Laryngeal Transplantation in 2005: A Review

There is no good surgical, medical or prosthetic solution to the problems faced by those with a larynx whose function is irreversibly damaged by tumor or trauma. Over the past 10 years, the pace of research designed to establish laryngeal transplantation as a therapeutic option for these persons has increased steadily. The biggest milestone in this field was the world's first true laryngeal transplant performed in Cleveland, Ohio in 1998. The recipient's graft continues to function well, in many respects, even after 7 years. However, it has also highlighted the remaining barriers to full-scale clinical trials. Stimulated by these observations, several groups have accumulated data which point to answers to some of the outstanding questions surrounding functional reinnervation and immunomodulation. This review seeks to outline the progress achieved in this field by 2005 and to point the way forward for laryngeal transplantation research in the 21st century.     

Effect of asymmetric vocal fold stiffness on traveling wave velocity in the canine larynx.

The vocal fold (VF) traveling wave is essential to normal voice production. The present investigation describes a new method to determine traveling wave velocity (TWV) in the in vivo canine phonatory model. This method synchronizes photoglottographic and electroglottographic waveforms with videostroboscopic images to determine the duration of time the traveling wave moves between two tattoos placed a known distance apart between the upper and lower margins of each VF. Using this method, we compared the TWV of a paralyzed VF with the TWV of the contralateral, electrically stimulated VF during phonation in two canines. In addition, the presumed VF stiffness asymmetry in the simulated acute recurrent laryngeal nerve paralysis state was confirmed by measuring Young's modulus of each VF. The results indicated that the TWV of the paralyzed VF averaged 55% of the TWV of the normal, stiffer VF when the glottal gap was small and entrainment occurred. This study demonstrated the feasibility of quantifying traveling wave motion in asymmetric VF stiffness disorders. The potential use of TWV in human beings as a target to optimize the phonosurgical results in asymmetric VF stiffness disorders is discussed.     

Resting metabolic rate and the influence of the pretesting environment.

We examined the effect of pretesting environment on measurement of resting metabolic rate (RMR). RMR was measured in 18 older (66.1 +/- 1.4 y) individuals after an overnight stay in the Clinical Research Center (ie, inpatient) and after subjects transported themselves to the laboratory (ie, outpatient). Similar measurements were also performed after an 8-wk endurance-training program. RMR was higher (P less than 0.01) before exercise training in subjects who transported themselves to the laboratory (ie, outpatients; 4.9 +/- 0.13 kJ/min) than in inpatients (4.6 +/- 0.13 kJ/min) and after exercise training in outpatients (5.4 +/- 0.08 kJ/min) vs inpatients (5.0 +/- 0.13 kJ/min). Training increased RMR under both inpatient (10%; P less than 0.01) and outpatient (11%; P less than 0.01) conditions. We conclude that RMR is higher when measured under outpatient conditions in older volunteers. Therefore, when daily energy requirements based on the assessment of RMR are being estimated, the pretesting environment should be considered. However, the exercise-training-induced increase in RMR can be detected by using either an inpatient or an outpatient protocol.     

Medical data analysis using microprocessor-based Walsh transformations

The use of Fourier transforms based on orthogonal sinusoidal functions is well established in the analysis of spectral components in noisy medical signals. In this paper the use of Walsh transformations based on orthogonal discrete signals is described for the analysis of ‘slow-wave’ rhythms in the gastro-intestinal tract of mammals. The Walsh transform approach has the advantage that very fast algorithms can be developed since multiplications involving sinusoidal functions are replaced by additions and subtractions. These algorithms are very suitable for simple microprocessors and it is shown that, for determining the frequency of gut rhythms, simple filtering and signal conditioning preceding the microprocessor dispenses with the need for analogue to digital conversion. Hence a very simple digital microprocessing system for the continuous monitoring of gut rhythms has been produced. It has also been extended to provide filtering of signals via forward and inverse Walsh transforms.     

Diabetes education: a chance to improve well-being of Turkish people with type 2 diabetes

To examine the influence of diabetes education on well-being, 255 patients with type 2 diabetes were recruited according to whether they attended a diabetes education program (n=126) or not (n=129). In patients who had participated in the program, the mean anxiety score was significantly lower, whereas positive well-being and general well-being scores were significantly higher than for patients who had not participated. Factors related to lower well-being included: being female, taking insulin, not attending a diabetes education program and having HbA(1c) level greater than 8%. The odds of having better well-being were two-fold higher in patients participating the diabetes education program compared with those who had not. Diabetes education has a crucial role in improving the well-being of patients with type 2 diabetes. All patients with diabetes should be encouraged to attend a diabetes education program.     

Ophthalmic findings in GAPO syndrome

BACKGROUND: The main manifestations of GAPO syndrome are growth retardation (G), alopecia (A), pseudoanodontia (P), and optic atrophy (O). CASES: This syndrome has been described in 21 patients from 16 different families. Four cases are from Turkey and have been presented by Sayli and Gül. The purpose of our study is to document the cases from Turkey and discuss the ophthalmological and neuro-ophthalmolgical findings of these and other reported GAPO cases. OBSERVATIONS: All patients in the literature and our 4 cases have severe growth retardation with delayed bone age in infancy, characteristic facial appearance (high and bossed forehead, midface hypoplasia), alopecia or severe hypotrichosis, and pseudoanodontia. Optic atrophy was present in 1 of our cases and in 5 previous cases. Glaucoma was present in 5 cases, including 2 of ours. Buphthalmia and keratopathy secondary to glaucoma were also observed. White eyelashes, seen only in our cases, may be a sign of "early senility." CONCLUSIONS: Optic atrophy is not a constant finding in GAPO syndrome. Glaucoma may accompany the ocular findings. This syndrome has been attributed to either ectodermal dysplasia or the accumulation of extracellular connective tissue matrix, due to an enzyme deficiency involved in its metabolism. Current studies show that an elastin defect and secondary changes in collagen may be important in the pathogenesis of the disease.     

Competitive inhibition of cytotoxic T lymphocyte-target cell conjugation. A direct evaluation of membrane antigens involved in cell-mediated immunity.

A method to determine directly the antigenic similarity of target cells (TCs) involved in cytotoxic T lymphocyte (CTL)-TC interactions is described. When fluorescently labeled TC (FL-TCs) are bound (conjugated) to CTLs in the presence of antigenically similar but unlabeled TCs, the percentage of CTL-TC conjugates containing unlabeled TCs corresponds linearly to the number of unlabeled TCs in the TC population. This assay is specific, permits direct observation of individual CTLs and TCs which interact to form conjugates, can be completed within 10 min, eliminates complications attributable to CTL recycling, and the degree of competition observed fits that theoretically expected. The results of this paper provide the theoretical basis for "cold" (unlabeled) target inhibition of radioactive assays of lymphocyte-mediated cytolysis.     

异常黑胆质成熟剂黄酮类化合物诱导HepG2细胞凋亡机制的研究

目的：观察异常黑胆质成熟剂中黄酮类化合物对人肝癌细胞株(HepG2)体外生长、凋亡及相关基因表达的调控作用,探讨异常黑胆质成熟剂黄酮类化合物诱导癌细胞凋亡及抗癌活性的物质基础及其作用机制。方法：采用四氮甲基唑蓝法(MTT)、琼脂糖凝胶电泳技术、流式细胞术及逆转录-多聚酶链式反应技术(RT-PCR)等,观察异常黑胆质成熟剂黄酮类化合物对HepG2生长、凋亡及凋亡基因调控的影响。结果：异常黑胆质成熟剂黄酮类化合物明显抑制HepG2细胞体外生长,HepG2细胞在sub-G₁期受到阻滞,并能诱导细胞发生凋亡,明显下调Bcl-2 mRNA表达水平,同时可上调p53,p21,Bax基因mRNA表达水平。结论：异常黑胆质成熟剂黄酮类化合物对癌细胞体外生长、凋亡及凋亡基因表达具有明显的调控作用。黄酮类化合物可能是异常黑胆质成熟剂发挥抗癌作用的主要活性成分,而抑制细胞生长、诱导细胞凋亡及调控凋亡基因表达等可能是其发挥抗癌活性的重要途径。     

Laryngeal configuration associated with glottography

This report describes a method for testing and confirming the relationship of glottography to the vibratory movements of the vocal folds. According to this method, vocal fold movement is monitored by photoglottography (PGG) and electroglottography (EGG) as photographs are taken using a 80-microsecond flash provided by a laryngostroboscope. The flash is recorded as an impulse on the PGG waveform, indicating the location on the glottographic signals of the corresponding single frame photograph. We then present a test case, in which various vocal fold configurations are documented, demonstrating that the timing of glottal events can be correlated to glottographic signals by this method.     

Transtracheal stimulation of the recurrent laryngeal nerve

Phonation was induced in 10 mongrel dogs under general anesthesia by way of transtracheal stimulation of the recurrent laryngeal nerves under conditions of constant air flow. Although stimulation voltages were approximately 10 times the voltage required for direct stimulation, no cardiac or respiratory abnormalities were observed. Photoglottographic and electroglottographic signals were the same for both direct and transtracheally induced phonation. This phonation induction method can be used in chronic animal preparations to study vocal fold vibration sequentially and may be clinically applied to the treatment of patients with laryngeal problems that have failed to respond, or are not amenable, to standard forms of vocal rehabilitation.