Data Evaluation of a Low-Cost Sensor Network for Atmospheric Particulate Matter Monitoring in 15 Municipalities in Serbia.

Conventional air quality monitoring networks typically tend to be sparse over areas of interest. Because of the high cost of establishing such monitoring systems, some areas are often completely left out of regulatory monitoring networks. Recently, a new paradigm in monitoring has emerged that utilizes low-cost air pollution sensors, thus making it possible to reduce the knowledge gap in air pollution levels for areas not covered by regulatory monitoring networks and increase the spatial resolution of monitoring in others. The benefits of such networks for the community are almost self-evident since information about the level of air pollution can be transmitted in real time and the data can be analysed immediately over the wider area. However, the accuracy and reliability of newly produced data must also be taken into account in order to be able to correctly interpret the results. In this study, we analyse particulate matter pollution data from a large network of low-cost particulate matter monitors that was deployed and placed in outdoor spaces in schools in central and western Serbia under the Schools for Better Air Quality UNICEF pilot initiative in the period from April 2022 to June 2023. The network consisted of 129 devices in 15 municipalities, with 11 of the municipalities having such extensive real-time measurements of particulate matter concentration for the first time. The analysis showed that the maximum concentrations of PM2.5 and PM10 were in the winter months (heating season), while during the summer months (non-heating season), the concentrations were several times lower. Also, in some municipalities, the maximum values and number of daily exceedances of PM10 (50 µg/m3) were much higher than in the others because of diversity and differences in the low-cost sensor sampling sites. The particulate matter mass daily concentrations obtained by low-cost sensors were analysed and also classified according to the European AQI (air quality index) applied to low-cost sensor data. This study confirmed that the large network of low-cost air pollution sensors can be useful in providing real-time information and warnings about higher pollution days and episodes, particularly in situations where there is a lack of local or national regulatory monitoring stations in the area.

Risk Factors and Outcomes of Children with Congenital Heart Disease on Extracorporeal Membrane Oxygenation-A Ten-Year Single-Center Report.

For children born with congenital heart defects (CHDs), extracorporeal life support may be necessary. This retrospective single-center study aimed to investigate the outcomes of children with CHDs on extracorporeal membrane oxygenation (ECMO), focusing on various risk factors. Among the 88 patients, 36 (41%) had a single-ventricle heart defect, while 52 (59%) had a biventricular defect. In total, 25 (28%) survived, with 7 (8%) in the first group and 18 (20%) in the latter. A p-value of 0.19 indicated no significant difference in survival rates. Children with biventricular hearts had shorter ECMO durations but longer stays in the intensive care unit. The overall rate of complications on ECMO was higher in children with a single ventricle (odds ratio [OR] 1.57, 95% confidence interval [CI] 0.67-3.7); bleeding was the most common complication in both groups. The occurrence of a second ECMO run was more frequent in patients with a single ventricle (22% vs. 9.6%). ECMO can be effective for children with congenital heart defects, including single-ventricle patients. Bleeding remains a serious complication associated with worse outcomes. Patients requiring a second ECMO run within 30 days have lower survival rates.

Source apportionment for indoor air pollution: Current challenges and future directions.

Source apportionment (SA) for indoor air pollution is challenging due to the multiplicity and high variability of indoor sources, the complex physical and chemical processes that act as primary sources, sinks and sources of precursors that lead to secondary formation, and the interconnection with the outdoor environment. While the major indoor sources have been recognized, there is still a need for understanding the contribution of indoor versus outdoor-generated pollutants penetrating indoors, and how SA is influenced by the complex processes that occur in indoor environments. This paper reviews our current understanding of SA, through reviewing information on the SA techniques used, the targeted pollutants that have been studied to date, and their source apportionment, along with limitations or knowledge gaps in this research field. The majority (78 %) of SA studies to date focused on PM chemical composition/size distribution, with fewer studies covering organic compounds such as ketones, carbonyls and aldehydes. Regarding the SA method used, the majority of studies have used Positive Matrix Factorization (31 %), Principal Component Analysis (26 %) and Chemical Mass Balance (7 %) receptor models. The indoor PM sources identified to date include building materials and furniture emissions, indoor combustion-related sources, cooking-related sources, resuspension, cleaning and consumer products emissions, secondary-generated pollutants indoors and other products and activity-related emissions. The outdoor environment contribution to the measured pollutant indoors varies considerably (<10 %- 90 %) among the studies. Future challenges for this research area include the need for optimization of indoor air quality monitoring and data selection as well as the incorporation of physical and chemical processes in indoor air into source apportionment methodology.

PROCALCITONIN GUIDED ANTIBIOTIC STEWARDSHIP: A BALKAN EXPERT CONSENSUS STATEMENT.

Sepsis as a consequence of infection is a frequent cause of death among critically ill patients. The most common sites of infection are lover respiratory tract, abdominal, urinary tract and catheter-associated blood stream infections. Early empiric, broad-spectrum therapy in those with severe sepsis and/or shock with the aim of reducing mortality may lead to antibiotic overuse, resistance and increased costs. Among numerous serum biomarkers, procalcitonin (PCT) has proved to be one of the most reliable ones in the diagnosis of sepsis. An important means of limiting antibiotic resistance is the antibiotic stewardship program, especially in intensive care units with critically ill patients and prevalence of multiple drug-resistant pathogens. The PCT-guided antibiotic stewardship was first started in Western Europe and Asia-Pacific countries, as well as in the United States. Considering that this method has proven to be effective in reducing antibiotic consumption while improving clinical outcome, a group of experts from the Balkan region decided to make their own recommendations and PCT protocol. When creating this protocol for initiation and duration of antibiotic treatment, they especially reviewed the literature for lower respiratory tract infection and sepsis. In the protocol, they have included the severity of illness, clinical assessment, and PCT levels. Developing a consensus on the clinical algorithm by eminent experts/specialists in various fields of medicine should enable clinicians to use PCT for initiation of antibiotic therapy and monitoring PCT to stop antibiotics earlier. It is crucial that the PCT-guided algorithm becomes an integral part of institutional stewardship program.

Bridging with Veno-Arterial Extracorporeal Membrane Oxygenation in Children: A 10-Year Single-Center Experience.

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is frequently used in children with and without congenital heart disease (CHD). This study, of a single-center and retrospective design, evaluated the use and timing of V-A ECMO in a pediatric cohort who underwent V-A ECMO implantation between January 2009 and December 2019. The patients were divided into a pre-/non-surgical group and a post-surgical group. Among the investigated variables were age, gender, weight, duration of ECMO, ECMO indication, and ventricular physiology, with only the latter being statistically relevant between the two groups. A total of 111 children (58 male/53 female), with a median age of 87 days (IQR: 7-623) were supported using V-A ECMO. The pre-/non-surgical group consisted of 59 patients and the post-surgical group of 52 patients. Survival at discharge was 49% for the pre-/non-surgical group and 21% for the surgical group (p = 0.04). Single-ventricle physiology was significant for a worse outcome (p = 0.0193). Heart anatomy still has the biggest role in the outcomes of children on ECMO. Nevertheless, children with CHD can be successfully bridged with ECMO to cardiac operation.

Filling the Gap in Southern Europe-Diversity of Cryphonectria parasitica and Associated Mycovirus (Cryphonectria hypovirus 1) in Montenegro.

Cryphonectria parasitica is an invasive fungal pathogen that causes blight disease on chestnut trees. Its destructive effect can be controlled with naturally occurring mycovirus Cryphonectria hypovirus 1 (CHV1). To date, the spread of C. parasitica and CHV1 in Europe is fairly well documented, but there are still several unexplored regions. Thus, we sampled blight cankers from four sweet chestnut populations in Bay of Kotor and Lake Skadar regions in Montenegro. We determined vegetative compatibility (vc) type and mating-type diversity using molecular vic and MAT1 genotyping, as well as confirming the presence of CHV1 by RT-PCR. We identified 11 vc types, with EU-12 being the dominant one represented by 58.2% of all fungal isolates. The Shannon diversity index ranged from 0.93 to 1.47. Both mating types of C. parasitica were found in all four populations. The prevalence of CHV1 ranged from 15% to 40%. All CHV1 isolates belonged to Italian subtype I of CHV1 and were closely related, with relatively recent common ancestors. Our results indicate a longer presence of C. parasitica and CHV1 in Montenegro than previously thought. Natural biocontrol with CHV1 seems to be well established. However, it has the potential for deterioration; thus, close monitoring is required.

Modelling Voluntary General Population Vaccination Strategies during COVID-19 Outbreak: Influence of Disease Prevalence.

A novel statistical model based on a two-layer, contact and information, graph is suggested in order to study the influence of disease prevalence on voluntary general population vaccination during the COVID-19 outbreak. Details about the structure and number of susceptible, infectious, and recovered/vaccinated individuals from the contact layer are simultaneously transferred to the information layer. The ever-growing wealth of information that is becoming available about the COVID virus was modelled at each individual level by a simplified proxy predictor of the amount of disease spread. Each informed individual, a node in a heterogeneous graph, makes a decision about vaccination "motivated" by their benefit. The obtained results showed that disease information type, global or local, has a significant impact on an individual vaccination decision. A number of different scenarios were investigated. The scenarios showed that in the case of the stronger impact of globally broadcasted disease information, individuals tend to vaccinate in larger numbers at the same time when the infection has already spread within the population. If individuals make vaccination decisions based on locally available information, the vaccination rate is uniformly spread during infection outbreak duration. Prioritising elderly population vaccination leads to an increased number of infected cases and a higher reduction in mortality. The developed model accuracy allows the precise targeting of vaccination order depending on the individuals' number of social contacts. Precisely targeted vaccination, combined with pre-existing immunity, and public health measures can limit the infection to isolated hotspots inside the population, as well as significantly delay and lower the infection peak.

Comparison of fine particulate matter level, chemical content and oxidative potential derived from two dissimilar urban environments.

Urban airborne particles contain a wide spectrum of components, known to have harmful effects on human health. This study reports a detailed investigation of fine particulate matter (PM2.5), chemical content and oxidative potential derived from two different urban environments. During summer and winter, 20-day campaigns were conducted at Belgrade city center (urban-background site - UB) and Bor (urban-industrial site - UI). Using various analytical techniques, carbonaceous compounds, water-soluble inorganic ions, major and trace elements were determined, while the oxidative potential of PM2.5 was estimated by dichloro-dihydro-fluorescein diacetate (DCFH-DA) assay (OPDCFH values). The mean PM2.5 concentrations in both urban environments were above the recommended daily value, and the dominant PM2.5 mass contributor was organic matter (29-55%). The OC/EC ratio was significantly higher at UB site during winter, which was an indication of a considerable contribution of secondary organic carbon to the overall organic carbon (OC). Water-soluble organic carbon (WSOC) was also higher at UB than at UI site, and it probably came from the same sources as OC. In general, the different partition of secondary organic aerosol (SOA) in warm and cold periods affected the number of organic components. Sulfates and nitrates were the most abundant ions at both sites and they counted approximately 40% (summer) and 50% (winter) of total ions. Further, the concentrations of the most elements, particularly some potentially carcinogenic elements such as As, Cd and Pb were significantly higher at UI, due to the emissions from the copper smelter complex in the vicinity. The mean OPDCFH values were similar during the summer at both sampling sites, whereas a statistically significant difference between sites was noticed in favor of UB environment in winter.

Measurements of Oxidative Potential of Particulate Matter at Belgrade Tunnel; Comparison of BPEAnit, DTT and DCFH Assays.

To estimate the oxidative potential (OP) of particulate matter (PM), two commonly used cell-free, molecular probes were applied: dithiothreitol (DTT) and dichloro-dihydro-fluorescein diacetate (DCFH-DA), and their performance was compared with 9,10-bis (phenylethynyl) anthracene-nitroxide (BPEAnit). To the best of our knowledge, this is the first study in which the performance of the DTT and DCFH has been compared with the BPEAnit probe. The average concentrations of PM, organic carbon (OC) and elemental carbon (EC) for fine (PM2.5) and coarse (PM10) particles were determined. The results were 44.8 ± 13.7, 9.8 ± 5.1 and 9.3 ± 4.8 µg·m-3 for PM2.5 and 75.5 ± 25.1, 16.3 ± 8.7 and 11.8 ± 5.3 µg·m-3 for PM10, respectively, for PM, OC and EC. The water-soluble organic carbon (WSOC) fraction accounted for 42 ± 14% and 28 ± 9% of organic carbon in PM2.5 and PM10, respectively. The average volume normalized OP values for the three assays depended on both the sampling periods and the PM fractions. The OPBPEAnit had its peak at 2 p.m.; in the afternoon, it was three times higher compared to the morning and late afternoon values. The DCFH and BPEAnit results were correlated (r = 0.64), while there was no good agreement between the BPEAnit and the DTT (r = 0.14). The total organic content of PM does not necessarily represent oxidative capacity and it shows varying correlation with the OP. With respect to the two PM fractions studied, the OP was mostly associated with smaller particles.

Cardiac biomarkers improve prediction performance of the combination of American Society of Anesthesiologists physical status classification and Americal College of Surgeons National Surgical Quality Improvement Program calculator for postoperative mortality in elderly patients: a pilot study.

BACKGROUND: Our previous research has shown American Society of Anaesthesiologists physical status classification (ASA) score and Americal College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator to have the most accuracy in the prediction of postoperative mortality. AIMS: The aim of our research was to define the most reliable combination of cardiac biomarkers with ASA and ACS NSQIP. METHODS: We have included a total of 78 patients. ASA score has been determined in standard fashion, while we used the available interactive calculator for the ACS NSQIP score. Biomarkers BIRC5, H-FABP, and hsCRP have been measured in specialized laboratories. RESULTS: All of the deceased patients had survivin (BIRC5) > 4.00 pg/ml, higher values of H-FABP and hsCRP and higher estimated levels of ASA and ACS NSQIP (P = 0.0001). ASA and ACS NSQIP alone had AUC of, respectively, 0.669 and 0.813. The combination of ASA and ACS NSQIP had AUC = 0.841. Combination of hsCRP with the two risk scores had AUC = 0.926 (95% CI 0.853-1.000, P < 0.0001). If we add three cardiac biomarkers to this model, we get AUC as high as 0.941 (95% CI 0.876-1.000, P < 0.0001). The correction of statistical models with comorbidities (CIRS-G score) did not change the accuracy of prediction models that we have provided. DISCUSSION: Addition of ACS NSQIP and biomarkers adds to the accuracy of ASA score, which has already been proved by other authors. CONCLUSION: Cardiac biomarker hsCRP can be used as the most reliable cardiac biomarker; however, the "multimarker approach" adds the most to the accuracy of the combination of clinical risk scores.

Enhanced Recovery after Vascular Surgery.

The beginnings of the enhanced recovery after surgery (ERAS) program were first developed for patients in colorectal surgery, and after it was established as the standard of care in this surgical field, it began to be applied in many others surgical areas. This is multimodal, evidence-based approach program and includes simultaneous optimization of preoperative status of patients, adequate selection of surgical procedure and postoperative management. The aim of this program is to reduce complications, the length of hospital stay and to improve the patients outcome. Over the past decades, special attention was directed to the postoperative management in vascular surgery, especially after major vascular surgery because of the great risk of multiorgan failure, such as: respiratory failure, myocardial infarction, hemodynamic instability, coagulopathy, renal failure, neurological disorders, and intra-abdominal complications. Although a lot of effort was put into it, there is no unique acceptable program for ERAS in this surgical field, and there is still a need to point out the factors responsible for postoperative outcomes of these patients. So far, it is known that special attention should be paid to already existing diseases, type and the duration of the surgical intervention, hemodynamic and fluid management, nutrition, pain management, and early mobilization of patients.

Enhanced Recovery in Thoracic Surgery: A Review.

The main goal of enhanced recovery program after thoracic surgery is to minimize stress response, reduce postoperative pulmonary complications, and improve patient outcome, which will in addition decrease hospital stay and reduce hospital costs. As minimally invasive technique, video-assisted thoracoscopic surgery represents an important element of enhanced recovery program in thoracic surgery. Anesthetic management during preoperative, intraoperative and postoperative period is essential for the enhanced recovery. In the era of enhanced recovery protocols, non-intubated thoracoscopic procedures present a step forward. This article focuses on the key elements of the enhanced recovery program in thoracic surgery. Having reviewed recent literature, the authors highlight potential procedures and techniques that might be incorporated into the program.

Addition of clinical risk scores improves prediction performance of American Society of Anesthesiologists (ASA) physical status classification for postoperative mortality in older patients: a pilot study.

PURPOSE: Many methods for preoperative risk stratifications used in everyday practice do not take into account all of the comorbidities and complex physiological status of older patients. Therefore, anaesthesiologists and surgeons must consider multiple ways of preoperative diagnostics. Determining which of the preoperative clinical risk scores [Revised Lee score, the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) calculator and Surgical Outcome Risk Tool (SORT)] best improves routinely used American Society of Anaesthesiologists (ASA) physical status classification. METHODS: The prospective pilot study included 78 patients who were being prepared for extensive non-cardiac surgeries under general anaesthesia. Preoperatively, anaesthesiologist determined ASA score according to guidelines. Then, the data of patients have been processed on the interactive calculators of Revised Lee score, ACS NSQIP and SORT. RESULTS: Mean age of included patients was 71.4 ± 6.9 years. When it comes to postoperative mortality prediction, three risk scores (ASA, ACS NSQIP and SORT) have been statistically significant, respectively, P = 0.016, P < 0.0001, P < 0.0001. Results showed that AUC being higher in ACS NSQIP and SORT (0.813; 0.797). Out of all three additional risk scores, ACS NSQIP showed to add the most to the specificity and sensitivity of ASA score, with combined AUC = 0.841. CONCLUSIONS: ACS NSQIP and SORT increase the accuracy of ASA score. Revised Lee score cannot be considered a good indicator of postoperative mortality risk since it is primarily the score which indicates risk for cardiovascular complications. Further studies, with a greater number of patients, are needed.

An evaluation tool kit of air quality micro-sensing units.

Recent developments in sensory and communication technologies have made the development of portable air-quality (AQ) micro-sensing units (MSUs) feasible. These MSUs allow AQ measurements in many new applications, such as ambulatory exposure analyses and citizen science. Typically, the performance of these devices is assessed using the mean error or correlation coefficients with respect to a laboratory equipment. However, these criteria do not represent how such sensors perform outside of laboratory conditions in large-scale field applications, and do not cover all aspects of possible differences in performance between the sensor-based and standardized equipment, or changes in performance over time. This paper presents a comprehensive Sensor Evaluation Toolbox (SET) for evaluating AQ MSUs by a range of criteria, to better assess their performance in varied applications and environments. Within the SET are included four new schemes for evaluating sensors' capability to: locate pollution sources; represent the pollution level on a coarse scale; capture the high temporal variability of the observed pollutant and their reliability. Each of the evaluation criteria allows for assessing sensors' performance in a different way, together constituting a holistic evaluation of the suitability and usability of the sensors in a wide range of applications. Application of the SET on measurements acquired by 25 MSUs deployed in eight cities across Europe showed that the suggested schemes facilitates a comprehensive cross platform analysis that can be used to determine and compare the sensors' performance. The SET was implemented in R and the code is available on the first author's website.

Association between ambient air pollution, meteorological conditions and exacerbations of asthma and chronic obstructive pulmonary disease in adult citizens of the town of Smederevo.

INTRODUCTION: Smederevo is the only town in Serbia with a steel factory, whose exhausts contribute to air pollution. Therefore, the city conducts continuous monitoring of air quality. In recent years, high levels of particulate matter (PM) including coarse (PM10) and fine (PM2.5) particles in the air have frequently been recorded. The aim of this study was to assess association between exacerbation of asthma or chronic obstructive pulmonary disease (COPD) in adults and air pollution or meteorological conditions. METHODS: The study was conducted in the secondary care General Hospital in Smederevo covering approximately 81,000 inhabitants living in the area of about 7 km around the automatic station for air quality monitoring from which the verified data were collected. Data on patients were obtained from medical records. The correlation between the incidence of diseases exacerbation and the number of days with exceedance of air pollutants limit level per month, as well as meteorological conditions, was tested with parametric Pearson bivariate correlation test in program SPSS. RESULTS: The study population consisted of adults registered as asthma or COPD suffering patients (n = 1,624) with 570 episodes of remarkable exacerbations (moderate or severe) of the disease in 2011. Asthma exacerbation was significantly more frequent in women than in men. The number of days with high levels of PM2.5 per month was statistically significantly associated with the total number of exacerbation (moderate and severe of both asthma and COPD) episodes among the female patients. There was also a statistically significant association between the number of days with PM2.5 exceedance and the number of moderate exacerbations in the subgroups of non-smokers and obese patients. A significant correlation of the number of days with the exceedance of PM10 limit level was shown only for the subgroup of obese, non-smoking patients with moderate exacerbation. A significant negative association with the average ambient temperature was proven for the obese female patients and obese non-smoking patients with moderate asthma exacerbations. The number of COPD exacerbation was in positive correlation with the average air pressure for the subgroup of female smokers, but the connection with air pollution was not proven. CONCLUSION: Exposure to airborne particles in the town of Smederevo, mainly to PM2.5, and to low temperature may trigger asthma exacerbation requiring emergency care. The most vulnerable may be women and obese patients.

On the use of small and cheaper sensors and devices for indicative citizen-based monitoring of respirable particulate matter.

Respirable particulate matter present in outdoor and indoor environments is a health hazard. The particle concentrations can quickly change, with steep gradients on short temporal and spatial scales, and their chemical composition and physical properties vary considerably. Existing networks of aerosol particle measurements consist of limited number of monitoring stations, and mostly aim at assessment of compliance with air quality legislation regulating mass of particles of varying sizes. These networks can now be supplemented using small portable devices with low-cost sensors for assessment of particle mass that may provide higher temporal and spatial resolution if we understand the capabilities and characteristics of the data they provide. This paper overviews typical currently available devices and their characteristics. In addition it is presented original results of measurement and modelling in the aim of one low-cost PM monitor validation.

Rationale and design of the on-treatment PLAtelet Reactivity-Guided Therapy Modification FOR ST-Segment Elevation Myocardial Infarction (PLATFORM) randomized trial.

OBJECTIVES: The present trial aims at examining whether antiplatelet regimen modification, guided by assessment of the on-treatment platelet reactivity, might result with clinical benefit in moderate to high-risk patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). BACKGROUND: High platelet reactivity has been associated with an increased rate of ischemic events after PCI. Recent large trials did not show a clinical benefit of platelet reactivity-guided therapy modification in acute coronary syndrome patients treated by PCI. METHODS: PLATFORM is an investigator-initiated, prospective, randomized, parallel-group, controlled clinical trial. Approximately 632 STEMI patients with intermediate to high-risk (RISK-PCI score >3) clinical features undergoing PPCI will be randomly allocated to treatment modification or standard therapy. Low responders to aspirin will receive 200 mg aspirin for 30 days. Low responders to clopidogrel will receive 180 mg ticagrelor for 1 year. The primary end-point is the time to the first composite major adverse cardiovascular events (MACE) including death, nonfatal infarction, stroke, or immediate target vessel revascularization. Key safety end-point is the rate of TIMI major bleeding unrelated to coronary artery bypass graft surgery. Our secondary end-points are individual components of MACE, definite stent thrombosis, total bleeding, and the need for blood transfusions. Patients will be followed-up at 30 days and at 1 year after PPCI. CONCLUSION: PLATFORM will determine whether the platelet reactivity-guided use of ticagrelor in combination with 200 mg aspirin, compared with standard antiplatelet regimen, improves clinical outcome in moderate to high-risk STEMI patients undergoing PPCI. CLINICAL TRIAL REGISTRATION: U.S. National Institutes of Health (NIH) at www.clinicaltrials.gov. ClinicalTrials.gov Identifier: NCT01739556, and Current Controlled Trials at www.controlledtrials.com. International Standard Randomized Controlled Trial Number ISRCTN83081599.

Voice quality after treatment of early glottic carcinoma.

OBJECTIVES: Increasing incidence of laryngeal carcinoma and advancement in diagnostics and therapy methods, have led to constant exploration in that field. Early glottic carcinoma can be treated successfully with several procedures: cordectomy through laryngofissure, laser cordectomy, and radiotherapy. Our objective was to assess the voice quality after these different modalities of treatment. STUDY DESIGN: Prospective controlled study with 69 patients, treated in a 1-year period for glottic Tis and T1a carcinoma at the tertiary medical centre. METHODS: Nineteen of our patients were treated endoscopically with CO(2) laser (types III-IV cordectomy according to recommended European Laryngological Society classification of endoscopic cordectomies). Thirty-five patients underwent cordectomy through laryngofissure, 15 patients had radiotherapy. Multidimensional computer analysis of voice and speech was conducted 1, 6, and 12 months after the treatment. Three programs included 14 parameters, which were observed. RESULTS: While comparing the parameters between the groups, there were significant differences in the values of fundamental frequency (Hz), jitter (%), normalized noise energy (dB), standard deviation of fundamental frequency (Hz), percent silent time (%), and sound-pressure level in the different follow-up periods (P<0.05). CONCLUSION: In the long run, patients treated with radiotherapy show better voice quality in comparison with other two groups.

Speech and language disorders secondary to diffuse subcortical vascular lesions: Neurolinguistic and acoustic analysis. A case report.

BACKGROUND AND PURPOSE: Subcortical white matter (WM) plays an important role in speech production and language processing. Most frequently, cerebral WM lesions are secondary to small vessel disease in patients with vascular risk factors. We report the case of a 53-year-old man with history of hypertension and ischemic subcortical lesions, who presented with speech difficulties and mild cognitive impairment. METHODS: Language and cognitive assessment included Boston Diagnostic Aphasia Examination, Boston Naming Test, Rey Auditory-Verbal Learning Test, Rey-Osterrieth Complex Figure Test, Trail Making Test A and B, Wisconsin Card Sorting Test, Scale for Evaluation of Perceptive Characteristics of Voice and Speech, and Multidimensional Evaluation of Speech and Voice. RESULTS: Brain MRI showed ischemic WM lesions and lacunar infarcts in the brainstem and right cerebellum. Cognitive testing revealed mild cognitive impairment, predominantly affecting attention and executive functions. Speech and language analysis demonstrated dysarthria, dysphonia with hypophonia, and imprecise articulation, as well as short rushes of speech, palilalia and mild subcortical dysphasia. CONCLUSIONS: Neurolinguistic and acoustic analysis in patients with ischemic WM lesions can provide additional information in the understanding of language and speech disturbances, and can assist in patient management.