Immediate and Short-term Effects of Straw Phonation in Air or Water on Vocal Fold Vibration and Supraglottic Activity of Adult Patients with Voice Disorders Visualized with Strobovideolaryngoscopy: A Pilot Study

Purpose The first purpose of this study was to investigate and compare the short-term effects after a semi-occluded vocal tract (SOVT) therapy session consisting of straw phonation (SP) in air or water on vocal fold vibration and supraglottic activity of adult patients with voice disorders, visualized with strobovideolaryngoscopy (SVL). The second purpose of this study was to investigate and compare immediate changes in the patients' vocal fold vibration and supraglottic activity during SP in air or water, visualized with SVL. Methods Twelve adult patients with voice disorders (eight women and four men, mean age 52 years) were assigned randomly to one of two study groups: SP in air or SP in water. Immediately before and after a therapy session of 15 min, participants underwent a rigid SVL to determine the short-term effects of the SP session. At the posttherapy examination, flexible SVL while performing SP was added to determine the effects occurring during SP. The visual-perceptual ratings were performed blindly and in random order by three laryngologists, using the Voice-Vibratory Assessment with Laryngeal Imaging rating form for stroboscopy. ResultsShort-term effects after SP: After the SP-in-air session, the supraglottic mediolateral compression decreased significantly. The SP-in-water session led to significantly increased left vibrational amplitude. Immediate effects during SP: During SP in air, a significantly increased left amplitude and mucosal wave, and significantly decreased mediolateral supraglottic activity, were found. SP in water tended to decrease the vibrational amplitude during performance of the task. A trend toward higher anteroposterior supraglottic compression was observed during both SP in air and water, being more prominent in the latter. Conclusion SP in air led to less false vocal fold adduction and consequently less hyperfunction. The small increment in anteroposterior supraglottic activity during SP in air and water might be related to epilarynx narrowing, an economic phenomenon associated with SOVT exercises. The effects on vibrational amplitude were rather ambiguous. The small reduction in amplitude during SP in water is expected to diminish vocal fold impact stress and therefore creates an ideal basis for voice therapy. The increment in amplitude and mucosal wave during SP in air might indicate insufficient supraglottic pressure to obtain the favorable effects of semi-occlusion. Whether or not the rise in amplitude after the SP-in-water session is due to voice efficiency or voice fatigue remains unknown. Future larger-scale investigation in subgroups of voice patients is needed to explore these hypotheses.

Otitis Media and Hearing Loss in Patients With Nonsyndromic Craniosynostosis: A Multicenter Study

OBJECTIVES

The objectives of this study were to: (1) determine the prevalence of otitis media with effusion in patients with nonsyndromic craniosynostosis; (2) determine the prevalence of hearing loss in patients with nonsyndromic craniosynostosis; and (3) identify potential patterns and outcomes in patients with nonsyndromic craniosynostosis.

METHODS

A retrospective chart review was conducted at 2 academic institutions, St Christopher's Hospital for Children and SUNY Upstate Medical University, from January 2015 through August 2018, to identify patients having nonsyndromic craniosynostosis with a concurrent diagnosis of otitis media and/or hearing loss. The demographic data and categorical variables were analyzed using descriptive statistics and chi-square testing, respectively.

RESULTS

In the entire cohort of patients (N = 113, age range 0-123 months), 36% had otitis media with effusion on either history, physical examination, tympanometry, and/or imaging. Half (50%) of patients with coronal synostosis had otitis media with effusion compared to sagittal (40.7%), metopic (26.3%), multiple (25%), and lambdoid (0%). However, these differences were not statistically significant (P = .190). Most patients had normal hearing (91%), while a minority had either conductive (7%) or sensorineural (2%) hearing loss.

CONCLUSION

The presence of otitis media in our cohort of patients with nonsyndromic craniosynostosis appears to be at the upper limit of normal when compared to historical rates in normocephalic children. Synostosis subtype did not appear to predict the presence of otitis media. Only 9% of patients with nonsyndromic craniosynostosis were found to have a hearing loss.

Investigation of topical intranasal cocaine for sinonasal procedures: a randomized, phase III clinical trial

BACKGROUND

The objective of this trial was to demonstrate the clinical efficacy and safety of topical cocaine as part of the effort to gain regulatory approval from the United States Food and Drug Administration.

METHODS

This phase III, randomized, prospective, double-blind, multicenter, single-dose, placebo- and dose-controlled, parallel-group study aimed to evaluate the safety and efficacy of topical intranasal cocaine (RX0041-002). A total of 925 subjects were screened and a total of 648 subjects were randomized: 95 to placebo; 275 to 4% RX0041-002; and 278 to 8% RX0041-002. Efficacy was assessed with subjective pain intensity scores using the visual numeric rating scale and objectively using the von Frey filament test. Adverse events (AEs), vital signs, Holter monitoring, nasal irritation on visual examination, and smell assessment were recorded. The placebo and experimental groups were compared using a two-tailed Fisher's exact test.

RESULTS

Topical 4% and 8% cocaine achieved significant subject analgesia, the primary efficacy endpoint. Both doses were safe and well-tolerated, with a safety profile similar to placebo. In the 4% and 8% groups, headache (1.5% and 2.5%, respectively), epistaxis (0.7% and 1.1%), and anxiety (0.7% and 0%) were the only AEs reported by >1 subject. No cardiovascular AEs, serious AEs, or deaths occurred. A higher percentage of subjects in the 4% and 8% groups compared with the placebo group had a modest increase in either systolic or diastolic blood pressure.

CONCLUSION

Topical 4% and 8% cocaine is an effective anesthetic that can be safely administered for nasal procedures.

Systemic Pharmacokinetics of Topical Intranasal Cocaine in Healthy Subjects

Background

Topical cocaine is currently available for local anesthesia of the upper airway mucous membranes.

Objective

The objective of this study was to define the safety and efficacy of topical intranasal cocaine for a subsequent phase II clinical trial.

Methods

This study was a single-dose, single-center, and open-label study of the plasma and urinary pharmacokinetics (PK) of 4% topical cocaine and its major metabolites, benzoylecgonine (BE) and ecgonine methyl ester (EME), in 30 healthy subjects. Subjects received the topical solution on cotton pledgets containing 4 mL of 4% topical cocaine applied for 20 minutes, which was equivalent to 160 mg of cocaine hydrochloride.

Results

A total of 30 subjects (14 males and 16 females) were enrolled, treated, and provided PK data for analysis. Mean plasma concentrations of cocaine rose rapidly during the intranasal exposure period, with peak levels (Cmax, 37.0 ± 17.3 ng/mL) observed at the time of pledget removal (Tmax, 0.43 ± 0.34 h). Mean plasma concentrations then fell rapidly and monoexponentially for the remainder of the study, with a mean half-life (t1/2) of 1.04 ± 0.35 hours. Following a 20-minute topical intranasal exposure to a 160 mg dose of cocaine 4% solution, the mean 0 to 12 hours recoveries of cocaine, BE, and EME were 117 ± 67 μg, 816 ± 440 μg, and 275 ± 113 μg, respectively. Plotting urinary recovery by collection interval showed that urinary excretion of cocaine closely followed the time course of plasma cocaine.

Conclusions

Cocaine was rapidly but incompletely absorbed and then rapidly eliminated. Only 4% of the administered cocaine dose appeared to be absorbed in this study. Cocaine appeared in the urine with a time course similar to that in plasma.

Temporal Augmentation: A Systematic Review

Clinicians employ various modalities in order to achieve temporal augmentation; however, no literature comprehensively describes these methods or provides perspective on available options. Understanding the available methodologies for cosmetic temporal augmentation allows for improved patient satisfaction with limited risk of complications. To synthesize the available literature on cosmetic temporal augmentation, including all available methodologies, patient satisfaction data, and complication rates, as well as to identify gaps in the available literature to encourage further research. A literature search was performed using the databases PubMed, Ovid Medline, Cochrane Library, and Web of Science. Using the key terms "temporal" or "temple" and "augmentation" or "rejuvenation," all article formats presenting primary literature data involving cosmetic temporal augmentation were included. Articles not presenting patient data or not discussing cosmetic indications were eliminated. A total of 12 articles were deemed appropriate for analysis. Of the 12 articles included, 6 (50%) evaluated filler techniques, 3 discussed fat grafting (25%), and 3 reviewed solid implant (25%) techniques. Eight (67%) of these were retrospective reviews, with the remaining being prospective trials (33%). All studies found high patient satisfaction rates and a small number of complications with their respective methodology. Several methods are employed for cosmetic temporal augmentation, including various types of injectable fillers, solid implants, and fat grafting, with all reporting successful satisfaction and complication outcomes. Further research is necessary to properly compare these modalities. Clinician discretion should guide procedural choice until future well-controlled studies are able to provide standardized outcomes.

Clinical language fMRI with real-time monitoring in temporal lobe epilepsy: online processing methods

The increasing demand for clinical fMRI data has resulted in a need to translate research methods to clinical use. Referrals for language lateralization prior to epilepsy surgery are becoming more common, but time constraints make this unachievable in many busy neuroimaging departments. This study examines whether a single covert verbal fluency paradigm with real-time monitoring and online processing (BrainWave) could replace conventional offline processing (SPM) for the purpose of establishing expressive language dominance prior to epilepsy surgery. We analyzed language fMRI results of 30 patients (17 female; 24 right-handed; median age: 30.5) with temporal lobe epilepsy. Concordance between visual assessment of SPM and BrainWave was 92.8%. Lateralization indices correlated closely with visual assessments of lateralization with a concordance of 85.7%. BrainWave provided a real-time, fast and accurate display of language lateralization easily applied in a clinical setting using only online image processing.

Automatic segmentation of the hippocampus and the amygdala driven by hybrid constraints: method and validation

The segmentation from MRI of macroscopically ill-defined and highly variable structures, such as the hippocampus (Hc) and the amygdala (Am), requires the use of specific constraints. Here, we describe and evaluate a fast fully automatic hybrid segmentation that uses knowledge derived from probabilistic atlases and anatomical landmarks, adapted from a semi-automatic method. The algorithm was designed at the outset for application on images from healthy subjects and patients with hippocampal sclerosis. Probabilistic atlases were built from 16 healthy subjects, registered using SPM5. Local mismatch in the atlas registration step was automatically detected and corrected. Quantitative evaluation with respect to manual segmentations was performed on the 16 young subjects, with a leave-one-out strategy, a mixed cohort of 8 controls and 15 patients with epilepsy with variable degrees of hippocampal sclerosis, and 8 healthy subjects acquired on a 3 T scanner. Seven performance indices were computed, among which error on volumes RV and Dice overlap K. The method proved to be fast, robust and accurate. For Hc, results with the new method were: 16 young subjects {RV = 5%, K = 87%}; mixed cohort {RV = 8%, K = 84%}; 3 T cohort {RV = 9%, K = 85%}. Results were better than with atlas-based (thresholded probability map) or semi-automatic segmentations. Atlas mismatch detection and correction proved efficient for the most sclerotic Hc. For Am, results were: 16 young controls {RV = 7%, K = 85%}; mixed cohort {RV = 19%, K = 78%}; 3 T cohort {RV = 10%, K = 77%}. Results were better than with the semi-automatic segmentation, and were also better than atlas-based segmentations for the 16 young subjects.

Increased sensitivity to pathological brain changes using co-registration of magnetic resonance imaging scans

PURPOSE

To compare automatic software-based co-registration of serial magnetic resonance imaging (MRI) scans with conventional visual comparison, by expert neuroradiologists.

MATERIAL AND METHODS

Sixty-four patients who were referred to our epilepsy MRI unit for cerebral imaging were identified as having potentially, non-, or slow-growing lesions or cerebral atrophy and followed with sequential scans over a period of up to 8 years, resulting in a total of 92 pairs of scans. Scans were categorized as showing either lesions or atrophy. Each pair of scans was reviewed twice for the presence of change, with and without co-registration, performed using automated software.

RESULTS

Co-registration and visual reporting without co-registration were discordant in the lesions group in nine out of 69 datasets (13%), and in 16 out of 23 pairs of scans in the atrophy group (69%). The most common cause of discordance was visual reporting not detecting changes apparent by co-registration. In three cases, changes detected visually were not detected following co-registration.

CONCLUSION

In the group of patients studied, co-registration was more sensitive for detecting changes than visual comparison, particularly with respect to atrophic changes of the brain. With the increasing availability of sophisticated independent consoles attached to MRI scanners that may be used for image co-registration, we propose that serial T1-weighted volumetric MRI brain co-registration should be considered for integration into routine clinical practice to assess patients with suspected progressive disease.

Phenylalkylamine abuse among opiate addicts attending a methadone treatment programme in the Republic of Ireland

Since the early 1990s ring-substituted derivatives of amphetamine have been abused widely in the Republic of Ireland. The main ring-substituted amphetamines being abused include methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA) and methylenedioxyethamphetamine (MDEA). A newer illicit synthetic analogue, which has been seized to a lesser extent by Irish police, is N-methyl-1-(3,4-methylenedioxyphenyl)-2-butanamine (MBDB). The work presented here involved the determination of the type of ring-substituted amphetamines being abused by a group of recovering opiate abusers participating in a methadone maintenance programme in a Dublin Drug Rehabilitation Centre. Urine samples which tested positive for amphetamines and ring-substituted amphetamines via EMIT immunoassay were subjected to further analysis using GC-MS with MBTFA flash derivatization. It was found that the methylenedioxypropanamines were being abused, as was amphetamine itself. However, no abuse of methylenedioxybutanamines or thioamphetamines was observed.

Radioimmunoassay of pancreatic polypeptide in mammalian and submammalian vertebrates using a carboxyl-terminal hexapeptide antiserum

Pancreatic polypeptide (PP) immunoreactivity in acid-ethanol extracts of the pancreas of representative species of mammals, birds, reptiles, amphibians, and fish was studied by a radioimmunoassay (RIA) that utilizes an antiserum which cross-reacts exclusively with the COOH-terminal hexapeptide of PP (CTPP). PP immunoreactivity in acid-ethanol extracts of rat nonpancreas tissues (stomach, duodenum, skeletal muscle, brain) was also examined. Significant concentrations of PP immunoreactivity were detected in the pancreatic extracts of all species, except fish. Appreciable quantities of PP immunoreactivity were also found in the stomach and duodenum of rats. In all cases, tissue extracts showed parallelism with reference PP (bovine) in the RIA. Gel chromatography (Sephadex G-50sf) of tissue extracts (rat, turtle) demonstrated a major peak of PP immunoreactivity, which eluted in the region of the reference PP. Salamander PP immunoreactivity eluted after bovine PP. In addition, the CTPP RIA can be applied to measure plasma levels of PP in rats, dogs, and humans. By using this PP RIA, we observed that plasma PP levels increase significantly in dogs (P less than 0.05) after intravenous administration of neurotensin. In rats, administration of intravenous bombesin resulted in a significant elevation of plasma PP.

Biosynthesis of 11 -hydroxyandrostenedione by human and baboon adrenals

The conversion of androstenedione and cortisol to 11β-hydroxyandrostenedione was studied by in vitro incubations of human and baboon adrenals and by in vivo perfusion of baboon adrenals. By both approaches, androstenedione appeared to be the major precursor. Some sidechain cleavage of cortisol also occurs during incubation with whole blood.