Systematic review and meta-analysis of randomized controlled trials comparing botulinum toxin injection with lateral internal sphincterotomy for chronic anal fissure

Objective  The aim of this review is to systematically analyze the prospective randomized controlled trials on the efficacy of botulinum toxin injection (Botox) vs. lateral internal sphincterotomy (LIS) for the treatment of chronic anal fissure (CAF). Materials and methods  A systematic review of the literature was undertaken. The prospective randomized controlled trials on the effectiveness of Botox vs. LIS for the management of CAF were selected according to specific criteria and analyzed to generate pooling data. Results  Four studies encompassing 279 patients were qualified for the meta-analysis. There was a statistically significant higher healing in LIS group compared with Botox group (RR 1.31[1.57, 1.50] 95% CI, z = 4.11, p < 0.0001). Absolute benefit increase rate (ABI) is 23% for LIS group compared with Botox group. The recurrence rate was statistically significantly higher in Botox groups than in LIS groups (RR 5.83[2.96, 11.49] 95% CI, z = 5.09, p < 0.00001).LIS was associated with a high rate of minor anal incontinence as compared to Botox (RR 0.08[0.01, 0.59] 95% CI, z = 2.47, p = 0.01). Conclusion  Botulinum toxin injection was associated with a higher rate of recurrent disease. LIS was more effective in healing chronic anal fissure.     

Treatment of vascular lesions located in the lip and in the oral cavity with Nd:YAG laser

Vascular lesions such as hemangiomas can be found in the oral cavity. Some therapeutic modalities can be used in the treatment of these lesions and Nd:YAG 1064 nm long pulse laser shows good results with easy application, fewer complications and satisfactory results. This study describes the technique and outcome of a case of hemangioma located on the tongue treated with Nd:YAG laser.     

四种重要生物恐怖毒素液相芯片多重检测方法的建立

目的建立包括蓖麻毒素B(Ricin toxion B,RTB)、肉毒梭菌毒素A(Clostri botulinum toxin A,CBTA)、金黄色葡萄球菌肠毒素B(Staphylococcal enterotoxin B,SEB)及产气荚膜毒素ε(Clostridium perfringens toxinε,CPTε)在内的4种重要生物恐怖因子的多重液相芯片检测方法。方法采用双抗夹心法原理和液相芯片技术平台,通过优化偶联抗体浓度和检测抗体浓度以及抗原抗体最佳孵育时间,建立4种生物恐怖因子液相芯片多重检测方法。结果反应条件优化实验结果表明,RTB、CBTA、SEA和CPTε偶联抗体的最佳用量分别为20μg、40μg、80μg、80μg;RTB、CBTA、SEA和CPTε检测抗体的最佳稀释比分别为1∶5000、1∶1000、1∶2000、1∶4000;4种毒素抗原抗体最佳孵育时间为60min。多重检测结果表明,本研究建立的毒素液相芯片多重检测方法可有效检测上述任意1种毒素、任意2种毒素组合、任意3种毒素组合并能同时检测4种毒素。灵敏度检测结果表明,RTB、CBTA、SEA、CPTε检测灵敏度分别为1 ng/ml、10 ng/ml、5 ng/ml、10 ng/ml。结论本研究建立的4种常见生物恐怖毒素液相芯片多重检测方法通过1次检测能同时检测RTB、CBTA、SEA、CPTε,是一种准确、灵敏、快速和高通量的检测方法。     

Spinal myoclonus in the periscapular muscles after mastectomy assessed by FDG-PET

We describe a 64-year-old woman who developed spinal myoclonus around the left scapula after long thoracic nerve injury by mastectomy. Involuntary muscle twitching was semi-rhythmic, and ultrasonography identified contraction of the serratus anterior, teres major, and rhomboid muscles. FDG-PET imaging revealed markedly increased glucose uptake only in the serratus anterior. Lidocaine injection into this muscle resulted in complete cessation of the involuntary movement, and then she was successfully treated with botulinum toxin type A. These findings raise the possibility that the myoclonus was primarily caused by ectopic firing of the injured long thoracic nerve, then spreading to adjacent muscles possibly via a central mechanism mediated by group Ia afferents. The new imaging tools, such as FDG-PET and ultrasonography, were useful to determine the therapeutic target muscle.     

Long-term follow-up of patients with frontalis sling operation in the treatment of essential blepharospasm unresponsive to botulinum toxin therapy

Objective Botulinum toxin is the treatment of choice in patients with essential blepharospasm, but about 4% of patients show no sufficient effect. Many of these patients try to open their eyes by innervating their frontalis muscle. This led to the idea of performing frontalis suspension, normally used for certain types of ptosis. We set out to evaluate the long-term results, complication rates and patient acceptance of this intervention.Methods Frontalis sling operation was carried out on 252 eyes of 132 blepharospasm patients between 1992 and 2004. In all patients botulinum toxin treatment was administered before surgery with no or only brief and incomplete effect even with increasing toxin doses. In 120 patients surgery was performed under local anaesthesia, while 12 patients were operated upon under general anaesthesia (mostly bilateral). Silk sutures were employed in the first 14 eyes, and in all others we used Gore-Tex suture material.Results The duration of follow-up was 3–154 months; 60 patients were followed up for at least 5 years. Seventy-three per cent of patients reported an improvement after surgery. Long-term subjective improvement showed a median of 50% on a scale ranging from 0%=no improvement to 100%=no complaints. No serious corneal complications occurred, although slight overcorrection is desirable in the first days after surgery for a satisfactory long-term result. Seven per cent of operations had to be revised due to suture granulomas or extruded suture material. The effect of surgery generally remained stable over the years, with most patients needing additional treatment with botulinum toxin. In cases of decreasing effect (5% of eyes), the sutures were tightened under local anaesthesia.Conclusion Frontalis suspension can be considered as a minimally invasive but very effective and even reversible procedure in “poor responders” to botulinum toxin, with good long-term effect and good acceptance by the patients. Additional treatment with botulinum toxin is required in most patients in order to increase the desirable imbalance between the frontalis and the orbicularis muscle.     

Avian eyelid assay, a new diagnostic method for detecting botulinum neurotoxin serotypes A, B and E.

Based upon botulinum neurotoxins' (BoNT) mechanism of action, a novel, rapid, and sensitive avian eyelid assay was developed to detect Clostridium botulinum neurotoxin serotypes A, B and E in assay buffer and mimic samples. It showed that chick was the most optimal model of 20-selected laboratory, non-laboratory animals. The eyelid closure of chick was the indicator symptom for positive results. The detection limits achieved range from 5 to 250 mouse LD(50) for toxin types A, B, and E in a buffer system and mimic samples. No cross reactivity occurred when using staphylococcal enterotoxin B, diphtheria toxin and nerve agent sarin, but cross reactivity was obtained in more than 6h for using high dose of tetanus toxin. This cross reactivity can be differentiated by BoNT neutralization tests with a serotype-specific antiserum in parallel. The avian eyelid assay can be performed within as short a time as 0.4-6 h. We report here the development of avian eyelid assay is the second animal bioassay for the detection of toxin types A, B, and E which approaches the sensitivity of the mouse bioassay, and is simple to perform as well as rapid to yield results.     

A型肉毒毒素治疗Meige's综合征

目的 评估A型肉毒毒素治疗Meige's综合征的疗效.方法 对A型肉毒毒素治疗的30例Meige's综合征患者资料进行回顾性分析.结果 30例Meige's综合征患者注射A型肉毒毒素后25例完全缓解,5例明显缓解,总有效率100%.起效时间注射当天～第3天.疗效维持平均为5个月.重复治疗有效.局部不良反应轻微、短暂、可逆,无全身不良反应及过敏反应.结论 A型肉毒毒素局部注射是治疗Meige's综合征的一种安全、有效、简便、易行的方法.     

B型肉毒毒素重链C端基因的克隆与表达

目的:扩增B型肉毒毒素重链C端基因并将其在大肠杆菌中表达.方法:首先克隆B型肉毒毒素重链C端片段(BoNTB/Hc),经IPTG诱导,在大肠杆菌中进行天然序列的表达.构建原核表达载体pET32/Hc后进行融合蛋白的表达.对5′端引物进行修饰,最终进行N端修饰蛋白的表达.结果:扩增得到的BoNTB/Hc与已知序列同源性达99%,未得到天然序列的表达,获得了融合蛋白和N端修饰蛋白的表达.Western blot鉴定结果表明,融合蛋白和N端修饰蛋白都可以和特异性抗体发生反应.结论:获得了B型肉毒毒素重链C端基因的表达,为肉毒毒素相关研究奠定了基础.     

A randomized,double-masked,crossover comparison of the efficacy and safety of botulinum toxin type A produced from the original bulk toxin source and current bulk toxin source for the treatment of cervical dystonia

In 1997, the US FDA approved a new bulk toxin source (now referred to as current) for the manufacture of botulinum toxin type A (BTX-A). The current BTX-A preparation has a lower neurotoxin complex protein load than the original BTX-A preparation, which may reduce antigenic potential. The present double-masked, multicenter study compared the efficacy and safety of BTX-A (BOTOX) produced from both original and current bulk toxin sources for the treatment of cervical dystonia. Patients (N = 133) were injected with BTX-A produced from original and current bulk toxin sources using a crossover design. Adverse events were assessed at each visit. Efficacy was assessed at 2 and 6 weeks post-injection using the severity and pain-disability subscales of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Mean BTX-A doses were comparable (original: 155 U, current: 156 U). Both BTX-A preparations produced similar, statistically significant reductions in TWSTRS severity and pain-disability scores at weeks 2 and 6 post-injection. The original and current BTX-A preparations showed no significant differences in adverse events, including both treatment-related (34%, 31%) and treatment-unrelated (27%, 32%), respectively. BTX-A produced from the original and current bulk toxin sources showed comparable efficacy and safety in the treatment of cervical dystonia; both significantly reduced dystonia severity and pain.     

A型肉毒毒素用于口角歪斜和鼻唇沟不对称的研究

目的 在面瘫患者健侧部分面肌中注射A型肉毒毒素用以矫正口角歪斜和不对称的鼻唇沟，以满足美容的需要。方法 将2001年1月-2005年12月来在门诊和住院的部分面瘫患者作为观察对象，除对照组外治疗组分别在健侧面肌中注射A型肉毒毒素，依据注射剂量随机分为5个治疗组：A组（各肌注射1．25u）、B组（各肌注射2．50u）、C组（各肌注射5．OOu）、D组（降、提口角肌和颧大、小肌各注射2．50U，笑肌注射5．00u）和E组（降、提口角肌和颧大、小肌各注射5．00u，笑肌注射2．50U），3d后定期观测每例患者双侧口角到门齿中缝的距离差。结果 除A组外，各治疗组的口角歪斜和鼻唇沟不对称均得到不同程度的纠正，注射剂量越大起效越快，持续时间越长，但表情动作受到的影响也略大。结论 根据口角歪斜和鼻唇沟不对称的程度，在健侧面肌注射相应剂量的A型肉毒毒素，既可以较好地纠正面瘫患者的口角歪斜和鼻唇沟的不对称，又可以避免并发症的发生。