Impact of Early Postnatal Androgen Exposure on Voice Development

Background: the impact of early postnatal androgen exposure on female laryngeal tissue may depend on certain characteristics of this exposure. We assessed the impact of the dose, duration, and timing of early androgen exposure on the vocal development of female subjects who had been treated for adrenocortical tumor (ACT) in childhood.Methods: the long-term effects of androgen exposure on the fundamental vocal frequency (F0), vocal pitch, and final height and the presence of virilizing signs were examined in 9 adult (age, 18.4 to 33.5 years) and 10 adolescent (13.6 to 17.8 years) female ACT patients. We also compared the current values with values obtained 0.9 years to 7.4 years after these subjects had undergone ACT surgery, a period during which they had shown normal androgen levels.Results: of the 19 subjects, 17 (89%) had been diagnosed with ACT before 4 years of age, 1 (5%) at 8.16 years, and 1 (5%) at 10.75 years. Androgen exposure (2 to 30 months) was sufficiently strong to cause pubic hair growth in all subjects and clitoromegaly in 74% (14/19) of the subjects, but did not reduce their height from the target value. Although androgen exposure induced a remarkable reduction in F0 (132 Hz) and moderate pitch virilization in 1 subject and partial F0 virilization, resulting in F0 of 165 and 169 Hz, in 2 subjects, the majority had normal F0 ranging from 189 to 245 Hz.Conclusions: Female laryngeal tissue is less sensitive to androgen exposure between birth and adrenarche than during other periods. Differential larynx sensitivity to androgen exposure in childhood and F0 irreversibility in adulthood are age-, concentration-, duration-, and timing-dependent events that may also be affected by exposure to inhibitory or stimulatory hormones. Further studies are required to better characterize each of these factors.Brazilian State of Parana Secretary of Science, Technology and Higher Education (SETI)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Raul Carneiro Hospital Association for Childhood Protection (AHPIRC)American Lebanese Syrian Associated Charities (ALSAC)SETIAHPIRCALSACInst Pesquisa Pele Pequeno Principe, Curitiba, Parana, BrazilHosp Pequeno Principe, Curitiba, Parana, BrazilFac Pequeno Principe, Curitiba, Parana, BrazilInst Voz Maringa, Maringa, Parana, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilClin Voz, Curitiba, Parana, BrazilIrmandade Santa Casa Misericordia São Paulo, São Paulo, BrazilUniv Fed Parana, Dept Saude Comunitaria, BR-80060000 Curitiba, Parana, BrazilUniversidade Federal de São Paulo, Dept Fonoaudiol, São Paulo, BrazilWeb of Scienc

European aerosol phenomenology - 8 : Harmonised source apportionment of organic aerosol using 22 Year-long ACSM/AMS datasets

Organic aerosol (OA) is a key component of total submicron particulate matter (PM1), and comprehensive knowledge of OA sources across Europe is crucial to mitigate PM1 levels. Europe has a well-established air quality research infrastructure from which yearlong datasets using 21 aerosol chemical speciation monitors (ACSMs) and 1 aerosol mass spectrometer (AMS) were gathered during 2013-2019. It includes 9 non-urban and 13 urban sites. This study developed a state-of-the-art source apportionment protocol to analyse long-term OA mass spectrum data by applying the most advanced source apportionment strategies (i.e., rolling PMF, ME-2, and bootstrap). This harmonised protocol was followed strictly for all 22 datasets, making the source apportionment results more comparable. In addition, it enables quantification of the most common OA components such as hydrocarbon-like OA (HOA), biomass burning OA (BBOA), cooking-like OA (COA), more oxidised-oxygenated OA (MO-OOA), and less oxidised-oxygenated OA (LO-OOA). Other components such as coal combustion OA (CCOA), solid fuel OA (SFOA: mainly mixture of coal and peat combustion), cigarette smoke OA (CSOA), sea salt (mostly inorganic but part of the OA mass spectrum), coffee OA, and ship industry OA could also be separated at a few specific sites. Oxygenated OA (OOA) components make up most of the submicron OA mass (average = 71.1%, range from 43.7 to 100%). Solid fuel combustion-related OA components (i.e., BBOA, CCOA, and SFOA) are still considerable with in total 16.0% yearly contribution to the OA, yet mainly during winter months (21.4%). Overall, this comprehensive protocol works effectively across all sites governed by different sources and generates robust and consistent source apportionment results. Our work presents a comprehensive overview of OA sources in Europe with a unique combination of high time resolution (30-240 min) and long-term data coverage (9-36 months), providing essential information to improve/validate air quality, health impact, and climate models.Peer reviewe

Timing and characteristics of virilization at ACT diagnosis and time of study.

(1)<p>Cushing’s syndrome. F: female pitch; M+: mild virilization; M++: moderate virilization; NA: not available. Initial F0 was obtained several weeks and 4 years after ACT diagnosis, as reported by Leonel in her thesis in 2003 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050242#pone.0050242-Leonel1" target="_blank">[4]</a>.</p

F0 and vocal pitch of control group.

<p>F0 and vocal pitch of control group.</p

A flow chart summarizing the results of this and other studies investigating the postnatal periods of lowest and greatest larynx sensitivity to androgen exposure and the mechanism of vocal development in response to this exposure.

<p>Pink curves correspond to female F0 spectra and blue curves to male F0 spectra. (1) Normal development of F0 differentiation in males and females. Adrenarche and activation of the hypothalamus–pituitary–gonadal axis (gonadarche) are the main events leading to attainment of adult vocal patterns. At puberty, the larynx, vocal folds, and vocal tract (e.g., the resonance tube up to the oral cavity) acquire increased mass, leading to variable degrees of F0 reduction in men at adrenarche and gonadarche and to partial reduction in women at adrenarche. F0 decreases and then stabilizes between the ages of 14 and 18 years. Mean F0, which is shown for normal male and female Brazilian subjects <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050242#pone.0050242-Leonel1" target="_blank">[4]</a>, slightly decreases with age, as was shown in a study of normal Swedish women <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0050242#pone.0050242-PegoraroKrook1" target="_blank">[2]</a> and in other studies (Hollien and Shipp, 1972; Stoicheff, 1981; Hollien et al., 1994), due to steroids and other factors. (2) A hypothesis based on the study results postulating that androgen exposure during pre- and post-pubertal stages in CAH females causes fluctuations in androgen levels and permanent virilization of F0. (3) A good marker identified for the accumulated androgen effect (represented by Tanner stage) is shown for all ACT cases. Each full dot represents 4 months of androgen exposure. Androgen exposure during the pre-pubertal stage leading to decreased F0 was found in only 3 ACT cases (3/19; 15.7%), leading to development of the hypothesis that laryngeal tissue has a low level of sensitivity to androgen exposure during the first 5 postnatal years in females.</p

Choledochal cyst in the pediatric population: experience of 13 laparoscopic procedures in two years at a single institution

ABSTRACT Objective: to describe the first 13 cases of laparoscopic correction of common bile duct cyst in the Pequeno Príncipe Hospital, Curitiba, Paraná, Brazil. Methods: we performed a retrospective analysis of medical records of cases of choledochal cyst operated by laparoscopy between March 2014 and September 2016. Results: of the 13 patients, eight were female and the mean age at surgery was 7.8 years. The most common symptom was abdominal pain. The hepaticoduodenal anastomosis was the most used reconstruction technique, in 84.6% of the cases. There was no conversion to laparotomy or intraoperative complications. Only one patient presented anastomotic fistula and was reoperated by laparotomy. All patients were followed up in an outpatient clinic, were asymptomatic and had no episode of cholangitis after surgery, with a mean follow-up of 16 months. Conclusion: laparoscopy is a safe method to correct choledochal cysts, even in younger children, with low rates of complications and low rates of conversion to open surgery when performed by well trained surgeons