• 제목/요약/키워드: Background variability

검색결과 192건 처리시간 0.023초

Parasympathetic Modulation Plays a Key Role in Initiation of Paroxysmal Atrial Fibrillation

  • Lee, Won-Jae;Shin, Dong-Gu;Hong, Geu-Ru;Park, Jong-Sun;Kim, Young-Jo
    • Journal of Yeungnam Medical Science
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    • 제24권2호
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    • pp.216-231
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    • 2007
  • 배경 : 자율 신경의 영향력을 반영하는 심박동의 가속 또는 감속은 발작성 심방세동의 시작전 관찰된다. 본 연구의 목적은 심방세동 시작 전에 선행하는 두 다른 형태의 심박동의 변화가 자율 신경에 상호작용하는 차이를 평가하기 위함이다. 재료 및 방법 : 발작성 심방 세동이 기록된 105개의 홀터 결과 중에 5분 이상의 발작성 심방세동이 발생하기 전에 최소 한 시간 이상동안 정상 동율동을 보인 55개의 홀터 결과를 선택하여 심박동의 다양성에 대한 시간-우선 및 빈도-우선 분석을 시행하였다. 55개의 홀터 결과를 두 그룹으로 나누었는데, 발작성 심방 세동이 발생하기 전 마지막 2분 동안 심박동의 가속이 있었던 결과들을 그룹 A(n=30)로 분류하였고, 심박동의 감소가 있었던 결과들은 그룹 B(n=25)로 분류하였다. 결과 : 그룹 A에서 저명하게 비교적 균일한 평균 RR 간격의 감소($924{\pm}30$ to $835{\pm}28ms$, $P$=0.001)가 관찰되었고, 그룹 B에서는 평균 RR 간격의 증가($831{\pm}32$ to $866{\pm}31ms$, $P$=0.046)가 관찰되었다. 그룹 A는 빈도-우선 분석에서 LF/HF 비가 점진적으로 비교적 균일하게 증가하였다($P$=0.005). 그룹 A에서 HF normalized units ($HF_{nu}$)값은 $30.8{\pm}4.0$에서 $16.1{\pm}1.8$으로 감소하였고($P$=0.003), natural logarithm-transformed HF ($In$HF) 값은 $4.49{\pm}0.25$에서 $4.07{\pm}0.22$로 감소하였다($P$=0.001). 그룹 A와는 정반대로 그룹 B에서 $HF_{nu}$ 값은 $22.6{\pm}3.2$에서 $30.2{\pm}4.0$으로 증가하였고 ($P$=0.005), $In$HF 값도 $4.27{\pm}0.27$에서 $4.75{\pm}0.33$으로 증가하였다($P$=0.001). LF/HF 비도 그룹 B에서 결과적으로 감소하였다. 두 그룹 사이에 LF 구성요소의 저명한 차이는 관찰되지 않았다. 결론 : 발작성 심방세동이 시작되기 전에 선행하는 심박동의 가속과 감속을 유발하는 자율신경의 구동은 부교감 신경의 가감조절 때문이다. 부교감 신경의 가감조절이 발작성 심방세동의 시작에 중요한 역할을 하는 것으로 판단된다.

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무안지역 메탄가스의 단주기적 농도변화에 대한 평가 (Studies of Short-Term Variability of Methane in the Moo-Ahn Observatory Site in Korea)

  • 최규훈;윤용훈;김창희;조영민;김기현
    • 한국지구과학회지
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    • 제22권4호
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    • pp.327-338
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    • 2001
  • 본 연구에서는 전남 무안지역을 중심으로 관측한 농도자료와 세계의 주요 배경관측지점인 Point Barrow(Alaska), Mauna Loa(Hawaii)를 중심으로 관측한 농도자료를 이용하여, 메탄의 농도분포특성을 지역 또는 시간의 함수로 비교분석하였다. 이들 관측점들은 주요 위도대를 대표하기 때문에, 위도별 베탄의 분포특성을 파악하는데도 중요한 단서를 제공하였다. 또한 본 연구결과에 기초하여 메탄의 농도변화양상을 여러 가지 시간적 주기로 비교하고, 그러한 결과의 의미를 다양한 통계적 기법에 기초하여 분석하였다. 전체 관측기간동안 확보된 일평균 농도자료로부터 계산된 무안지역의 농도는 1898${\pm}$85.3ppb(N=812)로 나타났다. 동일한 기관동안 두 개의 비교관측지점인 Point Barrow와 Mauna Loa 지역에서는 1832${\pm}$29.6ppb(N=823), 1745${\pm}$14.8ppb(N=818)의 평균농도가 각각 관측되었다. 각 지점에서 관측된 자료를 이용하여 빈도분포를 비교한 결과에 따르면, 무안지역에서 1900ppb의 최빈값을 나타낸 반면, Point Barrow, Mauna Loa 지역에서는 각각 1850, 1750ppb로 (상대적으로) 낮은 최빈값을 보여주었다. 이 논문에서는 국내의 관측점에서 발견되는 고농도의 메탄분포특성을 여러 관점에서 비교하고 해석하고자 하였다. 국외지역에서 주로 발견되는 미미한 수준의 농도변화 경향과 달리, 무안지역에서는 여타 지역들에 비해 절대적으로 높은 농도값이 유지되고 그 농도변화가 주야간대별로 뚜렷하게 구분될 정도로 주기적인 변화의 폭이 큰 것으로 확인되었다. 특히 무안지역에서는 낮시간대(6:00 AM 이후)에 농도가 낮아지고, 저녁시간대에 농도치가 상승하는 경향이 두드러졌다. 풍향과 CH$_4$농도관계를 비교한 결과, 연구대상지역이 서해안에 위치한 지리적인 요건으로 인해 상대적으로 청정한 해풍이 주를 이루는 서풍계열의 풍계가 나타날 때, CH$_4$의 농도는 낮은 수준을 유지하는 것으로 나타났다. 본 연구에 의하면, 국내 지점의 메탄농도는 국외여타 지점에 비해 뚜렷하게 구분이 될 정도로 높은 수준을 유지하고 있다. 이러한 현상을 초래하는 원인으로 여타 비교대상지역들에 비해, 무안지역이 보다 다양한 배출원의 영향에 직접적으로 노출된데 따른 영향을 직간접적으로 반영하는 결과로 사료된다. 연구지점에서 발견된 CH$_4$의 고농도 현상과 일주기를 중심으로 반복되는 농도의 큰 진동폭이 나타나는 현상도 역시 주목할 만하다.

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CCTV 영상 기반 강우강도 산정을 위한 실환경 실험 자료 중심 적정 강우 이미지 DB 구축 방법론 개발 (Rainfall image DB construction for rainfall intensity estimation from CCTV videos: focusing on experimental data in a climatic environment chamber)

  • 변종윤;전창현;김현준;이재준;박헌일;이진욱
    • 한국수자원학회논문집
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    • 제56권6호
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    • pp.403-417
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    • 2023
  • 본 연구에서는 CCTV 영상 기반 강우강도 산정 시 필수적으로 요구되는 적정 강우 이미지 DB를 구축하기 위한 방법론을 개발하였다. 먼저, 실환경에서 불규칙적이고 높은 변동성을 보일 수 있는 변수들(바람으로 인한 빗줄기의 변동성, 녹화 환경에서 포함되는 움직이는 객체, 렌즈 위의 흐림 현상 등)에 대한 통제가 가능한 한국건설생활환경시험연구원 내 기후환경시험실에서 CCTV 영상 DB를 구축하였다. 서로 다른 5개의 실험 조건을 고려하여 이상적 환경에서 총 1,728개의 시나리오를 구성하였다. 본 연구에서는 1,920×1,080 사이즈의 30 fps (frame per second) 영상 36개에 대하여 프레임 분할을 진행하였으며, 총 97,200개의 이미지를 사용하였다. 이후, k-최근접 이웃 알고리즘을 기반으로 산정된 최종 배경과 각 이미지와의 차이를 계산하여 빗줄기 이미지를 분리하였다. 과적합 방지를 위해 각 이미지에 대한 평균 픽셀 값을 계산하고, 설정한 픽셀 임계치보다 큰 자료를 선별하였다. 180×180 사이즈로의 재구성을 위해서 관심영역을 설정하고 10 Pixel 단위로 이동을 진행하여 픽셀 변동성이 최대가 되는 영역을 산정하였다. 합성곱 신경망 모델의 훈련을 위해서 120×120 사이즈로 재변환하고 과적합 방지를 위해 이미지 증강 과정을 거쳤다. 그 결과, 이미지 기반 강우 강도 합성곱 신경망 모델을 통해 산정된 결과값과 우량계에서 취득된 강우자료가 전반적으로 유사한 양상을 보였으며, 모든 강우강도 실험 조건에 대해서 약 92%의 데이터의 PBIAS (percent bias)가 절댓값 범위 10% 이내에 해당하였다. 본 연구의 결과물과 전이학습 등의 방법을 연계하여 기존 실환경 CCTV의 한계점을 개선할 수 있을 것으로 기대된다.

중등학교 교과서 황해난류 오개념 분석 및 해류 데이터 시각화 수업자료 개발 (Misconception on the Yellow Sea Warm Current in Secondary-School Textbooks and Development of Teaching Materials for Ocean Current Data Visualization)

  • 김수란;박경애;변도성;정광영;최병주
    • 한국지구과학회지
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    • 제44권1호
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    • pp.13-35
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    • 2023
  • 지구의 기후 변화를 유도하고 제어하는 가장 중요한 역할을 하는 것은 해양의 해류이다. 황해는 수심이 동해에 비해 매우 얕고, 다양한 바람과 조류, 강물의 유입, 동중국해에서의 해수 유입 등 외력의 영향으로 해수의 순환과 해류가 상당히 복잡하다. 황해난류는 겨울철 황해의 대표적인 해류로서 겨울철 황해와 동중국해 바람 변동성과 밀접한 관련이 있으며, 황해의 수온과 염분 분포에 큰 영향을 주어서 중등학교 교과서에서 중요하게 다루어질 필요성이 있다. 2015 개정 교육과정 기반 중등학교 과학 및 지구과학 교과서의 황해난류와 관련된 내용을 분석하였다. 또한 해류의 시간 변동성에 대한 교사들의 인식을 조사하기 위해 중등학교 과학 교사들을 대상으로 설문조사를 실시하였다. 대부분의 교사들은 황해난류가 우리나라 서해안으로 연중 북상하고 있으며 일반적인 난류와 같이 여름철에 강하다는 잘못된 지식을 가지고 있는 것으로 나타났다. 황해난류는 해류의 세기가 강한 계절변동성을 가지는 북한한류와 달리 해류 자체가 연중 항시 존재하지 않으며 겨울철에만 발생하는 해류이다. 이러한 교사들의 교과내용 지식에 대한 오류는 북한한류가 겨울철에 강하다는 오개념을 가지게 된 연유와 유사한 배경을 가지고 있었다. 따라서 본 연구에서는 황해난류에 대한 교과서 내용의 오류를 분석하여 제시하였다. 또한 학생들과 교사들의 데이터 리터러시 함양을 위하여 탐구활동에서 활용할 수 있는 황해난류에 대한 수업 자료를 개발하였다. 황해 해수면 온도를 가시화할 수 있는 GUI 프로그램을 소개하였고, WOA (World Ocean Atlas) 2018 해양 실측 수온 및 염분자료와 국립해양조사원에서 생성한 해양 수치모델 재분석자료를 활용하여 수온과 염분의 공간 분포를 도시하는 자료를 개발하여 제시하였다. 이러한 해양 자료를 활용한 데이터 시각화과정은 교사들의 오개념을 개선하고, 나아가 학생들과 교사들의 해양 리터러시뿐만 아니라 데이터 리터러시도 제고하는 계기가 될 것으로 기대된다.

Ovarian Masses: Is Multi-detector Computed Tomography a Reliable Imaging Modality?

  • Khattak, Yasir Jamil;Hafeez, Saima;Alam, Tariq;Beg, Madiha;Awais, Mohammad;Masroor, Imrana
    • Asian Pacific Journal of Cancer Prevention
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    • 제14권4호
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    • pp.2627-2630
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    • 2013
  • Background: Ovarian cancer continues to pose a major challenge to physicians and radiologists. It is the third most common gynecologic malignancy and estimated to be fifth leading cancer cause of death in women, constituting 23% of all gynecological malignancies. Multi-detector computed tomography (MDCT) appears to offer an excellent modality in diagnosing ovarian cancer based on combination of its availability, meticulous technique, efficacy and familiarity of radiologists and physicians. The aim of this study was to compute sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of 64-slice MDCT in classifying ovarian masses; 95% confidence intervals were reported. Materials and Methods: We prospectively designed a cross-sectional analytical study to collect data from July 2010 to August 2011 from a tertiary care hospital in Karachi, Pakistan. A sample of 105 women aged between 15-80 years referred for 64-MDCT of abdomen and pelvis with clinical suspicion of malignant ovarian cancer, irrespective of stage of disease, were enrolled by non-probability purposive sampling. All patients who were already known cases of histologically proven ovarian carcinoma and having some contraindication to radiation or iodinated contrast media were excluded. Results: Our prospective study reports sensitivity, specificity; positive and negative predictive values with 95%CI and accuracy were computed. Kappa was calculated to report agreement among the two radiologists. For reader A, MDCT was found to have 92% (0.83, 0.97) sensitivity and 86.7% (0.68, 0.96) specificity, while PPV and NPV were 94.5% (0.86, 0.98) and 86.7% (0.63, 0.92), respectively. Accuracy reported by reader A was 90.5%. For reader B, sensitivity, specificity, PPV and NPV were 94.6% (0.86, 0.98) 90% (0.72, 0.97) 96% (0.88, 0.99) and 87.1% (0.69, 0.95) respectively. Accuracy computed by reader B was 93.3%. Excellent agreement was found between the two radiologists with a significant kappa value of 0.887. Conclusion: Based on our study results, we conclude MDCT is a reliable imaging modality in diagnosis of ovarian masses accurately with insignificant interobserver variability.

Black Hispanic and Black Non-Hispanic Breast Cancer Survival Data Analysis with Half-normal Model Application

  • Khan, Hafiz Mohammad Rafiqullah;Saxena, Anshul;Vera, Veronica;Abdool-Ghany, Faheema;Gabbidon, Kemesha;Perea, Nancy;Stewart, Tiffanie Shauna-Jeanne;Ramamoorthy, Venkataraghavan
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권21호
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    • pp.9453-9458
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    • 2014
  • Background: Breast cancer is the second leading cause of cancer death for women in the United States. Differences in survival of breast cancer have been noted among racial and ethnic groups, but the reasons for these disparities remain unclear. This study presents the characteristics and the survival curve of two racial and ethnic groups and evaluates the effects of race on survival times by measuring the lifetime data-based half-normal model. Materials and Methods: The distributions among racial and ethnic groups are compared using female breast cancer patients from nine states in the country all taken from the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry. The main end points observed are: age at diagnosis, survival time in months, and marital status. The right skewed half-normal statistical probability model is used to show the differences in the survival times between black Hispanic (BH) and black non-Hispanic (BNH) female breast cancer patients. The Kaplan-Meier and Cox proportional hazard ratio are used to estimate and compare the relative risk of death in two minority groups, BH and BNH. Results: A probability random sample method was used to select representative samples from BNH and BH female breast cancer patients, who were diagnosed during the years of 1973-2009 in the United States. The sample contained 1,000 BNH and 298 BH female breast cancer patients. The median age at diagnosis was 57.75 years among BNH and 54.11 years among BH. The results of the half-normal model showed that the survival times formed positive skewed models with higher variability in BNH compared with BH. The Kaplan-Meir estimate was used to plot the survival curves for cancer patients; this test was positively skewed. The Kaplan-Meier and Cox proportional hazard ratio for survival analysis showed that BNH had a significantly longer survival time as compared to BH which is consistent with the results of the half-normal model. Conclusions: The findings with the proposed model strategy will assist in the healthcare field to measure future outcomes for BH and BNH, given their past history and conditions. These findings may provide an enhanced and improved outlook for the diagnosis and treatment of breast cancer patients in the United States.

Screening for the 3' UTR Polymorphism of the PXR Gene in South Indian Breast Cancer Patients and its Potential role in Pharmacogenomics

  • Revathidevi, Sundaramoorthy;Sudesh, Ravi;Vaishnavi, Varadharajan;Kaliyanasundaram, Muthukrishnan;MaryHelen, Kilyara George;Sukanya, Ganesan;Munirajan, Arasambattu Kannan
    • Asian Pacific Journal of Cancer Prevention
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    • 제17권8호
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    • pp.3971-3977
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    • 2016
  • Background: Breast cancer, the commonest cancer among women in the world, ranks top in India with an incidence rate of 1,45,000 new cases and mortality rate of 70,000 women every year. Chemotherapy outcome for breast cancer is hampered due to poor response and irreversible dose-dependent cardiotoxicity which is determined by genetic variations in drug metabolizing enzymes and transporters. Pregnane X receptor (PXR), a member of the nuclear receptor superfamily, induces expression of drug metabolizing enzymes (DMEs) and transporters leading to regulation of xenobiotic metabolism. Materials and Methods: A genomic region spanning PXR 3' UTR was amplified and sequenced using genomic DNA isolated from 96 South Indian breast cancer patients. Genetic variants observed in our study subjects were queried in miRSNP to establish SNPs that alter miRNA binding sites in PXR 3' UTR. In addition, enrichment analysis was carried out to understand the network of miRNAs and PXR in drug metabolism using DIANA miRpath and miRwalk pathway prediction tools. Results: In this study, we identified SNPs rs3732359, rs3732360, rs1054190, rs1054191 and rs6438550 in the PXR 3; UTR region. The SNPs rs3732360, rs1054190 and rs1054191 were located in the binding site of miR-500a-3p, miR-532-3p and miR-374a-3p resulting in the altered PXR level due to the deregulation of post-transcriptional control and this leads to poor treatment response and toxicity. Conclusions: Genetic variants identified in PXR 3' UTR and their effects on PXR levels through post-transcriptional regulation provide a genetic basis for interindividual variability in treatment response and toxicity associated with chemotherapy.

Hepatitis C Virus - Proteins, Diagnosis, Treatment and New Approaches for Vaccine Development

  • Keyvani, Hossein;Fazlalipour, Mehdi;Monavari, Seyed Hamid Reza;Mollaie, Hamid Reza
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권12호
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    • pp.5917-5935
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    • 2012
  • Background: Hepatitis C virus (HCV) causes acute and chronic human hepatitis infection and as such is an important global health problem. The virus was discovered in the USA in 1989 and it is now known that three to four million people are infected every year, WHO estimating that 3 percent of the 7 billion people worldwide being chronically infected. Humans are the natural hosts of HCV and this virus can eventually lead to permanent liver damage and carcinoma. HCV is a member of the Flaviviridae family and Hepacivirus genus. The diameter of the virus is about 50-60 nm and the virion contains a single-stranded positive RNA approximately 10,000 nucleotides in length and consisting of one ORF which is encapsulated by an external lipid envelope and icosahedral capsid. HCV is a heterogeneous virus, classified into 6 genotypes and more than 50 subtypes. Because of the genome variability, nucleotide sequences of genotypes differ by approximately 31-34%, and by 20-23% among subtypes. Quasi-species of mixed virus populations provide a survival advantage for the virus to create multiple variant genomes and a high rate of generation of variants to allow rapid selection of mutants for new environmental conditions. Direct contact with infected blood and blood products, sexual relationships and availability of injectable drugs have had remarkable effects on HCV epidemiology. Hundreds of thousands of people die each year from hepatitis and liver cancer caused by HCV virus infection. Approximately 80% of patients with acute hepatitis C progress into a chronic disease state leading to serious hepatic disorders, 10-20% of which develop chronic liver cirrhosis and hepatocellular carcinoma. The incubation period of HCV is 6-8 weeks and the infection is often asymptomatic so it is very hard to detect at early stages, making early treatment very difficult. Therefore, hepatitis C is called a "silent disease". Neutralizing antibodies are produced against several HCV proteins during infection but the virus mutates to escape from antibodies. Some patients with chronic hepatitis C may have some symptoms such as fatigue, muscle aches, nausea and pain. Autoimmune and immunecomplex-mediated diseases have also been reported with chronic HCV infection.

Feasibility Study of Deep Inspiration Breath-Hold Based Volumetric Modulated Arc Therapy for Locally Advanced Left Sided Breast Cancer Patients

  • Swamy, Shanmugam Thirumalai;Radha, Chandrasekaran Anu;Kathirvel, Murugesan;Arun, Gandhi;Subramanian, Shanmuga
    • Asian Pacific Journal of Cancer Prevention
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    • 제15권20호
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    • pp.9033-9038
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    • 2014
  • Background: The purpose of this study was to assess the feasibility of deep inspiration breath-hold (DIBH) based volumetric modulated arc therapy (VMAT) for locally advanced left sided breast cancer patients undergoing radical mastectomy. DIBH immobilizes the tumor bed providing dosimetric benefits over free breathing (FB). Materials and Methods: Ten left sided post mastectomy patients were immobilized in a supine position with both the arms lifted above the head on a hemi-body vaclock. Two thermoplastic masks were prepared for each patient, one for normal free breathing and a second made with breath-hold to maintain reproducibility. DIBH CT scans were performed in the prospective mode of the Varian real time position management (RPM) system. The planning target volume (PTV) included the left chest wall and supraclavicular nodes and PTV prescription dose was 5000cGy in 25 fractions. DIBH-3DCRT planning was performed with the single iso-centre technique using a 6MV photon beam and the field-in-field technique. VMAT plans for FB and DIBH contained two partial arcs ($179^{\circ}-300^{\circ}CCW/CW$). Dose volume histograms of PTV and OAR's were analyzed for DIBH-VMAT, FB-VMAT and DIBH-3DCRT. In DIBH mode daily orthogonal ($0^{\circ}$ and $90^{\circ}$) KV images were taken to determine the setup variability and weekly twice CBCT to verify gating threshold level reproducibility. Results: DIBH-VMAT reduced the lung and heart dose compared to FB-VMAT, while maintaining similar PTV coverage. The mean heart $V_{30Gy}$ was $2.3%{\pm}2.7$, $5.1%{\pm}3.2$ and $3.3%{\pm}7.2$ and for left lung $V_{20Gy}$ was $18.57%{\pm}2.9$, $21.7%{\pm}3.9$ and $23.5%{\pm}5.1$ for DIBH-VMAT, FB-VMAT and DIBH-3DCRT respectively. Conclusions: DIBH-VMAT significantly reduced the heart and lung dose for left side chest wall patients compared to FB-VMAT. PTV conformity index, homogeneity index, ipsilateral lung dose and heart dose were better for DIBH-VMAT compared to DIBH-3DCRT. However, contralateral lung and breast volumes exposed to low doses were increased with DIBH-VMAT.

노인에서 성대 용종의 후두 미세수술 후 음성검사 결과 (Result of Voice Analysis after Laryngeal Microsurgery for Vocal Polyp in Elderly)

  • 최정임;여장옥;진성민;이상혁
    • 대한후두음성언어의학회지
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    • 제22권1호
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    • pp.47-51
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    • 2011
  • Background and Objectives: Vocal polyps arc one of the most frequent benign laryngeal diseases. They arc usually found at the midpoint of the vocal fold. They are mainly caused by vocal overuse. Vocal polyps arc usually removed surgically. Generally, age-related changes to speech are attributed to change in anatomy and physiology of the speech mechanism. These changes result in increased variability in the acoustic properties of speech with age. Still, not 'all studies of age-related changes in speech have taken differences between the young group and adult group after laryngeal microsurgery into account. The aim of this investigation was to compare improvement of acoustic analysis in young patients and elderly patients with vocal polyps, before and after the laryngeal microsurgery. Materials and Method: One hundred and twenty-eight patients who underwent laryngeal microsurgery for vocal polyps from 2008 through 2011 were reviewed retrospectively. 105 of the 128 patients under age 60 were classified as adult group (AG), and remaining 23 patients as elderly group (EG). The speech of AG and EG were evaluated before and after surgery for identification of differences for age group across measures of fundamental frequency (F0), Jitter, Shimmer and Maximum phonation time (MPT). Results: There were not significant differences between two groups for improvement of F0, Jitter, Shimmer, NHR, and MPT before and after surgery. The findings suggest that elderly group compares quite well with adult group in effectiveness of surgery. However, comparison between elderly group and young group (Age under 40) there was significant difference of improvement in Jitter and Shimmer. Conclusion: In general, the results of the present research showed significant improvement in vocal quality after phonosurgery of vocal polyp in both elderly and adult group. However, comparison of improvement between elderly group and young group, there were significant differences of improvement in jitter and shimmer. Therefore, in treatment planning of elderly group, we should consider age related changes of vocal cord.

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