A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者的疗效探讨

摘要 目的：探讨A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者的疗效。方法：收集2016年3月至2021年6月苏州大学附属第二医院耳鼻喉科或神经内科门诊就诊或住院的帕金森病患者,追问病史,发现部分患者有单侧或双侧耳鸣症状,并进行电测听+声导抗检查回报,其中有73 %患者有神经性听力下降,根据治疗方法将其分为A型肉毒毒素耳后注射组（实验组,22例）和地塞米松耳后注射组（对照组,22例）,A型肉毒毒素注射组予以100U A型肉毒毒素耳垂后方自上而下3个点注射,地塞米松注射组予以5 mg地塞米松耳垂后方自上而下3个点注射,对比两组鸣残疾评估量表（THI）评分、耳鸣评价量表（TEQ）评分、治疗总有效率、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）评分、匹兹堡睡眠质量指数（PSQI）评分。结果：两组治疗前THI和TEQ评分比较无差异（P>0.05）,两组治疗后THI和TEQ评分均有所降低,且实验组均低于对照组（P<0.05）;实验组治疗后1周、治疗后4周、治疗后14周治疗总有效率为63.64 %、81.82 %、90.91 %,对照组治疗总有效率分别为63.64 %、63.64 %、72.73 %,两组治疗总有效率比较无差异（P>0.05）,但实验组略高于对照组;两组治疗前HAMA、HAMD评分比较无差异（P>0.05）,两组治疗后14周HAMA、HAMD评分均有多下降,且实验组均低于对照组（P<0.05）;两组治疗前入睡时间、睡眠时间、睡眠质量、睡眠效率、睡眠障碍、日间功能障碍、安眠药物评分以及总分比较无差异（P>0.05）,两组治疗后14周上述各项评分均有所降低,且实验组均低于对照组（P<0.05）。结论：A型肉毒毒素耳后注射治疗帕金森病合并神经性耳鸣患者,可改善耳鸣症状,提高临床治疗效果,缓解焦虑抑郁情绪,改善睡眠质量,值得临床不断深入研究。     

左炔诺孕酮宫内节育系统联合桂枝茯苓胶囊对子宫腺肌症患者性激素、血脂及血清hs-CRP、VEGF水平的影响

摘要 目的：探讨左炔诺孕酮宫内节育系统联合桂枝茯苓胶囊对子宫腺肌症患者超敏C反应蛋白（hs-CRP）、性激素、血管内皮生长因子（VEGF）以及血脂的影响。方法：选取2016年4月~2019年8月期间我院接收的90例子宫腺肌症患者,按照随机数字表法分为对照组（45例,左炔诺孕酮宫内节育系统治疗）和研究组（45例,对照组的基础上联合桂枝茯苓胶囊治疗）,比较两组患者疗效、性激素、血脂、血清hs-CRP、VEGF水平、子宫内膜厚度、痛经视觉模拟评分法（VAS）评分以及不良反应。结果：治疗6个月后研究组临床总有效率较对照组高（P<0.05）。两组治疗6个月后卵泡刺激素（FSH）、hs-CRP、黄体生成素（LH）、VEGF水平以及子宫内膜厚度、痛经VAS评分均较治疗前下降,且研究组较对照组低（P<0.05）;雌二醇（E2）水平较治疗前升高,且研究组较对照组高（P<0.05）。两组治疗6个月后总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）水平对比未见统计学差异（P>0.05）。两组不良反应发生率对比无差异（P>0.05）。结论：左炔诺孕酮宫内节育系统联合桂枝茯苓胶囊治疗子宫腺肌症安全有效,可改善机体性激素、血清hs-CRP、VEGF水平及子宫内膜厚度,减轻痛经症状,且对机体血脂情况影响轻微。     

A型肉毒毒素联合肌电生物反馈治疗脑卒中后上肢肌痉挛的临床疗效分析

目的:分析A型肉毒毒素与肌电生物反馈联合用于治疗脑卒中后上肢肌痉挛的临床疗效。方法:选择2014年10月至2016年12月辽宁本溪市中心医院和北京博爱医院收治的84例脑卒中后上肢肌痉挛患者,并将其随机分为观察组和对照组,每组42例。两组患者均首先接受常规康复训练,随后对照组加用肌电生物反馈治疗,观察组患者在对照组的基础之上注射A型肉毒毒素。采用改良Ashworth痉挛量表(MAS)比较两组治疗前后的上肢肌痉挛改善情况,采用Fugl-Meyer评定量表评价患者上肢运动功能,采用量角器测量治疗前后患者的腕关节主动活动范围,采用改良的Barthel指数评价患者治疗前后的日常生活能力。结果:治疗后,观察组的上肢痉挛改善总有效率显著高于对照组(P0.05);治疗2周和4周时,两组的Fugl-Meyer评分、腕关节主动活动范围、改良的Barthel指数(MBI)均较治疗前显著升高(P0.05),且观察组治疗后2周和4周的Fugl-Meyer评分、腕关节主动活动范围、改良的Barthel指数(MBI)均显著高于对照组(P0.05)。结论:A型肉毒毒素与肌电生物反馈联合用于治疗脑卒中后上肢肌痉挛的临床疗效显著,可有效降低患者上肢痉挛状态,改善上肢和腕部运动能力,提高患者的日常生活能力。     

针刺疗法联合穴位贴敷对急性呼吸衰竭机械通气患者血气分析指标、膈肌功能及炎症免疫指标的影响

摘要 目的：观察穴位贴敷、针刺疗法联合治疗对急性呼吸衰竭机械通气患者血气分析指标、膈肌功能及炎症免疫指标的影响。方法：选择2021年11月～2022年12月期间在安徽中医药大学附属六安医院接受治疗的92例急性呼吸衰竭机械通气患者,按照随机数字表法将患者分为对照组（常规治疗,46例）和研究组（对照组的基础上增加针刺疗法联合穴位贴敷治疗,46例）。对比两组血气分析指标、膈肌功能、炎症免疫指标及胃肠功能,同时记录两组并发症发生率。结果：研究组撤机前氧合指数（OI）、pH、动脉血氧分压（PaO2）高于对照组,动脉血二氧化碳分压（PaCO₂）低于对照组（P<0.05）。研究组撤机前右侧膈肌呼气末厚度（Tdi-ee）、吸气末厚度（Tdi-ei）、膈肌增厚分数（TFdi）低于对照组（P<0.05）。研究组撤机前超敏C反应蛋白（hs-CRP）、降钙素原（PCT）、白细胞计数（WBC）低于对照组,CD4⁺高于对照组（P<0.05）。研究组撤机前胃肠功能评分低于对照组（P<0.05）。两组并发症发生率组间对比无统计学差异（P>0.05）。结论：针刺疗法联合穴位贴敷在改善急性呼吸衰竭机械通气患者的血气分析指标、膈肌功能、炎症免疫指标中的应用价值较好。     

A型肉毒毒素联合CO2点阵激光治疗眼周皱纹的近期疗效评估

目的:探讨A型肉毒毒素联合CO_2点阵激光治疗眼周皱纹的近期临床疗效。方法:选择2013年6月到2014年6月我院接收眼部皱纹改善手术的患者90例,随机分为激光组、肉毒毒素组及联合治疗组,各30例,分别给予CO_2点阵激光治疗、A型肉毒毒素注射和A型肉毒毒素注射联合CO_2点阵激光治疗。所有患者在治疗后7 d、1月及3月进行疗效随访评价,比较三组不良反应情况。结果:三组患者眼周皱纹均有所改善,治疗1个月时效果最为明显。激光组的静态皱纹治疗效果明显,对动态皱纹治疗效果不明显;肉毒毒素组对动态皱纹治疗效果明显,对静态皱纹治疗效果不明显;联合治疗组对静态皱纹和动态皱纹均有明显的改善,其满意度评价总分数明显高于其他两组。三组患者对CO_2点阵激光和注射A型肉毒毒素所引起疼痛均能耐受,安全性好。结论:A型肉毒毒素联合CO_2点阵激光对静态皱纹和动态皱纹均有明显的改善作用,且不良反应轻,安全性好。     

A型肉毒毒素治疗偏侧面肌痉挛和头颈部肌张力障碍的疗效观察

为评估Ａ型肉毒毒素治疗偏侧面肌痉挛和头颈部肌张力障碍的疗效,本文对４２例偏侧面肌痉挛及３４例头颈部肌张力障碍（后者包括１８例眼睑痉挛,１２例Ｍｅｉｇｅ氏病、４例痉挛性斜颈）病人进行Ａ型肉毒毒素肌肉多点注射治疗,并治疗前后的病情分级对比。结果表明,Ａ型肉毒毒素治疗有效率为１００％,疗效持续８～２６周,可重复注射,并再次取得疗效。部分病人局部出现轻度肌无力,数周后均可恢复,无全身毒副作用。结论认为Ａ型肉毒毒素能治疗偏侧面肌痉挛和头颈部局限性肌张力障碍,不失为一种有效安全简便易行的治疗手段。     

高强度聚焦超声消融治疗（HIFU术）联合补肾活血方治疗子宫腺肌病的临床研究

摘要 目的：探讨高强度聚焦超声消融治疗（HIFU术）联合补肾活血方治疗子宫腺肌病的临床疗效。方法：选取我院2020年3月到2023年3月收治的100例子宫腺肌病患者作为研究对象,应用随机数字表法将其分为观察组与对照组,每组50例。对照组患者采取HIFU术治疗,观察组患者采取HIFU术联合补肾活血方治疗,对比两组患者临床疗效,治疗前后中医证候积分,对比手术前、手术后3个月、6个月的糖类抗原CA125及血红蛋白水平变化,并在治疗3个月后和治疗6个月应用子宫体积、痛经评分、经量评分评价患者远期预后情况。结果：两组临床疗效比较无差异（P>0.05）;治疗前两组患者腰膝酸软、经期腰骶痛、经期腹痛相关中医证候积分对比无明显差异（P＞0.05）,治疗后两组患者腰膝酸软、经期腰骶痛、经期腹痛相关中医证候积分均降低,且观察组低于对照组（P＜0.05）;手术两组患者糖类抗原CA125、Hb水平对比无明显差异（P＞0.05）,术后3个月、6个月两组患者糖类抗原CA125水平降低,观察组低于对照组,Hb水平升高,观察组高于对照组（P＜0.05）;观察组治疗后3个月的子宫体积、痛经评分、经量评分明显低于对照组（P＜0.05）,且治疗6个月后两组患者子宫体积、痛经评分、经量评分均降低,观察组低于对照组（P＜0.05）。结论：对子宫腺肌病患者应用高强度聚焦超声消融术联合补肾活血方治疗可提升其临床治疗效果,减轻患者临床症状,改善患者糖类抗原CA125表达水平,减轻贫血情况,且远期疗效较好,能够进一步改善患者子宫体积、疼痛程度和月经量,值得临床应用推广。     

MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响

摘要 目的：探讨MOTOmed下肢智能运动训练联合运动想象疗法对脑卒中偏瘫患者下肢功能、步行能力和躯干屈伸肌群肌力的影响。方法：148例脑卒中偏瘫患者来源于我院2019年5月~2021年5月期间我院接收的患者,根据随机数字表法分为对照组（n=74,常规康复训练的基础上结合MOTOmed下肢智能运动训练）和研究组（n=74,对照组的基础上结合运动想象疗法）。两组均干预12周。对比两组下肢功能、步行能力和躯干屈伸肌群肌力变化。结果：两组干预12周后Fugl-Meyer运动功能量表（FMA）、Barthel指数（BI）、功能性步行能力分级量表（FAC）评分升高,且研究组高于对照组（P<0.05）。两组干预12周后步频、步速、跨步长比率升高,且研究组高于对照组（P<0.05）。两组干预12周后健侧腹直肌、竖脊肌表面肌电信号的均方根值未见明显变化,且组间同时点对比无差异（P>0.05）。两组干预12周后患侧腹直肌、竖脊肌表面肌电信号的均方根值升高,且研究组高于对照组（P<0.05）。结论：脑卒中偏瘫患者在MOTOmed下肢智能运动训练的基础上进行运动想象疗法,可促进下肢功能改善,提高步行能力,同时还可改善患侧躯干屈伸肌群肌力。     

本体感觉训练联合肌内效贴对前交叉韧带断裂术后患者肢体肿胀程度、运动平衡功能及生活质量的影响

摘要 目的：观察本体感觉训练联合肌内效贴对前交叉韧带断裂术后患者肢体肿胀程度、运动平衡功能及生活质量的影响。方法：选择2019年1月-2022年1月期间我院接收的120例行前交叉韧带断裂术患者,按照信封抽签法将患者分为对照组（60例,本体感觉训练）和研究组（60例,对照组的基础上接受肌内效贴干预）。对比两组优良率、肢体肿胀程度、运动平衡功能及生活质量。结果：研究组的优良率高于对照组（P<0.05）。两组治疗2周后、治疗4周后肢体肿胀值减小,且研究组低于对照组（P<0.05）。两组治疗4周后Fugl-Meyer运动量表（FMA）、Berg 评分量表（BBS）评分升高,且研究组高于对照组（P<0.05）。两组治疗4周后总体/精神健康、生理/社会功能、活力、躯体疼痛和情感/生理职能评分升高,且研究组高于对照组（P<0.05）。结论：本体感觉训练联合肌内效贴对前交叉韧带断裂术后患者,可有效减轻肢体肿胀程度,改善运动平衡功能及生活质量,效果显著。     

髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病患者盆底功能及应激反应的影响

摘要 目的：探讨髋部肌锻炼联合盆底电刺激生物反馈对盆底功能障碍性疾病（PFD）患者盆底功能及应激反应的影响。方法：选取2021年1月-2022年12月在我院接受治疗的120例PFD患者作为研究对象,按随机数字表法分为对照组和观察组,每组各60例。对照组患者进行髋部肌锻炼,观察组患者在对照组的基础上联合盆底电刺激生物反馈治疗,观察分析两组患者盆底功能以及应激反应的变化。结果：两组治疗后观察组临床总有效率显著高于对照组（P＜0.05）;两组患者治疗后PFDI-20、PISQ-12及PFIQ-7评分显著优于治疗前,且观察组上述指标明显优于对照组（P＜0.05）;治疗后两组患者前盆底肌电位、动态肌张力、静态肌张力及收缩力较治疗前显著改善,且观察组相较于对照组上述指标显著提升（P＜0.05）;治疗后两组患者去甲肾上腺素（NE）、前列腺素（PGE₂）、皮质醇（COR）水平明显提高,且观察组明显优于对照组（P＜0.05）。结论：髋部肌锻炼联合盆底电刺激生物反馈使肌肉功能得到锻炼,提高了盆底肌张力水平,促进盆底功能的恢复和应激反应的提高,明显提高患者的生活质量。     

The use of botulinum toxin type A in aesthetic mandibular contouring

The lower third of Asian faces is wider than that of Caucasians and it is determined by the size and width of the mandibular bone and the thickness of muscles and subcutaneous fat tissues surrounding it. Efforts to create an aesthetically slim and smooth facial contour line in nonobese people have led the authors to focus on two approaches: surgical resection of the masseteric muscle and modeling ostectomy of the square-angled mandibular bone. Because these procedures present some problems, the authors adopted a nonsurgical concept that chemically denervates muscles and reduces the bulk of the muscle. The authors have conducted a total of 1021 clinical cases from March of 2001 through September of 2002, in which patients were treated with botulinum toxin type A (Dysport; Ipsen Ltd, Slough, United Kingdom) for remodeling the lower facial contour line; 383 of those cases were followed up for at least 3 months after the initial injection. A database was made by measuring the change in the thickness of the injected muscle with an ultrasonogram. Eleven patients underwent resection of the mandibular angle before injection. The preinjection ostectomy group was involved in the study as a result of their dissatisfaction with the surgical results; they had a rather thick masseter muscle and not a bone problem. Some had both bone problems and a thick masseter muscle. Three months after the botulinum toxin injection, the thickness of the muscle was reduced by 31 percent on average. The atrophic effect of injection was observed after 2 to 4 weeks for most patients. Seventy percent of the 383 patients tracked were greatly satisfied with the result, with another 23 percent generally satisfied. No long-term side effects were reported. Masseteric hypertrophy is frequent in Asians because of racial characteristics and dietary habits. Botulinum toxin type A has made a new epoch in facial contouring for Asians. Considering that Asians have a prominent malar and a prominent mandible angle, the reduction in the thickness of the masseter can provoke relative prominence of the malar and mandible angle. Therefore, precise indication and anatomy of the facial muscle should be thoroughly understood, which will decrease the incidence of side effects and problems. Botulinum toxin type A (Dysport) injection is simple in technique, has few side effects, and promises a rapid return to daily life. The authors conclude that the injection of botulinum toxin type A can replace surgical masseter resection.     

Type A botulinum toxin for the treatment of hypertrophy of the masseter and temporal muscles: an alternative treatment

The treatment of hypertrophy of the masseter and temporal muscles has to date been dominated by conservative and surgical measures. Local therapy with type A botulinum toxin permits an alternative method of treatment. After targeted, sometimes electromyographically controlled, intramuscular injection of the affected muscles, marked inactivity atrophy occurred in the muscles of seven patients over the course of 3 to 8 weeks. This atrophy remained constant over a follow-up period of up to 25 months, and no side effects were observed. Because of its minimal invasiveness, this technique seems to have an advantage over conventional surgical therapy. Consequently, treatment with type A botulinum toxin can be regarded as a sensible alternative to surgery in cases of hypertrophy of the masseter and/or temporal muscles.     

A型肉毒素治疗带状疱疹后遗神经痛的临床观察

目的:观察A型肉毒素皮内注射治疗带状疱疹后遗神经痛(Postherpetic Neuralgia,PHN)的临床效果。方法:选择76例胸背部带状疱疹后神经痛患者,采用乒乓球抽签法随机分为观察组与对照组,每组38例患者。在口服药物治疗的基础上,观察组与对照组的局部疼痛敏感点分别皮内注射A型肉毒素与生理盐水。比较两组治疗前与治疗后第1、7、30、60天的视觉模拟评分量表(Visual Analogue Scale,VAS)及睡眠质量评分量表(Quality of Sleep,QS)评分的变化。结果:两组患者治疗后第1、7、30、60天的VAS及QS评分均明显低于治疗前(P0.05),观察组患者治疗后第1、7、30、60天的VAS及QS评分结果明显低于对照组(P0.05)。两组均未见明显的治疗相关并发症。结论:A型肉毒素皮内注射疗法可以显著减轻PHN患者的疼痛及改善睡眠质量。     

Protective Effects of Clenbuterol against Dexamethasone-Induced Masseter Muscle Atrophy and Myosin Heavy Chain Transition

Background

Glucocorticoid has a direct catabolic effect on skeletal muscle, leading to muscle atrophy, but no effective pharmacotherapy is available. We reported that clenbuterol (CB) induced masseter muscle hypertrophy and slow-to-fast myosin heavy chain (MHC) isoform transition through direct muscle β2-adrenergic receptor stimulation. Thus, we hypothesized that CB would antagonize glucocorticoid (dexamethasone; DEX)-induced muscle atrophy and fast-to-slow MHC isoform transition.

Methodology

We examined the effect of CB on DEX-induced masseter muscle atrophy by measuring masseter muscle weight, fiber diameter, cross-sectional area, and myosin heavy chain (MHC) composition. To elucidate the mechanisms involved, we used immunoblotting to study the effects of CB on muscle hypertrophic signaling (insulin growth factor 1 (IGF1) expression, Akt/mammalian target of rapamycin (mTOR) pathway, and calcineurin pathway) and atrophic signaling (Akt/Forkhead box-O (FOXO) pathway and myostatin expression) in masseter muscle of rats treated with DEX and/or CB.

Results and Conclusion

Masseter muscle weight in the DEX-treated group was significantly lower than that in the Control group, as expected, but co-treatment with CB suppressed the DEX-induced masseter muscle atrophy, concomitantly with inhibition of fast-to-slow MHC isoforms transition. Activation of the Akt/mTOR pathway in masseter muscle of the DEX-treated group was significantly inhibited compared to that of the Control group, and CB suppressed this inhibition. DEX also suppressed expression of IGF1 (positive regulator of muscle growth), and CB attenuated this inhibition. Myostatin protein expression was unchanged. CB had no effect on activation of the Akt/FOXO pathway. These results indicate that CB antagonizes DEX-induced muscle atrophy and fast-to-slow MHC isoform transition via modulation of Akt/mTOR activity and IGF1 expression. CB might be a useful pharmacological agent for treatment of glucocorticoid-induced muscle atrophy.     

A型肉毒毒素注射在改善面上部动力性皱纹的疗效及可行性分析

目的:探讨A型肉毒毒素改善面上部动力性皱纹的临床疗效,并分析其可行性。方法:选择2016年2月到2016年10月在我院接受面上部动力性皱纹改善治疗的患者35例作为研究对象,所有患者均给予注射A型肉毒毒素治疗。评价并比较患者在治疗后30 min、治疗后3 d、治疗后7 d的优良率。采用面部皱纹量表(FWS)评价患者面部皱纹严重程度指数,比较患者治疗前、治疗后4周及治疗后6月的FWS指数。观察并比较治疗后面上部紧绷感、乏力感、注射点局部瘀斑等不良反应发生情况。结果:患者治疗后30 min、3 d及7 d时的优良率逐渐升高,治疗后3 d、7 d的优良率明显高于治疗后30 min,治疗后7 d的优良率明显高于治疗后3 d,差异均具有统计学意义(P0.05)。患者治疗后4周和治疗后6月的FWS指数均明显小于治疗前,并且治疗后4周的FWS指数明显小于治疗后6月,差异均具有统计学意义(P0.05)。治疗后,仅有4例患者出现轻微不适,所有症状均于休息3-4 d后自行消失,不影响患者的正常工作和生活。结论:A型肉毒毒素改善面上部动力性皱纹的临床疗效显著,维持时间较长,不良反应较少且较轻,安全性较好,值得在临床上推广应用。     

A型肉毒素与复方倍他米松注射液联用治疗瘢痕疙瘩患者的疗效及安全性研究

目的:分析A型肉毒素与复方倍他米松注射液联用治疗瘢痕疙瘩患者的疗效及安全性。方法:选取2015年1月-2016年8月期间我院收治的90例瘢痕疙瘩患者为研究对象,根据治疗方法将患者随机分为A组、B组和C组各30例。A组给予A型肉毒素治疗,B组给予复方倍他米松注射液治疗,C组给予A型肉毒素联合复方倍他米松注射液治疗。比较三组患者的相关指标改善评分、临床疗效、不良反应发生率和复发率。结果:C组患者体积、痛痒觉、硬度和自我评价的改善评分均高于B组和A组(P0.05),B组的各项指标改善评分和A组相比差异无统计学意义(P0.05)。三组总有效率比较差异有统计学意义,且C组高于B组(P0.05),A组和C组总有效率比较差异无统计学意义(P0.05)。A组不良反应总发生率低于B组和C组,差异有统计学意义(P0.05),B组与C组不良反应总发生率相比,差异无统计学意义(P0.05)。A组和C组治疗后半年、1年瘢痕疙瘩复发率均低于B组(P0.05),但A组和C组比较差异无统计学意义(P0.05)。结论:与单独使用A型肉毒素或复方倍他米松注射液相比,A型肉毒素与复方倍他米松注射液联合使用治疗瘢痕疙瘩能显著提高疗效,降低复发率,且不会增加不良反应发生率,安全性较高,值得进一步推广应用。     

Efficacy of reconstituted and stored botulinum toxin type A: an electrophysiologic and visual study in the auricular muscle of the rabbit

Once botulinum toxin type A is reconstituted, the manufacturer recommends that it be used in approximately 4 hours. As a result, a significant amount of this costly drug is often discarded because it is not completely used in the recommended period. The purpose of the present study was to compare fresh versus stored reconstituted botulinum toxin type A for (1) initial potency, (2) duration of action, and (3) bacterial colonization.Using a rabbit model, 20 New Zealand White rabbits were divided into four groups (I to IV). All rabbits had an injection of 2.5 U of reconstituted botulinum toxin into the right anterior auricular muscle. The first group was injected with botulinum toxin type A that was freshly reconstituted and served as the control. The second, third, and fourth groups were injected with botulinum toxin type A that had been reconstituted and stored for 2, 6, and 12 weeks, respectively, in a conventional freezer. Each rabbit had daily visual evaluation of the ear, with the position of auricle being graded from I to III. In addition, each rabbit had a nerve conduction study performed on the right anterior auricular muscle before injection and every 2 weeks after injection. Amplitude was chosen as the principal variable in the data analysis because it is the best predictor of physiologic changes at the muscle motor unit level. The endpoint of the study was defined as the time at which the nerve conduction studies and the visual inspections returned to baseline, preinjection levels. Botulinum toxin type A was also cultured before injection into each group.Overall, the nerve conduction data revealed a trend with a faster recovery (return to baseline) with the stored botulinum toxin. Groups IV and III returned to baseline first, followed by groups II and I. However, there was no significant difference among the groups at 2 and 4 weeks after injection, indicating that initial potency was unchanged. The differences between the groups became significant (p < 0.05) at 6 weeks and onward, suggesting that the duration was affected. Group I (fresh botulinum toxin) and group II (toxin stored for 2 weeks) had comparable outcomes and were not significantly different at any time period. Under visual inspection, the mean recovery time for each group was as follows: group IV, 5.4 weeks; group III, 7.0 weeks; group II, 6.75 weeks; and group I, 7.80 weeks. The results showed significance (p < 0.05) beginning after 3 weeks among some groups. Again, there was an overall quicker trend to return to baseline with the longer storage of the botulinum toxin (groups III and IV). These results support the authors' conduction study data, which suggest that the initial potency is not affected but the duration of action is. Again, groups I and II had comparable results. Microbiology cultures showed no growth of either aerobic or anaerobic bacteria at 7 days.In conclusion, using the rabbit model, it seems that reconstituted and stored botulinum toxin type A has the same initial potency but the duration of action is affected sometime after 2 weeks of storage. No bacterial contamination was associated with storing unpreserved reconstituted botulinum toxin type A for up to 12 weeks.     

Effect of Botulinum Toxin on Spasticity Level Assessed by Tonic Stretch Reflex Threshold: A Feasibility Pilot Study

IntroductionSpasticity is one of the most disabling neurological conditions, generally associated with pain and articular contracture. Its management involves multiple rehabilitation techniques, including botulinum toxin. Studies were developed with the intention of assessing the clinical effects of the Botulinum toxin (BoNT) injection in spastic muscles, however most of them, utilized subjective assessment methods. The aim of this study was to investigate the feasibility of applying Tonic Stretch Reflex Threshold (TSRT) method in clinical practice to assess the spasticity before and after BoNT injection and compare the results with those provided by methods traditionally used for this purpose: Modified Ashworth Scale (MAS) and Range of Motion (ROM).MethodsFive patients were evaluated before and after 21 days of BoNT injection in biceps brachii. Three parameters were considered: MAS, ROM of elbow and TSRT.ResultsAll patients presented improvement in ROM (p = 0.05) and TSRT (p = 0.06), with ROM average improvement bigger than TSRT. Two patients did not present evolution in MAS (p = 0.14).ConclusionsThe feasibility pilot study was the first to utilize the TSRT as an evaluation method after BoNT application. The TSRT method was able to identify improvement in patients that MAS did not able to, and is a good alternative to assess spasticity even when the evolution is small. Hence, TSRT showed to be an effective method for monitoring more precisely spasticity in BoNT treatment.     

基于经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效

摘要 目的：探讨经会阴实时三维超声评估生物反馈电刺激联合盆底肌锻炼治疗产后盆底功能障碍的临床疗效。方法：选择2020年9月至2022年9月我院收治的96例产后盆底功能障碍患者,根据随机数字表法将患者分为两组,对照组（48例）采用盆底肌锻炼治疗,研究组（48例）采用生物反馈电刺激联合盆底肌锻炼治疗。治疗前后采用经会阴实时三维超声检查,对比两组治疗前后的盆底功能障碍调查表（PFDI-20）、盆底障碍影响简易问卷7（PFIQ-7）评分、静息和Valsalva动作状态下的肛提肌超声参数。分析肛提肌超声参数与PFDI-20、PFIQ-7评分的相关性。结果：两组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积较治疗前降低（P＜0.05）,静息时肛提肌厚度较治疗前增加（P＜0.05）。研究组治疗后PFDI-20、PFIQ-7评分,静息和Valsalva动作状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积低于对照组（P＜0.05）,静息时肛提肌厚度大于对照组（P＜0.05）。静息和Valsalva状态下肛提肌裂孔前后径、肛提肌裂孔左右径、肛提肌裂孔面积与PFDI-20、PFIQ-7评分呈正相关（P＜0.05）,静息状态肛提肌厚度与PFDI-20、PFIQ-7评分呈负相关（P＜0.05）。结论：经生物反馈电刺激联合盆底肌锻炼治疗后肛提肌裂孔大小较治疗前降低,肛提肌厚度较治疗前增加,且与PFDI-20、PFIQ-7评分改善有关,经会阴实时三维超声可客观、有效评价产后盆底功能障碍患者的治疗效果。