The mountainous Cretan dietary patterns and their relationship with cardiovascular risk factors: the Hellenic Isolated Cohorts MANOLIS study

Objective We carried out de novo recruitment of a population-based cohort (MANOLIS study) and describe the specific population, which displays interesting characteristics in terms of diet and health in old age, through deep phenotyping. Design Cross-sectional study where anthropometric, biochemical and clinical measurements were taken in addition to interview-based completion of an extensive questionnaire on health and lifestyle parameters. Dietary patterns were derived through principal component analysis based on a validated FFQ. Setting Geographically isolated Mylopotamos villages on Mount Idi, Crete, Greece. Subjects Adults (n 1553). Results Mean age of the participants was 61·6 years and 55·8 % were women. Of the population, 82·7 % were overweight or obese with a significantly different prevalence between overweight men and women (43·4 v. 34·7 %, P=0·002). The majority (70·6 %) of participants were married, while a larger proportion of women were widowed than men (27·8 v. 3·5 %, P<0·001). Smoking was more prevalent in men (38·7 v. 8·2 %, P<0·001), as 88·8% of women had never smoked. Four dietary patterns emerged as characteristic of the population; these were termed ‘local’, ‘high fat and sugar, ‘Greek café/tavern’ and ‘olive oil, fruits and vegetables’. Individuals more adherent to the local dietary pattern presented higher blood glucose (β=4·026, P<0·001). Similarly, individuals with higher compliance with the Greek café/tavern pattern had higher waist-to-hip ratio (β=0·012, P<0·001), blood pressure (β=1·015, P=0·005) and cholesterol (β=5·398, P<0·001). Conclusions Profiling of the MANOLIS elderly population identifies unique unhealthy dietary patterns that are associated with cardiometabolic indices

In vivo study of the neuropretective actions of somatostatin in a model of retinal excitotoxicity

An increasing number of clinical and laboratory studies have focused on the investigation of the pathophysiology and therapy of retinal diseases, such as diabetic retinopathy, glaucoma and age-related macular degeneration, that lead to visual impairment and blindness. Ischemia has been shown to be the underlying cause of these diseases. It leads to neovascularization and neuronal cell death. The cascade of events leading to the ischemia induced cell death involves increases in glutamate, the major excitatory neurotransmitter in retina, intracellular calcium ions and nitric oxide (NO) levels (Osborne et al., 2004). The neuropeptide somatostatin has been considered as a possible therapeutic target because of its well known inhibitory actions on Ca2+ channels and intracellular calcium levels (Reisine, 1990, Tallent et al., 1996). The aim of the present study was to investigate the neuroprotective effects of somatostatin in an in vivo model of retinal excitotoxicity, employing the excitatory amino acid AMPA. The intravitreal administration of AMPA (42nmol per rat eye) resulted in a loss of retinal neurons such as cholinergic amacrine, bNOS expressing amacrine and horizontal cells, 24 hours after its administration. An increase in apoptosis was also observed in the AMPA treated samples. Somatostatin levels and the expression of the sst2 and sst5 somatostatin receptor subtypes were not affected by the AMPA treatment. Intravitreal co-injection of AMPA with somatostatin or sst2 and sst5 selective analogs protected the retina from the AMPA induced toxicity in a dose dependent manner. The best protection was afforded by sst2 selective ligands since immunohistochemical studies showed that AMPA induced retinal cell loss was fully reversed. TUNEL studies confirmed the above results. The increase in apoptosis observed in the AMPA treated samples was drastically reduced in the presence of the somatostatinergic sst2 analogs. Intravitreal injection of the sst2 selective analogs after the administration of AMPA afforded partial protection. In order to study the mechanism involved in somatostatin’s neuroprotective actions against excitotoxicity, the involvement of the intracellular signaling pathway NO/cGMP was studied. The blockade of NO synthase and guanylate cyclase, the enzymes that catalyze the synthesis of nitric oxide and cGMP respectively, reversed the actions of the somatostatinergic analogs. These results offer new in vivo evidence supporting that sst2 and sst5 selective ligands, for the first time injected intravitreally, protect the retina from excitotoxic insults, and reinforce the theory of the involvement of NO/cGMP signaling in somatostatin’s protective effects. The present data encourage the therapeutic use of somatostatin either alone or in combination with other treatments presently applied (photocoagulation, anti-VEGFs) in the therapeutics of retinal diseases whose pathophysiology involves ischemia induced neurodegeneration or ischemia induced neovascularization. Further investigations are essential to study the pharmacokinetic properties of sst2 and sst5 selective analogs to assess the best conditions for optimum efficacy

The contribution of acoustic voice analysis in diagnosis of benign larungeal lesions and the outcome of phonosurgery

Acoustic measures have been extensively studied, in terms of their relation with laryngeal pathology, the perceptual severity of dysphonia and the outcome of interventions (surgical and conservative), as well as the other measures of vocal performance, and the results have been controversial. In the present study, patients, operated for benign laryngeal lesions with microlaryngoscopy were included. They were assessed according to the protocol, proposed by the European Laryngological Society (Dejonkere et al, 2001) with stroboscopy, perceptual analysis, voice analysis, aerodynamic measurements and subjective evaluation questionnaires, before and after the operation.In the first part of the study, the role of the Greek version of Voice Handicap Index (VHI) was studied, in comparison with the Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome. A statistical significant change in subscale scores, as well as in total score, was found. VHI and VoiSS correlated strongly to each other. Both VHI and VoiSS correlated with perceptual characteristics before and after the operation. Among acoustic measures, Harmonic-to-Noise Ratio (HNR) and shimmer, showed significant correlation with both VHI and VoiSS subscale and total scores, post-operatively. None of the two, however, correlated with stroboscopic, and aerodynamic measurements. VHI and VoiSS were considered useful tools in evaluating voice surgery outcome, in the Greek language.In the second part of the study, acoustic measurements (jitter, shimmer, HNR, NHR) by two commercially available analysis programs, Praat and MDVP were compared, in terms of independent information they provide, and the influence of parameters such as gender, SPL, as well the data acquisition system. Moreover, the relationships between acoustic measurements and the other measures of vocal assessment, especially perception and VHI, were studied with correlation coefficients, as well as with Mutual Information analysis. All measurements changed significantly postoperatively, except for F0. The results were dispersed among individuals, as not all patients had pathological measurements preoperatively, neither improved in all measurements postoperatively. The two programs seemed to correlate in the majority of cases, MDVP measuring higher values. Noise measures from Praat were observed to correlate the most with perceptual parameters (GRBAS scale). MI analysis, revealed in many cases nonlinear relationships between the pairs of measures analyzed.Acoustic voice analysis was proven to a useful outcome measure of microlaryngoscopy, as part of the multidimensional voice assessment protocol.Η ακουστική ανάλυση σήματος αποτελεί πεδίο έρευνας και κλινικών εφαρμογών, εδώ και δεκαετίες. Συγκεκριμένα, από την περιγραφή της ανάλυσης διαταραχής και των χαρακτηριστικών της από τον Lieberman, έως την ευρεία πλέον χρήση των προγραμμάτων ανάλυσης στην κλινική πράξη, έχουν μεσολαβήσει πολυάριθμες ερευνητικές καινοτομίες στους αλγορίθμους και τα προγράμματα επεξεργασίας, που στόχο είχαν την βελτίωση της αξιοπιστίας της ακουστικής ανάλυσης, ως αντικειμενικό μέσο αξιολόγησης της φωνητικής λειτουργίας.Τα χαρακτηριστικά μεγέθη της ακουστικής ανάλυσης κατηγοριοποιούνται βάσει των χαρακτηριστικών σήματος που μεταφέρουν. Ένα αποδεκτό σύστημα ταξινόμησης είναι μεταξύ «χαρακτηριστικών απεριοδικότητας» (aperiodicity features) και «χαρακτηριστικών θορύβου» (noise features). Τα πρώτα, μετρούν μικρής διάρκειας (από κύκλο σε κύκλο) διαταραχές του ακουστικού σήματος, που αφορούν αποκλίσεις της θεμελιώδους συχνότητας ή της έντασης, ενώ τα δεύτερα χρησιμοποιούνται για τη μέτρηση του θορύβου που περιέχεται στο φωνητικό σήμα, ως ποσοστό απεριοδικότητας του φωνητικού σήματος. Τα ακουστικά μεγέθη έχουν βρεθεί να αντικατοπτρίζουν χαρακτηριστικά της αντιληπτικής ποιότητας της φωνής.Η ακουστική ανάλυση του φωνητικού σήματος, επίσημα από το 2001, περιλαμβάνεται στο προτεινόμενο πρωτόκολλο της Ευρωπαїκής Λαρυγγολογικής Κοινότητας (European Laryngological Society) για την αξιολόγηση της φωνητικής λειτουργίας μαζί με την στροβοσκόπηση, την αντιληπτική αξιολόγηση της φωνής, τις αεροδυναμικές μετρήσεις και την υποκειμενική εκτίμηση της φωνής από τον ίδιο τον ασθενή. Επίσης, η χρήση της στην κλινική πράξη έχει εδραιωθεί τις τελευταίες δεκαετίες, με τη χρήση διαθέσιμων στο εμπόριο προγραμμάτων ανάλυσης. Βιβλιογραφικά, τα ακουστικά χαρακτηριστικά έχουν εκτεταμένα μελετηθεί όσον αφορά την ικανότητά τους να διαφοροδιαγιγνώσκουν μεταξύ των φωνητικών διαταραχών, τη συσχέτισή τους με την αντιληπτική αξιολόγηση των φωνητικών συμπτωμάτων του ασθενή και τη χρησιμότητά τους ως αντικειμενικά μέσα αξιολόγησης έκβασης της θεραπευτικής παρέμβασης (λογοθεραπευτικής, χειρουργικής ή φαρμακευτικής). Ωστόσο, τα έως τώρα βιβλιογραφικά δεδομένα είναι αντικρουόμενα, και διαφοροποιούνται συχνά ανάλογα με τις ομάδες ασθενών που μελετώνται και τα προγράμματα ανάλυσης που χρησιμοποιούνται.Η παρούσα μελέτη επιχειρεί να εξετάσει το ρόλο της ακουστικής ανάλυσης ρουτίνας ως μέσο αντικειμενικής εκτίμησης της φωνητικής λειτουργίας στη διάγνωση των συνήθων καλοηθών χειρουργικών παθήσεων του λάρυγγα και την αξιολόγηση της έκβασης της χειρουργικής θεραπείας.Στο «Γενικό Μέρος», περιλαμβάνονται, αρχικά, στοιχεία ανατομίας του λάρυγγα και φυσιολογίας της φωνητικής λειτουργίας, και περιγραφή των βασικότερων καλοηθών λαρυγγικών παθήσεων καθώς και των βασικών αρχών της φωνοχειρουργικής. Ακολουθεί εκτεταμένη βιβλιογραφική ανασκόπηση, όσον αφορά τις μεθόδους αξιολόγησης της φωνητικής λειτουργίας και ειδικότερα της ακουστικής ανάλυσης, με τις βασικές θεωρητικές αρχές αυτής. Στο «Ειδικό Μέρος», περιγράφεται ο σχεδιασμός της μελέτης και οι μέθοδοι ανάλυσης που χρησιμοποιήθηκαν. Συγκεκριμένα, η μελέτη περιελάμβανε δυο φάσεις, και πραγματοποιήθηκε ως εξής:Οι ασθενείς που μελετήθηκαν, χειρουργήθηκαν για καλοήθεις λαρυγγικές παθήσεις (πολύποδες, οίδημα Reinke, κύστεις και οζίδια) με μικρολαρυγγοσκόπηση και αξιολογήθηκαν πριν και μετά την χειρουργική επέμβαση, σύμφωνα με τις οδηγίες του Ευρωπαїκού πρωτοκόλλου.Στην πρώτη φάση της μελέτης, πραγματοποιήθηκε συγκριτική μελέτη των ελληνικών μεταφράσεων του Voice Handicap Index (VHI) και του Voice Symptom Scale (VoiSS). Τα VHI και VoiSS αποτελούν ερωτηματολόγια σχεδιασμένα για ασθενείς με φωνητικές διαταραχές, με παρόμοια δομή αλλά διαφορές στο περιεχόμενο των ερωτημάτων. Tα ερωτηματολόγια συγκρίθηκαν, όσον αφορά τη συσχέτιση μεταξύ τους καθώς και τις συσχετίσεις τους με τα λοιπά μέσα αξιολόγησης.Η δεύτερη φάση της μελέτης, αφορούσε τα χαρακτηριστικά μεγέθη της ακουστικής ανάλυσης από δυο προγράμματα ανάλυσης, το Praat και το MDVP, τα οποία είναι ευρέως διαθέσιμα και χρησιμοποιούμενα στην κλινική πράξη. Οι μετρήσεις από τα δυο προγράμματα μελετήθηκαν συγκριτικά, όσον αφορά το βαθμό ανεξαρτησίας τους, τους παράγοντες επηρεασμού των ακουστικών μετρήσεων καθώς και το ρόλο τους ως μέσα αξιολόγησης της αντιληπτικής ποιότητας της φωνής. Επιπλέον, διερευνήθηκε ο ρόλος της ακουστικής ανάλυσης των δυο προγραμμάτων στην αξιολόγηση του αποτελέσματος της χειρουργικής επέμβασης σε συνάρτηση με τις αντιληπτικές, αεροδυναμικές και στροβοσκοπικές παραμέτρους καθώς και την υποκειμενική αξιολόγηση από τους ασθενείς. Τέλος, οι συσχετίσεις των ακουστικών μετρήσεων με τις αντιληπτικές παραμέτρους και τη βαθμολογία του VHI, μελετήθηκαν περαιτέρω με τη μέθοδο της Αμοιβαίας Πληροφορίας

CO2 laser cordectomy for glottic squamous cell carcinoma involving the anterior commissure: voice and oncologic outcomes

Transoral CO2 laser cordectomy for squamous cell carcinoma (SCC) of the glottis has resulted in excellent voice and oncologic outcomes as compared with non-surgical therapy. However, published experience with primary CO2 laser cordectomy specifically for glottic SCC involving the anterior commissure (AC) is limited. A review of single academic institution experience with CO2 laser cordectomy for glottic SCC involving the AC. Patients undergoing European Laryngological Society (ELS) classification cordectomy type Va or type VI between 2005 and 2013 were included. Post-surgical voice analysis was performed by speech language pathologists (SLP) from the reporting institution. Thirty patients were identified for inclusion. Mean post-surgical follow-up time was 47.6 months (range 11–59). Initial local recurrence was identified in 5/30 (16.7 %) patients. 2/5 recurrences were successfully salvaged by repeat CO2 laser resections, 2/5 ultimately required salvage total laryngectomy, and 1/5 patient developed a second primary preventing further curative treatment. Overall laryngeal preservation rate was 28/30 (93.3 %). Overall survival of the study cohort was 96.7 %. Mean postoperative voice handicap index-120 score was 36.9 (SD = 21.4). Perceptual analysis performed on the GRBAS scale resulted in mean scores: G = 2.1 (SD = 0.9), R = 1.3 (SD = 1.1), B = 1.6 (SD = 1.2). Though cancers involving the AC represent an aggressive subgroup of glottic SCC, CO2 laser cordectomy results in encouraging oncologic and voice outcomes without the need for further therapy in the majority of cases. Clinical trials are encouraged to further define optimal treatment recommendations for glottic SCC involving the AC

Evaluation of surgical treatment outcome in real-time conditions using a portable device :preliminary data

info:eu-repo/semantics/publishe

Wendler glottoplasty: An effective pitch raising surgery in male-to-female transsexuals

Objectives: Evaluation of the voice results after Wendler glottoplasty in male-to-female transsexuals (MFTs). Study Design: Retrospective case series. Methods: We retrospectively reviewed 31 MFT patients treated with a Wendler glottoplasty technique. The procedure consists of the CO2-laser de-epithelialization of the anterior commissure along with the anterior third of the two vocal folds, the suturing of the two vocal folds with two 3.0 resorbable threads, and next, the application of fibrin sealant to strengthen the stitches. Voice assessment was based mainly on fundamental frequency, frequency range, maximum phonation time, phonation quotient, estimated subglottic pressure (ESGP), grade of dysphonia (G), and voice handicap index. The measurements were performed preoperatively and on the last follow-up visit and compared using IBM SPSS 20 statistical package (IBM Corp, Armonk, NY). The patients have been divided in two groups (group A younger than 40 years and group B of or older than 40 years) for assessing the influence of the age of treatment on the results. Results: Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3 Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8 Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction. Conclusion: Wendler glottoplasty seems to be an effective technique to feminize the voice in MFTs with better results when performed in younger individuals. © 2013 The Voice Foundation

The Effect of Voice Rest on the Outcome of Phonosurgery for Benign Laryngeal Lesions: Preliminary Results of a Prospective Randomized Study.

OBJECTIVES: According to the literature, voice rest following phonosurgery, as recommended in clinical practice, varies between 3 and 7 days. However, up until now, no randomized trials have been published comparing voice rest of short versus long duration. METHODS: This is an ongoing prospective randomized study, comparing strict voice rest of 5 versus 10 days on the voice following phonosurgery. Thirty-one elective patients operated on for benign laryngeal lesions were randomized. They completed pre- and postoperative assessments, including perceptual voice quality (Grade, Roughness, Breathiness, Asthenia, Strain, Instability scale), Voice Handicap Index total score, and voice analysis with both acoustic and aerodynamic measurements. Additional factors such as smoking, vocal abuse, reflux, and preoperative speech therapy were also taken into account. RESULTS: Sixteen patients were randomized to follow 5 days' voice rest and 15 patients were randomized to 10 days' voice rest. Statistical analysis showed no significant differences in pre- or postoperative measurements between the 2 groups. However, multilinear regression analysis for the effect of voice rest duration on postoperative values showed a significant improvement in maximum phonation time (MPT) with 10 days' voice rest. CONCLUSIONS: Preliminary results show a benefit of prolonged voice rest (10 days' duration) on MPT