Diaphragmatic excursion studied by M-Mode ultrasonography in singers. A preliminary study

Ultrasound scan is an image instrument that allows the assessment of diaphragmatic function and it does not have any side effects for patients. We have not found any literature about the use of M-mode ultrasonography to assess the diaphragmatic movement while singing. For this reason, in this paper we intend to assess this movement in two singers (soprano and contralto) after singing a high note and a low one. The diaphragmatic rise, measured as an angle of inclination, was smaller in the high notes than in the low ones in both singers an in all measurements taken. We consider that the study of diaphragmatic movement by using M-mode ultrasonography can be a study method of the behavior of this muscle while singing. This method, in the future, could be applied to the study of obstructive respiratory pathologies

Gemelli-obturator complex in the deep gluteal space: an anatomic and dynamic study

Objective: To investigate the behavior of the sciatic nerve during hip rotation at subgluteal space. Materials and methods: Sonographic examination (high-resolution ultrasound machine at 5.0–14 MHZ) of the gemelli-obturator internus complex following two approaches: (1) a study on cadavers and (2) a study on healthy volunteers. The cadavers were examined in pronation, pelvis-fixed position by forcing internal and external rotations of the hip with the knee in 90° flexion. Healthy volunteers were examined during passive internal and external hip rotation (prone position; lumbar and pelvic regions fixed). Subjects with a history of major trauma, surgery or pathologies affecting the examined regions were excluded. Results: The analysis included eight hemipelvis from six fresh cadavers and 31 healthy volunteers. The anatomical study revealed the presence of connective tissue attaching the sciatic nerve to the structures of the gemellus-obturator system at deep subgluteal space. The amplitude of the nerve curvature during rotating position was significantly greater than during resting position. During passive internal rotation, the sciatic nerve of both cadavers and healthy volunteers transformed from a straight structure to a curved structure tethered at two points as the tendon of the obturator internus contracted downwards. Conversely, external hip rotation caused the nerve to relax. Conclusion: Anatomically, the sciatic nerve is closely related to the gemelli-obturator internus complex. This relationship results in a reproducible dynamic behavior of the sciatic nerve during passive hip rotation, which may contribute to explain the pathological mechanisms of the obturator internal gemellus syndrome.Peer ReviewedPostprint (author's final draft

Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers

We hypothesize that the sciatic nerve in the subgluteal space has a specific behavior during internal and external coxofemoral rotation and during isometric contraction of the internal and external rotator muscles of the hip. In 58 healthy volunteers, sciatic nerve behavior was studied by ultrasound during passive internal and external hip rotation movements and during isometric contraction of internal and external rotators. Using MATLAB software, changes in nerve curvature at the beginning and end of each exercise were evaluated for longitudinal catches and axial movement for transverse catches. In the long axis, it was observed that during the passive internal rotation and during the isometric contraction of external rotators, the shape of the curve increased significantly while during the passive external rotation and the isometric contraction of the internal rotators the curvature flattened out. During passive movements in internal rotation, on the short axis, the nerve tended to move laterally and forward, while during external rotation the tendency of the nerve was to move toward a medial and backward position. During the isometric exercises, this displacement was less in the passive movements. Passive movements of hip rotation and isometric contraction of the muscles affect the sciatic nerve in the subgluteal space. Retrotrochanteric pain may be related to both the shear effect of the subgluteus muscles and the endoneural and mechanosensitive aggression to which the sciatic nerve is subjected.Peer ReviewedPostprint (published version

Estudio Ecográfico de la laringe en cantantes niños y adultos

Presentamos un estudio ecográfico realizado en cantantes niños y adultos. Mediante ecografía se ha visualizado y analizado el comportamiento de los pliegues vocales durante la respiración tranquila y durante distintas vocalizaciones. Los resultados obtenidos muestran que la técnica ecográfica presenta mayor resolución en el caso de los niños y niñas que en los adultos. En estos últimos, la visualización es mejor en las mujeres que en los hombres. Dado que la ecografía permite captar procesos dinámicos en tiempo real, se han realizado diversas filmaciones de los pliegues vocales durante la emisión de voz. Se ha pedido a dos cantantes, una soprano y una contralto, que realizaran una nota grave y una aguda. En ambos casos los pliegues vocales tienen un comportamiento análogo, observándose en el caso de las notas agudas una mayor tensión de los pliegues durante la fonación. Creemos que la ecografía es una técnica muy interesante para el estudio de la laringe en cantantes, ya que es una técnica no invasiva y por ello puede ser usada en niños y adultos sin ningún efecto secundario adverso

An ultrasound study of the larynx in children and adults singers

Presentamos un estudio ecográfico realizado en cantantes niños y adultos. Mediante ecografía se ha visualizado y analizado el comportamiento de los pliegues vocales durante la respiración tranquila y durante distintas vocalizaciones. Los resultados obtenidos muestran que la técnica ecográfica presenta mayor resolución en el caso de los niños y niñas que en los adultos. En estos últimos, la visualización es mejor en las mujeres que en los hombres. Dado que la ecografía permite captar procesos dinámicos en tiempo real, se han realizado diversas filmaciones de los pliegues vocales durante la emisión de voz. Se ha pedido a dos cantantes, una soprano y una contralto, que realizaran una nota grave y una aguda. En ambos casos los pliegues vocales tienen un comportamiento análogo, observándose en el caso de las notas agudas una mayor tensión de los pliegues durante la fonación. Creemos que la ecografía es una técnica muy interesante para el estudio de la laringe en cantantes, ya que es una técnica no invasiva y por ello puede ser usada en niños y adultos sin ningún efecto secundario adverso.We introduce an ultrasound study carried out to children and adults singers. The behaviour of the vocal folds has been visualised and analysed by sonography during the calm breathing and different vocalisations. The results obtained display us that the ultrasound technique presents a higher resolution in the case of boys and girls than in adults. In the latter, the visualisation is better in women than in men. Owing to the sonography allows for capture dynamic processes in real time, there was accomplished several shootings of vocal folds during the voice output. It has requested two singers, a soprano and a contralto, to perform a low note and a high note. In both cases, the vocal folds have an analogous behaviour, but it was observed a higher tension in the folds during the phonation of high notes. We think that the sonography is a very interesting technique to the larynx study in singers, because it is a non-invasive technique and that is why it can be used in children and adults without adverse side effects.Facultad de Bellas Arte

An ultrasound study of the larynx in children and adults singers

Presentamos un estudio ecográfico realizado en cantantes niños y adultos. Mediante ecografía se ha visualizado y analizado el comportamiento de los pliegues vocales durante la respiración tranquila y durante distintas vocalizaciones. Los resultados obtenidos muestran que la técnica ecográfica presenta mayor resolución en el caso de los niños y niñas que en los adultos. En estos últimos, la visualización es mejor en las mujeres que en los hombres. Dado que la ecografía permite captar procesos dinámicos en tiempo real, se han realizado diversas filmaciones de los pliegues vocales durante la emisión de voz. Se ha pedido a dos cantantes, una soprano y una contralto, que realizaran una nota grave y una aguda. En ambos casos los pliegues vocales tienen un comportamiento análogo, observándose en el caso de las notas agudas una mayor tensión de los pliegues durante la fonación. Creemos que la ecografía es una técnica muy interesante para el estudio de la laringe en cantantes, ya que es una técnica no invasiva y por ello puede ser usada en niños y adultos sin ningún efecto secundario adverso.We introduce an ultrasound study carried out to children and adults singers. The behaviour of the vocal folds has been visualised and analysed by sonography during the calm breathing and different vocalisations. The results obtained display us that the ultrasound technique presents a higher resolution in the case of boys and girls than in adults. In the latter, the visualisation is better in women than in men. Owing to the sonography allows for capture dynamic processes in real time, there was accomplished several shootings of vocal folds during the voice output. It has requested two singers, a soprano and a contralto, to perform a low note and a high note. In both cases, the vocal folds have an analogous behaviour, but it was observed a higher tension in the folds during the phonation of high notes. We think that the sonography is a very interesting technique to the larynx study in singers, because it is a non-invasive technique and that is why it can be used in children and adults without adverse side effects.Facultad de Bellas Arte

An ultrasound study of the larynx in children and adults singers

Presentamos un estudio ecográfico realizado en cantantes niños y adultos. Mediante ecografía se ha visualizado y analizado el comportamiento de los pliegues vocales durante la respiración tranquila y durante distintas vocalizaciones. Los resultados obtenidos muestran que la técnica ecográfica presenta mayor resolución en el caso de los niños y niñas que en los adultos. En estos últimos, la visualización es mejor en las mujeres que en los hombres. Dado que la ecografía permite captar procesos dinámicos en tiempo real, se han realizado diversas filmaciones de los pliegues vocales durante la emisión de voz. Se ha pedido a dos cantantes, una soprano y una contralto, que realizaran una nota grave y una aguda. En ambos casos los pliegues vocales tienen un comportamiento análogo, observándose en el caso de las notas agudas una mayor tensión de los pliegues durante la fonación. Creemos que la ecografía es una técnica muy interesante para el estudio de la laringe en cantantes, ya que es una técnica no invasiva y por ello puede ser usada en niños y adultos sin ningún efecto secundario adverso.We introduce an ultrasound study carried out to children and adults singers. The behaviour of the vocal folds has been visualised and analysed by sonography during the calm breathing and different vocalisations. The results obtained display us that the ultrasound technique presents a higher resolution in the case of boys and girls than in adults. In the latter, the visualisation is better in women than in men. Owing to the sonography allows for capture dynamic processes in real time, there was accomplished several shootings of vocal folds during the voice output. It has requested two singers, a soprano and a contralto, to perform a low note and a high note. In both cases, the vocal folds have an analogous behaviour, but it was observed a higher tension in the folds during the phonation of high notes. We think that the sonography is a very interesting technique to the larynx study in singers, because it is a non-invasive technique and that is why it can be used in children and adults without adverse side effects.Facultad de Bellas Arte

Patrones musculares en el canto. Un estudio piloto.

En estudios electromiográficos realizados previamente en diferentes cantantes, observamos cómo durante la emisión de la voz se producía la activación de los músculos espiradores y en paralelo se producía la contracción de los músculos intercostales externos, potentes inspiradores. Dadas estas observaciones, hemos realizado un estudio piloto con una cantante analizando el comportamiento conjunto de los músculos antes mencionados y del diafragma. Durante dife - rentes vocalizaciones hemos medido paralelamente la actividad muscular con electromiografía (EMG) y hemos observado el retorno diafragmático mediante ecografía. Los resultados apuntan a que el ascenso del diafragma está directamente relacionado con la nota emitida. Así, en el caso de una nota grave, el diafragma retorna lentamente acompañando el sonido. En el caso de las notas agudas, el diafragma se mantiene casi inmóvil durante la mayor parte de la emisión sonora y sólo al final de la vocalización se produce su ascenso de manera lenta. Se observa que durante la espiración en el canto, los músculos intercostales ex - ternos actúan elevando y fijando las costillas lo que impide el ascenso libre del diafragma, que se mantiene en tensión y se eleva de manera lenta y controlada gracias a la presión ejercida por los músculos del abdome

Tumor phenotype and breast density in distinct categories of interval cancer: results of population-based mammography screening in Spain

Introduction: Interval cancers are tumors arising after a negative screening episode and before the next screening invitation. They can be classified into true interval cancers, false-negatives, minimal-sign cancers, and occult tumors based on mammographic findings in screening and diagnostic mammograms. This study aimed to describe tumor-related characteristics and the association of breast density and tumor phenotype within four interval cancer categories. Methods: We included 2,245 invasive tumors (1,297 screening-detected and 948 interval cancers) diagnosed from 2000 to 2009 among 645,764 women aged 45 to 69 who underwent biennial screening in Spain. Interval cancers were classified by a semi-informed retrospective review into true interval cancers (n = 455), false-negatives (n = 224), minimal-sign (n = 166), and occult tumors (n = 103). Breast density was evaluated using Boyd’s scale and was conflated into: 75%. Tumor-related information was obtained from cancer registries and clinical records. Tumor phenotype was defined as follows: luminal A: ER+/HER2- or PR+/HER2-; luminal B: ER +/HER2+ or PR+/HER2+; HER2: ER-/PR-/HER2+; triple-negative: ER-/PR-/HER2-. The association of tumor phenotype and breast density was assessed using a multinomial logistic regression model. Adjusted odds ratios (OR) and 95% confidence intervals (95% CI) were calculated. All statistical tests were two-sided. Results: Forty-eight percent of interval cancers were true interval cancers and 23.6% false-negatives. True interval cancers were associated with HER2 and triple-negative phenotypes (OR = 1.91 (95% CI:1.22-2.96), OR = 2.07 (95% CI:1.42-3.01), respectively) and extremely dense breasts (>75%) (OR = 1.67 (95% CI:1.08-2.56)). However, among true interval cancers a higher proportion of triple-negative tumors was observed in predominantly fatty breasts (<25%) than in denser breasts (28.7%, 21.4%, 11.3% and 14.3%, respectively; <0.001). False-negatives and occult tumors had similar phenotypic characteristics to screening-detected cancers, extreme breast density being strongly associated with occult tumors (OR = 6.23 (95% CI:2.65-14.66)). Minimal-sign cancers were biologically close to true interval cancers but showed no association with breast density. Conclusions: Our findings revealed that both the distribution of tumor phenotype and breast density play specific and independent roles in each category of interval cancer. Further research is needed to understand the biological basis of the overrepresentation of triple-negative phenotype among predominantly fatty breasts in true interval cancers

Muscle patterns in singing. A pilot study

En estudios electromiográficos realizados previamente en diferentes cantantes, observamos cómo durante la emisión de la voz se producía la activación de los músculos espiradores y en paralelo se producía la contracción de los músculos intercostales externos, potentes inspiradores. Dadas estas observaciones, hemos realizado un estudio piloto con una cantante analizando el comportamiento conjunto de los músculos antes mencionados y del diafragma. Durante diferentes vocalizaciones hemos medido paralelamente la actividad muscular con electromiografía (EMG) y hemos observado el retorno diafragmático mediante ecografía. Los resultados apuntan a que el ascenso del diafragma está directamente relacionado con la nota emitida. Así, en el caso de una nota grave, el diafragma retorna lentamente acompañando el sonido. En el caso de las notas agudas, el diafragma se mantiene casi inmóvil durante la mayor parte de la emisión sonora y sólo al final de la vocalización se produce su ascenso de manera lenta. Se observa que durante la espiración en el canto, los músculos intercostales externos actúan elevando y fijando las costillas lo que impide el ascenso libre del diafragma, que se mantiene en tensión y se eleva de manera lenta y controlada gracias a la presión ejercida por los músculos del abdomen.In electromyographic studies previously executed in different singers, we observed how the activation of exhaling muscles was produced during the voice output, and how the contraction of the external intercostal muscles -powerful inspiratories- was produced in parallel. Given these observations, we conducted a pilot study with a female singer and analysed the behavior of all the aforementioned muscles and of the diaphragm. During different vocalisations, we have measured in parallel the muscle activity with electromyography (EMG) and have observed the diaphragmatic return by ultrasound. The results suggest that the rise of the diaphragm is directly related to the issued notes. Thus, in the case of a low note, the diaphragm returns slowly accompanying the sound. In the case of the high notes, the diaphragm remains almost immobile for most of the sound emission and his rise occurs slowly only at the end of the vocalisation. It is noted that during the expiration in singing, external intercostal muscles raise and fixe the ribs which prevents a free ascent of the diaphragm -which is held in tension and rised slowly and controllably thanks to the pressure exerted by the abdominal muscles.Facultad de Bellas Arte