PURPOSE Research studies of maximum phonation time, have questioned its validity and value as a tool to assess laryngeal competence. This study proposes a fresh look at phonation time, from a different perspective. The interrelationships of the durations between semiocclusion vs. open vocal tract (/s/-/z/ vs. /a/) and voiced vs voiceless (/z/-/a/ vs. /s/) sound are examined to determine whether this approach might provide additional clinical insight into the respiratory phonatory efficiency of patients. METHODS Comfortable sustained phonation time of /s/, /z/ and /a/ was collected as part of the voice evaluation of patients referred by laryngologists for voice therapy. Inclusionary criteria male and female subjects 19 years of age or older. Exclusionary criteria autoimmune disorders, malignancies, major pulmonary/respiratory disorders. RESULTS A total of 218 patients (150 females and 68 males) mean age of 53.6 met all the criteria. Means, standard deviations and t test were conducted to determine whether significant differences existed. t test results indicate significance between s/z P = 0.002 and z/a P = 0.004 for females but only slight significance in s/a P = 0.03 for males. Close analysis of individual results observed four (4) different conditions or effects of fricative/semiocclusion and voicing the close durations of the /s/ and /z/ relative to the /a/; the /z/ and /a/ are close in duration relative to the /s/; the spread of more than 5 seconds between /s/, /z/ and /a/ relative to the others; and similar duration of /s/, /z/, and /a/. CONCLUSION Significant differences exist in the durations of comfortable phonation time of sustained /s/ and /z/ and /a/ thought to be related to effects of semiocclusion, fricative consonants, and voicing. Phonation time should be seen not only in terms of duration, but the interplay of the phonemic qualities of the sounds as they relate of laryngeal efficiency. OBJECTIVE This investigation aimed to verify if there were any differences in autonomic nervous system function and voice parameters of teachers with and without voice complaints. STUDY DESIGN Cross-sectional study. METHODS The Questionnaire of Autonomic Dysfunction was answered by 24 teachers, 6 males, and 18 females, whose heart rate variability was also assessed. Aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were done. Participants were divided into two groups without voice complaints (WVCG; n = 11) and with voice complaints (VCG; n = 13) based on the completion of the Sociodemographic and Clinical Questionnaire. RESULTS For auditory-perceptual analysis, VCG showed significantly higher values on GRBASH subscales Grade (P less then 0.001) and Roughness (P = 0.011). Regarding the heart rate variability, it was found that in the VCG, the square root of the mean squared difference of successive RR intervals (RMSSD) and the percentage of adjacent NN intervals differing by more than 50 milliseconds (pNN50) were significantly lower than in the WVCG (P = 0.023 and P = 0.032, respectively). The VCG presented a higher occurrence of neurovegetative symptoms directly related to voice, namely in fluctuating nose obstruction (P = 0.011), neck pain (while or after speaking) (P = 0.017) and in fatigability when speaking (P = 0.004). Concerning the aerodynamic assessment of voice, acoustic analysis of voice and neurovegetative symptoms not directly related to voice, no statistically significant differences between groups were found. CONCLUSIONS Findings indicated significantly lower values in RMSSD and pNN50 of teachers VCG when compared with teachers WVCG and that the teachers VCG presented a higher occurrence of neurovegetative symptoms directly related to voice than the ones WVCG. INTRODUCTION Increasingly, for pediatric patients with short bowel syndrome (SBS), intestinal lengthening procedures such as serial transverse enteroplasty (STEP) are being offered with the hope of improving patients’ chances for achieving enteral autonomy. However, it remains unclear to what extent STEP reduces the long-term need for intestinal transplant or improves survival. METHODS Based on existing literature, a decision analytic Markov state transition model was created to simulate the life of 1,000 pediatric SBS patients. Two simulations were modeled 1) No STEP patients were listed for transplant once medical management failed and 2) STEP patients underwent STEP therapy and subsequent transplant listing if enteral autonomy was not achieved. Sensitivity analysis of small bowel length and anatomy was completed. Base case patients were defined as neonates with a small bowel length of 30cm. Aminoguanidine hydrochloride clinical trial RESULTS For base case patients with an ostomy and a NEC SBS etiology, STEP was associated with increased rates of enteral autonomy after 10 years for patients with an ICV (53.9% [STEP] vs. 51.1% [No STEP]) and without an ICV (43.4% [STEP] vs. 36.3% [No STEP]). Transplantation rates were also reduced following STEP therapy for both ICV (17.5% [STEP] vs. 18.2% [No STEP]) and non-ICV patients (20.2% [STEP] vs. 22.1% [No STEP]). 10-year survival was the highest in the (+) STEP and (+) ICV group (85.4%) and lowest in the (-) STEP and (-) ICV group (83.3%). CONCLUSIONS For SBS patients, according to our model, STEP increases rates of enteral autonomy, reduces need for intestinal transplantation, and improves long-term survival. TYPE OF STUDY Economic/Decision Analysis or Modeling Studies LEVEL OF EVIDENCE Level III. PURPOSE Occurrence of Hirschsprung’s disease in anorectal malformation (ARM) patients is rare, but many surgeons still ask to pathologists to search for ganglia in the terminal rectum/fistula; the histological procedure is time and money consuming and the results confounding. A consecutive series of ARM patients, in which the presence of ganglia in terminal rectum was revised, is herein presented. MATERIALS AND METHODS Rectal specimens of ARM patients who underwent corrective surgery in the last 6 years were retrieved. The histological protocol included H&E staining and calretinin immunohistochemistry. Each specimen is processed until all material is examined if no ganglia are retrieved after the first twelve sections. RESULTS Forty cases were examined. Eight patients were younger than 1 month of age at operation. The mean length of the specimen was 1.5cm (range 1-3 cm). Upon clinical request, ganglia were searched in 15/40 cases (37.5%) and resulted absent in 10/15 (66.5%). All patients have been followed and none developed signs or symptoms suggestive for Hirschsprung.