Comparison between telelaryngoscopy and suspension laryngoscopy in the diagnosis of benign vocal fold lesions

Proper diagnosis of laryngeal benign lesions still brings doubts among experienced laryngologists, despite current diagnostic progress. AIM: the goal of this study was to compare telelaryngoscopy (preoperative) with suspension laryngoscopy (intraoperative) on the diagnosis of vocal fold benign lesions. MATERIALS AND METHODS: We carried out a restrospective study analyzing 79 charts from patients followed up in a University Hospital. In all the charts there was at least diagnostic hypothesis suggested by telelaryngoscopy, which was later on compared to intraoperative findings of suspension laryngoscopy. RESULTS: Almost two-thirds of the patients were females, with ages varying between 12 and 66 years (mean of 37 years). Of the 79 patients studied, we diagnosed 95 lesions with telelaryngoscopy and 124 with suspension laryngoscopy. The most frequently found benign lesion was the vocal polyp in both methods. In 64.5% of the cases the diagnosis of the lesions in the outpatient ward was the same as those in the surgical findings. CONCLUSION: Laryngologists must be prepared to alter their surgical planning and treatment approaches because of diagnostic changes that may happen during surgery.O correto diagnóstico das lesões benignas da laringe ainda causa dúvida em laringologistas experientes, apesar dos avanços diagnósticos. OBJETIVO: O objetivo desse estudo foi comparar a telelaringoscopia (pré-operatória) com a laringoscopia de suspensão (intra-operatória) no diagnóstico das lesões benignas das pregas vocais. MATERIAL E MÉTODO: Foi realizado um estudo retrospectivo através da análise de 79 prontuários de pacientes acompanhados em um hospital universitário. Em todos os prontuários havia pelo menos uma hipótese diagnóstica ambulatorial sugerida pela telelaringoscopia, que posteriormente foi comparada aos achados intra-operatórios da laringoscopia de suspensão. RESULTADOS: Quase dois terços dos pacientes eram do gênero feminino, com idade variando de 12 aos 66 anos (média de 37 anos). Dos 79 pacientes estudados, foram diagnosticadas 95 lesões com a telelaringoscopia e 124 com a laringoscopia de suspensão. A lesão benigna mais freqüente foi pólipo vocal em ambos os métodos. Em 64,5% dos casos, o diagnóstico das lesões feito no ambulatório foi o mesmo dos achados cirúrgicos. CONCLUSÃO: O laringologista deve estar preparado para alterar seu planejamento cirúrgico e abordagens terapêuticas devido às mudanças diagnósticas que ocorrem no intra-operatório.UNIFESP-EPMUniversidade Federal de São Paulo (UNIFESP) Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMUNIFESP, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPMSciEL

Fifteen years of hoarseness: case report of a rare laryngeal schwannoma

Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Departamento de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoUNIFESP, EPM, Depto. de Otorrinolaringologia e Cirurgia de Cabeça e PescoçoSciEL

Detection of hyaluronic acid receptor in human vocal folds by immunohistochemistry

Hyaluronic acid receptor is a glycoprotein of the plasmatic membrane, and the CD44 is its representative, expressed in many cell types where it has the task of cell adhesion. AIM: the goal of the present experimental study is to investigate the possibility of using immunohistochemistry to identify the distribution of hyaluronic acid along the vocal fold. MATERIALS AND METHODS: We resected the normal vocal folds from a normal 23 year-old male black individual. The slides were analyzed by means of a histomorphometric study, comparing the color intensity in the superficial, middle and deep layers of the lamina propria. In the silanized slides we used immunohistochemistry, and evaluated the slides under light microscopy with 40x magnification, and the color changed to brown when there was a reaction with the receptor for hyaluronic acid. RESULTS: Immunohistochemical findings showed the presence of hyaluronic acid receptors in the epithelium covering the vocal fold, being more concentrated in the central region of the vocal fold. CONCLUSION: immunohistochemistry, used to assess the distribution of hyaluronic acid receptors in the central portion of the vocal fold, proved it to be present in the vocal fold epithelium and it prevailed in its middle third.O receptor do ácido Hialurônico é uma glicoproteína da membrana plasmática, sendo o principal o CD44, e está expresso em vários tipos de células onde possui a função de adesão celular. OBJETIVO: Estudar a possibilidade de empregar o método imunohistoquímico para identificar a distribuição dos receptores de ácido hialurônico ao longo da prega vocal humana. MATERIAL E MÉTODOS: Foram ressecadas as pregas vocais normais de um indivíduo de 23 anos, sexo masculino, cor negra. As lâminas foram analisadas por meio de estudo histomorfométrico, comparando-se a intensidade das cores nas camadas superficial, média e profunda da lâmina própria. Nas lâminas silanizadas foi utilizado método imunohistoquímico, sendo avaliadas através de microscopia óptica com aumento 40 vezes, obtendo coloração marrom onde houve a reação com receptor para ácido hialurônico. RESULTADOS: Os achados imunohistoquímicos mostraram presença de receptores para ácido hialurônico no epitélio de cobertura da prega vocal tendo maior concentração na região central da prega vocal. CONCLUSÃO: A técnica de imunohistoquímica, utilizada para avaliar a distribuição dos receptores para ácido hialurônico na pregas vocais humanas, mostrou sua disposição em epitélio da prega vocal e predomínio no terço médio, em relação às demais regiões na prega vocal estudada.UNIFESP-EPM Departamento de ORLUFBAUNIFESP-EPM Departamento de PatologiaUNIFESP Departamento de ORLUNIFESP, EPM, Depto. de ORLUNIFESP, EPM Depto. de PatologiaUNIFESP, Depto. de ORLSciEL

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Population and fertility by age and sex for 195 countries and territories, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. Methods: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10–54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10–14 years and 50–54 years was estimated from data on fertility in women aged 15–19 years and 45–49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories. Findings: From 1950 to 2017, TFRs decreased by 49·4% (95% uncertainty interval [UI] 46·4–52·0). The TFR decreased from 4·7 livebirths (4·5–4·9) to 2·4 livebirths (2·2–2·5), and the ASFR of mothers aged 10–19 years decreased from 37 livebirths (34–40) to 22 livebirths (19–24) per 1000 women. Despite reductions in the TFR, the global population has been increasing by an average of 83·8 million people per year since 1985. The global population increased by 197·2% (193·3–200·8) since 1950, from 2·6 billion (2·5–2·6) to 7·6 billion (7·4–7·9) people in 2017; much of this increase was in the proportion of the global population in south Asia and sub-Saharan Africa. The global annual rate of population growth increased between 1950 and 1964, when it peaked at 2·0%; this rate then remained nearly constant until 1970 and then decreased to 1·1% in 2017. Population growth rates in the southeast Asia, east Asia, and Oceania GBD super-region decreased from 2·5% in 1963 to 0·7% in 2017, whereas in sub-Saharan Africa, population growth rates were almost at the highest reported levels ever in 2017, when they were at 2·7%. The global average age increased from 26·6 years in 1950 to 32·1 years in 2017, and the proportion of the population that is of working age (age 15–64 years) increased from 59·9% to 65·3%. At the national level, the TFR decreased in all countries and territories between 1950 and 2017; in 2017, TFRs ranged from a low of 1·0 livebirths (95% UI 0·9–1·2) in Cyprus to a high of 7·1 livebirths (6·8–7·4) in Niger. The TFR under age 25 years (TFU25; number of livebirths expected by age 25 years for a hypothetical woman who survived the age group and was exposed to current ASFRs) in 2017 ranged from 0·08 livebirths (0·07–0·09) in South Korea to 2·4 livebirths (2·2–2·6) in Niger, and the TFR over age 30 years (TFO30; number of livebirths expected for a hypothetical woman ageing from 30 to 54 years who survived the age group and was exposed to current ASFRs) ranged from a low of 0·3 livebirths (0·3–0·4) in Puerto Rico to a high of 3·1 livebirths (3·0–3·2) in Niger. TFO30 was higher than TFU25 in 145 countries and territories in 2017. 33 countries had a negative population growth rate from 2010 to 2017, most of which were located in central, eastern, and western Europe, whereas population growth rates of more than 2·0% were seen in 33 of 46 countries in sub-Saharan Africa. In 2017, less than 65% of the national population was of working age in 12 of 34 high-income countries, and less than 50% of the national population was of working age in Mali, Chad, and Niger. Interpretation: Population trends create demographic dividends and headwinds (ie, economic benefits and detriments) that affect national economies and determine national planning needs. Although TFRs are decreasing, the global population continues to grow as mortality declines, with diverse patterns at the national level and across age groups. To our knowledge, this is the first study to provide transparent and replicable estimates of population and fertility, which can be used to inform decision making and to monitor progress

Population and fertility by age and sex for 195 countries and territories, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND: Population estimates underpin demographic and epidemiological research and are used to track progress on numerous international indicators of health and development. To date, internationally available estimates of population and fertility, although useful, have not been produced with transparent and replicable methods and do not use standardised estimates of mortality. We present single-calendar year and single-year of age estimates of fertility and population by sex with standardised and replicable methods. METHODS: We estimated population in 195 locations by single year of age and single calendar year from 1950 to 2017 with standardised and replicable methods. We based the estimates on the demographic balancing equation, with inputs of fertility, mortality, population, and migration data. Fertility data came from 7817 location-years of vital registration data, 429 surveys reporting complete birth histories, and 977 surveys and censuses reporting summary birth histories. We estimated age-specific fertility rates (ASFRs; the annual number of livebirths to women of a specified age group per 1000 women in that age group) by use of spatiotemporal Gaussian process regression and used the ASFRs to estimate total fertility rates (TFRs; the average number of children a woman would bear if she survived through the end of the reproductive age span [age 10-54 years] and experienced at each age a particular set of ASFRs observed in the year of interest). Because of sparse data, fertility at ages 10-14 years and 50-54 years was estimated from data on fertility in women aged 15-19 years and 45-49 years, through use of linear regression. Age-specific mortality data came from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 estimates. Data on population came from 1257 censuses and 761 population registry location-years and were adjusted for underenumeration and age misreporting with standard demographic methods. Migration was estimated with the GBD Bayesian demographic balancing model, after incorporating information about refugee migration into the model prior. Final population estimates used the cohort-component method of population projection, with inputs of fertility, mortality, and migration data. Population uncertainty was estimated by use of out-of-sample predictive validity testing. With these data, we estimated the trends in population by age and sex and in fertility by age between 1950 and 2017 in 195 countries and territories

Estudo da proporção glótica em indivíduos sem queixa vocal com idade acima de 46 anos

BV UNIFESP: Teses e dissertaçõe

Analysis of hyaluronic acid concentration in rat vocal folds during estral and gravidic puerperal cycles

Os hormônios exercem importante influência sobre a laringe. Variações da voz são comuns na prática clínica, e podem refletir alterações nas pregas vocais ao nível macroscópico e ultraestrutural. A prega vocal contém, entre outras substâncias, 0 ácido hialurônico, sendo este responsável, em grande parte, pelas suas propriedades viscoelásticas. A concentração do ácido hialurônico nos tecidos pode variar com a ação dos hormônios. OBJETIVO: 0 objetivo deste trabalho e analisar comparativamente a concentração do ácido hialurônico nas pregas vocais de ratas durante 0 ciclo estral e ciclo gravídico-puerperal. MÉTODO: Foram utilizadas 40 ratas adultas, divididas em dois grupos, ciclo estral e gravídico-puerperal. No primeiro grupo utilizamos 20 ratas para determinação da concentração do ácido hialurônico no ciclo estral; no segundo grupo, também de 20 animais, foi realizado 0 mesmo experimento no ciclo gravídico-¬puerperal. Os dois grupos foram divididos em subgrupos de acordo com a fase do ciclo em que se encontravam, e com 0 tempo de prenhez do animal. Nos subgrupos de cinco animais, quatro foram utilizados para 0 estudo da concentração do AH e um para os procedimentos histológicos. 0 método utilizado foi desenvolvido no Departamento de Biologia Molecular da Universidade de São Paulo-Escola Paulista de Medicina e trata-¬se de um método fluorimétrico para a determinação do AH em fluidos biológicos, utilizando sondas de ligação do AH. Os cortes histológicos foram submetidos a coloração de Hematoxilina-Eosina, e azul de alcian com e sem tratamento com hialuronidase. RESULTADOS: No grupo do ciclo estral não se observou variação da concentração do ácido hialurônico. No grupo do ciclo gravídico-puerperal houve aumento da concentração do ácido hialurônico no subgrupo do puerpério. Na comparação entre os dois grupos do ciclo estral e gravídico-puerperal não houve diferença. Quando comparamos todos os subgrupos há diferença no grupo do puerpério. CONCLUSÕES: Comparando-se todos os subgrupos do ciclo estral e ciclo gravídico-puerperal, só no puerpério houve aumento da concentração do ácido hialurônico..Hormones play an important role in the larynx. Voice variations are common in the clinical practice and may reflect alterations in the vocal folds at the macroscopic and ultrastructural levels. The vocal fold is composed of a number of substances that provideits viscoelastic properties nestly the hialuronic acid. The concentration of hyaluronic acid in the tissues may vary according to hormone action. OBJECTIVE: the objective of this study is to analyze the concentration of hyaluronic acid in the vocal folds during estral and gravidic-puerperal cycles. METHOD: 40 adult female rats were divided into two groups: Group I- 20 adult female rats were to determine concentration of hyaluronic acid during the estral cycle, and group II , 20 animals were submitted to the same procedure but during the gravidic-puerperal cycle. The two groups were divided into sub-groups according to the rats phase of the cycle and according to gestacional phase. In the sub-groups of five animals, four were used to analyze the HA concentration and one was used for histological procedures. The method used was developed in the Department of Molecular Biology of the Federal University of São Paulo University – Escola Paulista de Medicina. It is a fluorometric method that determines HA in biologic fluids, using a probe to bind HA. Histological sections were submitted to alcian blue/ hematoxylin-eosin staining method with and without hyaluronidase treatment. RESULTS: Variation in the concentration of hyaluronic acid was not observed during the estral cycle. In the gravidic puerperal cycle group, an increase in the hyaluronic acid concentration was observed only in the puerperal subgroup. No difference could be observed in the comparison between the two groups of estral and gravidic-puerperal cycles, CONCLUSIONS: When comparing all subgroups of the estral and gravidic-puerperal cycles, an increase in the hyaluronic acid concentration could be seen only in the puerperal phase