of intermittent WBV was shown to produce an acute reduction in MVC in healthy individuals, which recovered after 24 h. No significant changes were identified in salivary concentration of testosterone and cortisol suggesting that WBV with low acceleration does not represent a stressful stimulus for the neuroendocrine system.

Overproduction of abscisic acid in tomato increases transpiration efficiency and root hydraulic conductivity and influences leaf expansion.

Overexpression of genes that respond to drought stress is a seemingly attractive approach for improving drought resistance in crops. However, the consequences for both water-use efficiency and productivity must be considered if agronomic utility is sought. Here, we characterize two tomato (Solanum lycopersicum) lines (sp12 and sp5) that overexpress a gene encoding 9-cis-epoxycarotenoid dioxygenase, the enzyme that catalyzes a key rate-limiting step in abscisic acid (ABA) biosynthesis. Both lines contained more ABA than the wild type, with sp5 accumulating more than sp12. Both had higher transpiration efficiency because of their lower stomatal conductance, as demonstrated by increases in delta(13)C and delta(18)O, and also by gravimetric and gas-exchange methods. They also had greater root hydraulic conductivity. Under well-watered glasshouse conditions, mature sp5 plants were found to have a shoot biomass equal to the wild type despite their lower assimilation rate per unit leaf area. These plants also had longer petioles, larger leaf area, increased specific leaf area, and reduced leaf epinasty. When exposed to root-zone water deficits, line sp12 showed an increase in xylem ABA concentration and a reduction in stomatal conductance to the same final levels as the wild type, but from a different basal level. Indeed, the main difference between the high ABA plants and the wild type was their performance under well-watered conditions: the former conserved soil water by limiting maximum stomatal conductance per unit leaf area, but also, at least in the case of sp5, developed a canopy more suited to light interception, maximizing assimilation per plant, possibly due to improved turgor or suppression of epinasty.