Multifaceted superoxide dismutase 1 expression in amyotrophic lateral sclerosis patients:a rare occurrence?

Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.

三维超声VOCAL技术:一种精确测量子宫肌瘤体积的方法

目的:评估二维超声(2D-US)、三维超声VOCAL技术(3D-VOCAL)对子宫肌瘤体积(UMV)测量的精确性。方法:选取2022年10月~2023年4月于福建医科大学附属龙岩第一医院行子宫肌瘤外科手术治疗的患者45例,术前运用2D-US、3D-VOCAL对UMV进行测量,与手术切除后的实际肌瘤体积进行比较,评估两种超声技术测量UMV的准确性及重复性。结果:3D-VOCAL测量肌瘤体积的一致性(ICC=0.992)高于2D-US(ICC=0.976),且3D-VOCAL在不同大小肌瘤中的ICC均高于2D-US(均P<0.001)。2D-US、3D-VOCAL、手术术后3组间UMV测值的体积在最大径<8 cm差异无统计学意义(P>0.05),而3组间在最大径≥8 cm差异有统计学意义(P<0.05);进一步两两分析显示,在最大径≥8 cm UMV中,2D-US与手术术后的UMV测值差异有统计学意义(P<0.05),3D-VOCAL与手术术后的UMV测值差异无统计学意义(P>0.05)。3D-VOCAL在不同观察者间及观察者内的一致性均优于2D-US。结论:3D-VOCAL对于术前UMV的测量优于2D-US,是一种简便、高效的可靠方法,为临床随访提供理论依据。

Pitfalls in internal jugular vein cannulation

Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the increased safety profile and insertion convenience,it has complications.Herein,we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.

Nasogastric tube syndrome:A Meta-summary of case reports

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.

Atypical presentation of a posterior fossa tumour:A case report

BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

A Study of the Effect of Sichuan Opera Singing on the Vocal Skills of Music Students

The purpose of the article is to explore the effects of Sichuan opera singing on music majors’vocal skills,focusing on three key aspects:pitch test,assessment of rhythmic perception,and emotional expression.Through a quasi-experimental design,100 music majors were selected as research subjects and divided into an experimental group that received Sichuan opera singing instruction and a control group that received traditional vocal instruction.The results showed that compared with the control group,the experimental group receiving Sichuan opera singing teaching showed significant improvement in pitch mastery,rhythm perception,and emotional expression.

The Contribution of Vocal Music Education in Colleges and Universities to Cultural Inheritance and Innovation

The importance of education and cultural inheritance is becoming increasingly prominent.Through literature review and empirical research,combining quantitative data and qualitative analysis,this paper assesses the teaching methods,curriculum,and student interest and participation in vocal music education in colleges and universities.The study found that vocal music education played a positive role in increasing students’participation in cultural activities,enhancing their identification with traditional music and improving their skills,despite problems such as inadequate teaching systems and homogenized curricula.In particular,the participation rate of students in cultural activities before and after the educational changes increased significantly from 31–54.7%to 62.4–83.6%,indicating that vocal music education can effectively stimulate students’enthusiasm for cultural participation.In addition,the strengthening of the teaching staff and innovations in teaching methods,such as the application of multimedia and virtual reality technologies,provide students with richer learning experiences and personalized learning paths.

Vocal repertoire of Azure-winged Magpies(Cyanopica cyanus):A context-associated communication system

Signals within animals’vocal communication are considered functional referential and context-specific.Even in the absence of the context,receivers are expected to acquire the information of calls and respond specificallyWhereas the framework was supported by plenty of evidence,its exhaustivity in describing all animal vocalisations has been questioned.Here,we investigated the vocal repertoire of a cooperatively breeding species,Azure-winged Magpie(Cyanopica cyanus),to present evidence for referential signals.The results showed that Azure-winged Magpies had a relatively large vocal repertoire,consisting of twelve distinct calls.These calls were associated with the context including movement,begging for food,contact,vigilance against predators,etc.However,even the predator-specific alarm calls would induce various responses of receivers.This implies that multiple pieces of information are involved in the vocalisation,which could be utilised by the receiver to select an appropriate response based on the surroundings.Our study gives a detailed description of the context and function of the vocal repertoire in Azure-winged Magpies,laying the foundation for further investigation on the developmental mechanisms of bird vocalisations.This study also suggests that the referential signals of animal vocalisations may not be limited to the context-specific responses of receivers and need to be discussed from a broader perspective.

声带寻常疣1例

1临床资料患者,男,52岁,因“声音嘶哑、呼吸困难2个月余”于2019年7月就诊于云南省保山市第二人民医院。患者2个月前无明显诱因出现声音嘶哑及呼吸困难,偶有咳嗽且咳少量黄色脓痰,无咽喉疼痛、头痛及吞咽困难。患者既往体健,否认烟酒史,否认有免疫系统疾病及慢性疾病病史。体格检查:一般情况可,气管居中,颈部未触及明显肿物。

Antipredatory call behavior of lapwing species in an Afrotropical environment

Predation is an important source of natural selection on prey species and has resulted in adaptations such as antipredator vocal signals,which can alert others to the presence of predators and solicit cooperative attack.Although vocal alarm signals of birds have been well studied,they are poorly known in tropical African species.To address this lack of information,the antipredatory signals and responses of two lapwings(Wattled Lapwing Vanellus senegallus and Spur-winged Lapwing Vanellus spinosus)to potential predators were investigated using data collected from focal observation,distance measurements,focal recordings,and playback experiment.The lapwing calls elicited to predators were classified as alarm or mobbing calls based on whether the calls elicited alert behavior or attack from other lapwings.Discriminant linear analysis(DLA)was used to compare the time and frequency parameters of the call types measured in Raven PRO.Also,lapwings’responses to intruders,alert and start distance,time of day,and latency,as well as the effects of flock size and distance to cover were examined.About 48%of all calls was correctly classified by DLA.The best predictors of call type for the lapwings were maximum frequency and high frequency.Both alarm and mobbing calls were elicited by African Wattled Lapwings to dogs and humans.Mobbing calls were elicited to intruders by the Spur-winged Lapwings.Alert distance was positively associated with start distance,and differed between morning and evening in both lapwings.With scarce information from tropical Africa,this study put in perspective vocal and antipredator behavior of lapwing species in Africa.

Quiet in the nest:The nest environment attenuates song in a grassland songbird

The nest environment may limit the ability of nest-bound birds to hear sounds from the outside world.In vocal learning species,such as humans and songbirds,it is vital for young animals to hear the voices of conspecific animals early in life.In songbirds,nest structure varies considerably across species,and the resulting impact on sound transmission may have consequences for vocal learning in nestlings.In this study,we tested the hypothesis that the nest environment attenuates song of Savannah Sparrows(Passerculus sandwichensis),grassland songbirds that build nests on the ground under cover of dense vegetation.We recorded live Savannah Sparrows singing at variable distances from 21 nests.We recorded songs using one microphone inside the nest(the typical position of a nestling)and another placed 1 m directly above the nest(a typical position of an adult).We found a substantial reduction in signal-to-noise ratio,where songs recorded inside the nest were an average of 11 dB lower than songs recorded directly above the nest.We estimate that the attenuation imposed by the nest reduced the maximum acoustic environment from 117.7 m(for recordings above the nest),to 78.6 m(for recordings within the nest),which is analogous to listening from a position 39.1 m farther away from the singer.Previous research estimated that song transmits up to 100 m in this species,so any adult male within 100 m of a young bird was previously considered a potential vocal tutor.By reducing the nestling acoustic environment from 100 m to 78.6 m,the number of male tutors available to nestlings is reduced by an average of 27%.Given the growing evidence that song learning begins very early in life,future research on vocal development should account for how the structural properties of the natal environment affect the songs that nestlings hear.

Paradoxical vocal fold motion masquerading as post-anesthetic respiratory distress:A case report

BACKGROUND Functional vocal cord disorders can be a differential diagnosis for postoperative upper airway obstruction requiring urgent intervention.However,this may be unfamiliar to anesthesiologists who would favor inappropriate airway intervention and increased morbidity.CASE SUMMARY A 61-year-old woman underwent cervical laminectomy,followed by laparoscopic cholecystectomy 10 mo later.Despite adequate reversal of neuromuscular blockade,the patient experienced repetitive respiratory difficulty with inspiratory stridor after extubation.After the second operation,the patient was diagnosed with paradoxical vocal fold motion(PVFM)by an otolaryngologist based on the clinical features and fiberoptic bronchoscopy results,and the patient was successfully treated.CONCLUSION PVFM should be considered a differential diagnosis if a patient presents with stridor after general anesthesia.

A 3D Geometry Model of Vocal Tract Based on Smart Internet of Things

The Internet of Things(IoT)plays an essential role in the current and future generations of information,network,and communication development and applications.This research focuses on vocal tract visualization and modeling,which are critical issues in realizing inner vocal tract animation.That is applied in many fields,such as speech training,speech therapy,speech analysis and other speech production-related applications.This work constructed a geometric model by observation of Magnetic Resonance Imaging data,providing a new method to annotate and construct 3D vocal tract organs.The proposed method has two advantages compared with previous methods.Firstly it has a uniform construction protocol for all speech organs.Secondly,this method can build correspondent feature points between different speech organs.There are less than three control parameters can be used to describe every speech organ accurately,for which the accumulated contribution rate is more than 88%.By means of the reconfiguration,the model error is less than 1.0 mm.Regarding to the data from Chinese Magnetic resonance imaging(MRI),this is the first work of 3D vocal tract model.It will promote the theoretical research and development of the intelligent Internet of Things facing speech generation-related issues.

三维VOCAL技术及MRI检查在子宫切口瘢痕妊娠中的诊断价值

目的探讨三维超声容积测量(Virtual organ computer-aided analysis,VOCAL)技术及磁共振成像技术(Magnetic resonance imaging technique,MRI)检查在子宫切口瘢痕妊娠中的诊断价值。方法选取2020年10月-2022年11月河北省衡水市第二人民医院169例瘢痕妊娠女性(研究组),另选取同期169例剖宫产术后正常妊娠女性(对照组)。两组均进行MRI及三维VOCAL检查,比较两组三维VOCAL参数[血管化血流指数(Vascularized blood flow index,VFI)、血流指数(Blood flow index,FI)、血管形成指数(Vascularity index,VI)]及MRI参数(不均匀强化率、剩余肌层厚度),并比较三维VOCAL技术及MRI检查对瘢痕妊娠诊断情况。结果研究组不均匀强化率、VFI、FI、VI高于对照组,剩余肌层厚度小于对照组(P<0.05)。三维VOCAL检查、MRI检查单独及联合诊断敏感度、准确度、阴性预测值比较,差异有统计学意义(P<0.05),联合检查特异度、阳性预测值与三维VOCAL、MRI单独检查间差异无统计学意义(P>0.05)。结论三维VOCAL联合MRI较单独检查,可提升子宫切口瘢痕妊娠诊断敏感度与准确度,降低漏诊及误诊风险,值得推广。

A Giant Granuloma of the Vocal Process after Double-Lumen Bronchial Catheter Insertion: A Rare Case Report and Literature Review

Background: Double-lumen endotracheal (DLT) is commonly used for one-lung ventilation and lung separation during thoracic surgery. There are case reports of medically induced laryngeal granulomas, mainly in patients after single-lumen endotracheal (SLT) tube intubation and tracheotomy, and giant granulomas of the vocal cords due to double-lumen bronchial tube insertion have rarely been reported. Case presentation: A 49-year-old female patient underwent single-port thoracoscopy after DLT intubation as well as a wedge resection of the lower lobe of the left lung, which caused giant vocal process granulomas (VPGs) postoperatively. Based on a retrospective analysis of the general condition, current medical history, past medical history, and visual laryngoscopic observation of the vocal folds tissue, which ruled out preoperative vocal fold granuloma formation, we hypothesized that double-lumen bronchial catheter intubation may have been the primary cause of her vocal fold granuloma formation. Conclusions: Giant granuloma of the vocal folds after DLT insertion is a rare postoperative complication;therefore, if DLT intubation is to be performed, the anesthesiologist should choose an appropriate intubation plan and deal with it promptly to avoid the risk factors to ensure that the patient’s perioperative period is safe and smooth. In addition, if postoperative complications are encountered, they should be followed up and observed on time.

Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1st 2008 and March 31st 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.

CO_2激光在喉癌前病变中的应用

癌前病变是指一类比正常黏膜更易发生癌变的疾病，包括喉角化病、声带白斑、成人喉乳头状瘤等，对此类患者应积极干预治疗，阻止癌变的发生。

声带息肉合并喉梗阻症状的治疗方法探讨

目的研究喉显微镜支撑喉镜下CO2激光手术治疗声带息肉合并不同程度喉梗阻患者的疗效。方法选取18例声带息肉伴有不同程度喉梗阻患者为研究对象,均采用纤维支气管镜引导下经鼻气管插管,实施喉显微镜支撑喉镜下CO2激光切除声带息肉手术,术后1个月复查电子喉镜,统计患者治疗总有效率及嗓音功能恢复、并发症以及术后复发等情况。结果 18例患者均一次性插管成功,无气管切开病例,除2例口咽侧壁擦伤外无其他并发症,术后呼吸困难症状改善明显,术后1个月嗓音功能恢复良好,治愈14例(77.78%),好转4例(22.22%),随访半年,无复发病例。结论纤维支气管镜引导下经鼻气管插管,CO2激光显微外科手术是治疗声带息肉合并喉梗阻患者安全、有效、微创的手术方法,值得临床推广应用。

激光联合局部应用玻璃酸钠注射液治疗声带粘连

声带粘连是声带疾病术后及喉外伤的常见并发症,其治疗至今仍是临床上的棘手课题。声带粘连轻者可引起声嘶,丧失语言交流能力,重者还易发生呼吸困难、丧失劳动力,甚至危及生命。该病治疗方法虽多,但疗效却不甚理想。作者采用激光切割联合经皮环甲膜穿刺局部注射施沛特（玻璃酸钠注射液）治疗声带粘连,取得一定效果,现报道如下。

喉动力切削系统在声带良性病变中的应用

喉动力切削系统具有负压吸引与旋转吸切相结合的功能,使喉部手术快速、精确、安全,大大提高了手术的效率和质量,目前已广泛应用于喉部微创手术[1]。回顾性分析我科2009年6月～2011年6月采用鼻内镜辅助支撑喉镜下喉动力切削系统治疗的84例声带良性病变,报道如下。