Effects of vagal nerve stimulation on laryngeal function

Functional electrical stimulation is a developing methodology that shows significant potential in the management of peripheral neuromuscular deficits. Potential applications in the head and neck area, including control of bilateral vocal fold paralysis and spasmodic dysphonia, have recently been explored. Despite promising early results, very little is known about the mechanisms of action or the long-term effects of electrical stimulation on human laryngeal function. Recent development of implantable vagal nerve stimulators as a method to control intractable seizures in individuals who have not responded to medication provides a unique opportunity to study its effect on the normal human larynx. Laryngeal and vocal function testing was studied on five individuals who had undergone vagal nerve stimulator implants for intractable seizures. Consistent abduction/adduction of the left vocal fold was achieved at 20 and 40 Hz, respectively. Higher levels of electrical stimulation produced hemispasm of the larynx. Results were consistent with studies in the literature of recurrent laryngeal nerve stimulation in animal and human models. The vagus nerve provides relatively easy access for implantation of electrodes to provide electrical stimulation to the muscles of the larynx. Vagal nerve stimulation may prove efficacious in the treatment of movement disorders of the larynx; further study is needed.     

DYNGA: a general purpose QM-MM-MD program. I. Application to water

We present a general purpose QM-MM-MD engine (DYNGA) designed to test alternative hybrid Hamiltonians geared towards the treatment of problems of interest in structural biology including the use of experimental data constraints. In this first presentation we use DYNGA to explore the behaviour of a traditional QM-MM approach in the treatment of the water—water interaction. We find the potential energy hypersurface for the water dimer computed with the HF 4–31G*/TIP3P hybrid Hamiltonian tends to be too flat. We also explore the effect of using traditional QM-MM techniques on proton wires and conclude there is a need for improvement, possibly addressed by using polarizable force fields.     

“Compensatory falsetto”: Effects on vocal quality

The term “compensatory falsetto”, for the purpose of this investigation, refers to the development of an abnormally high-pitched voice in the presence of laryngeal pathology where more socially acceptable lower pitched voice production is possible. The purpose of this investigation was to compare laryngeal compensations and their effects on objective measures of vocal function during production of compensatory falsetto voice. Eighteen patients with abnormally high-pitched voice in the presence of underlying laryngeal pathology were evaluated in the Department of Otolaryngology at the University of Miami School of Medicine from January 1988 through December 1992 and were diagnosed with “compensatory falsetto”. Vocal fold paralysis (n = 11) was the most common laryngeal pathology. Vibratory characteristics were evaluated through videostrobolaryngoscopic examination. Acoustic and aerodynamic parameters assessed included fundamental frequency, jitter rate, harmonic-to-noise ratio, glottal air flow, and maximum phonation time. Production of a higher-pitched voice appeared to improve glottic closure and decrease the amount of air loss during phonation. A corresponding increase in maximum phonation time and improvement in acoustic characteristics of jitter and harmonic-to-noise ratio was also observed.     

PAST AND FUTURE MANAGEMENT OF A COLLAPSED FISHERY: THE BAY OF BISCAY ANCHOVY

Abstract We analyze the efficiency of the international management of the Bay of Biscay anchovy. While a sharing agreement between France and Spain has been in place since 1992, the fish stock collapsed in 2005 and the fishery closed from 2005 to spring 2010. We consider differences in production technologies between both countries and calibrate our model using data from 1987 to 2009. Our results suggest two sources of rent dissipation under the existing sharing agreement: inefficient quota allocation and production inefficiencies due to inflexible national regulations. We discuss several alternatives to improve management.     

ConFlo III - an interface for high precision delta(13)C and delta(15)N analysis with an extended dynamic range

A newly developed interface coupling a CHN combustion device (elemental analyser 'EA') to an isotope ratio mass spectrometer is described and evaluated. The purpose of the device is to extend the dynamic range of delta(13)C and delta(15)N analysis from less than 2 orders of magnitude to more than 3 orders of magnitude. Carbon isotope ratio measurements of atropine as a model compound have been performed analysing between 1 μg to 5 mg C with acceptable to excellent precision (0.6 to 0.06 per thousand, delta-notation). The correction due to the blank signal is critical for sample amounts smaller than 4 μg C. The maximum sample weight is determined by the combustion capacity of the EA. Larger sample amounts are measured using dilution of a small part of the EA effluent with helium. The dilution mechanism works virtually free of isotope fractionation. Copyright 1999 John Wiley & Sons, Ltd.     

Early results of transcutaneous injection laryngoplasty with micronized acellular dermis versus type-I thyroplasty for glottic incompetence dysphonia due to unilateral vocal fold paralysis

Medialization thyroplasty (type I) has become the gold standard to improve glottic closure due to unilateral vocal fold paralysis. A newer injection method utilizing homologous collagen from cadaveric human tissue has been described as an attractive alternative as no donor site is required, there is a very low risk of hypersensitivity, and the intact, acellular collagen fibers may suffer a reduced long-term reabsorption rate. Preliminary results on eight patients comparing presurgical and postsurgical parameters (perceptual, stroboscopic, acoustic, and aerodynamic) revealed comparable results when compared with a control group of individuals, age- and sex-matched, that had undergone standard medialization thyroplasty (type I). Further study is needed to assess the long-term results with this minimally invasive method of vocal fold medialization.     

Outpatient transoral laser vaporization of anterior glottic webs and keel placement: Risks of airway compromise

Management of acquired anterior glottic webs involves resection of the web with reconstitution of a linear vocal fold edge and anterior commissure. Traditional procedures such as transcervical midline thyrotomy (with tracheostomy) and keel placement have been used for patients with extensive scar formation and airway compromise. However, in selected patients with more limited scarring and minimal-to-no airway compromise, a transoral endoscopic approach may be a viable option. In three patients, transoral laser vaporization followed by transoral keel placement and outpatient removal resulted in a vocal quality that perceptually improved without any evidence of respiratory compromise postoperatively.