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Objective:To assess the clinical result of repeated combined detrusor-trigone botulinum toxin A(BTX-A)injection and intermittent catheterization(IC) for male adults with neurogenic detrusor overactivity (NDO) and urinary incontinence(UI) secondary to spinal cord injury(SCI).Methods:From January to August 2021, the data of 43 adult male patients with NDO and UI secondary to SCI who received repeated trigone-including intradetrusor BTX-A injection in Guangdong Provincial Work Injury Rehabilitation Hospital were retrospectively analyzed. The mean age of the patients was (29.1±10.7) years. The mean incontinence specific quality of life (I-QOL) was (39±4.8). The UI episodes was (11.9±2.6), mean voiding volume was (170.7±20.1)ml, mean maximum detrusor pressure at first NDO was (81.4±19.6) cmH 2O and mean volume at first NDO was (169.1±40.0)ml.All patients received trigone-including intradetrusor BTX-A (300 U, 30 sites) injection for four times and IC. Clinical data including I-QOL, bladder diary, video-urodynamic test and adverse events were recorded at baseline and 12 weeks after each injection. Results:Mean interval between four injections were (220.6±27.4), (222.8±24.1) and (224.4±39.0) d ( P=0.13). Compared with baseline data before first injection, mean I-QOL after the first, second, third and fourth injection increased to (54.9±9.1), (56.1±7.9), (61.7±9.1) and (68.8±8.9) (all P<0.001). The number of urinary incontinence cases decreased to 36, 35, 35 and 33 (all P<0.05). The mean urinary incontinence episodes per day decreased to (4.4±0.6), (3.8±0.4), (2.2±0.5) and (2.1±0.3)(all P<0.001). Mean voiding volume increased to (288.3±40.2), (300.0±38.6), (316.9±46.8) and (319.5±36.7) ml (all P<0.001). Mean maximum detrusor pressure at first NDO decreased to (29.4± 11.0), (26.1±8.7), (20.3±5.9) and (18.5±6.0) cmH 2O (all P<0.001) and mean volume at first NDO increased to (270.0±48.7), (284.9±51.3), (287.7±47.9) and (303.0±46.2) ml (all P<0.001), respectively. Compared with four injections, no difference in response was found in the mean I-QOL, the number of urinary incontinence cases, mean urinary incontinence episodes mean voiding volume, mean maximum detrusor pressure at first NDO and mean volume at first NDO (all P>0.05). No de novo VUR occurred and 2 cases of grade Ⅱ VUR at baseline had resolved after the first injection. 9 patients experienced serious gross hematuria within first week after injection, but the urine returned to clear by prolonging the catheter indwelling time or bladder irrigation. 12 patients with active urinary tract infection were treated with indwelling catheter and sensitive antibiotics. Patients continued IC when the symptoms, signs and laboratory examination were normal. Conclusions:Combined detrusor-trigone BTX-A injection and IC could help decrease detrusor pressure, restore some of the lower urinary tract function and improve the quality of life for male patients with NDO and UI secondary to SCI. Repeated injection is as effective and safe as the first injection.
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Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.
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To accurately localize the centers of intramuscular nerve dense regions (CINDRs) of rotator cuff muscles. Twenty adult cadavers were used. The curves on skin connecting the superior angle of scapula with the acromion, and with the inferior angle of scapula were designed as the horizontal (H) and longitudinal (L) reference lines, respectively. One side of the rotator cuff muscles were removed and subjected to Sihler's staining to show intramuscular nerve dense regions, and the contralateral muscles' CINDRs were labeled with barium sulfate and scanned by computed tomography (to determine body surface projection points (P)). The intersection of the longitudinal line from point P to line H, and that of the horizontal line from point P to line L, were recorded as PH and PL, respectively. The projection of CINDRs on the anterior body surface across the saggital plane was defined as P' and the line connecting P to P' was recorded as Line PP'. Percentage positions of CINDRs of PH and PL on lines H and L, and the depths on line PP' were determined under the Syngo system. Two, four, one, and one CINDRs were identified in supraspinatus, infraspinatus, teres minor, and subscapularis muscles, respectively. The positions of PH of these CINDRs on the H-line are as follows: supraspinatus, 25.43 % and 26.59 %; infraspinatus, 53.85 %, 34.63 %, 35.96 % and 58.17 %; teres minor, 74.50 %; and subscapularis, 20.33 %. The PL on the L-line: supraspinatus, 11.09 % and 14.83 %; infraspinatus, 21.59 %, 27.93 %, 48.55 % and 57.52 %; teres minor, 68.28 %; and subscapularis, 52.82 %. The depth on line PP': supraspinatus, 24.83 % and 25.40 %; infraspinatus, 21.55 %, 16.10 %, 10.01 % and 8.14 %; teres minor, 13.27 %; and subscapularis, 22.88 %. The identification of these CINDRs should provide the optimal target position for injecting botulinum toxin A to treat rotator cuff muscles spasticity accompanied by shoulder pain and to improve the efficiency and efficacy of blocking target localization.
Con el objetivo de localizar con precisión los centros de las regiones densas del nervio intramuscular (CRDNI) de los músculos del manguito rotador, se utilizaron veinte cadáveres adultos. Las curvas en la piel que conectan el ángulo superior de la escápula con el acromion y con el ángulo inferior de la escápula se determinaron como líneas de referencia horizontales (H) y longitudinales (L), respectivamente. Se extrajo de un lado los músculos del manguito rotador y se sometió a la tinción de Sihler para mostrar regiones densas de nervios intramusculares, y los CRDNI de los músculos contralaterales se marcaron con sulfato de bario y se escanearon mediante tomografía computarizada (para determinar los puntos de proyección de la superficie corporal (P)). La intersección de la línea longitudinal desde el punto P a la línea H, y de la línea horizontal desde el punto P a la línea L, se registraron como PH y PL, respectivamente. La proyección de CRDNI en la superficie del cuerpo anterior a través del plano sagital se definió como P 'y la línea que conecta P a P' se registró como Línea PP '. Las posiciones porcentuales de los CRDNI de PH y PL en las líneas H y L, y las profundidades en la línea PP 'se determinaron bajo el sistema Syngo. Se identificaron dos, cuatro, uno y un CINDR en los músculos supraespinoso, infraespinoso, redondo menor y subescapular, respectivamente. Las posiciones de PH de estos CRDNI en la línea H son las siguientes: supraespinoso, 25,43 % y 26.59 %; infraspinatus, 53,85 %, 34,63 %, 35,96 % y 58,17 %; redondo menor, 74,50 %; y subescapular, 20,33 %. El PL en la línea L: supraespinoso, 11.09 % y 14.83 %; infraspinatus, 21,59 %, 27,93 %, 48,55 % y 57,52 %; redondo menor, 68.28 %; y subescapular, 52,82 %. La profundidad en la línea PP ': supraespinoso, 24,83 % y 25,40 %; infraspinatus, 21,55 %, 16,10 %, 10,01 % y 8,14 %; redondo menor, 13.27 %; y subescapularis, 22,88 %. La identificación de estos CRDNI debería proporcionar la posición objetivo óptima para inyectar la toxina botulínica A para tratar la espasticidad de los músculos del manguito rotador acompañada de dolor en el hombro y para mejorar la eficiencia y la eficacia del bloqueo de la localización del objetivo.
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Humans , Male , Female , Adult , Middle Aged , Aged , Peripheral Nerves/anatomy & histology , Rotator Cuff/innervation , Botulinum Toxins, Type A , Nerve Block , Cadaver , Anatomic Landmarks , Muscle SpasticityABSTRACT
BACKGROUND: Facial scars are mainly caused by trauma or surgery, which greatly affect the appearance. Dermatologists and plastic surgeons have tried many ways to change the appearance of scars. Botulinum toxin A injection is widely used in clinical practice for prevention of scars, but the efficacy and safety are not proved. OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar. METHODS: PubMed, EMbase, the Cochrane library, CNKI, CBM, WanFang, and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars. Manual retrieval was done for supplement of incomplete data. Two doctors were responsible for literature screen and evaluation. Finally, 11 randomized controlled clinical trials were included. The experimental group was injected with botulinum toxin A, and the control group was given saline or nothing. Part of the data was analyzed using Revman 5.3 software for meta-analysis, and the data that could not be analyzed using software were subjected to a descriptive analysis. RESULTS AND CONCLUSION: Eleven randomized controlled trials were included, involving 436 patients with 518 wounds. Meta-analyses showed that Vancouver scar scale score, visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group (weighted mean difference (WMD)=-1.61, 95% confidence interval (CI)=-2.06 to -0.26, P = 0.02; WMD=1.7, 95%CI=0.38 to 3.02, P = 0.01; WMD=-0.17, 95%CI=-0.22 to -0.12, P < 0.000 1). Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group (χ2 =8.335, P=0.004), but they were all slight and easy to release. There were no serious adverse events in both groups. It seems that botulinum toxin A injection can reduce the width of scars, improve Vancouver scale and visual analogue scale scores. However, it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.
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@#AIM:The dry eye model of rat was induced either by lacrimal gland extirpation or injection of botulinum toxin A into lacrimal gland. The clinical manifestations, pathological features and cytokine changes of these two models were compared, then we discussed their advantages, disadvantages and applicable scope.<p>METHODS:Thirty healthy 8-week-old male Brown Norway rats were randomly assigned into three groups equally. The left eye of group A was blank group, group B was the left lacrimal gland extirpation model, the left tear gland of group C was injected with botulinum toxin A. We compared the data of Schirmer I test, tear break-up time(BUT), and the corneal fluoresceince staining scores at different times(1d before experiment, 3d, 7d, 14d, 28d, and 42d after the surgical process). We observed pathological changes of conjunctiva, cornea and lacrimal gland at 42d, and we used real-time polymerase chain reaction to analyze interleukin-6(IL-6), tumor necrosis factor-α(TNF-α)and epithelial growth factor(EGF).<p>RESULTS:At the 3d, compared with group A, the tear secretion of both group B and group C were continuous decrease(<i>P</i><0.05). At the 7d, compared with group A, the BUT of both group B and group C began to decreased(<i>P</i><0.05), and the corneal epithelial staining scores of both group B and group C began to significantly increase(<i>P</i><0.05). There was no statistical difference in the above clinical data between group B and group C(<i>P></i>0.05). The corneal epithelial cells in group A was set as normal morphology, while the corneal epithelial cells in group B and group C showed filamentous separation of surface cells to varying degrees, and the number of conjunctival goblet cells was decreased. The lacrimal gland of group C was obviously atrophic. In conjunctival and corneal tissues, the expression of EGF, TNF-α and IL-6 were significantly increased in group B and group C, which was statistically significant compared with group A(<i>P</i><0.05). The expression of EGF and TNF-α didn't altered significantly between group B and group C(<i>P</i>>0.05), however, the expression of IL-6 in group B was much higher than that in group C(<i>P</i><0.05).<p>CONCLUSION:In this study, we proved that both lacrimal gland extirpation and lacrimal gland injection botulinum toxin A could construct a stable aqueous tear deficiency dry eye rat model. The appropriate animal model should be selected according to the experimental design and research purpose.
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Purpose: Our study aims at evaluating the efficacy and safety of botulinum toxin A in the early treatment of sixth nerve palsy in type 2 diabetic patients. Methods: This study is a prospective and interventional clinical case series of patients presenting with acute onset of sixth cranial nerve palsy, who received injection botulinum toxin A. Results: Thirty-one cases were included in the study. 58% of the study subjects had incomplete palsy at presentation (abduction deficit -1 to -3) and 42% had complete palsy (-4 and -5). The median dosage of injection was 5 U (range 3--6 U). The median follow-up period is 2 months. The P value shows that there is statistically significant improvement in head turn, ocular deviation in primary position, and improvement in abduction between baseline and 1 week (P-value <0.001), 1 month (P-value <0.001) and 2 month (P-value <0.001) postinjection follow-up visits. 90.3% of patients had full resolution of symptoms in the last follow-up visit. 83.9% of patients were successfully treated. Conclusion: Early injection of botulinum toxin A in select patients with acquired sixth nerve palsy due to diabetes is a safe and efficient treatment option in alleviating symptoms, restoring function and quality of life and reducing need for surgical interventions in future.
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BACKGROUND@#Most manufacturers of commercially available botulinum toxin A (BTX-A) recommend that the vials should be used within 24 hours after reconstitution to ensure efficacy, which in some instances would mean wastage of remaining reconstituted solution. Several studies have evaluated the efficacy of stored reconstituted BTX-A and have concluded that the use of BTX-A reconstituted and refrigerated for up to 6 weeks prior to administration does not significantly alter its efficacy in the treatment of facial rhytides.@*OBJECTIVES@#Our study aimed to compare the clinical efficacy and safety of freshly reconstituted BTX-A and BTX-A reconstituted 1, 2 or 3 months prior to administration in the treatment of axillary hyperhidrosis.@*METHODOLOGY@#Patients with primary axillary hyperhidrosis were enrolled in this pilot study. Freshly reconstituted BTX-A and BTX-A reconstituted 1, 2 and 3 months prior were administered in 4 pre-determined areas in the same patient. The degree of hyperhidrosis was assessed subjectively using Hyperhidrosis Disease Severity Scale (HDSS) and objectively using Minor’s iodine starch test followed by Sweating Intensity Visual Scale (SIVS) at 0, 2, 6 and 12 weeks after administration.@*RESULTS@#Five patients were enrolled in the study. Kruskall-Wallis test showed that HDSS at baseline was significantly different from follow-up periods with noted improvement from baseline to 2 weeks follow-up. Using Kruskall-Wallis test, SIVS was found to be not significantly different among these 4 treatment areas. In addition, significantly improved SIVS scores were noted as early as 2 weeks after administration in all 4 areas of treatments. There were no noted adverse effects in all patients at baseline and at all follow-up visits.@*CONCLUSION@#The clinical efficacy and safety of BTX-A reconstituted 1, 2 and 3 months prior to administration is comparable to that of freshly reconstituted BTX-A in the treatment of axillary hyperhidrosis.
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Objective@#To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity(DU).@*Methods@#A prospective and self-controlled trail was conducted from August 2012 to October 2017. Male patients with nerve injury, dysuria more than 6 months, DU(bladder contractility index less than 100) were enrolled in this study. Exclusion criteria included patients with acute urinary tract infection, bladder stone, benign prostate hyperplasia, urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline, and the solution of BTX- A was injected into 4 different points(3-o’clock, 6-o’clock, 9-o’clock, and 12-o’clock) in external urinary sphincter with each point of 1ml solution. Patients were evaluated at baseline and 12 weeks after injection. The outcomes included post void residual (PVR), maximum flow rate (Qmax), maximum detrusor pressure during voiding phases (Pdet.max), maximum urethral closure pressure (MUCP), the case number of intermittent catheterization (IC)and the score of quality of life (QOL score). Adverse events were also recorded.@*Results@#A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital)with mean age 28.6 years suffered from cerebral palsy (n=2), cerebrovascular accident(n=19)and spinal cord injury(n=37) were included into the study. Compared to baseline data, significant difference were observed at week 12 in PVR (56.68 ml vs. 280.11 ml, P<0.001), Pdet.max(23.95 cmH2O vs. 30.01 cmH2O, P=0.019), Qmax(6.74 ml/s vs. 3.28 ml/s, P=0.042), MUCP(48.25 cmH2O vs. 79.34 cmH2O, P<0.001), the case number of IC(40 vs. 58, P<0.001) and QOL score(3.63 vs.5.22, P<0.001) respectively. 5 cases developed perineal pain and 16 cases developed mild transient haematuria. These adverse events were disappeared by medical symptomatic treatment during 3-5 days.@*Conclusions@#BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.
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Objective To assess clinical effect and safety of botulinum toxin A injection in external urethral sphincter for male patient with neurogenic detrusor underactivity (DU).Methods A prospective and self-controlled trail was conducted from August 2012 to October 2017.Male patients with nerve injury,dysuria more than 6 months,DU (bladder contractility index less than 100) were enrolled in this study.Exclusion criteria included patients with acute urinary tract infection,bladder stone,benign prostate hyperplasia,urethral stricture and urethral diverticulum.100 IU BTX-A was dissolved in 4ml normal saline,and the solution of BTX-A was injected into 4 different points(3-o'clock,6-o'clock,9-o'clock,and 12-o'clock) in external urinary sphincter with each point of 1ml solution.Patients were evaluated at baseline and 12 weeks after injection.The outcomes included post void residual (PVR),maximum flow rate (Qmax),maximum detrusor pressure during voiding phases (Pdet.max),maximum urethral closure pressure (MUCP),the case number of intermittent catheterization (IC) and the score of quality of life (QOL score).Adverse events were also recorded.Results A total of 58 male patients (all from Guangdong provincial work injury rehabilitation hospital) with mean age 28.6 years suffered from cerebral palsy (n =2),cerebrovascular accident(n =19)and spinal cord injury(n =37) were included into the study.Compared to baseline data,significant difference were observed at week 12 in PVR (56.68 ml vs.280.11 ml,P ＜ 0.001),Pdet.max (23.95 cmH2O vs.30.01 cmH2O,P =0.019),Qmax(6.74 ml/s vs.3.28 ml/s,P =0.042),MUCP(48.25 cmH2O vs.79.34 cmH2O,P ＜0.001),the case number of IC(40 vs.58,P ＜0.001) and QOL score(3.63 vs.5.22,P ＜ 0.001) respectively.5 cases developed perineal pain and 16 cases developed mild transient haematuria.These adverse events were disappeared by medical symptomatic treatment during 3-5 days.Conclusions BTX-A externalurethral sphincter injections help reduce urethra resistance and also improve the quality of life for patients with neurogenic detrusor underactivity.
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Objective To observe the effect of injecting botulinum toxin type A on muscle tension,disability level and ability in the activities of daily living in patients with post-stroke dystonia.Methods Thirty-two patients with post-stroke dystonia were divided into an observation group (n =16) and a control group (n =15).The patients in the observation group were injected with 200-600 U of botulinum toxin type A in the relevant muscles,while the patients in the control group were given 12 mg diphenhydrazole hydrochloride tablets orally.Before and 2,6 and 12 weeks after the treatment,spasticity,disability and daily living ability were evaluated in both groups using the modified Ashworth scale (MAS),a disability assessment scale (DAS) and the modified Barthel index (MBI).Results After the treatment,the average MAS,DAS and MBI scores of both groups were significantly better than before the treatment.And the average MAS,DAS and MBI scores of the observation group were significantly better than those of the control group.Conclusion Botulinum toxin A injection can significantly improve dystonia and relieve disability among stroke survivors.
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The studies of Botulinum toxin A (BoNT/A) are progressing in many fields. BoNT/A has been used in neurological disorders, such as pains, spasticity, dystonias and autonomic disorders, etc. The pharmacological interaction among BoNT/A, neuronal transport and protein has been explored, and promoted basic science studies.
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[Objective] To determine the efficacy and safety of local injections of botulinum toxin A in the treatment of androgenetic alopecia.[Methods] 72 male patients were randomly into botulinum toxin An group (n=35) and the control group (n=37),the treatment time was 6 months.All the patients were photographed and evaluated,before the treatment,and 3 months and 6 months.[Results] After the treatment of half a year,a good result was observed,the hair density in the treatment group was higher after 3months and 6 months than before the treatment (P＜0.05),but there was no difference between the after 3months and 6 months (P＞0.05),the hair density in the control group was higher after 6 months than before the treatment and after 3 months (P＜0.05),but there was no difference between the after 3 months and before the treatment (P＞0.05);but there was no difference between the after 3 months and 6 months (P＞0.05);After 6 months,the effective ratio and in two group were 91.4％ and 86.5％ in treated group,it showed no significant difference (P＞0.05) [Conclusion] the treatment of local injections of botulinum toxin A has a marked effect on androgenetic alopecia,it is safe and effective.
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Objective To discuss the clinical effect of facial contour remodeling using transplantation of the autologous granular fat grafting combined with botulinum toxin A injection.Methods Negative-pressure liposuction was carried out in the inner thigh or abdomen using liposuction needle connected with an injector,to let stand for layered,discharge lower layer water,rinse,extract the fat particles into a 2 ml syringe,inject into facial depression area with multipoint,multiple-tunnel,and multilayer manner,over injection of about 20％-30％ every time.89 patients received the injection;some accepted two injections;13 cases were injected in temple (14.6％),and 16 in forehead (17.98％).30 of them received subcutaneous injection of botulinum toxin A,each side dose was less than 20 U.Results Patients had been followed up for 3-36 months,and obvious improvements were observed in facial contour in the frontal and temporal region as well as the skin texture;the survival rate of fat granule reached to 60％-80％.No hematoma,nodes and infection been observed.Patients combined with botulinum toxin A injection had more ideal facial contour and more satisfaction.Conclusions Autologous fat granules transplantation in the face has stable clinical effect,and combining with botulinum toxin A injection can improve facial contour.It is a safe,ideal treatment in facial rejuvenation and facial contour remodeling and it therefore can be widely recommended in clinical treatment.
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Underactive bladder (UAB) is a hot research topic in the field of urinary continence.At present,the research on UAB is not in-depth,which brings many serious problems for the diagnosis and treatment of lower urinary tract dysfunction.In this paper,the definition,classification,risk factors,pathogenesis and diagnostic criteria of UAB are described.Some clinical problems related to UAB are discussed in details,such as the indications and surgical expectations of benign prostatic hyperplasia (BPH) and female stress urinary incontinence (SUI) with UAB,strategic issues in detrusor hyperactivity with impaired contractility (DHIC),oral anticholinergic drugs,and bladder wall injection of botulinum toxin A may lead to urinary retention.
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BACKGROUND: The objective of this study was to evaluate the influence of masticatory muscle injection of botulinum toxin type A (BTX-A) on the growth of the mandibular bone in vivo. METHODS: Eleven Sprague-Dawley rats were used, and BTX-A (n = 6) or saline (n = 5) was injected at 13 days of age. All injections were given to the right masseter muscle, and the BTX-A dose was 0.5 units. All of the rats were euthanized at 60 days of age. The skulls of the rats were separated and fixed with 10% formalin for micro-computed tomography (micro-CT) analysis. RESULTS: The anthropometric analysis found that the ramus heights and bigonial widths of the BTX-A-injected group were significantly smaller than those of the saline-injected group (P < 0.05), and the mandibular plane angle of the BTX-A-injected group was significantly greater than in the saline-injected group (P < 0.001). In the BTX-A-injected group, the ramus heights II and III and the mandibular plane angles I and II showed significant differences between the injected and non-injected sides (P < 0.05). The BTX-A-injected side of the mandible in the masseter group showed significantly lower mandibular bone growth compared with the non-injected side. CONCLUSION: BTX-A injection into the masseter muscle influences mandibular bone growth.
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Animals , Rats , Bone Development , Botulinum Toxins , Botulinum Toxins, Type A , Formaldehyde , Mandible , Masseter Muscle , Masticatory Muscles , Rats, Sprague-Dawley , SkullABSTRACT
Objetivo: evaluar los resultados terapéuticos de la aplicación de toxina botulínica A en pacientes con alteraciones espásticas palpebrales. Métodos: se realizó un estudio observacional, descriptivo, longitudinal y prospectivo en 18 pacientes con estas afecciones, seleccionados en la consulta de Oculoplastia del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido entre enero y diciembre del año 2016. Se describió la muestra según la edad, el sexo, el color de la piel, los antecedentes patológicos personales, las afecciones palpebrales y las limitaciones en tareas de la vida diaria. Se evaluó en el posoperatorio el tiempo de desaparición de los síntomas, la duración del efecto de la inyección de toxina botulínica, las complicaciones inmediatas y las mediatas. Resultados: el 70,6 por ciento estuvo comprendido en el rango de edad mayor de 60 años, y el 52,9 por ciento fueron mujeres. La piel blanca constituyó el 58,8 por ciento de la muestra. La afección que se presentó con mayor frecuencia fue el blefaroespasmo (47,1 por ciento). Todos los pacientes presentaron limitaciones para realizar tareas de la vida diaria. El 100 por ciento presentó dolor en el sitio de la inyección. En el 94,1 por ciento de ellos hubo desaparición de los movimientos involuntarios entre el cuarto y el quinto día posterior a la aplicación de xeomeen y en el 88,2 por ciento demoró la reaparición de los síntomas entre cuatro y seis meses. Conclusiones: la toxina botulínica es efectiva en la corrección de las afecciones palpebrales espásticas con desaparición de los síntomas en un período de tiempo entre cuatro y cinco días, con una rápida incorporación del paciente a la vida laboral y social por cuatro a seis meses(AU)
Objective: to evaluate the therapeutic results of the application of toxin botulínica A in patients with palpebral spastic alterations. Methods: an observational, descriptive, longitudinal and prospective study was performed on 18 patients with these conditions, who were selected at the Oculoplasty Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology in the period from January to December 2016. The analyzed variables were age, sex, race, personal pathological history, eyelid disorders and restricted daily life. In the postoperative period, length of time for symptom relief, duration of the effect of botulinum toxin injection, and immediate and mediate complications were assessed. Results: in the group, 70,6 percent were included in the over 60 y age group and 52,9 percent were women. Caucasians accounted for 58,8 percent of the sample. The most frequent condition was blepharospasm (47,1 percent). All patients had limitations to perform daily life tasks. In 94,1 percent of the patients, involuntary movements disappeared between the 4th and the 5th day after the administration of Xeomeen and in 88,2 percent, the symptoms delayed to appear again from 4 to 6 months. Conclusions: botulinum toxin A is an effective alternative to correct palpebral spastic conditions, with symptoms disappearing in four to five days, and quick reincorporation of the patient to working and social life for 4 to 6 months(AU)
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Humans , Female , Blepharospasm/therapy , Botulinum Toxins, Type A/therapeutic use , Hemifacial Spasm/therapy , Meibomian Glands/injuries , Epidemiology, Descriptive , Longitudinal Studies , Observational Study , Prospective StudiesABSTRACT
Objective To observe the effect of botulinum toxin A combined with delivery autologous platelet rich plasma into skin with microneedle for facial rejuvenation.Methods 82 patients from our hospital treated for facial rejuvenation were randomly divided into observation group(41 cases)and control group(41 cases).The control group was given delivery autologous platelet rich plasma into skin with microneedle therapy.The observation group was treated with botulinum toxin A on the base of control group.After the treatment,the effect was observed.The facial skin moisture,skin elasticity,grease and spots were detected before and after treatment in the two groups.Before and after treatment,the role function,emotional function,social function,body function and the overall quality of life score were detected by the quality of life table.Observe all of the patients reaction duration of therapy.Results The total effective rate was 95.1% in observation group,significantly higher than the control group(P0.05).And there was no adverse reactions happened in the two groups.Conclusion Botulinum toxin A combined with delivery autologous platelet rich plasma into skin with microneedle for facial rejuvenation has a good effect and high safety.
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Objective To investigate the clinical efficacy of bromhidrosis with botulinum toxin A by needle free injection.Methods A total of 40 patients with bromhidrosis were collected and divided into needle free group and needle group.A comparative study was carried out in those subjects.Patients in needle free group received needle free injection of botulinum toxin A by INJEX30;Needle group received traditional injection by 26 G needles.Results In needle free group,16 cases were cured,3 cases were effective,1 case was ineffective,no significant pain,hematomas or necrosis were found.In needle group,15 cases were cured,4 cases were effective,and 1 case was ineffective;localized hematoma occurred in 2 cases.And cases in group needle experienced pain more intensely than cases in needle free group.Conclusions The INJEX30 improves the security,comfort and therapy compliance of botulinum toxin A injection in the bromhidrosis patients,with similar efficacy with traditional injection.
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Objective To investigate therapeutic effect of bromhidrosis by botulinum toxin A injections and situation of bromhidrosis recurrence.Methods Clinical data of bromhidrosis patients were analyzed in our hospital from January 2013 to June 2014.A total of 89 cases were involved in this study and randomized into two groups:observation group (42 cases) were treated by botulinum toxin A,and patients with the control group (47 cases) were treated by small skin excision.The total effective rate,incidence of complications and recurrence rate in both groups were compared.Results After treatment for 3 months,the total effective rate of both group had no statistical difference (P＞ 0.05).After different treatment,the incidence of complications in observation group of patients was 2.38％ (1/42),and that in the control group was 14.89％ (7/47);complication rates of control group patients was significantly higher than that of the observation group,with statistical significance (x2 =4.245,P＜0.05).After 9 months follow-up,31 cases in the observation group of patients showed bromidrosis recurrence,with recurrence rate of 73.81％;2 patients in the control group showed bromidrosis recurrence,with recurrence rate of 4.26％.Log-Rank test showed that recurrence rate in observation group was significantly higher than that of control group (x2 =43.21,P ＜0.05).Conclusions Botulinum toxin A injection is an uninvasive method for the treatment of bromhidrosis with fewer complications and good effect,but the postoperative recurrence rate is higher and it needs injections for many times.
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Objective To systematically review the clinical efficacy of botulinum toxin A for the treatment of upper limb spasticity after stroke. Methods PubMed,EMbase,Cochrane Library,CBM, China National Knowledge Internet (CNKI),and Wanfang Data were retrieved by a computer. The randomized controlled trials and Case-control study of comparing botulinum toxin A combined with rehabilitation training and routine rehabilitation treatment for upper limb spasticity after stroke were collected. The retrieval time was from the foundation of the database to September 1,2016. At least two reviewers conducted literature screening,data extraction,and quality evaluation according to the inclusion and exclusion criteria. The Rev-Man 5. 3 software provided by the Cochrane Collaboration was used to conduct the Meta-analysis. Results A total of 356 articles were retrieved. Finally,11 articles met the inclusion criteria. The modified Jadad score showed that the scores of 9 articles were more than 4,which belonged to high-quality literature. Eleven articles included 614 patients,in which 316 were treated with botulinum toxin A. There were 298 patients in the control group. The results of Meta-analysis indicated that the Fugl-Meyer score (SMD =0. 94,95% CI 0. 75 to 1. 12),modified Ashworth score (SMD = - 1. 59,95% CI - 1. 78 to - 1. 40),and modified Barthel index (SMD = 0. 86,95% CI 0. 65 to 1. 08)in the botulinum toxin treatment group were superior to the control group. There were significant differences (all P 0. 05). Conclusion The efficacy of treatment of upper limb spasticity after stroke with botulinum toxin A is exact,and the security is high. The appropriate rehabilitation training can effectively improve the limb motor function,muscle tension,and quality of life of patients.