Differences Between Flexible and Rigid Endoscopy in Assessing the Posterior Glottic Chink

Objective

To determine whether different modalities of laryngeal examination produce differences in the assessment of the posterior glottic chink (PGC), and whether the prevalence of PGC differs by gender.

Introduction

The PGC has been described as a triangular laryngeal space between the posterior laryngeal wall and the vocal processes during glottic closure found commonly in human females, but less often in males. The purpose of this study was not only to identify whether there are gender differences in prevalence of posterior glottic but also to determine whether there is a difference in detection of this configuration dependent on the modality of laryngeal imaging, specifically flexible nasopharyngolaryngoscopy (FNPL) versus rigid laryngoscopy (RL).

Methods

A review of 104 consecutive initial laryngeal examinations was performed. All patients underwent both flexible laryngoscopy (FL) and RL performed under stroboscopic light. Patients with immobile vocal folds, masses causing glottic gaps, atrophy, or severe muscle tension dysphonia causing an inability to fully visualize the entire length of the vocal fold were excluded. In the remaining patients, the posterior glottic configuration showing a posterior chink in relation to the vocal process was graded on a 0–4 scale (called the Posterior Glottic Closure Score [PGCS]); 0 was used to indicate a closed glottis and 4 the most open configuration without creating a complete glottic gap. PGCSs for males were compared with those of females, and the PGCSs obtained by flexible nasopharyngolaryngoscopy was compared with RL.

Results

Fifty-two patients were included in the study. Twenty-four of the patients were male, and 28 were female. The average age of the patients was 48.4 years (SD ± 17.35), and the range was 15–81 years. On RL, eight males had a PGCS 1–4, that is, evidence of PGC, and 23 females had a PGCS 1–4. On flexible nasopharyngolaryngoscopy, only four males had a PGCS 1–4 and 24 females had PGCS 1–4. Twenty-two females had a PGC detected by both modalities, and the PGCS was significantly higher using RL (2.73 ± 0.70 vs 2.14 ± 0.834) than FL. For the four males in which PGC was detected by both modalities, there was no statistical significance when comparing the PGCS between RL and FL (1.75 ± 0.96 vs 1.75 ± 0.5, P < 0.05). When comparing only males and females who had a PGC (PGCS 1–4), females had a higher PGCS (2.65 ± 0.78) than males (1.75 ± 0.71, P < 0.05) on RL, indicating a more open posterior glottis in females. On flexible examination, there was no difference detected in the average PGCS, 2.08 ± 0.83 for females and males 1.75 ± 0.50. PGCs were more common in younger (age 43 years) than older (age 54–56 years) subjects for both laryngoscopic modalities.

Conclusion

From this pilot study, we determined that there is a difference in male and female PGC prevalence and size. PGC is more common in females than males. Prevalence (or the detection rate) is about the same with RL and FL in females, but higher with RL than FL in males. The average score of the glottic opening, when present, was statistically significantly different between RL and FL in females but not in males. Furthermore, females had a larger PGCS on both modalities when compared with males, although this difference was only found to be statistically significant on RL; and complete glottic closure was more common in older than in younger subjects.     

Stability of carboplatin and oxaliplatin in their infusion solutions is due to self-association

Carboplatin and oxaliplatin are commonly used platinum anticancer agents that are sold as ready-to-use aqueous infusion solutions with shelf lives of 2 and 3 years, respectively. The observed rate constants for the hydrolysis of these drugs, however, are too large to account for their long shelf lives. We here use electrospray-trap mass spectrometry to show that carboplatin and oxaliplatin are self-associated at concentrations in their ready-to-use infusion solutions (~27 mM and 13 mM, respectively) and, as expected, when the drug concentration is reduced to more physiologically relevant concentrations (100 μM and 5 μM, respectively) the association equilibrium is shifted in favor of the monomeric forms of these drugs. Using (1)H NMR we measure the intensity of the NH resonance of the two symmetry-equivalent NH(3) molecules of carboplatin, relative to the intensity of the γ-methylene CH resonance, as a function of total drug concentration. Then, by fitting the data to models of different molecularity, we show that the association complex is a dimer with a monomer-dimer association constant of K (M(-1)) = 391 ± 127. The work presented here shows that carboplatin and oxaliplatin mainly exist as association complexes in concentrated aqueous solution, a property that accounts for the long term stability of their ready-to-use infusion solutions, and that these association complexes may exist, to some extent, in the blood after injection.     

Probing the protic ionic liquid surface using X-ray reflectivity

The structure of the free liquid surface of three protic ionic liquids, ethylammonium nitrate (EAN), propylammonium nitrate (PAN), and ethylammonium formate (EAF), has been elucidated using X-ray reflectivity. The results show all three liquids have an extended interfacial region, spanning at least five ion pairs, which can be divided into two parts. Adjacent to the gas phase are aggregates consisting of multiple cations and anions. Below this are layers oriented parallel to the macroscopic surface that are alternately enriched and depleted in cation alkyl chains and polar domains of cation ammonium groups and their anions, gradually decaying to the isotropic sponge-like bulk structure. The most pronounced layering is observed for PAN, driven by strong solvophobic interactions, while reduced hydrogen bonding in EAF results in the least structured and least extensive interfacial region.     

Discovery of kibdelomycin, a potent new class of bacterial type II topoisomerase inhibitor by chemical-genetic profiling in Staphylococcus aureus

Bacterial resistance to known therapeutics has led to an urgent need for new chemical classes of antibacterial agents. To address this we have applied?a Staphylococcus aureus fitness test strategy to natural products screening. Here we report the discovery of kibdelomycin, a novel class of antibiotics produced by a new member of the genus Kibdelosporangium. Kibdelomycin exhibits broad-spectrum, gram-positive antibacterial activity and is a potent inhibitor of DNA synthesis. We demonstrate through chemical genetic fitness test profiling and biochemical enzyme assays that kibdelomycin is a structurally new class of bacterial type II topoisomerase inhibitor preferentially inhibiting the ATPase activity of DNA gyrase and topoisomerase IV. Kibdelomycin is thus the first truly novel bacterial type II topoisomerase inhibitor with potent antibacterial activity discovered from natural product sources in more than six decades.     

Dilute Solution Properties of Styrene-N-Butyl Methacrylate (65:35) Copolymer: Short- and Long-Range Interaction of the Polymer Chain

Abstract

Viscosity and light-scattering data on styrene-n-butyl methacrylate (65:35) in chloroform are presented and tested by the two-parameter theoretical relations. The short-range interactions K and A and the long-range interaction parameter B have been calculated by different equations, using intrinsic viscosity and second virial coefficient data. These are then compared to the values of the homopolymer polystyrene. The conformation or the steric factor for the polymer chain has also been calculated. The excluded volume parameter Z, which is related to both the short- and long-range parameters, has been evaluated along with the expansion factor α _n . The higher value of the short-range parameters and the conformation factor compared to the parent styrene homopolymer is attributed to the effect of unlike monomer interactions causing extension of the polymer chain. An increase in the restriction of the internal rotation of side chains about the C-C bonds is also suggested. The excess interaction parameter has a negative value. The expansion factor α _n has been related to the excluded volume factor Z and the coefficient C is in close agreement with the theoretically calculated value of Yamakawa and Tanaka.     

Simultaneous separation and determination of 16 testosterone and nandrolone esters in equine plasma using ultra high performance liquid chromatography-tandem mass spectrometry for doping control

The potential for using testosterone and nandrolone esters in racehorses to boost the biological concentrations of these steroids and enhance athletic performance is very compelling and should be seriously considered in formulating regulatory policies for doping control. In order to regulate the use of these esters in racehorses, a sensitive and validated method is needed. In this paper, we report such a method for simultaneous separation, screening, quantification and confirmation of 16 testosterone and nandrolone esters in equine plasma by ultra high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Analytes were extracted from equine plasma by liquid-liquid extraction using a mixture of methyl tert-butyl ether and ethyl acetate (50:50, v/v) and separated on a sub-2 micron C(18) column. Detection of analytes was achieved on a triple-quadrupole mass spectrometer by positive electrospray ionization mode with selected reaction monitoring (SRM). Mobile phase comprised 2 mM ammonium formate and methanol. Deuterium-labeled testosterone enanthate and testosterone undecanoate were used as dual-internal standards for quantification. Limits of detection (LOD) and quantification (LOQ) were 25-100 pg/mL and 100-200 pg/mL, respectively. The linear dynamic range of quantification was 100-10,000 pg/mL. For confirmation of the presence of these analytes in equine plasma, matching of the retention time with mass spectrometric ion ratios from MS/MS product ions was used. The limit of confirmation (LOC) was 100-500 pg/mL. The method is sensitive, robust, selective and reliably reproducible.     

Selectivity in the photo‐Fenton and photocatalytic hydroxylation of biphenyl‐4‐carboxylic acid and derivatives (viz. 4‐phenylsalicylic acid and 5‐phenylsalicylic acid)

The selectivity of hydroxylation of the distal rings of 4‐phenylbenzoic acid, 4‐phenylsalicylic acid, and 5‐phenylsalicylic acid were determined using partial TiO₂‐mediated photocatalytic degradation and photo‐Fenton conditions. This separation of the binding site from the phenyl group being hydroxylated allows a less‐biased evaluation. The hydroxylation regiochemistry behaves as qualitatively expected for an electrophilic reaction, given the assumption that 4‐carboxyphenyl is a slightly electron‐withdrawing substituent. Selectivity for hydroxylation of the distal phenyl in 4‐ and 5‐phenylsalicylic acid is reversed, due to the reversal of the electronic demand, while adsorption to the TiO₂ surface is assumed to be analogous for the two structures. Copyright © 2011 John Wiley & Sons, Ltd.     

A Novel Application of Indocyanine Green Immunofluorescence in Emergent Colorectal Surgery

Here, we report on the feasibility of ICG fluorescence imaging to localize lesions in emergent minimally invasive surgery. A 49-year old female presented to the emergency department with a previously unknown malignant bowel obstruction. She was taken emergently to the operating room for a laparoscopic extended right hemicolectomy, based on tumor location from imaging. With intraoperative difficulty localizing the lesion, an on-table colonoscopy was performed. When the tumor was encountered, peritumoral ICG injections were performed, and the fluorescence lymphoscintigraphy was performed intraoperatively in an attempt to visualize the primary tumor laparoscopically. Intraoperative ICG Immunofluorescence allowed precise, real-time localization of the mass in the descending colon. This information changed the course of the operation, as a laparoscopic left hemicolectomy was then performed instead of the planned extended right hemicolectomy. The patient underwent an end-to-end anastomosis without the need for a defunctioning ileostomy. From this case, we demonstrate the use of ICG fluorescence imaging for tumor localization in the emergent setting is safe, feasible, and effective. This information gained from this technology enables real-time decision making, and can even change the operative plan in the emergent setting for the best patient outcomes. What does this paper add to the existing literature? This paper offers a novel application of an emerging technology- ICG fluorescence- that in this capacity allowed precise, real-time localization of a previously unknown mass in the emergent setting, and changed the course of the operation.     

Analysis of DNA methylation markers for tissue identification in individuals with different clinical phenotypes

Deoxyribonucleic acid (DNA) methylation patterns can be used to identify the type of tissue or body fluid found at a crime scene. However, tissue-related methylation levels have not been analyzed in individuals with different illnesses and medical conditions in forensic-specific studies. The primary goal of this study was to investigate if certain clinical phenotypes can alter the methylation levels of CpG sites in genes involved in tissue typing. Four studies with focus on DNA methylation analysis on individuals with different clinical conditions were selected from the Gene Expression Omnibus database. Then, a list of 137 CpG sites was compiled for further investigation. Statistical tests were performed to compare the beta-values results obtained for the control groups and the individuals affected by medical conditions. For each study, CpG sites that presented significant statistical differences between patients and control group were identified and it was possible to notice that DNA methylation levels can be affected in sites with potential forensic use. Although the observed DNA methylation variation (less than 10% difference) in this study would likely not cause any issues in body fluid identification, the results are important to show that this type of analysis should be taken into consideration when investigating and further validating body fluid markers. The CpG sites identified in this study should be further investigated by future studies on body fluids identification, and due to the significant difference in methylation levels in samples from affected individuals, caution must be taken before including these sites in tissue identification investigations.