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Background: Exercise-induced laryngeal obstruction (EILO) is distinguished as upper airway obstruction accompanied by inspiratory dyspnoea and stridor during highly intensive exercises. Epiglottic retraction in the diagnosis of EILO has not been sufficiently explored. Aims/objectives: We highlight the importance of epiglottic retraction in patients with EILO by evaluation by several diagnostic methods for EILO. Consideration of epiglottic retraction may be important for accurate diagnosis of EILO. Results: Epiglottic retraction could be observed in three patients by laryngoscopy during heavy breathing and in two patients by continuous laryngoscopy during exercise. Stridor occurred by the forward prolapse of the arytenoids, but not by epiglottic retraction. In comparison with three athletes from other sports, lung volume was significantly greater in four swimmers although it was not different related to depending on the existence of epiglottic retraction. Conclusions and significance: Laryngoscopy during heavy breathing is suggested to be useful to detect the epiglottic retraction, which might be overlooked if only continuous laryngoscopy during exercise is used. Epiglottic retraction was not rare in Japanese swimmers' exercise-induced laryngeal obstruction in our cohort and it might be related to the greater lung volume. [ABSTRACT FROM AUTHOR]

Density perturbations accompanying seismic waves are expected to generate prompt gravity perturbations preceding the arrival of P-waves. Vallée et al. (Science 358:1164–1168, 2017, https://doi.org/10.1126/science.aao0746) reported the detection of such pre-P-wave signals in broadband seismograms during the 2011 Tohoku-oki earthquake. Kimura et al. (Earth Planets Space 71:27, 2019, https://doi.org/10.1186/s40623-019-1006-x) considered that their detection involved some uncertain points, including a concern regarding their signal processing procedure. Specifically, to remove the instrumental response, Vallée et al. (2017) applied acausal deconvolution to the seismograms truncated at the P-wave arrivals. Generally, acausal deconvolution produces artifacts at the edge of the time window. However, they did not present quantitative assessment whether the detected signals were artifacts due to the signal processing. To avoid this concern, Kimura et al. (2019) employed another procedure that eliminated acausal processes, resulting in the detection of a pre-P-wave signal with a statistical significance of 7σ in stacked broadband seismograms. Subsequently, Vallée et al. (Earth Planets Space 71:51, 2019, https://doi.org/10.1186/s40623-019-1030-x) commented that the procedure employed by Kimura et al. (2019) for the signal detection was inappropriate because it dismissed the low-frequency components of data. Although we admit the loss of low-frequency components in the data in Kimura et al. (2019), Vallée et al. (2019) have not yet provided a full account of the validity of their own procedure. Here, we assessed the validity of the procedure employed by Vallée et al. (2017) by quantitatively evaluating the magnitude of the acausal artifacts. First, we investigated how the input acceleration waveform, having an ideal signal-like shape, was distorted by their procedure. Their acausal deconvolution indeed generated a large-amplitude terminal artifact; however, it was removed by the causal band-pass filtering performed after the deconvolution and consequently became negligible. Next, we constrained the maximum amplitude of the artifact due to the noise in a seismogram and showed that it was sufficiently small compared to the reported signal amplitudes. These results suggest that the signal waveforms seen after their procedure were not artifacts but were representing the input acceleration with sufficient accuracy. Namely, their procedure well functions as a detection method for pre-P-wave signals. In the context of this validation, we replied to the comments of Vallée et al. (2019). [ABSTRACT FROM AUTHOR]

Carcinoma showing thymus-like differentiation (CASTLE) is a rare thyroid cancer. This is the first report of a case of concurrent occurrence of CASTLE with papillary thyroid carcinoma (PTC). A 66-year-old male patient had hoarseness with right vocal cord paralysis. Ultrasonography revealed a hypoechoic nodule in the inferior pole of the right thyroid lobe. Ultrasound-guided fine-needle aspiration cytology suggested differentiated thyroid cancer. The patient underwent total thyroidectomy with neck dissection. Pathological examination revealed two different thyroid cancers: a CASTLE and a follicular variant of PTC. Postoperative radiation therapy was performed. The patient was still alive after 5 year following the initial treatment without evidence of recurrence. The oncological management of patients with concurrent occurrence of different thyroid cancers should consider the biological behavior of both tumors. [ABSTRACT FROM AUTHOR]