Preserved white matter microstructure in adolescent patients with atypical anorexia nervosa

Objective: Patients with atypical anorexia nervosa (AN) are often in the normal-weight range at presentation; however, signs of starvation and medical instability are not rare. White matter (WM) microstructural correlates of atypical AN have not yet been investigated, leaving an important gap in our knowledge regarding the neural pathogenesis of this disorder. Method: We investigated WM microstructural integrity in 25 drug-naïve adolescent patients with atypical AN and 25 healthy controls, using diffusion tensor imaging (DTI) with a tract-based spatial statistics (TBSS) approach. Psychological variables related to the eating disorder and depressive symptoms were also evaluated by administering the eating disorder examination questionnaire (EDE-Q) and the Montgomery–Åsberg depression rating scale (MADRS-S) respectively, to all participants. Results: Patients and controls were in the normal-weight range and did not differ from the body mass index standard deviations for their age. No between groups difference in WM microstructure could be detected. Discussion: Our findings support the hypothesis that brain structural alterations may not be associated to early-stage atypical AN. These findings also suggest that previous observations of alterations in WM microstructure in full syndrome AN may constitute state-related consequences of severe weight loss. Whether the preservation of WM structure is a pathogenetically discriminant feature of atypical AN or only an effect of a less severe nutritional disturbance, will have to be verified by future studies on larger samples, possibly directly comparing AN and atypical AN

How do ventricular folds behave during vocal effort ?

International audienceThe human two ventricular folds constitute an additional laryngeal vibrator, whose biomechanical properties differ from those of the vocal folds. Often considered solely anecdoticaly, they may adduct, get into contact, and even vibrate during speech and singing. This present study aims at characterizing their behavior during situations of vocal effort, such as shouted speech, growls, and crescendos-decrescendos. A database of phonatory gestures which accompanies vocal effort has been constituted by the cinematographic, audio and electroglottographic recordings of five speakers and three singers. The signals have been recorded simultaneously and synchronized to the high-speed laryngeal images. A ventricular-fold systematic movement is observed during vocal effort, as compared to usual phonation. The two folds get closer, and this movement may go with a spectral increase of energy in the 2-4 kHz frequency band with no direct correlation on vocal intensity. The closing movement is either localized on the median and/or antero-median part, or it may occur over the whole fold length. In the case of contact, the ventricular folds may start to vibrate, periodically or not, and in phase or not with the vocal-folds vibratory movement. Using an aerodynamical theoretical approach, the influence of a supra-laryngeal constriction on the glottal vibratory movement has been evidenced (Bailly et al., 2008). This aerodynamical modeling approach is combined here with high-speed visualization in order to predict the physical impact of the observed ventricular constrictions on glottal vibration, similarly to a previous study on period-doubling phonation (Bailly et al., 2010). Ventricular area is detected on high-speed laryngeal images, and given as an input parameter to the model. Glottal vibratory behavior is then simulated by applying a two-mass model inspired from Ruty et al. (2007). The resulting signal is compared with glottal contact area as measured by electroglottography. Bailly, L., Pelorson, X., Henrich, N., and Ruty, N. (2008). "Influence of a constriction in the near field of the vocal folds: Physical modeling and experimental validation," J. Acoust. Soc. Am. 124(5), 3296-3308. Bailly, L. (2009). "Vocal fold and ventricular fold vibration in period-doubling phonation: Physiological description and aerodynamic modeling," J. Acoust. Soc. Am. 127(5), 3212-3222. Ruty, N., Pelorson, X., Van Hirtum, A., Lopez-Arteaga, I., and Hirschberg, A. (2007). "An "in-vitro‟ setup to test the relevance and the accuracy of low-order vocal folds models," J. Acoust. Soc. Am. 121 (1), 479-490

Vocal folds vibratory patterns of “laryngeal mechanism M0” as investigated with high-speed cinematography and electroglottography

International audienceA human vocal production is characterized by the use of different laryngeal mechanisms(Roubeau,1993 ; Henrich et al., 2003), among which laryngeal mechanisms M1 and M2 arethe most frequently used and studied in speech and singing. Chest, or modal voice, isproduced in M1, while falsetto, or female head voice is produced in M2. Besides that, anothermechanism known as laryngeal mechanism 0 (M0) can also be found in speech and sometypes of singing. Vocal fry, pulse register, creaky voice, glottal fry are the terms frequentlyused to refer to this vocal production. Yet, these terms are sometimes considered assynonymous (Hollien, 1974), while in other cases, they would characterize different vocalproductions. The M0 mechanism has mainly been studied for pathological voices, but it isalso of interest for linguists, as it can be found in hesitations and at the end of utterances.Thus our aim is to investigate the different vibratory patterns that can be involved in M0thanks to high speed cinematography and to compare them with the EGG signal. The glottalvibratory movement has been simultaneously investigated in two ways: first, with the help ofelectroglottography (EGG), and secondly, with high-speed cinematography. The high-speedimages have been recorded using a high-speed camera unit Wolf HS Endocom 5560, and theEGG signal has been recorded using a Laryngograph Ltd. Two male speakers were asked toproduce a sustained vowel in M0 with or without vocal effort, and transitions between M1and M0. The high-speed images and the EGG signal were recorded simultaneously atdifferent sampling frequencies, respectively 4000 Hz and 44170 Hz. The data were thenprocessed using Matlab. The EGG signal was differentiated, and both EGG and DifferentiatedEGG (DEGG) signals were synchronized with the high-speed images, so as to compare theEGG and DEGG data with the vibratory movements observed on the images. An imageprocessing algorithm based on the detection of contrast (light energy threshold) wasdeveloped for relative measurement of glottal area, antero-posterior and transversal distances.It is a known fact that the glottal area function in M0 is characterized by short pulses, whichcan be single, double or triple within a fundamental period (Whitehead et al., 1984 ; Childersand Lee, 1991).On a physiological point of view, the thyroarytenoid muscles tend to shorten, subsequentlythickening the anterior-posterior dimension of the vocal folds, and allowing the anterior partof the vocal ligaments to vibrate (Hollien, 1974). However the physiological propertiesassociated with the multiple vibratory patterns mentioned above are not fully described,especially regarding the precise movements of the vocal folds margins, the degree of vocalfold adduction and the contribution of the ventricular folds.The analysis shows that different realizations of M0 can be found in this corpus especiallywhen comparing (i) the M0 realized with vocal effort from (ii) the M0 realized without vocaleffort. The first one is more likely to be characterized by a single pulse, while the second oneis frequently produced with multiple pulses - both realizations having different typical EGGshapes. We also found that in the case of single pulse pattern, the anterior portion of the vocalfolds is more involved in the vibrating process than the posterior one, while the posteriorportion of the vocal folds can also be active in the case of a multiple pulse pattern. Transitionsproduced by the two speakers were also investigated, thus revealing different which werepossibly used. The validity of EGG signals rendering the different vibratory patterns will bediscussed as well as implications for synthesis

Exploration of vocal-folds and ventricular-bands interaction in singing using high-speed cinematography and electroglottography

International audienceThe human vocal-folds vibratory system is a non-linear dynamical system. Evidences of bifurcation, period-doubling and chaotic behaviours have been found in the study of voiced sounds in speech and singing. In singing, period-doubling occurrences are commonly found in Asian vocal cultures, such as Mongolian Kargyraa throat singing or Tibetan Dzo-ke chants. Similarly, it is a common feature of the bassu's production in traditional Sardinian ‘A Tenore' singing. The combined vibrations of vocal folds and ventricular bands have been observed during the production of such low-pitch bass-type sound. In this paper, we aim to explore the ventricular-band vibration and its interaction with vocal-fold vibration using synchronized high-speed cinematography and electroglottography. The vibratory properties of both vocal folds and ventricular bands in interaction are presented. In particular, the periodic variation of glottal cycle duration and the effect of ventricular-band adduction on glottal closing time are demonstrated

The Ventricular-Fold Dynamics in Human Phonation

International audiencePurpose: In this study, the authors aimed (a) to provide a classification of the ventricular-fold dynamics during voicing, (b) to study the aerodynamic impact of these motions on vocal-fold vibrations, and (c) to assess whether ventricularfold oscillations could be sustained by aerodynamic coupling with the vocal folds. Method: A 72-sample database of vocal gestures accompanying different acoustical events comprised highspeed cinematographic, audio, and electroglottographic recordings of 5 subjects. Combining the physiological correlates with a theoretical model of phonation, the vocal-ventricular aerodynamic interactions were investigated. Results: A ventricular-fold motion is found during (de)crescendos, shout, throat singing, yodel, growls, and glides with transitions between registers. Three main types of dynamics are identified: slow nonoscillatory motion and fast oscillatory motion with aperiodical or periodical vibrations. These patterns accompany a change in voice quality, pitch, and/or intensity. Alterations of glottal-oscillatory amplitude, frequency, and contact were predicted. It is shown that a ventricular oscillation can be initiated and sustained by aerodynamic coupling with the vocal folds. Conclusions: Vocal-ventricular aerodynamic interactions can alter, enhance, or suppress vocal-fold vibrations or leave them unchanged, depending on the ventricular-fold dynamics involved. Depending on its variation in time, a similar level of ventricular-fold adduction impacts the glottal vibratory magnitude and contact much differently

Analysis of hip range of motion in everyday life ::a pilot study

Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the “normal hip” in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction

Analysis of hip range of motion in everyday life: a pilot study

Patients undergoing total hip arthroplasty are increasingly younger and have a higher demand concerning hip range of motion. To date, there is no clear consensus as to the amplitude of the "normal hip" in everyday life. It is also unknown if the physical examination is an accurate test for setting the values of true hip motion. The purpose of this study was: 1) to precisely determine the necessary hip joint mobility for everyday tasks in young active subjects to be used in computer simulations of prosthetic models in order to evaluate impingement and instability during their practice; 2) to assess the accuracy of passive hip range of motion measurements during clinical examination. A total of 4 healthy volunteers underwent Magnetic Resonance Imaging and 2 motion capture experiments. During experiment 1, routine activities were recorded and applied to prosthetic hip 3D models including nine cup configurations. During experiment 2, a clinical examination was performed, while the motion of the subjects was simultaneously captured. Important hip flexion (mean range 95°-107°) was measured during daily activities that could expose the prosthetic hip to impingement and instability. The error made by the clinicians during physical examination varied in the range of ±10°, except for flexion and abduction where the error was higher. This study provides useful information for the surgical planning to help restore hip mobility and stability, when dealing with young active patients. The physical examination seems to be a precise method for determining passive hip motion, if care is taken to stabilise the pelvis during hip flexion and abduction

Anatomic Acromioclavicular Joint Reconstruction With Semitendinosus Allograft: Surgical Technique

Acromioclavicular joint separations are common shoulder injuries in the active patient population. Nonoperative management is recommended for Rockwood type I and II injuries, whereas surgical reconstruction is recommended for type IV and VI separations. The management for type III and V injuries is more controversial and is determined on a case-by-case basis. A multitude of surgical reconstruction techniques exist, and there is little evidence to support one technique over another. The anatomic technique aims at reconstructing the coracoclavicular ligaments and bringing the clavicle back into its anatomic position. When the anatomic technique is augmented with a graft, biomechanical studies have shown superior reconstruction strength and stability compared with standard nonanatomic techniques. Additionally, anatomic reconstruction allows for better cosmesis and functional outcome measures at midterm follow-up compared with nonanatomic techniques. In this Technical Note, we describe our preferred technique for anatomic repair of acromioclavicular joint separation using a semitendinosus allograft

Arthroscopic Intramuscular Side-to-Side Repair of an Isolated Infraspinatus Tear

Intramuscular, full-thickness rotator cuff tears are uncommon and present a challenging clinical scenario for repair because traditional suture anchor or transosseous repair techniques are less feasible. The goal of repair is to achieve a tension-free reduction of both ends of the muscle to allow for adequate healing over time. Intramuscular tears of the infraspinatus specifically have rarely been reported. The clinical presentation of these patients can be challenging to interpret, and other causes of rotator cuff dysfunction, including compression to the suprascapular nerve, must be ruled out. In this Technical Note, we describe our technique for arthroscopic side-to-side suture repair of an isolated intramuscular infraspinatus tear