Gender-related voice problems in transsexuals — therapeutical demands

  The paper presents a case study of a transsexual patient who underwent a voice pitch elevation surgery performed in Poland for the first time. The human voice is a reflection of the working of hormones and human psyche. This fact is of particular importance in transsexualism, a disorder consisting in incongruence between the individual’s biological sex and their identified gender. For many transsexual people, especially of the MTF (male to female) type, who have undergone hormonal and surgical sex change, the voice still presents a major problem, causing difficulties in everyday life. Hormonal treatment does not influence feminisation of the larynx. In the described MTF case, the patient’s low androphonic voice was perceived as a male voice. In order to feminise the patient’s voice a phonosurgical procedure was performed: the length of the vibrating portion of the vocal folds was shortened by over 50% of their total length by means of suturing of the anterior part of the vocal fold. As a result of the surgical treatment the pitch of voice was raised considerably, with F0 of spoken voice increased from 109 Hz to 209 Hz. The voice range also changed towards female tones, from 59–146 Hz to 148–343 Hz. Pitch elevation positively influenced the patient’s subjective voice assessment: total score of the Voice Handicap Index (VHI) improved from 99 to 19 points, and the score of its emotional sub-scale: 39 and 2 points, respectively. The described case of a surgical male-to-female voice change presents one of the dilemmas faced by modern medicine. (Endokrynol Pol 2016; 67 (4): 452–455)    Przedstawiono przypadek pacjentki transseksualnej, u której po raz pierwszy w Polsce przeprowadzono zabieg chirurgiczny zmiany głosu z męskiego na żeński. Głos ludzki — drugorzędowa cecha płciowa — jest odzwierciedleniem działania hormonów i psychiki. Fakt ten nabiera szczególnego znaczenia w transseksualizmie, zaburzeniu polegającym na niezgodności płci biologicznej z płcią psychiczną. Dla wielu osób transseksualnych, szczególne w postaci transseksualizmu M/K (mężczyzna/kobieta) po hormonalnej i chirurgicznej zmianie płci biologicznej ważnym problemem nastręczającym trudności w życiu codziennym pozostaje głos, gdyż leczenie hormonalne nie wpływa na feminizację krtani — aparatu głosowego. W opisywanym przypadku niski androfoniczny głos pacjentki był percepowany przez otoczenie jako męski. W celu feminizacji głosu wykonano leczenie fonochirurgiczne: skrócono fałdy głosowe o ponad 50% ich długości poprzez założenie szwów zespalających w ½ przedniej części głośni. W wyniku zabiegu podwyższono znacząco głos: przedoperacyjna częstotliwość głosu mówionego wyraźnie przesunęła się po operacji w górę z wartości 109 Hz do 209 Hz. Zakres głosu także zmienił się w kierunku tonów żeńskich z 59–146 Hz do 148–343 Hz. Zmiana wysokości głosu u pacjentki wpłynęła pozytywnie na jej subiektywną ocenę głosu: wynik kwestionariusza VHI (Voice Handicap Index) poprawił się z 99 pkt — przed operacją do 19 pkt — po operacji. Na poprawę jakości życia wskazuje także spadek problemów emocjonalnych związanych z głosem, ocenianych za pomocą podskali emocjonalnej VHI, której wynik wynosił odpowiednio: 39 pkt przed vs. 2 pkt po operacji. Prezentowany przypadek chirurgicznej zmiany głosu z męskiego na żeński, dokonany po raz pierwszy w warunkach polskich, przedstawia jeden z dylematów stawianych przed współczesną medycyną. (Endokrynol Pol 2016; 67 (4): 452–455)

miR-125b-5p, miR-155-3p, and miR-214-5p and target E2F2 gene in oral squamous cell carcinoma

It is known that E2F2 (E2F transcription factor 2) plays an important role as controller in the cell cycle. This study aimed to analyse the expression of the E2F2 gene and E2F2 protein and demonstrate E2F2 target microRNAs (miRNAs) candidates (miR-125b-5p, miR-155-3p, and miR-214-5p) in oral squamous cell carcinoma tumour and margin samples. The study group consisted 50 patients. The E2F2 gene and miRNAs expression levels were assessed by qPCR, while the E2F2 protein was assessed by ELISA. When analysing the effect of miRNAs expression on E2F2 gene expression and E2F2 protein level, we observed no statistically significant correlations. miR-125b-5p was downregulated, while miR-155-3p, and miR-214-5p were upregulated in tumour samples compared to margin. We observed a difference between the miR-125b-5p expression level in smokers and non-smokers in margin samples. Furthermore, HPV-positive individuals had a significantly higher miR-125b-5p and miR-214-5p expression level compared to HPV-negative patients in tumour samples. The study result showed that the E2F2 gene is not the target for analysed miRNAs in OSCC. Moreover, miR-155-3p and miR-125b-5p could play roles in the pathogenesis of OSCC. A differential expression of the analysed miRNAs was observed in response to tobacco smoke and HPV status

miR-125b-5p, miR-155-3p, and miR-214-5p and target E2F2 gene in oral squamous cell carcinoma

It is known that E2F2 (E2F transcription factor 2) plays an important role as controller in the cell cycle. This study aimed to analyse the expression of the E2F2 gene and E2F2 protein and demonstrate E2F2 target microRNAs (miRNAs) candidates (miR-125b-5p, miR-155-3p, and miR-214-5p) in oral squamous cell carcinoma tumour and margin samples. The study group consisted 50 patients. The E2F2 gene and miRNAs expression levels were assessed by qPCR, while the E2F2 protein was assessed by ELISA. When analysing the effect of miRNAs expression on E2F2 gene expression and E2F2 protein level, we observed no statistically significant correlations. miR-125b-5p was downregulated, while miR-155-3p, and miR-214-5p were upregulated in tumour samples compared to margin. We observed a difference between the miR-125b-5p expression level in smokers and non-smokers in margin samples. Furthermore, HPV-positive individuals had a significantly higher miR-125b-5p and miR-214-5p expression level compared to HPV-negative patients in tumour samples. The study result showed that the E2F2 gene is not the target for analysed miRNAs in OSCC. Moreover, miR-155-3p and miR-125b-5p could play roles in the pathogenesis of OSCC. A differential expression of the analysed miRNAs was observed in response to tobacco smoke and HPV status

Molecular mechanisms of glucocorticoids action: implications for treatment of rhinosinusitis and nasal polyposis

Intra-nasal glucocorticoids are the most effective drugs available for rhinosinusitis and nasal polyposis treatment. Their effectiveness depends on many factors and not all of them have been well recognized so far. The authors present the basic information on molecular mechanisms of glucocorticoid action, direct and indirect effects of glucocorticoids on transcription of genes encoding inflammatory mediators. They focus on recently proved nongenomic mechanisms which appear quickly, from several seconds to minutes after glucocorticoid administration and discuss clinical implications resulting from this knowledge. Discovery of nongenomic glucocorticoid actions allows for better use of these drugs in clinical practice

Zakażenia szpitalne — problem nowo otwartego oddziału intensywnej terapii

BACKGROUND: Health-care associated infections (HAI) are common complications in ICU patients as an effect of high invasive device utilization rate. The aim of the study was to analyze the epidemiology of ventilator — associated pneumonia (VAP), blood stream infections (BSI), urinary tract infections (UTI) and surgical site infections (SSI) in newly opened medical-surgical intensive care unit.METHODS: VAP, BSI, UTI and SSI were detected and registered by hospital Infection Control Team according to CDC criteria during first 12 months following opening of new ICU.RESULTS: During 12-month period HAI was diagnosed in 44 out of 168 patients (26%). The ventilator utilization rate was 72%. The incidence density of VAP was 15.5/1000 ventilator days. The central line utilization was 100%. The BSI rate was 5/1000 catheter days. The urinary catheter utilization was 95%. The UTI rate was 1.9/1000 catheterization days. In 8 out of 60 surgical patients SSI occurred (13%). The most common isolates were Gram negative bacteria.CONCLUSIONS: The incidence of VAP was higher than the mean values reported for USA, western Europe and similar to the mean value reported for developing countries. BSI and UTI rate was comparable to those given in NNIS and HELICS programs results. High VAP rate indicates the necessity of introducing an effective preventing program.BACKGROUND: Health-care associated infections (HAI) are common complications in ICU patients as an effect of high invasive device utilization rate. The aim of the study was to analyze the epidemiology of ventilator — associated pneumonia (VAP), blood stream infections (BSI), urinary tract infections (UTI) and surgical site infections (SSI) in newly opened medical-surgical intensive care unit.METHODS: VAP, BSI, UTI and SSI were detected and registered by hospital Infection Control Team according to CDC criteria during first 12 months following opening of new ICU.RESULTS: During 12-month period HAI was diagnosed in 44 out of 168 patients (26%). The ventilator utilization rate was 72%. The incidence density of VAP was 15.5/1000 ventilator days. The central line utilization was 100%. The BSI rate was 5/1000 catheter days. The urinary catheter utilization was 95%. The UTI rate was 1.9/1000 catheterization days. In 8 out of 60 surgical patients SSI occurred (13%). The most common isolates were Gram negative bacteria.CONCLUSIONS: The incidence of VAP was higher than the mean values reported for USA, western Europe and similar to the mean value reported for developing countries. BSI and UTI rate was comparable to those given in NNIS and HELICS programs results. High VAP rate indicates the necessity of introducing an effective preventing program

The Influence of Environmental Exposure to Heavy Metals on the Occurrence of Selected Elements in the Maxillary Bone

The elemental composition of the body’s calcified tissues may reflect the environmental exposure of the population to heavy metals. The aim of the study was to assess whether the elemental composition of the maxillary bone from individuals belonging to a given population reflects the environmental exposure of this population to lead and cadmium. The research material consisted of cortical bone from the anterolateral walls of the maxilla collected from 126 patients during Caldwell–Luc maxillary sinus surgery on residents of two cities differing in terms of the lead and cadmium pollution of the natural environment. The content levels of lead, cadmium, iron, manganese, chromium, copper, and iron were determined by using atomic absorption spectrophotometry. The content levels of lead and cadmium in the samples of the maxillary bones of residents of Bielsko-Biala were 3.26 ± 2.42 µg/g and 0.74 ± 0.38 µg/g, respectively, whereas in the samples from the residents of Katowice, they were 7.66 ± 2.79 µg/g and 1.12 ± 0.08 µg/g, respectively. It was found that the lead and cadmium levels in the maxillary bone corresponded to the environmental exposure to these heavy metals in the place of residence, which was proven here via the example of the residents of two cities with different concentrations of these heavy metals in the air over long time periods. Additionally, higher content levels of essential metals such as manganese, chromium, copper, and iron are characteristic of the maxillary bone samples of residents of the area that is more polluted with heavy metals

Zastosowanie CFD w ocenie drożności górnych dróg oddechowych

Obliczeniowa dynamika płynów (CFD) to szybko rozwijająca się dziedzina nauki, mająca szereg zastosowań praktycznych. Od lat używana jest w aerodynamice, inżynierii, hydraulice, meteorologii, budownictwie oraz wielu innych dziedzinach. Pierwsze publikacje dotyczące użycia CFD w medycynie dotyczyły przede wszystkim pulmonologii i kardiologii, czyli dziedzin, w których dynamiczne właściwości gazu i płynu odgrywają ważną rolę w prawidłowym funkcjonowaniu organizmu. W laryngologii CFD umożliwia pomiar oraz wizualizację dynamicznie zmieniających się parametrów przepływu powietrza w górnych drogach oddechowyc