Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment

Abstract Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment.

Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.

Does Abrupt Weight Loss Caused by Bariatric Surgery Compromise the Voice in Women?

OBJECTIVE: To evaluate vocal symptoms, voice characteristics and videolaryngoscopy in obese women before and after bariatric surgery. METHODS: Obese patients (18 to 59 years old), candidates for bariatric surgery were recruited. Evaluation times: T1 (preoperative), T2 (after six months), T3 (after 12 months). Evaluated parameters: weight, height, body mass index, abdominal and neck circumference, vocal self-assessment, perceptual and acoustic vocal assessment, and videolaryngoscopy. RESULTS: A total of 37 obese women were included, average age 40.8 years. There was a decrease in anthropometric measurements between the preoperative assessment and after 12 months: weight (121.18 ± 15.4 kg; 77.1 ± 11.6 kg), BMI (46.6 ± 6.95 kg/m2; 30 ± kg/m2), abdominal circumference (128 ± 16.1; 99.1 ± 12.1), and neck circumference (41.1 ± 5.85; 36.6 ± 3.02). Gastroesophageal (21.6%) and vocal symptoms (27%) prevailed. No difference was identified in vocal self-assessment between the evaluations. In the acoustic analysis, f0 increased and the soft phonation index decreased. The perceptual analysis registered lower scores for the degree of dysphonia (G) and voice instability (I). The maximum phonation time values increased without changing the s/z ratio. Videolaryngoscopies showed a posterior middle cleft and improvement in the signs of reflux. CONCLUSIONS: Bariatric surgery led to an important and gradual decrease in anthropometric parameters. The voice became less hoarse, with higher pitch and more stable, with an improvement in maximum phonation time, however with slight breathiness. Such changes were not noticed by the patients.

Effect of Aging on the Vocal Muscle.

INTRODUCTION: Sarcopenia is a common and natural condition in the elderly, and leads to loss of muscle mass and function. In the presbylarynx there is atrophy of the vocal folds, however the degree of vocal muscle atrophy is poorly studied and the results are contradictory. AIMS: The aim of this study was to evaluate the effect of aging on the vocal muscle (thyroarytenoid muscle). METHODS: Thirteen larynxes removed during necropsy from 13 cadavers were included into two age groups: Control group - G1 (n5), between 25 and 40 years; Elderly Group - GI (n-8), aged 70 years or older. The vocal folds were dissected and prepared for scanning electron microscopy, ensuring a cross-section in the musculature area to allow measurements of muscle fiber parameters. Images were analyzed and photographed at different magnifications. Through the ImageJ software, ten distinct fields of each part were selected. Parameters studied:  area, perimeters and diagonals of the thyroarytenoid muscle bundles of both groups. RESULTS: The cross-sectional areas, perimeters and diagonals of the muscle fibers of the thyroarytenoid muscle of the elderly group were significantly smaller than those of the control group. CONCLUSION: We demonstrated that the vocal muscle is affected in the presbylarynx, with a reduction of its muscle fibers, corresponding to muscle atrophy. However, these findings may not be directly related to vocal symptoms because the patient may develop muscle compensatory mechanisms capable of reducing glottic insufficiency.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study.

OBJECTIVE: To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women. METHODS: A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX). RESULTS: Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD. CONCLUSION: In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

Is there a relationship between diet quality and bone health in elderly women? A cross-sectional study

ABSTRACT Objective: To evaluate whether there is a relationship between diet quality and bone health in a group of elderly Brazilian women. Subjects and methods: A cross-sectional study was performed with 105 elderly women. Participants were evaluated regarding diet quality (good, needing improvement, and poor) and its relationship with bone mineral density (BMD), bone-specific alkaline phosphatase (BSAP), and C-telopeptide (CTX). Results: Fifty eight participants (55.2%) presented a poor-quality diet and 47 (44.8%) required dietary improvements, while no subjects presented a good quality diet. The group requiring dietary improvements had lower CTX [0.35 (0.05;1.09) vs. 0.52 (0.10;1.45); p = 0.03)] and BSAP (38.7 ± 12.9 U/L vs. 46.10 ± 15.2 U/L; p < 0.01) levels than the poor-quality diet group. Groups did not differ in terms of BMD. Conclusion: In this group of elderly Brazilian women, there was a relationship between diet quality and bone health, where worse diet quality was associated with higher levels of bone remodelling markers.

An estimate of the incidence and prevalence of laryngeal papillomatosis in São Paulo State (Brasil).

BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities - 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities - 1,602,845 inhabitants), Ribeirão Preto (26 cities - 1,483,715 inhabitants), Bauru (68 cities - 1,770,427 inhabitants), and Sorocaba (47 cities - 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.

An estimate of the incidence and prevalence of laryngeal papillomatosis in São Paulo State (Brasil)

SUMMARY BACKGROUND: Recurrent laryngeal papillomatosis, caused by the Human Papilloma Virus, has a significant economic impact worldwide and there are no epidemiological data of this disease in Brasil. OBJECTIVE: The objective of the study was to estimate the incidence and prevalence of laryngeal papillomatosis of some otorhinolaryngology centers in São Paulo State (Brasil). METHODS: A questionnaire containing data on the number of new and follow-up cases diagnosed with laryngeal papillomatosis was sent to the Otorhinolaryngology services (n=35) of São Paulo State (Brasil). RESULTS: A total of 20 otorhinolaryngology centers answered the questionnaire. Of these, the five largest regional health centers were selected as follows: Campinas (42 cities - 4,536,657 inhabitants), Sao Jose do Rio Preto (102 cities - 1,602,845 inhabitants), Ribeirão Preto (26 cities - 1,483,715 inhabitants), Bauru (68 cities - 1,770,427 inhabitants), and Sorocaba (47 cities - 2,478,208 inhabitants). The incidence and prevalence of each regional health centers were, respectively: Campinas (5.51;7.27), Sorocaba (2.02;6.86), São José do Rio Preto (1.87;7.49), Ribeirão Preto (11.46;22.92), and Bauru (3.95;7.91). CONCLUSION: The incidence and prevalence of the laryngeal papillomatosis of the five largest regional health centers of the interior of São Paulo State (Brasil) varied between 1.87 to 11.46 and 6.86 to 22.92 per 1,000,000 inhabitants, respectively for a total population of 11,871,852 inhabitants.

RESUMO CONTEXTO: A papilomatose recorrente da laringe, causada pelo vírus do papiloma humano, tem um impacto econômico significativo em todo o mundo e não existem dados epidemiológicos dessa doença no Brasil. OBJETIVO: O objetivo do estudo foi estimar a incidência e prevalência de papilomatose laríngea em alguns centros de otorrinolaringologia do estado de São Paulo (Brasil). MÉTODOS: Um questionário contendo dados sobre o número de casos novos e de retornos diagnosticados com papilomatose laríngea foi enviado aos serviços de otorrinolaringologia (n-35) do estado de São Paulo (Brasil). RESULTADOS: Vinte centros de otorrinolaringologia responderam ao questionário e, destes, os cinco maiores centros regionais de saúde foram selecionados da seguinte forma: Campinas (42 cidades - 4.536.657 habitantes), São José do Rio Preto (102 cidades - 1.602.845 habitantes), Ribeirão Preto (26 cidades - 1.483.715 habitantes), Bauru (68 cidades - 1.770.427 habitantes) e Sorocaba (47 cidades - 2.478.208 habitantes). A incidência e prevalência de cada centro de saúde regional foram, respectivamente: Campinas (5,51; 7,27), Sorocaba (2,02; 6,86), São José do Rio Preto (1,87; 7,49), Ribeirão Preto (11,46; 22,92), Bauru (3,95; 7,91). CONCLUSÃO: A incidência e prevalência da papilomatose laríngea dos cinco mais importantes centros regionais de saúde do interior do estado de São Paulo (Brasil) variaram entre 1,87 e 11,46 e 6,86 e 22,92, por 1.000.000 de habitantes, respectivamente, para uma população total de 11.871.852 habitantes.

Laryngeal and vocal alterations after thyroidectomy / Alterações laríngeas e vocais após tireoidectomia

Abstract Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21). Conclusion: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Resumo Introdução: A disfonia é um sintoma comum após a tireoidectomia. Objetivo: Analisar os sintomas vocais, auditivo-perceptivos e acústica vocal, videolaringoscopia, procedimento cirúrgico e achados histopatológicos em pacientes submetidos à tireoidectomia. Método: Estudo prospectivo. Pacientes submetidos à tireoidectomia foram avaliados da seguinte forma: anamnese, laringoscopia e avaliações vocais acústicas. Momentos: pré-operatório, 1ª avaliação pós (15 dias), 2ª avaliação pós (1 mês), 3ª avaliação pós (3 meses) e 4ª avaliação pós-operatória (6 meses). Resultados: Dos 151 pacientes, 130 eram mulheres e 21, homens. Tipos de cirurgia: lobectomia + istmectomia n = 40, tireoidectomia total n = 88, tireoidectomia + dissecção de linfonodo n = 23. Sintomas vocais foram relatados por 42 pacientes na 1ª avaliação pós-operatória (27,8%), reduzidos para 7,2% após 6 meses. Na análise acústica, f0 e APQ estavam diminuídos nas mulheres. As videolaringoscopias mostraram que 144 pacientes (95,3%) tiveram exames normais no momento pré-operatório. Paralisia das cordas vocais foi diagnosticada em 34 pacientes na 1ª avaliação pós-operatória, 32 do nervo laríngeo recorrente (lobectomia + istmectomia - n = 6; tireoidectomia total - n = 17; tireoidectomia total + dissecção de linfonodos - n = 9) e 2 do nervo laríngeo superior (lobectomia + istmectomia - n = 1; tireoidectomia total + dissecção de linfonodos - n = 1). Após 6 meses, 10 pacientes persistiram com paralisia do nervo laríngeo recorrente (6,6%). Histopatologia e correlação com paralisia das cordas vocais: bócio coloide nodular (n = 76; paralisia n = 13), tireoidite (n = 8; paralisia n = 0) e carcinoma (n = 67; paralisia n = 21). Conclusão: Os sintomas vocais, relatados por 27,8% dos pacientes na 1ª avaliação pós-operatória, diminuíram para 7% em 6 meses. Na análise acústica, f0 e APQ diminuíram. A paralisia transitória de cordas vocais secundária à lesão do nervo laríngeo recorrente e nervo laríngeo superior ocorreu, respectivamente, em 21% e 1,3% dos pacientes, reduziu-se para 6,6% e 0% após 6 meses.

Laryngeal and vocal alterations after thyroidectomy.

INTRODUCTION: Dysphonia is a common symptom after thyroidectomy. OBJECTIVE: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. METHODS: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). RESULTS: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy+isthmectomy n=40, total thyroidectomy n=88, thyroidectomy+lymph node dissection n=23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy+isthmectomy n=6; total thyroidectomy n=17; thyroidectomy+lymph node dissection n=9) and 2 superior laryngeal nerve (lobectomy+isthmectomy n=1; Total thyroidectomy+lymph node dissection n=1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n=76; palsy n=13), thyroiditis (n=8; palsy n=0), and carcinoma (n=67; palsy n=21). CONCLUSION: Vocal symptoms, reported by 27.8% of the patients on the 1st post decreased to 7% in 6 months. In the acoustic analysis, f0 and APQ were decreased. Transient paralysis of the vocal folds secondary to recurrent and superior laryngeal nerve injury occurred in, respectively, 21% and 1.3% of the patients, decreasing to 6.6% and 0% after 6 months.

Is There an Association With Spino-Pelvic Relationships and Clinical Outcome of Type A Thoracic and Lumbar Fractures Treated Non-Surgically?

BACKGROUND: The objective was to evaluate if there is an association of the spino-pelvic relationships and the global spinal alignment with the outcome of AO type A injuries treated nonsurgically. METHODS: This is a retrospective case series. Patients treated nonsurgically for AOSpine type A fractures (T1-L5) with at least 1 year follow-up identified. A standing antero-posterior and lateral 36-inch radiographs and measures of spino-pelvic relationships and sagittal alignment were obtained, as well as clinical assessment using the visual analog scale, the Short-Form 36 (SF-36) questionnaire, the Oswestry Disability Index (ODI), and labor status. RESULTS: Twenty-two patients with 33 fractures were included (L1 was the most injured level with 18.2%). There were 17 men (77.2%) and the mean age was 47.1 years. Follow-up ranged from 12 to 60 months (mean of 27.8 months). There were 22 type A1 (66.7%), 3 type A2 (9%), 6 type A3 (18%), and 2 type A4 (6%) fractures. The ODI ranged from 4% to 58%, with a mean of 24.4%. The SF-36 physical health score ranged from 23 to 82.25 (mean 49.59), and the mental health score ranged from 14.75 to 94.25 (mean 63.28). No association was identified between the spino-pelvic measurements, global alignment, and patient-reported outcomes. CONCLUSIONS: Type A fractures had a clinically relevant amount of long-term disability even when surgical treatment is not required. Spino-pelvic relationships and final global spinal alignment did not associate with outcome measurements.

Aging voice and the laryngeal muscle atrophy.

OBJECTIVES/HYPOTHESIS: To study by means of morphometric measurements the severity of vocal muscle atrophy in the elderly. STUDY DESIGN: Cadaver study. SETTING: Universidade Estadual Paulista (UNESP), Botucatu Medical School, Brazil. SUBJECTS AND METHODS: Thirty vocal folds were collected from necropsies distributed into three groups: aged 60 to 75 years (n=10); aged 76 to 90 years (n=10); and a control group aged 30 to 50 years (n=10). Specimens for histology were obtained from the middle portion of the vocal folds. The stained specimens were analyzed using Axion Vision software (coupled to a Zeiss [Oberkochen, Germany] microscope) and used in the morphometric analyses conducted with the ImageJ software. The diameters of 200 muscle fibers from each slide were measured, and the mean values were statistically analyzed. RESULTS: The mean values of the diameters of the vocal muscle fibers of the elderly age groups were smaller than in the control: control (30-50 years: 16.389 µm); elderly (60-75 years: 14.412 µm; 76-90 years: 14.162 µm) (P<0.01). No statistical differences were observed between genders. CONCLUSION: The morphometric analysis showed smaller diameters of vocal muscle fibers in the elderly when compared to controls, demonstrating the atrophy of the muscle. No statistical differences were observed between genders. LEVEL OF EVIDENCE: N/A.

Hyaluronic acid behavior in the lamina propria of the larynx with advancing age.

OBJECTIVES: To analyze the hyaluronic acid behavior in the lamina propria of the larynx with advancing age. STUDY DESIGN: Prospective study. SETTING: UNESP-Univ Estadual Paulista, Botucatu Medical School, Brazil. SUBJECTS AND METHODS: Thirty vocal folds were obtained at necropsy from 10 adult males (30-50 years old) and 20 geriatric males (10: 60-75 years old; 10: over 76 years old). Midmembranous vocal fold sections were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the hyaluronic acid distribution over the lamina propria of vocal folds, from superficial to deep layers. RESULTS: Hyaluronic acid distribution was homogeneous for the larynges, at both superficial and deep layers (41.6 and 38.5, respectively). For both 30- to 50-year-old men geriatric age groups, hyaluronic acid level was lower at both layers. CONCLUSION: Hyaluronic acid level in the lamina propria of the larynx of geriatric men decreases with advancing age at both layers of the lamina.

Perceptual and acoustic parameters of vocal nodules in children.

UNLABELLED: Vocal nodules constitute the major cause of dysphonia during childhood. Auditory-perceptual and acoustic vocal analyses have been used to differentiate vocal nodules from normal voice in children. PURPOSE: To study the value of auditory-perceptual and acoustic vocal analyses in assessments of children with nodules. DESIGN: Diagnostic test study. PATIENTS AND INTERVENTIONS: A comparative study was carried out including 100 children with videolaryngoscopic diagnosis of vocal nodules (nodule group-NG); and 100 children without vocal symptoms and with normal videolaryngoscopic exams (control group-CG). The age range of both groups was between 4 and 11 years. All children underwent auditory-perceptual vocal analyses (GRBASI scale); maximum phonation time and s/z ratio were calculated, and acoustic vocal analysis (MDVP software) were carried out. RESULTS: There was no difference in the values of maximum phonation time and s/z ratio between groups. Auditory-perceptual analysis indicated greater compromising of voice parameters for NG, compared to CG: G (79 versus 24), R (53 versus 3), B (67 versus 23) and S (35 versus 1). The values of acoustic parameters jitter, PPQ, shimmer, APQ, NHR and SPI were higher for NG for CG. The parameter f0 did not differ between groups. CONCLUSION: Compromising of auditory-perceptual (G, R, B and S) and acoustic vocal parameters (jitter, PPQ, shimmer, APQ, NHR and SPI) was greater for children with nodules than for those of the control group, which makes them important methods for assessing child dysphonia.

Differential morphofunctional characteristics and gene expression in fast and slow muscle of rats with monocrotaline-induced heart failure.

Heart failure (HF) is characterized by limited exercise tolerance, skeletal muscle atrophy, a shift toward fast muscle fiber, and myogenic regulatory factor (MRF) changes. Reactive oxygen species (ROS) also contribute to target organ damage in this syndrome. In this study, we investigated and compared morphofunctional characteristics and gene expression in Soleus (SOL--oxidative and slow twitching muscle) and in Extensor Digitorum Longus (EDL--glycolytic and fast twitching muscle) during HF. Two groups of rats were used: control (CT) and heart failure (HF), induced by a single injection of monocrotaline. MyoD and myogenin gene expression were determined by RT-qPCR, and MHC isoforms by SDS-PAGE; muscle fiber type frequency and cross sectional area (CSA) were analyzed by mATPase. A biochemical study was performed to determine lipid hydroperoxide (LH), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD); myography was used to determine amplitude, rise time, fall time, and fatigue resistance in both muscles. HF showed SOL and EDL muscle atrophy in all muscle fiber types; fiber frequency decreased in type IIC and muscle contraction fall time increased only in SOL muscle. Myogenin mRNA expression was lower in SOL and myoD decreased in HF EDL muscle. LH increased, and SOD and GSH-Px activity decreased only in HF SOL muscle. HF EDL muscle did not present changes in MHC distribution, contractile properties, HL concentration, and antioxidant enzyme activity. In conclusion, our results indicate that monocrotaline induced HF promoted more prominent biochemical, morphological and functional changes in SOL (oxidative and slow twitching muscle). Although further experiments are required to better determine the mechanisms involved in HF pathophysiology, our results contribute to understanding the muscle-specific changes that occur in this syndrome.