Botulinum toxin injection in the treatment of vocal fold paralysis associated with multiple sclerosis: A case report

Botulinum toxin has been demonstrated clinically to be an effective treatment for a variety of laryngeal problems, most notably spasmodic dysphonia. As in other movement disorders, the theory behind the injection of this substance in the larynx has been a weakening of the vocal fold musculature to relieve uncoordinated and spasmodic movement of the vocal folds, presumably rebalancing the forces within the intralaryngeal musculature. Recently, this concept was applied to help reposition the arytenoid cartilage in acute and longstanding anteromedial cricoarytenoid dislocations. This same concept may apply to the paralyzed vocal fold. In support of this idea, a number of investigators have shown that immobile, clinically paralyzed vocal folds may still have partial voluntary motor unit activity. This voluntary activation may not produce clinically evident movement but may be sufficient to produce tone within the fold. If the voluntary motor units in the abductor musculature of the paralyzed fold are weakened with botulinum toxin, the continued pull of the functioning adductor musculature may be sufficient to medialize the paralyzed fold. This idea has been supported by animal experiments, which have shown that botulinum toxin may affect the ability of the fold to rebalance itself. With this evidence in mind, a patient with fold immobility secondary to multiple sclerosis was treated in an attempt at laryngeal rebalancing, using botulinum toxin to medialize the fold. However, instead of simply having the fold return fixed to the midline, the patient regained normal laryngeal mobility and voice. While it is unclear whether the botulinum toxin alone was responsible, the coincidence of this occurrence certainly requires reporting. This paper is a report of the first successful treatment of vocal fold paralysis using botulinum toxin to treat vocal fold fixation in a patient with multiple sclerosis.     

Essay: An Alternative to Inflation

Inflationary models are generally credited with explaining the large scale homogeneity, isotropy, and flatness of our universe as well as accounting for the origin of structure (i.e., the deviations from exact homogeneity) in our universe. We argue that the explanations provided by inflation for the homogeneity, isotropy, and flatness of our universe are not satisfactory, and that a proper explanation of these features will require a much deeper understanding of the initial state of our universe. On the other hand, inflationary models are spectacularly successful in providing an explanation of the deviations from homogeneity. We point out here that the fundamental mechanism responsible for providing deviations from homogeneity—namely, the evolutionary behavior of quantum modes with wavelength larger than the Hubble radius—will operate whether or not inflation itself occurs. However, if inflation did not occur, one must directly confront the issue of the initial state of modes whose wavelength was larger than the Hubble radius at the time at which they were born. Under some simple hypotheses concerning the birth time and initial state of these modes (but without any fine tuning), it is shown that non-inflationary fluid models in the extremely early universe would result in the same density perturbation spectrum and amplitude as inflationary models, although there would be no slow roll enhancement of the scalar modes.     

Über das Verhalten von Metall-Äthylendiamintetraessigsäure-Komplexen an Anionenaustauschersäulen; II. Thorium-Komplexe

Ohne ZusammenfassungMit 3 Abbildungen     

"Contact voltage" in nanoparticle/molecule connections

This work presents conclusive evidence that connecting Pt and Co nanoparticles stabilized by an aluminum-organic shell with molecular spacers interacting with this shell can induce notable changes in the electronic structure of the metal. X-ray absorption spectroscopy measurements at the Al K-, the Pt L(III)-, and the Co K-edge provide consistent evidence for this effect. The changes induced by cross-linking with an acidic spacer are discussed in detail as an example to elucidate the mechanism of this effect. It turns out that a reconfiguration of the protection shell that occurs upon networking is responsible for the observed changes.     

How to mine energy from a black hole

We describe a process by which energy literally can be mined from a black hole. We argue that the only limit placed by fundamental considerations on the rate at which energy can be extracted from a black hole by this process isdE/dt ～ 1 in Planck unitsG = c = ? = 1. This is far greater than the ratedE/dt ～ 1/M² at which the black hole spontaneously loses energy by Hawking radiation.     

Protein adhesion on dental surfaces—a combined surface analytical approach

Protein adsorption is a field of huge interest in a number of application fields. Information on protein adhesion is accessible by a variety of methods. However, the results obtained are significantly influenced by the applied technique. The objective of this work was to understand the role of adhesion forces (obtained by scanning force spectroscopy, SFS) in the process of protein adsorption and desorption. In SFS, the protein is forced to and retracted from the surface, even under unfavorable conditions, in contrast to the natural situation. Furthermore, adhesion forces are correlated with adhesion energies, neglecting the entropic part in the Gibbs enthalpy. In this context, dynamic contact angle (DCA) measurements were performed to identify the potential of this method to complement SFS data. In DCA measurements, the protein diffuses voluntarily to the surface and information on surface coverage and reversibility of adsorption is obtained, including entropic effects (conformational changes and hydrophobic effect). It could be shown that the surface coverage (by DCA) of bovine serum albumin on dental materials correlates well with the adhesion forces (by SFS) if no hydrophobic surface is involved. On those, the entropic hydrophobic effect plays a major role. As a second task, the reversibility of the protein adsorption, i.e., the voluntary desorption as studied by DCA, was compared to the adhesion forces. Here, a correlation between low adhesion forces and good reversibility could be found as long as no covalent bonds were involved. The comparative study of DCA and SFS, thus, leads to a more detailed picture of the complete adsorption/desorption cycle.