Gastroesophageal reflux disease and vocal disturbances

CONTEXTO: A doença do refluxo gastroesofágico (DRGE) é uma doença crônica na qual o conteúdo gastroduodenal reflui para o esôfago. O quadro clínico da DRGE é usualmente referido como pirose e regurgitação (manifestações típicas). Manifestações atípicas (distúrbios da voz e asma) podem também ser referidas. OBJETIVO: Analisar os aspectos clínicos, endoscópicos, manométricos e pHmétricos de pacientes portadores da DRGE com distúrbios da voz. MÉTODO: Foram estudados 50 pacientes com a DRGE, sendo 25 com distúrbios da voz (grupo 1 - G1) e 25 sem estes sintomas (controles, grupo 2 - G2). Todos os pacientes foram submetidos a endoscopia, manometria e pHmetria esofágica (dois sensores). Os pacientes do G1 foram submetidos a videolaringoscopia. RESULTADOS: Achados endoscópicos: DRGE não-erosiva foi observada em 95% dos pacientes de G1 e em 88% de G2. Videolaringoscopia: congestão das pregas vocais, assimetria, nódulos e pólipos foram diagnosticados nos pacientes do G1. Manometria esofágica: pressão no esfíncter inferior do esôfago (mm Hg): 11,6 ± 5,2 em G1 e 14,0 ± 6,2 em G2 (P = 0,14); pressão no esfíncter superior do esôfago (mm Hg): 58,4 ± 15,9 em G1 e 69,5 ± 30,7 nos controles. Achados pHmétricos: índice de DeMeester: 34,0 ± 20,9 em G1 e 15,4 ± 9,4 em G2 (P<0,001); número de episódios de refluxo no sensor distal: 43,0 ± 20,4 em G1 e 26, 4 ± 17,2 em G2 (P<0,003); percentagem do tempo com pH esofágico menor que 4 unidades (sensor distal): 9,0% ± 6,4% em G1 e 3,4% ± 2,1% em G2 (P<0,001); número de episódios de refluxo no sensor proximal: 7,5 ± 10,9 em G1 e 5,3 ± 5,7 em G2 (P = 0,38); percentagem de tempo com pH esofágico menor que quatro unidades (sensor proximal): 1,2% ± 2,7% em G1 e 0,5% ± 0,7% em G2 (P = 0,210). CONCLUSÕES: Os aspectos clínicos, endoscópicos e manométricos em pacientes com a DRGE e distúrbios da voz não diferem dos pacientes sem estes sintomas. A intensidade do refluxo gastroesofágico é maior nos pacientes com distúrbios da voz. Os pacientes sem distúrbios da voz podem também apresentar episódios de refluxo gastroesofágico no sensor proximal.

Repertório vocal de Hylodes phyllodes (Amphibia, Anura, Hylodidae)

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Programa de saúde vocal para educadores: ações e resultados

TEMA: a voz do professor tem sido foco de estudos nas últimas duas décadas devido à alta ocorrência de alterações vocais nesta classe profissional, assim, reforçou-se a necessidade dos professores participarem de ações para garantir saúde vocal. Poucos são os estudos na literatura que descrevem programas e seus resultados. PROCEDIMENTOS: Descrever um Programa de Saúde Vocal desenvolvido no período 2002 a 2005, para educadores de ensino público (infantil e fundamental) do interior do Estado de São Paulo, composto por grupos básicos de voz oferecendo conhecimento teórico prático de cuidados vocais, com triagem da qualidade da voz dos participantes; grupos avançados buscando reorganização dos processos de fonação e do uso vocal em sala de aula. RESULTADOS: em média 56% dos educadores inscritos frequentaram as ações; 62,9% das vozes apresentavam distúrbios na triagem vocal com maioria em grau discreto; no início dos grupos avançados 100% dos educadores participantes referiram mais de 3 sintomas associados ao uso vocal, e após, somente 45% deles ainda de 4 a 13 sintomas; os dados de autopercepção vocal revelaram baixos escores de impacto da voz nas atividades profissionais. CONCLUSÃO: a descrição revelou a necessidade de ajustes constantes do programa para alcançar seus objetivos. A baixa participação às ações pode estar relacionada à presença de impacto discreto da voz nas atividades profissionais, fato a ser mais bem investigado no futuro, e o benefício constatado objetivamente da participação dos educadores nos grupos avançados de voz foi a diminuição na quantidade de sintomas vocais.

Effect of mechanical loading on the I-c degradation behavior of Bi-2223 tapes

During the winding process of HTS coils the tapes of Bi-2223 are subjected to the influence of bending strain, axial strain, compressive force and torsional deformation resulting in I-c degradation. In the literature the effects of the individual strain components are separately analyzed in spite of during coil winding and energizing the strain-stress effects are combined. In this work using commercial tapes of Bi-2223 Ag/AgMg with and without stainless steel reinforcement several samples were wound on cylindrical FRP G-10 holder in which different combined strains are applied. Measurements of I - V characteristic curves are done to determine the degree of critical current degradation and the operational limits. The results are compared with the I, values of short samples and other specimens subjected to deformation generated by loading types such as tensile and bending strain.

Study of the effect of the peptide loading and solvent system in SPPS by HRMAS-NMR

The SPPS methodology has continuously been investigated as a valuable model to monitor the solvation properties of polymeric materials. In this connection, the present work applied HRMAS-NMR spectroscopy to examine the dynamics of an aggregating peptide sequence attached to a resin core with varying peptide loading (up to 80%) and solvent system. Low and high substituted BHAR were used for assembling the VQAAIDYING sequence and some of its minor fragments. The HRMAS-NMR results were in agreement with the swelling of each resin, i.e. there was an improved resolution of resonance peaks in the better solvated conditions. Moreover, the peptide loading and the attached peptide sequence also affected the spectra. Strong peptide chain aggregation was observed mainly in highly peptide loaded resins when solvated in CDCl3. Conversely, due to the better swelling of these highly loaded resins in DMSO, improved NMR spectra were acquired in this polar aprotic solvent, thus enabling the detection of relevant sequence-dependent conformational alterations. The more prominent aggregation was displayed by the VQAAIDYING segment and not by any of its intermediary fragments and these findings were also corroborated by EPR studies of these peptide-resins labelled properly with an amino acid-type spin probe. Copyright (c) 2005 European Peptide Society and John Wiley & Sons, Ltd.

Fatigue crack growth of Al 7475 T761 under constant and variable amplitude loading

Experimental programs in constant and variable amplitude loading were performed to obtain a x N curves and to study retardation in fatigue crack growth due to overloads. The main aim of this research program was to analyse the effect of overload ratio and number of overload peaks. The effect of underloads, before and after the overload blocks was also studied. The generalised equation of Paris-Erdogan type was used for modelling of obtained data on crack propagation under constant amplitude load.

Morphometric and histochemical study of the human vocal muscle

The present study was conducted on vocal muscles removed at autopsy Rom adult individuals (10 men and 8 women, aes ranging from 48 to 78 years) with no laryngeal disease. Histologic analysis was performed with hematoxylin and eosin staining, and histochemical analysis was performed by nicotinamide-adenine-dinucleotide tetrazolium reductase, succinate dehydrogenase, and acid and alkaline myofibrillar adenosine triphosphatase reactions. The histochemical reactions showed that the muscle consists of slow-twitch oxidative (SO), fast-twitch glycolytic (FG), and fast-twitch glycolytic oxidative (FOG) fibers distributed in mosaic form. The frequencies of SO, FOG, and FG fibers were 40.50%, 54.75%, and 4.75%, respectively. The higher frequency of SO and FOG oxidative fibers characterizes the muscle as having aerobic metabolism, resistance to fatigue, and fast contraction. The mean minimum diameters were 31.37 mu m for SO fibers and 36.46 mu m for FOG and FG fibers.

All-on-four concept and immediate loading for simultaneous rehabilitation of the atrophic maxilla and mandible with conventional and zygomatic implants

We report the simultaneous rehabilitation of an edentulous patient with a hybrid (zygomatic and conventional implants) all-on-four implant-supported prosthesis for the maxilla and a standard (conventional implants) all-on-four implant-supported prosthesis for the mandible. The transfer impression was made with a multifunctional guide and the upper and lower prostheses were placed 24 h postoperatively. Clinical and radiographic examinations showed no infection or bony resorption 2 years later. Simultaneous maxillary and mandibular rehabilitation with all-on-four immediate loading is a viable, fast and effective option for edentulous patients. (C) 2009 Published by Elsevier Ltd on behalf of The British Association of Oral and Maxillofacial Surgeons.

Structural behaviour of three-pile caps subjected to axial compressive loading

This work presents a comparative analysis about the behaviour of pile caps supported by 3 piles subjected to axial loading. Piles with 20 cm and 30 cm diameters were analysed. The main reinforcement was maintained in all the specimens, however, the arrangement of the secondary reinforcement varied. The main reinforcement consisted of steel bars connecting the piles. The secondary reinforcement was made up of: (a) bars going through the piles and through the projection of the column, (b) bars forming a network, and (c) vertical and horizontal stirrups. The main objective was the observation of the pile cap behaviour regarding the cracks and the modes of rupture. The real scale specimens were subjected to experimental tests until failure by rupture. Instruments were placed with the aim to obtain the displacement of the bases, the strains in the main and secondary reinforcement bars, in the compression struts, in the lower and upper nodal zones and in the sides of the caps. None of the caps reached failure by rupture with a load less than 1.12 times the theoretical load. The specimens ruptured due to the cracking of the compression strut and/or the yielding of the reinforcement bars in one direction.

Mechanical strength and subcritical crack growth under wet cyclic loading of glass-infiltrated dental ceramics

Objectives. Evaluate the flexural strength (sigma) and subcritical crack growth (SCG) under cyclic loading of glass-infiltrated alumina-based (IA, In-Ceram Alumina) and zirconia-reinforced (IZ, In-Ceram Zirconia) ceramics, testing the hypothesis that wet environment influences the SCG of both ceramics when submitted to cyclic loading.Methods. Bar-shaped specimens of IA (n = 45) and IZ ( n = 45) were fabricated and loaded in three-point bending (3P) in 37 degrees C artificial saliva (IA(3P) and IZ(3P)) and cyclic fatigued (F) in dry (D) and wet (W) conditions (IA(FD), IA(FW), IZ(FD), IZ(FW)). The initial sigma and the number of cycles to fracture were obtained from 3P and F tests, respectively. Data was examined using Weibull statistics. The SCG behavior was described in terms of crack velocity as a function of maximum stress intensity factor (K(Imax)).Results. The Weibull moduli (m = 8) were similar for both ceramics. The characteristic strength (sigma(0)) of IA and IZ was and 466 MPa 550 MPa, respectively. The wet environment significantly increased the SCG of IZ, whereas a less evident effect was observed for IA. In general, both ceramics were prone to SCG, with crack propagation occurring at K(I) as low as 43-48% of their critical K(I). The highest sigma of IZ should lead to longer lifetimes for similar loading conditions.Significance. Water combined with cyclic loading causes pronounced SCG in IZ and IA materials. The lifetime of dental restorations based on these ceramics is expected to increase by reducing their direct exposure to wet conditions and/or by using high content zirconia ceramics with higher strength. (C) 2010 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

Early loading of single crowns supported by 6-mm-long implants with a moderately rough surface: a prospective 2-year follow-up cohort study

AimTo evaluate prospectively the clinical and radiographic outcomes after 2 years of loading of 6 mm long moderately rough implants supporting single crowns in the posterior regions.Material and methodsForty SLActive Straumann (R) short (6 mm) implants were placed in 35 consecutively treated patients. Nineteen implants, 4.1 mm in diameter, and 21 implants, 4.8 mm in diameter, were installed. Implants were loaded after 6 weeks of healing. Implant survival rate, marginal bone loss and resonance frequency analysis (RFA) were evaluated at different intervals. The clinical crown/implant ratio was also calculated.ResultsTwo out of 40 implants were lost before loading. Hence, the survival rate before loading was 95%. No further technical or biological complications were encountered during the 2-year follow-up. The mean marginal bone loss before loading was 0.34 +/- 0.38 mm. After loading, the mean marginal bone loss was 0.23 +/- 0.33 and 0.21 +/- 0.39 mm at the 1- and 2-year follow-ups. The RFA values increased between insertion (70.2 +/- 9) and the 6-week evaluation (74.8 +/- 6.1). The clinical crown/implant ratio increased with time from 1.5 at the delivery of the prosthesis to 1.8 after 2 years of loading.ConclusionShort implants (6 mm) with a moderately rough surface loaded early (after 6 weeks) during healing yielded high implant survival rates and moderate loss of bone after 2 years of loading. Longer observation periods are needed to draw more definite conclusions on the reliability of short implants supporting single crowns.To cite this article:Rossi F, Ricci E, Marchetti C, Lang NP, Botticelli D. Early loading of single crowns supported by 6-mm-long implants with a moderately rough surface: a prospective 2-year follow-up cohort study.Clin. Oral Impl. Res. 21, 2010; 937-943.doi: 10.1111/j.1600-0501.2010.01942.x.

Paralisia de corda vocal e cisto de tiroide

The authors present a rare case of vocal cord paralysis following thyroid cyst. The clinical diagnostic and evolution aspects are presented. The importance of precise evaluation of the thyroid gland in all cases of vocal cord paralysis is emphasized.