Management of a complete mole and coexisting fetus in post-dobbs world.

BACKGROUND: Twin pregnancies consisting of a complete hydatidiform mole and a coexistent fetus (CMCF) are rare and associated with a high rate of maternal-fetal morbidity and mortality. Management of these pregnancies remains controversial and increasingly challenging following the Dobbs versus Jackson Women's Health decision given the viability of the coexisting twin fetus. CASE: This case looks at the diagnosis, management, and maternal-fetal outcomes of a viable fetus coexisting molar pregnancy at a large academic center in an abortion-restricted state. CONCLUSION: CMCF pregnancies are associated with a high risk of morbidity and mortality and are increasingly difficult to manage following the Dobbs decision. Testing platforms, which identify genetic abnormalities in the first trimester, are increasingly important as access to abortion care in the United States is restricted.

Protocol for teen inflammation glutamate emotion research (TIGER): Toward predictors of treatment response and clinical course in depressed adolescents.

Adolescent-onset depression is a prevalent and debilitating condition commonly associated with treatment refractory depression and non-response to first-line antidepressants. There are, however, no objective tests to determine who may or may not respond to antidepressants. As depressed adolescents are especially vulnerable to the lifelong consequences of ineffectively-treated depression, it is critical to identify neurobiological predictors of treatment non-response in this population. Here, we describe the scientific rationale and protocol for the Teen Inflammation Glutamate Emotion Research (TIGER) study, a prospective 18-month investigation of 160 depressed adolescents who will be assessed before and after treatment with selective serotonin reuptake inhibitors. TIGER will be using ultra-high field imaging to test the effects of acute stress and antidepressant treatment on inflammatory and glutamatergic processes hypothesized to underlie depression maintenance. Results from this work will motivate future studies testing alternative therapeutics for depressed adolescents at risk for treatment resistant depression. ClinicalTrials.gov Identifier: NCT05329441.

Neighborhood Socioeconomic Disadvantage and White Matter Microstructure of the Arcuate Fasciculus and Uncinate Fasciculus in Adolescents.

Background: Neighborhood- or area-level socioeconomic disadvantage is associated with neural alterations across the life span. However, few studies have examined the effects of neighborhood disadvantage on white matter microstructure during adolescence, an important period of development that coincides with increased risk for psychopathology. Methods: In 200 adolescents (ages 13-20 years; 54.5% female, 4% nonbinary) recruited from 2 studies enriched for early adversity and depression, we examined whether neighborhood socioeconomic disadvantage derived from census tract data was related to white matter microstructure in several major white matter tracts. We also examined whether depressive symptoms and sex moderated these associations. Results: Greater neighborhood socioeconomic disadvantage was associated with lower fractional anisotropy (FA) in the left arcuate fasciculus (ß = -0.24, false discovery rate [FDR]-corrected p = .035) and right uncinate fasciculus (ß = -0.32, FDR-corrected p = .002) above and beyond the effects of family-level socioeconomic status. Depressive symptoms significantly moderated the association between left arcuate fasciculus FA and both neighborhood (ß = 0.17, FDR-corrected p = .026) and unemployment (ß = 0.22, FDR-corrected p = .004) disadvantage such that these associations were only significant in adolescents who reported less severe depression. Sex did not moderate the association between socioeconomic disadvantage and FA in these tracts. Conclusions: Greater neighborhood socioeconomic disadvantage, particularly poverty and educational attainment levels, was associated with lower FA in the arcuate fasciculus and uncinate fasciculus above and beyond the effects of family-level measures of socioeconomic status. These patterns were only observed in adolescents with low levels of depression, suggesting that we must be cautious about generalizing these findings to youths who struggle with mental health difficulties.

Adherencia a la atención prenatal en el contexto sociocultural de países subdesarrollados: una revisión narrativa

La atención prenatal tiene como fin preservar y mejorar la salud de la madre y del producto de su gestación, pero la calidad de este servicio y las tasas de asistencias son variables, siendo los países subdesarrollados los que presentan las tasas más bajas. Existen brechas culturales que impiden el adecuado acceso a los cuidados prenatales, y ello pone en riesgo la salud del binomio madre e hijo. El objetivo fue realizar una revisión actualizada sobre las brechas culturales y su repercusión en la atención prenatal. Para la ejecución de la revisión narrativa, se efectuó una búsqueda en las bases de datos en inglés de Pubmed y Scopus, y en español, de Scielo, de todos los artículos que fueron publicados hasta el 17 de diciembre del 2022. Existen diversas situaciones por las cuales las gestantes no acuden a su cita prenatal; entre ellas, destacan el machismo, que ha sido reportado como una causa común de inasistencia a los controles prenatales en países subdesarrollados y, sobre todo, en comunidades rurales; la falta de educación en las familias, razón por la cual las mujeres no asisten a los controles prenatales por ignorancia sobre el cuidado y riesgos del embarazo, así como por sus creencias y costumbres sobre su proceso; las dificultades geográficas para llegar al centro de salud; el maltrato en la atención prenatal, sea por parte del profesional de la salud o por falta de inclusión en el centro de salud; el estado migratorio y el problema de acceso a la salud que esto representa. Reconocer estas situaciones es tan importante como saber sus consecuencias; una vez identificadas, se pueden buscar diferentes alternativas de solución desde el primer nivel de atención. El personal de salud debe capacitarse con el fin de ayudar a la población a entender la importancia del control prenatal, y para ello debe conocer y respetar las costumbres y tradiciones de cada paciente, sin menoscabar sus ideologías.

Prenatal care is intended to preserve and improve maternal and child health; however, the quality of this service and the attendance rates vary, with developing countries having the lowest rates. There are cultural gaps that prevent adequate access to prenatal care, putting the maternal and child health at risk. Our objective was to carry out an updated review on cultural gaps and their impact on prenatal care. This narrative review was conducted by searching all articles published until December 17, 2022, in English databases such as PubMed and Scopus, and Spanish databases such as SciELO. There are various situations that force pregnant women not to attend prenatal appointment, including machismo, reported as a common cause of non-attendance to prenatal checkups in developing countries and especially in rural communities; poor education in families, so women do not attend prenatal checkups due to ignorance about pregnancy care and risks, as well as their beliefs and customs about pregnancy; difficulty accessing health care services due to geographic issues; mistreatment from health professionals while receiving prenatal care or lack of inclusion in the health center; immigration status and the resulting problems with access to health care. Recognizing these situations is as important as knowing their consequences since, once identified, different solution alternatives can be sought from the primary health care. Health personnel must be trained to help the population understand the importance of prenatal care by knowing and respecting the customs and traditions of each patient, and not undermining their ideologies.

The Effects of Humor in Clinical Settings on Medical Trainees and the Implications for Medical Educators: A Scoping Review.

Background: Clinical settings represent the site of patient care and clinical training for medical students and residents. Both processes involve social interaction, and humor is a fundamental component of social interaction that remains underexplored in medical education. This study investigated the impact of humor on medical trainees in the context of the clinical learning environment and examined the implications for medical educators. Methods: Following scoping review methodology, the authors systematically searched six databases and Google Scholar in February 2021 and March 2022. Articles were screened and selected according to inclusion/exclusion criteria, and findings from included articles were synthesized using procedures of metasynthesis. Results: Fifteen articles met inclusion criteria. Six themes emerged relating to the functions and effects of humor in clinical training settings: (1) managing emotions; (2) demarcating insider vs outsider status; (3) facilitating camaraderie; (4) ensuring conformity; (5) negotiating power differentials; and (6) fostering discrimination. Conclusions: The use of humor by medical educators plays an integral role in trainees' everyday experiences. Positive humor helps with coping and communication, while negative humor serves as an indirect medium for communicating ridicule and prejudice. Further research drawing on social psychology theories may identify ways to reduce effects of negative humor and promote well-being and diversity in medical education. Supplementary Information: The online version contains supplementary material available at 10.1007/s40670-023-01769-0.

Effects of the COVID-19 Pandemic on Mental Health and Brain Maturation in Adolescents: Implications for Analyzing Longitudinal Data.

Background: The COVID-19 pandemic has caused significant stress and disruption for young people, likely leading to alterations in their mental health and neurodevelopment. In this context, it is not clear whether youth who lived through the pandemic and its shutdowns are comparable psychobiologically to their age- and sex-matched peers assessed before the pandemic. This question is particularly important for researchers who are analyzing longitudinal data that span the pandemic. Methods: In this study we compared carefully matched youth assessed before the pandemic (n=81) and after the pandemic-related shutdowns ended (n=82). Results: We found that youth assessed after the pandemic shutdowns had more severe internalizing mental health problems, reduced cortical thickness, larger hippocampal and amygdala volume, and more advanced brain age. Conclusions: Thus, not only does the COVID-19 pandemic appear to have led to poorer mental health and accelerated brain aging in adolescents, but it also poses significant challenges to researchers analyzing data from longitudinal studies of normative development that were interrupted by the pandemic.

A Social Gradient of Cortical Thickness in Adolescence: Relationships With Neighborhood Socioeconomic Disadvantage, Family Socioeconomic Status, and Depressive Symptoms.

BACKGROUND: Mental and physical health are affected by family and neighborhood socioeconomic status (SES). Accelerated maturation in the context of lower SES is one mechanism that might contribute to underlying health disparities; few studies, however, have considered neighborhood SES in relation to putative markers of brain maturation in adolescents. METHODS: In 120 adolescents 13 to 18 years of age, we examined family and neighborhood SES in relation to cortical thickness adjusted for age. We also examined whether cortical thickness was related to depressive symptoms and explored regions of interest. RESULTS: Controlling for age, neighborhood socioeconomic disadvantage was associated with a thinner cortex in the left hemisphere (standardized ß = -0.20), which was related to more severe depressive symptoms (standardized ß = -0.33). Family SES was not significantly associated with age-adjusted mean cortical thickness in either hemisphere after controlling for relevant covariates. In exploratory, covariate-adjusted analyses of cortical thickness at the regional level, neighborhood socioeconomic disadvantage was associated with reduced cortical thickness in the left superior frontal gyrus (standardized ß = -0.27), fusiform gyrus (standardized ß = -0.20), and insula (standardized ß = -0.21), whereas family SES was positively associated with cortical thickness in the right lateral and right medial orbitofrontal cortex (standardized ß = 0.21 and standardized ß = 0.19, respectively) and left transverse temporal gyrus (standardized ß = 0.22). CONCLUSIONS: Our findings provide evidence for a social gradient of cortical thickness during adolescence. Adolescents living in less advantaged community or family contexts appear to have a thinner cortex according to global and regional measures. Reduced cortical thickness in the left hemisphere may indicate increased risk for depression in adolescence.

Religion and Death in the United States: A Meta-Regression Comparative Assessment of Between-County Mortality Heterogeneity in the United States.

Religion can have a favorable impact on individual-level health. The influence of religion on population health, however, remains less clear. This study investigated the association between religion and mortality at the population-level. Using county data, a meta-regression was performed to examine between-county mortality heterogeneity. The percent heterogeneity associated with religion variables were compared to demographics (i.e., place, race, language, age, and gender) and health factors (i.e., individual behaviors, clinical care, social and economic, and physical environment) as predictors of mortality. Religion was measured in terms of adherence (i.e., prevalence attending/belonging to a congregation), congregation density, and the diversity of adherents and congregation by denominations. Results showed counties with lower mortality were associated with higher proportions of religion adherents and a greater diversity of adherents and congregations. Counties with higher mortality were associated with higher religion congregation density. Religion, as a parsimonious multivariate model with all demographic and health factor predictors, had less added value when controlled for individual variables or constructs. The direction of association between religion and mortality was consistent, even when controlling for demographics and health factors, and thus merits further consideration as a population health determinant, as it may play a critical role in understanding other population health outcomes.

Biomaterials direct functional B cell response in a material-specific manner.

B cells are an adaptive immune target of biomaterials development in vaccine research but, despite their role in wound healing, have not been extensively studied in regenerative medicine. To probe the role of B cells in biomaterial scaffold response, we evaluated the B cell response to biomaterial materials implanted in a muscle wound using a biological extracellular matrix (ECM), as a reference for a naturally derived material, and synthetic polyester polycaprolactone (PCL), as a reference for a synthetic material. In the local muscle tissue, small numbers of B cells are present in response to tissue injury and biomaterial implantation. The ECM materials induced mature B cells in lymph nodes and antigen presentation in the spleen. The synthetic PCL implants resulted in prolonged B cell presence in the wound and induced an antigen-presenting phenotype. In summary, the adaptive B cell immune response to biomaterial induces local, regional, and systemic immunological changes.

HPV RNA in-situ hybridization as a diagnostic aid in papillary laryngeal lesions.

OBJECTIVES: In the larynx, differentiating squamous papillomas from de-novo papillary squamous dysplasias or squamous cell carcinomas (SCC) has significant consequences for management. Overlapping clinical presentations and cytologic changes across the spectrum of papillary lesions presents diagnostic challenges for otolaryngologists and pathologists. In this study, we evaluate whether ribonucleic acid (RNA) in-situ hybridization (ISH) for low-risk and high-risk human papillomavirus (HPV) can help distinguish these lesions. METHODS: We constructed tissue microarrays from 97 papillary laryngeal lesions, including 61 squamous papillomas, two papillomas with dysplasia, two SCCs-ex papilloma, 14 papillary squamous dysplasias, and 18 papillary SCCs identified at the Johns Hopkins Hospital between 2000 and 2017. We performed RNA ISH using probes for low-risk and high-risk HPV types. RESULTS: Low-risk HPV RNA was identified in 55 benign papillomas (90%), two papillomas with dysplasia (100%), and two SCCs-ex papilloma (100%) but was absent in de-novo papillary dysplasias and SCCs (0%). High-risk HPV RNA ISH was positive only in four papillary SCC (22%). Overall, low-risk HPV RNA ISH was 90% sensitive and 89% specific for benign papillomas with a positive predictive value of 93% and negative predictive value of 84%. In contrast, high-risk HPV was 20% sensitive for SCC. CONCLUSION: Low-risk HPV RNA ISH is a useful diagnostic adjunct for distinguishing laryngeal squamous papillomas from papillary squamous dysplasia and SCC. However, it is not entirely specific for benign processes as it is also retained in papillomas with dysplasia and SCCs-ex papilloma. Because high-risk HPV is rare in papillary laryngeal lesions, high-risk HPV RNA ISH has limited utility. LEVEL OF EVIDENCE: Level 4 Laryngoscope, 130:955-960, 2020.

[Seroprevalence of Trypanosoma cruzi infection in the rural population of Sucre State, Venezuela]. / Seroprevalencia de la infección por Trypanosoma cruzi en la población rural del estado Sucre, Venezuela.

The current study aimed to determine the seroprevalence of Trypanosoma cruzi infection in Sucre State, Venezuela, and its association with epidemiological risk factors. The cluster sampling design allowed selecting 96 villages and 576 dwellings in the State's 15 municipalities. A total of 2,212 serum samples were analyzed by ELISA, HAI, and IFI. Seroprevalence in Sucre State was 3.12%. Risk factors associated with T. cruzi infection were: accumulated garbage, flooring and wall materials, type of dwelling, living in a house with wattle and daub walls and/or straw roofing, living in a house with risky walls and roofing, risky buildings and wattle and daub outbuildings, poultry inside the human dwelling, and presence of firewood. Infection was associated with individual age, and three seropositive cases were found in individuals less than 15 years of age. Sucre State has epidemiological factors that favor the risk of acquiring T. cruzi infection.

Resumen: El objetivo del presente estudio fue determinar la seroprevalencia de la infección por Trypanosoma cruzi en el estado Sucre (Venezuela) y su asociación con factores de riesgo epidemiológicos. El diseño muestral por conglomerados permitió seleccionar 96 centros poblados y 576 viviendas en los 15 municipios del estado. Asimismo, se evaluaron un total de 2.212 muestras de sueros, a través de las pruebas de ELISA, HAI e IFI. La seroprevalencia en el estado Sucre fue de 3,12%. Los factores de riesgo asociados a la infección por T. cruzi fueron: deposición de basura, materiales predominantes en el piso y paredes, tipo de vivienda, vivir en casas con paredes de bahareque y/o techos de palmas, vivir en casa con paredes y techos de riesgo, construcciones de riesgo y anexos de bahareque, aves dentro de la vivienda y la presencia de leña. La infección se encontró asociada a la edad de los individuos, se detectaron tres casos seropositivos en menores de 15 años. En el estado Sucre existen variables epidemiológicas que favorecen el riesgo a contraer la infección por T. cruzi.

Resumo: O estudo teve como objetivo determinar a soroprevalência da infecção pelo Trypanosoma cruzi no Estado de Sucre, Venezuela, e a associação com fatores de risco epidemiológicos. O delineamento da amostragem em clusters permitiu a seleção de 96 vilarejos e 576 moradias nos 15 municípios do Estado. No total, 2.212 amostras de soro foram analisadas com ELISA, HAI e IFI. O estudo mostrou uma soroprevalência de 3,12% no Estado de Sucre. Os seguintes fatores de risco estiveram associados à infecção pelo T. cruzi: acúmulo de lixo, materiais de piso e paredes impróprios, tipo de moradia, moradias com paredes de pau-a-pique e/ou teto de palha, moradias em situação de risco e construções anexas feitas de pau-a-pique, aves dentro das moradias e presença de lenha. A infecção esteve associada à idade individual, e três casos soropositivos foram identificados em indivíduos com menos de 15 anos de idade. O Estado de Sucre apresenta fatores epidemiológicos que aumentam o risco de infecção pelo T. cruzi.

Seroprevalencia de la infección por Trypanosoma cruzi en la población rural del estado Sucre, Venezuela / Seroprevalence of Trypanosoma cruzi infection in the rural population of Sucre State, Venezuela / Soroprevalência de infecção pelo Trypanosoma cruzi na população rural do Estado de Sucre, Venezuela

Resumen: El objetivo del presente estudio fue determinar la seroprevalencia de la infección por Trypanosoma cruzi en el estado Sucre (Venezuela) y su asociación con factores de riesgo epidemiológicos. El diseño muestral por conglomerados permitió seleccionar 96 centros poblados y 576 viviendas en los 15 municipios del estado. Asimismo, se evaluaron un total de 2.212 muestras de sueros, a través de las pruebas de ELISA, HAI e IFI. La seroprevalencia en el estado Sucre fue de 3,12%. Los factores de riesgo asociados a la infección por T. cruzi fueron: deposición de basura, materiales predominantes en el piso y paredes, tipo de vivienda, vivir en casas con paredes de bahareque y/o techos de palmas, vivir en casa con paredes y techos de riesgo, construcciones de riesgo y anexos de bahareque, aves dentro de la vivienda y la presencia de leña. La infección se encontró asociada a la edad de los individuos, se detectaron tres casos seropositivos en menores de 15 años. En el estado Sucre existen variables epidemiológicas que favorecen el riesgo a contraer la infección por T. cruzi.

Abstract: The current study aimed to determine the seroprevalence of Trypanosoma cruzi infection in Sucre State, Venezuela, and its association with epidemiological risk factors. The cluster sampling design allowed selecting 96 villages and 576 dwellings in the State's 15 municipalities. A total of 2,212 serum samples were analyzed by ELISA, HAI, and IFI. Seroprevalence in Sucre State was 3.12%. Risk factors associated with T. cruzi infection were: accumulated garbage, flooring and wall materials, type of dwelling, living in a house with wattle and daub walls and/or straw roofing, living in a house with risky walls and roofing, risky buildings and wattle and daub outbuildings, poultry inside the human dwelling, and presence of firewood. Infection was associated with individual age, and three seropositive cases were found in individuals less than 15 years of age. Sucre State has epidemiological factors that favor the risk of acquiring T. cruzi infection.

Resumo: O estudo teve como objetivo determinar a soroprevalência da infecção pelo Trypanosoma cruzi no Estado de Sucre, Venezuela, e a associação com fatores de risco epidemiológicos. O delineamento da amostragem em clusters permitiu a seleção de 96 vilarejos e 576 moradias nos 15 municípios do Estado. No total, 2.212 amostras de soro foram analisadas com ELISA, HAI e IFI. O estudo mostrou uma soroprevalência de 3,12% no Estado de Sucre. Os seguintes fatores de risco estiveram associados à infecção pelo T. cruzi: acúmulo de lixo, materiais de piso e paredes impróprios, tipo de moradia, moradias com paredes de pau-a-pique e/ou teto de palha, moradias em situação de risco e construções anexas feitas de pau-a-pique, aves dentro das moradias e presença de lenha. A infecção esteve associada à idade individual, e três casos soropositivos foram identificados em indivíduos com menos de 15 anos de idade. O Estado de Sucre apresenta fatores epidemiológicos que aumentam o risco de infecção pelo T. cruzi.

Time-driven activity-based costing to estimate cost of care at multidisciplinary aerodigestive centers.

OBJECTIVES/HYPOTHESIS: Providing high-value healthcare to patients is increasingly becoming an objective for providers including those at multidisciplinary aerodigestive centers. Measuring value has two components: 1) identify relevant health outcomes and 2) determine relevant treatment costs. Via their inherent structure, multidisciplinary care units consolidate care for complex patients. However, their potential impact on decreasing healthcare costs is less clear. The goal of this study was to estimate the potential cost savings of treating patients with laryngeal clefts at multidisciplinary aerodigestive centers. STUDY DESIGN: Retrospective chart review. METHODS: Time-driven activity-based costing was used to estimate the cost of care for patients with laryngeal cleft seen between 2008 and 2013 at the Massachusetts Eye and Ear Infirmary Pediatric Aerodigestive Center. Retrospective chart review was performed to identify clinic utilization by patients as well as patient diet outcomes after treatment. Patients were stratified into neurologically complex and neurologically noncomplex groups. RESULTS: The cost of care for patients requiring surgical intervention was five and three times as expensive of the cost of care for patients not requiring surgery for neurologically noncomplex and complex patients, respectively. Following treatment, 50% and 55% of complex and noncomplex patients returned to normal diet, whereas 83% and 87% of patients experienced improved diets, respectively. Additionally, multidisciplinary team-based care for children with laryngeal clefts potentially achieves 20% to 40% cost savings. CONCLUSIONS: These findings demonstrate how time-driven activity-based costing can be used to estimate and compare patient costs in multidisciplinary aerodigestive centers. LEVEL OF EVIDENCE: 2c. Laryngoscope, 127:2152-2158, 2017.

Modified Best-Practice Algorithm to Reduce the Number of Postoperative Videofluoroscopic Swallow Studies in Patients With Type 1 Laryngeal Cleft Repair.

IMPORTANCE: There is no consensus as to the timing of videofluoroscopic swallow studies (VFSSs) in determining resolving aspiration after laryngeal cleft repair. There is a growing literature on the effect of radiation exposure in children. OBJECTIVE: To modify a previously published best-practice algorithm based on a literature review and our clinical experience to maintain the quality of care provided after successful type 1 laryngeal cleft repair, while reducing the total number of postoperative VFSSs by 10% or greater. DESIGN, SETTING, AND PARTICIPANTS: The previously published algorithm was modified by a multidisciplinary group at a tertiary care academic medical center (Massachusetts Eye and Ear) and was prospectively applied to 31 children who underwent type 1 laryngeal cleft repair from January 1, 2013, to February 28, 2015. MAIN OUTCOMES AND MEASURES: The number of VFSSs obtained in the first 7 months after surgery was compared with the peer-reviewed literature and with a retrospective cohort of 27 patients who underwent type 1 laryngeal cleft repair from January 1, 2008, to December 31, 2012. RESULTS: The study cohort comprised 31 patients. Their ages ranged from 10 to 48 months, with a mean (SD) age of 23.94 (9.93) months, and 19% (6 of 31) were female. The mean (SD) number of postoperative VFSSs per patient before and after implementation of the algorithm was 1.22 (0.42) and 1.03 (0.55), respectively. The use of the algorithm reduced the number of VFSSs by 0.19 (95% CI, -0.07 to 0.45). This reduction in radiation exposure is equivalent to 1.47 chest radiographs per child per course of care. Surgical success was 87% (27 of 31) compared with our group's previously published success rate of 78% (21 of 27) (absolute difference, 0.09; 95% CI, -0.17 to 0.34). CONCLUSIONS AND RELEVANCE: This modified algorithm to help guide decisions on when and how often to obtain VFSSs after type 1 laryngeal cleft repair can limit patients' radiation exposure, while maintaining high surgical success rates.

Collagen Content Limits Optical Coherence Tomography Image Depth in Porcine Vocal Fold Tissue.

OBJECTIVE: Vocal fold scarring, a condition defined by increased collagen content, is challenging to treat without a method of noninvasively assessing vocal fold structure in vivo. The goal of this study was to observe the effects of vocal fold collagen content on optical coherence tomography imaging to develop a quantifiable marker of disease. STUDY DESIGN: Excised specimen study. SETTING: Massachusetts Eye and Ear Infirmary. SUBJECTS AND METHODS: Porcine vocal folds were injected with collagenase to remove collagen from the lamina propria. Optical coherence tomography imaging was performed preinjection and at 0, 45, 90, and 180 minutes postinjection. Mean pixel intensity (or image brightness) was extracted from images of collagenase- and control-treated hemilarynges. Texture analysis of the lamina propria at each injection site was performed to extract image contrast. Two-factor repeated measure analysis of variance and t tests were used to determine statistical significance. Picrosirius red staining was performed to confirm collagenase activity. RESULTS: Mean pixel intensity was higher at injection sites of collagenase-treated vocal folds than control vocal folds (P < .0001). Fold change in image contrast was significantly increased in collagenase-treated vocal folds than control vocal folds (P = .002). Picrosirius red staining in control specimens revealed collagen fibrils most prominent in the subepithelium and above the thyroarytenoid muscle. Specimens treated with collagenase exhibited a loss of these structures. CONCLUSION: Collagen removal from vocal fold tissue increases image brightness of underlying structures. This inverse relationship may be useful in treating vocal fold scarring in patients.

Using attenuation coefficients from optical coherence tomography as markers of vocal fold maturation.

OBJECTIVES/HYPOTHESIS: Optical coherence tomography (OCT) is a promising technology to noninvasively assess vocal fold microanatomy. The goal of this study was to develop a methodology using OCT to identify quantifiable markers of vocal fold development. STUDY DESIGN: In vivo study. METHODS: A two-step process was developed to reproducibly image the midmembranous vocal fold edge of 10 patients younger than 2 years and 10 patients between 11 and 16 years of age using OCT. An image analysis algorithm was implemented to extract OCT-derived A-lines for each patient. These A-lines were divided into three zones according to apparent changes in slope. Relative attenuation coefficients, or tissue- and system-dependent parameters that describe the rate at which optical signal decays, were calculated for each zone. RESULTS: Young patients had distinct relative attenuation coefficients in zone 1 (P < .0001), whereas zones 2 and 3 were indistinct (P = .1129). Older patients had distinct relative attenuation coefficients in zones 1, 2, and 3 (P < .0370). Between age groups, relative attenuation coefficients were different in zones 2 and 3 (P < .0001, P = .0315, respectively) and indistinct in zone 1 (P = .1438). CONCLUSIONS: Relative attenuation coefficients can be used as markers of vocal fold development. Differences in relative attenuation coefficients likely represent changes in extracellular matrix structure within the lamina propria and may become useful for guiding treatment of voice disorders in the pediatric population. LEVEL OF EVIDENCE: NA Laryngoscope, 126:E218-E223, 2016.

[Entomological study of Trypanosoma cruzi vectors in the rural communities of Sucre state, Venezuela]. / Estudio entomológico de vectores transmisores de la infección por Trypanosoma cruzi en la población rural del estado Sucre, Venezuela.

INTRODUCTION: The ecological niche of Reduvidae vectors has been modified due to environmental changes and human encroachment into the rural areas. OBJECTIVE: This study evaluates the current entomological indices of triatomines responsible for Trypanosoma cruzi infection in Sucre State, Venezuela. MATERIALS AND METHODS: A cross-sectional and prospective study was conducted in 95 towns and 577 dwellings in the 15 municipalities of the state of Sucre, Venezuela, from August to November, 2008. Triatomine bugs were identified on the basis of morphological characteristics, and their feces examined for T. cruzi infection through direct microscopy. Positive slides were stained with Giemsa and parasites were identified by morphologic characterization. RESULTS: The entomological indices expressing the highest values were dispersion (16.67%) and household colonization (33.33%). The triatomine species captured were: Rhodnius prolixus , Rhodnius main intradomiciliary vector. CONCLUSIONS: Despite the low index of vector infection (1.72%), the existence of species with domiciliary and peridomiciliary reproductive success ensures the persistence of the epidemiological chain both for the disease and the parasite.

Estudio entomológico de vectores transmisores de la infección por Trypanosoma cruzi en la población rural del estado Sucre, Venezuela / Entomological study of Trypanosoma cruzi vectors in the rural communities of Sucre state, Venezuela

Introducción. Debido a los cambios ambientales y a la intervención del hombre en los espacios silvestres, se ha cambiado el nicho ecológico de los vectores reduvídeos. Objetivo. En el presente estudio se evaluó la situación actual de los índices entomológicos de los triatominos responsables de la transmisión de Trypanosoma cruzi en el estado Sucre. Materiales y métodos. Se llevó a cabo un estudio prospectivo transversal en 96 centros poblados y 576 viviendas de los 15 municipios del estado Sucre, Venezuela, entre agosto y noviembre de 2008. Los vectores se identificaron con base en sus características morfológicas. La identificación de Trypanosoma spp. en las heces de los triatominos se hizo mediante el examen directo por microscopía. Las láminas positivas se tiñeron con Giemsa y los parásitos se identificaron por sus características morfológicas. Resultados. Los índices entomológicos con los valores más elevados fueron la dispersión en centros poblados rurales del estado Sucre (16,67 %) y la colonización de las viviendas (33,33 %). Las especies de triatominos capturados fueron Rhodnius prolixus , Rhodnius pictipes , Rhodnius robustus , Triatoma maculata y Panstrongylus geniculatus , siendo T . maculata el principal vector en el domicilio. Conclusiones. A pesar del bajo índice de infección natural en vectores (1,72 %), la existencia de especies con éxito reproductivo en el domicilio y el peridomicilio puede garantizar el mantenimiento de la cadena epidemiológica, tanto de la enfermedad como del parásito.

Introduction: The ecological niche of Reduvidae vectors has been modified due to environmental changes and human encroachment into the rural areas. Objective: This study evaluates the current entomological indices of triatomines responsible for Trypanosoma cruzi infection in Sucre State, Venezuela. Materials and methods: A cross-sectional and prospective study was conducted in 95 towns and 577 dwellings in the 15 municipalities of the state of Sucre, Venezuela, from August to November, 2008. Triatomine bugs were identified on the basis of morphological characteristics, and their feces examined for T. cruzi infection through direct microscopy. Positive slides were stained with Giemsa and parasites were identified by morphologic characterization. Results: The entomological indices expressing the highest values were dispersion (16.67%) and household colonization (33.33%). The triatomine species captured were: Rhodnius prolixus , Rhodnius main intradomiciliaryvector. Conclusions: Despite the low index of vector infection (1.72%), the existence of species with domiciliary and peridomiciliary reproductive success ensures the persistence of the epidemiological chain both for the disease and the parasite.

Establishment of a normative cepstral pediatric acoustic database.

IMPORTANCE: Few studies have used objective measures to evaluate the development of the normal pediatric voice. Cepstral analysis of continuous speech samples is a reliable method for gathering acoustic data; however, it has not been used to examine the changes that occur with voice development. OBJECTIVE: To establish and characterize acoustic patterns of the normal pediatric voice using cepstral analysis of voice samples from a normal pediatric voice database. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of 218 children aged 4 to 17 years, for whom English was the primary language spoken at home, conducted at a pediatric otolaryngology practice and pediatric practice in a tertiary hospital (April 2012-May 2014). INTERVENTIONS AND EXPOSURES: Sustained vowel utterances and continuous speech samples (4 Consensus Auditory-Perceptual Evaluation of Voice [CAPE-V] and 2 sentences from the rainbow passage) were recorded and analyzed from children with normal voices. MAIN OUTCOMES AND MEASURES: Normal values were collected for the acoustic measures studied (ie, fundamental frequency, cepstral peak fundamental frequency, cepstral peak prominence [CPP], low-to-high spectral ratio [L/H ratio], and cepstral-spectral index of dysphonia in recorded phrases) and compiled into a normative acoustic database. RESULTS: Significant changes in fundamental frequency were observed with a distinct shift in slope at ages 11 and 14 years in boys for sustained vowel (ages 4-11 years, -6.83 Hz/y [P < .001]; 11-14 years, -27.62 Hz/y [P < .001]; and 14-17 years, -5.68 Hz/y [P = .001]), all voiced (ages 4-11 years, -4.19 Hz/y [P = .002]; 11-14 years, -29.42 Hz/y [P < .001]; and 14-17 years, -4.63 Hz/y [P < .001]), glottal attack (ages 4-11 years, -4.51 Hz/y; 11-14 years, -27.23 Hz/y; and 14-17 years, -1.70 Hz/y [P < .001 for all]), and rainbow (ages <14 years, -20.68 Hz/y [P < .001]; and 14-17 years, -4.50 Hz/y [P = .001]) recordings. A decreasing linear trend in fundamental frequency among all recordings (vowel, all voiced, easy onset, glottal attack, plosives, and rainbow) was found in girls (-2.56 Hz/y [P < .001], -3.48 Hz/y [P < .001], -2.82 Hz/y [P < .001], -3.49 Hz/y [P < .001], -2.30 Hz/y [P < .001], and -2.98 Hz/y [P = .01], respectively). A linear increase in CPP was seen with age in boys, with significant changes seen in recordings for vowel (0.10 dB/y [P = .05]), all voiced (0.2 dB/y [P < .001]), easy onset (0.13 dB/y [P < .001]), glottal attack (0.12 dB/y [P < .001]), plosives (0.15 dB/y [P < .001]), and rainbow (0.17 dB/y [P = .006]). A significant linear increase in CPP for girls was only seen in all voiced (0.13 dB/y [P < .001]). L/H ratio showed a linear increase with age among all speech samples (vowel, all voiced, easy onset, glottal attack, plosives, and rainbow) in boys (1.14 dB/y [P < .001], 0.92 dB/y [P < .001], 1.19 dB/y [P < .001], 0.79 dB/y [P < .001], 0.69 dB/y [P < .001], and 0.54 dB/y [P = .002], respectively) and girls (0.96 dB/y, 0.60 dB/y, 0.75 dB/y, 0.37 dB/y, 0.44 dB/y, and 0.58 dB/y, respectively [P ≤ .001 for all]). CONCLUSIONS AND RELEVANCE: This represents the first pediatric voice database using frequency-based acoustic measures. Our goal was to characterize the changes that occur in both male and female voices as children age. These findings help illustrate how acoustic measurements change with development and may aid in our understanding of the developing voice, pathologic changes, and response to treatment.