Severe Botulism after Intragastric Botulinum Toxin-A Injection: A Case Series

Intragastric botulismus toxin-A (BoNT-A) is one of the new approaches in the treatment of obesity. We aimed to contribute to the literature by presenting the clinical features, laboratory findings and treatment responses of iatrogenic botulism cases due to intragastric BoNT-A administered in our clinic. All detailed medical information was obtained by accessing the medical records of the patients who were hospitalized and followed up and treated between September 2022 and December 2022, and the diagnosis of A.05.1 Botulism was entered according to ICD-10, and whose clinical findings were compatible with botulism disease and who underwent intragastric BoNT-A application beforehand. These records were obtained by examining this information. 10 patients who developed botulism after intragastric BoNT-A application between 01/09/2022 and 28/02/2023 were followed up in our clinic. All of the patients were women. The mean age was 35. The mean hospital stay was 9 days. Only 1 of our cases required intensive care. Good response to treatment was accepted as a complete or near-complete improvement in the clinical findings of the patients and all of them had a good response to treatment. Intragastric BoNT-A administration is a procedure that requires careful indication with a profit/loss calculation considering the potential side effects. In addition, attention should be paid to dilution rates and dose amounts.

Botulinum Toxin-A for the Treatment of Voiding Dysfunction: Our Initial Experience

Objective: Evaluation of Botulinum Toxin-A (BTX-A) as an alternative treatment option in patients whom previous treatments were failed. Methods: Between March 2005 and September 2006, a total 19 patients;16 patients with overactive bladder (5 neurologic, 11 idiopathic), 2 with nocturnal enuresis, 1 with interstitial cystitis, intravesical BTX-A injection was applied. Except one patient, 18 patients with a median age 46 (20 - 80) were registered to the study. Patients were examined at postoperative 3 weeks and 6 months with ICIQ-SF (International Consultation on Incontinence Questionnaire-Short Form) and satisfaction forms used in our clinic. Results: The median follow-up time was 16 months (6 - 18). When evaluated according to diagnosis, symptoms were improved 100% in neurologic overactive bladder (5/5), 80% in idiopathic overactivity (8/10), 50% in nocturnal enuresis (1/2). In one patient with interstitial cystitis there was no improvement. Median efficiency time of BTX-A treatment was 6 months (1 - 17). At 3 weeks and 6 months after the treatment, ICIQ-SF score was decreased to 3.6 and 7.5 respectively from preoperative level of 18.7. Quality of life scores at preoperative, 3 week and 6 months were 9.7, 2.7 and 4.3 respectively. Except 3 patients with overactive neurologic bladder because of spinal cord injury, symptoms of patients with pollacuria and nocturia decreased at 3. week. Even if these rates increased at 6 months they still were significantly less than preoperative status. The spinal cord injured 3 patients had clean intermittent catheterization per 1 hour and had urinary incontinence between the catheterizations preoperatively, however at 3 weeks and 6 months the intervals of catheterisations was 4 hours and 3 hours respectively and also the urinary incontinance between the catheterisations improved. At patient satisfactions, 78% of patients declared that they were pleased and underwent the procedure again and will recommend it to their relatives with similar problems. One patient had a complication as tansient weakness on her legs. Conclusion: BTX-A injections provide an alternative treatment before surgery at overactive bladder especially for those who doesn’t response to medical treatment or cannot use antimuscarinics because of their side effects. Further studies with a greater number of patients are needed for determining the effectiveness of BTX-A on patients with voiding dysfunctions.

Botulinum toxin type A in treating early-stage patients with small-angle acute acquired comitant esotropia

AIM:To investigate botulinum toxin A(BTXA)efficacy on small-angle(≤25Δ)acute acquired concomitant esotropia(AACE)in early-stage patients.METHODS:The electronic medical record data of AACE patients during March 2019 and June 2023 were collected in this retrospective and hospital-based cohort study.A total of 72 small-angle AACE patients received BTXA extraocular muscle injection.Patients were grouped by onset-to-treatment time(Group A:≤6mo,Group B:>6mo).Deviation of esotropia,eye alignment and stereopsis were analyzed at the period of pre/post-injection(1wk,1,3,and 6mo).Orthophoria rate at 6mo(horizontal deviation<10Δand binocular single vision)were considered as outcome index.RESULTS:There were no significant baseline differences(P>0.05)between two groups except onset-to-treatment time(2mo vs 11mo,P<0.001).Higher orthophoria rates were in Group A at last follow-up(94.74%vs 73.53%,P=0.013).Post-BTXA deviations of two groups at 1mo showed no difference(P>0.05);while in 3 and 6mo Group A was significantly smaller than group B(all P<0.001).No statistically significant differences were observed among all post-BTXA deviations of near and distance in Group A.In Group B,deviation at 3mo(near:2Δvs 0,P<0.001;distance:4Δvs 0,P<0.001)and 6mo(near:6Δvs 0,P<0.001;distance:6Δvs 0,P<0.001)was significant increased compared to deviation at 1wk after treatment.Group A showed better stereopsis recovery in last follow-up compared to Group B(80″vs 200″,P=0.002).Both groups obtained improved stereopsis after treatment(Group A:80″vs 300″,P<0.001;Group B:200″vs 300″,P=0.037).CONCLUSION:BTXA is effective for AACE with small deviation(≤25Δ)in early stage.Delayed treatment(>6mo)may reduce BTXA efficacy.Early BTXA intervention benefits long-term eye alignment and stereopsis recovery.

Botulinum toxin type A-targeted SPP1 contributes to neuropathic pain by the activation of microglia pyroptosis

BACKGROUND Neuropathic pain(NP)is the primary symptom of various neurological condi-tions.Patients with NP often experience mood disorders,particularly depression and anxiety,that can severely affect their normal lives.Microglial cells are as-sociated with NP.Excessive inflammatory responses,especially the secretion of large amounts of pro-inflammatory cytokines,ultimately lead to neuroinflam-mation.Microglial pyroptosis is a newly discovered form of inflammatory cell death associated with immune responses and inflammation-related diseases of the central nervous system.METHODS Two models,an in vitro lipopolysaccharide(LPS)-stimulated microglial cell model and a selective nerve injury model using BTX-A and SPP1 knockdown treatments,were used.Key proteins in the pyroptosis signaling pathway,NLRP3-GSDMD,were assessed using western blotting,real-time quantitative polymerase chain reaction,and immunofluorescence.Inflammatory factors[interleukin(IL)-6,IL-1β,and tumor necrosis factor(TNF)-α]were assessed using enzyme-linked immuno-sorbent assay.We also evaluated microglial cell proliferation and apoptosis.Furthermore,we measured pain sensation by assessing the delayed hind paw withdrawal latency using thermal stimulation.RESULTS The expression levels of ACS and GSDMD-N and the mRNA expression of TNF-α,IL-6,and IL-1βwere enhanced in LPS-treated microglia.Furthermore,SPP1 expression was also induced in LPS-treated microglia.Notably,BTX-A inhibited SPP1 mRNA and protein expression in the LPS-treated microglia.Additionally,depletion of SPP1 or BTX-A inhibited cell viability and induced apoptosis in LPS-treated microglia,whereas co-treatment with BTX-A enhanced the effect of SPP1 short hairpin(sh)RNA in LPS-treated microglia.Finally,SPP1 depletion or BTX-A treatment reduced the levels of GSDMD-N,NLPRP3,and ASC and suppressed the production of inflammatory factors.CONCLUSION Notably,BTX-A therapy and SPP1 shRNA enhance microglial proliferation and apoptosis and inhibit microglial death.It improves pain perception and inhibits microglial activation in rats with selective nerve pain.

Dermal thickness,rather than drug concentration and injection speed,influences the effective area of botulinum toxin type A in the dermis

Background:Recently,microbotulinum,a new technique that involves injecting botulinum toxin type A(BoNTA)microdroplets into superficial cutaneous tissue,has gained popularity.The precise distribution of BoNTA in the targeted area profoundly affects outcomes.Many factors may influence the effective area of BoNTA in the dermis.This study aimed to determine the dermal distribution properties of BoNTA to guide microbotulinum injection.Methods:Ten healthy males aged 18–65 years without BoNTA treatment in the previous year were recruited to receive intradermal injections in the chest and back.Ultrasound was used to ensure the intradermal delivery of injections and measure the dermal thickness.The minor iodine starch test was performed at baseline and 3 days,7 days,21 days,1 month,and 2 months after treatment.Results:All participants received intradermal injections.The dermis was thinner on the chest(thickness,0.20±0.03 cm)than on the back(thickness,0.39±0.07 cm)(P<0.05).An injection in the thicker dermis had a significantly smaller effective area at every follow-up visit.The drug concentration did not affect the effective area except at 3 days after treatment.Injection speed did not influence the effective area at any follow-up visits.Conclusion:An injection in a thicker dermis leads to a smaller effective area for intradermal injections.When the BoNTA dose is the same,the drug concentration and injection speed do not matter.

Clinical effect of botulinum toxin type A combined with autologous fat grafting in patients with nasolabial fold depression

BACKGROUND Nasolabial fold(NLF)depression can affect the facial appearance of patients to some extent and increase their psychological burdens.In recent years,autologous fat grafting(AFG)combined with botulinum toxin A(BTX-A)injection(AFG+BTX-A injection)has been gradually applied in the treatment of patients with NLF depression.Although studies have been conducted on the efficacy and safety of AFG+BTX-A injection in treating NLF depression,the experimental design,observational indicators,and sample enrollment criteria vary remarkably,making it difficult to draw convincing and consistent conclusions.Thus,further relevant research is warranted.AIM To assess the esthetic improvement,efficacy,and safety of AFG+BTX-A injections in patients with NLF depression.METHODS This study included 60 patients with NLF depression who were treated in our hospital from February 2019 to April 2021.These patients were categorized into control(n=30)and observation(n=30)groups.The observation group received AFG+BTX-A injection,whereas the control group underwent AFG only.All patients were evaluated using the wrinkle severity rating scale(WSRS)and global aesthetic improvement scale.The compactness of facial contours,skin evaluation indexes,adverse reactions,and satisfaction of the two groups were evaluated 3 months postoperatively.RESULTS The WSRS scores of the observation group at 1,3,and 6 months postoperatively were lower than those of the control group(P<0.05).Three months postoperatively,facial fine lines and pores showed obvious improvement and the skin index score was higher in the observation group than in the control group(P<0.05).The compactness of facial contours was better in the observation group than in the control group(P<0.05).In addition,no remarkable differences were noted in the incidence of postoperative adverse reactions such as facial stiffness,facial asymmetry,facial bruising,and facial concavity inequality(P>0.05).CONCLUSION AFG+BTX-A injection is a highly safe,cost-effective,effective,and long-lasting treatment for NLF depression with high esthetic value,which should be promoted in the future.

Botulinum toxin type A injection combined with biofeedback in the treatment of spastic pelvic floor syndrome

BACKGROUND Spastic pelvic floor syndrome(SPFS)is a refractory pelvic floor disease characterized by abnormal(uncoordinated)contractions of the external anal sphincter and puborectalis muscle during defecation,resulting in rectal emptation and obstructive constipation.The clinical manifestations of SPFS are mainly characterized by difficult defecation,often accompanied by a sense of anal blockage and drooping.Manual defecation is usually needed during defecation.From physical examination,it is commonly observed that the patient's anal muscle tension is high,and it is difficult or even impossible to enter with his fingers.AIM To investigate the characteristics of anorectal pressure and botulinum toxin A injection combined with biofeedback in treating pelvic floor muscle spasm syndrome.METHODS Retrospective analysis of 50 patients diagnosed with pelvic floor spasm syndrome.All patients underwent pelvic floor surface electromyography assessment,anorectal dynamics examination,botulinum toxin type A injection 100 U intramuscular injection,and two cycles of biofeedback therapy.RESULTS After the botulinum toxin A injection combined with two cycles of biofeedback therapy,the patient's postoperative resting and systolic blood pressure were significantly lower than before surgery(P<0.05).Moreover,the electromyography index of the patients in the resting stage and post-resting stages was significantly lower than before surgery(P<0.05).CONCLUSION Botulinum toxin A injection combined with biofeedback can significantly reduce pelvic floor muscle tension in treating pelvic floor muscle spasm syndrome.Anorectal manometry is an effective method to evaluate the efficacy of treatment objectively.However,randomized controlled trials are needed.

Botulinum toxin type A for treating chronic low back pain:A double blinded randomized control study

BACKGROUND Low back pain(LBP)is a prevalent issue that orthopedic surgeons frequently address in the outpatient setting.LBP can arise from various causes,with stiffness in the paraspinal muscles being a notable contributor.The administration of Botulinum toxin type A(BoNT-A)has been found to alleviate back pain by relaxing these stiff muscles.While BoNT-A is approved for use in numerous conditions,a limited number of randomized clinical trials(RCTs)validate its efficacy specifically for treating LBP.AIM To study the safety and the efficacy of BoNT-A in minimizing pain and improving functional outcomes in patients of chronic LBP(CLBP).METHODS In this RCT,adults aged 18-60 years with mechanical LBP persisting for at least six months were enrolled.Participants were allocated to either the Drug group,receiving 200 Ipsen Units(2 mL)of BoNT-A,or the Control group,which received a 2 mL placebo.Over a 2-month follow-up period,both groups were assessed using the Visual Analog Scale(VAS)for pain intensity and the Oswestry Disability Index(ODI)for disability at the start and conclusion of the study.A decrease in pain by 50%was deemed clinically significant.RESULTS The study followed 40 patients for two months,with 20 in each group.A clinically significant reduction in pain was observed in 36 participants.There was a statistically significant decrease in both VAS and ODI scores in the groups at the end of two months.Nonetheless,when comparing the mean score changes,only the reduction in ODI scores(15 in the placebo group vs 16.5 in the drug group,clinically insignificant)was statistically significant(P=0.012),whereas the change in mean VAS scores was not significant(P=0.45).CONCLUSION The study concludes that BoNT-A does not offer a short-term advantage over placebo in reducing pain or improving LBP scores in CLBP patients.

Prospective observational study to assess the validity of the functional disability score in patients with blepharospasm,hemifacial spasm and synkinesis treated with botulinum toxin injection

Background:Benign essential blepharospasm(BEB),aberrant facial nerve degeneration and hemifacial spasm(HFS)are all examples dystonia which,though not life-threatening,can have a significant impact on patient quality of life.The need for reliable self-rating surveys to monitor functional disability is fundamental.The Blepharospasm Disability Index(BSDI)is already a widely utilised and validated selfrating score for blepharospasm whilst the functional disability score(FDS)requires further validation.The principle aim of this study is to repeat validation of the FDS against the BSDI,which has been validated by several groups since its original description but only in patients with BEB.Methods:A randomised blinded prospective cohort study was conducted at a single unit on 38 patients with BEB,aberrant facial nerve degeneration and HFS.Patients were blinded to complete the FDS followed by the BSDI or the BSDI followed by the FDS with a 30-minute interval.Results:Both the FDS and BSDI were found to be reliable with high internal consistency and test-retest reliability.Both scales were also found to be moderately correlated with the Jankovic disease severity score.Conclusions:This study is the first to use the FDS as a rating scale in patients with HFS and aberrant facial nerve degeneration.It is also the first study to formally validate the FDS as an acceptable rating scale for patients with dystonia and in particular it provides validation for its use in patients with HFS and aberrant facial nerve degeneration.

Systematic evaluation of the efficacy and safety of botulinum toxin type A in the treatment of spastic cerebral palsy

Background:Botulinum toxin type A(BTX-A)is a neuromuscular blocking agent.BTX-A inhibits acetylcholine release,causes neuromuscular transmission impairment,and decreases muscle spasms.Objective:To explore the efficacy and safety of BTX-A injection in the treatment of spastic cerebral palsy through systematic evaluation and to provide a reference for the clinical use of BTX-A.Methods:We used“Cerebral palsy”and“BTX-A”as the subject terms and used a combination of subject terms and free words for the search.We searched 7 databases,including CNKI,Wanfang,VIP,Sinomed,PubMed,Embase,and Web of science.Based on the inclusion and exclusion criteria,we screened the articles by reading their titles,abstracts,and full texts and finally included relevant literature for systematic evaluation.Result:A total of 93 papers were systematically evaluated,revealing that BTX-A injection treatment can effectively reduce muscle tone,increase joint mobility,improve gait and motor posture,and enhance gross motor movements in patients with spastic cerebral palsy.The benefits of BTX-A treatment can be sustained for 3–6 months,with motor ability improvement lasting up to 1 year.Combining BTX-A treatment with rehabilitation or external fixation therapy can enhance its efficacy.However,the effectiveness of BTX-A treatment is influenced by several factors,such as the dosage,number of injections,and patient age.Adverse reactions to BTX-A treatment are typically mild and can be relieved within 1–2 weeks.Conclusion:BTX-A injection is relatively safe but reversible.

5针法A型肉毒杆菌毒素注射在治疗膀胱过度活动症中的应用研究

目的对比分析膀胱内注射A型肉毒杆菌毒素治疗膀胱过度活动症过程中,采用5针注射法与标准的20针注射法的疗效及安全性。方法回顾性分析2015年1月至2022年12月在杭州市第三人民医院泌尿外科接受膀胱内注射A型肉毒杆菌毒素治疗的48例膀胱过度活动症患者,根据注射针数分为两组,各24例,观察组采用5针注射法,对照组采用标准的20针注射法。分别记录两组患者治疗前后平均每日排尿次数、膀胱过度活动症分问卷(international consultation on incontinence questionnaire-overactive bladder,ICIQ-OAB)、膀胱过度活动症调查问卷(overactive bladder,OAB-Q)评分、视觉模拟评分(visual analogue scale,VAS)评分,以及治疗后患者全身状况改善问卷(patient generated index,PGI-I)评分、并发症发生率和重复注射意愿情况。结果两组患者年龄、性别、病程以及治疗前平均每日排尿次数和各评分基线数据等一般资料差异无统计学意义,具有可比性。所有患者均完成治疗,与治疗前相比,治疗后平均每日排尿次数、ICIQ-OAB、OAB-Q均有所改善(P<0.05),两组比较差异无统计学意义(P>0.05)。两组治疗后各评分数据、并发症发生率,差异均无统计学意义(P>0.05)。但是观察组患者更愿意接受再次注射(P<0.05)。结论5针法膀胱内注射A型肉毒杆菌毒素治疗膀胱过度活动症的疗效及安全性与标准的20针法相似,更容易被患者所接受,是一种安全有效的替代标准技术的方法。

2940 nm点阵激光联合A型肉毒毒素改善眶周皮肤老化的临床疗效

目的观察2940 nm点阵激光联合A型肉毒毒素改善眶周皮肤老化的临床疗效。方法将105例求美者随机分为3组:联合治疗组(35例),注射对照组(35例)和激光对照组(35例)。联合治疗组:先采用2940 nm点阵激光治疗1次,两周后采用A型肉毒毒素进行1次注射,间隔2个月再次使用2940 nm点阵激光治疗1次;注射对照组:仅采用A型肉毒毒素进行1次注射;激光对照组仅使用2940nm点阵激光治疗2次,每次间隔2个月。三组均随访26周,由医师及求美者对其静态和动态的眶周皱纹分别进行客观评价及满意度打分。结果采用皱纹严重等级量表(WSRS)统计分析3组求美者眶周皮肤老化均得到改善。面部动态皱纹的治疗效果:注射组4周有效率达到了93.3%,26周降到6.7%;激光组4周有效率为13.3%,26周达到了60%;联合组4周的有效率达到了93.3%,26周达到66.7%。面部静态皱纹的治疗效果:注射组4周有效率达到了73.3%,26周降到3.3%;激光组4周有效率为36.7%,26周达到了73.3%;联合组4周的有效率达到了83.3%,26周达到80%。结论2940nm点阵激光联合A型肉毒素改善眶周皮肤老化,起效快,效果显著,持续时间长,安全可靠,值得推广。

A型肉毒毒素联合真皮内超减张缝合治疗病理性瘢痕的效果

目的:探讨A型肉毒毒素联合真皮内超减张缝合治疗病理性瘢痕的效果。方法:回顾性分析赣州市人民医院2021年3月—2023年3月收治的62例病理性瘢痕患者的临床资料,根据不同治疗方法分为两组,各31例;其中对照组采用真皮内超减张缝合,试验组采用A型肉毒毒素联合真皮内超减张缝合。比较两组温哥华瘢痕评价量表(VSS)评分、观测者瘢痕评价量表(OSAS)评分、瘢痕宽度、瘢痕厚度、切口不良反应发生情况及复发情况。结果:术前,两组OSAS评分、VSS评分、瘢痕宽度、瘢痕厚度比较,差异均无统计学意义(P>0.05);术后6个月,两组OSAS评分、VSS评分、瘢痕宽度、瘢痕厚度均低于术前,且试验组均低于对照组,差异均有统计学意义(P<0.05)。两组术后切口不良反应发生率比较,差异无统计学意义(P>0.05);试验组复发率为3.23%,低于对照组的19.35%,差异有统计学意义(P<0.05)。结论:A型肉毒毒素联合真皮内超减张缝合可有效促进病理性瘢痕患者切口愈合,提高切口美观度,减轻瘢痕形成程度,降低复发率。

个体化综合治疗在眼周年轻化中的效果观察

目的观察个体化综合治疗眼周衰老的效果,探讨恢复眼周年轻态的优选方案。方法回顾性分析2018年5月至2023年5月就诊的女性患者。选取符合眼周年轻化治疗适应证的患者522例,根据诉求结合实际情况个体化制定综合治疗方案,包括但不限于手术、A型肉毒毒素注射除皱、自体脂肪移植、透明质酸填充等。观察治疗效果,术后6个月评估患者满意度。结果本组患者(n=522)整体满意度为97.9%,其中495例为非常满意,16例基本满意,11例不满意。术后无严重并发症,眼周整体形态呈现饱满年轻状态。结论个体化运用注射填充配合外科手术的综合诊疗方案,可有效恢复眼周年轻化外形。

高原牧区不同害鼠胃肠内容物对D型肉毒神经毒素的破坏强度分析

为探明高原牧区不同害鼠胃肠内容物对D型肉毒毒素的破坏强度与害鼠对毒素的敏感性之间的关系,采用霍恩氏法测定了D型肉毒毒素对高原鼠兔(Ochotona curzoniae)、高原鼢鼠(Eospalax baileyi)及青海松田鼠(Neodon fuscus)的灌胃半数致死剂量(LD50),并测定3种害鼠胃肠内容物及其上清液与D型肉毒毒素作用后的毒素残留量。结果表明:D型肉毒毒素对高原鼠兔、高原鼢鼠及青海松田鼠的LD50分别为5110、5840、50100 MLD/kg。害鼠胃肠内容物对毒素的破坏强度由高到低依次是青海松田鼠、高原鼢鼠、高原鼠兔。3种害鼠胃肠内容物对D型肉毒毒素的破坏作用存在差异,且LD50与毒素残留量之间呈正相关性。胃肠道环境差异是导致不同害鼠对D型肉毒毒素产生敏感性差异的原因之一,研究结果对今后选育高效、特异性D型肉毒毒素生物灭鼠剂具有指导意义。

A型肉毒毒素防治额部外伤瘢痕的美学效果及对血清TGF-β_(1)、BMP-7水平的影响

目的:探讨A型肉毒毒素防治额部外伤瘢痕的美学效果及对血清TGF-β_(1)、BMP-7水平的影响。方法:选取2020年7月-2022年10月笔者医院收治的84例额部外伤患者为研究对象,按随机数字表法分为观察组和对照组,各42例。对照组采用清创美容缝合联合外用硅凝胶制剂防治瘢痕;观察组采用美容缝合拆线后伤口两侧注射A型肉毒毒素防治瘢痕。拆线后3个月,统计比较两组瘢痕临床防治有效率、瘢痕评分[温哥华瘢痕量表(Vancouver scar scale,VSS)]、瘢痕疼痛或瘙痒程度评分[视觉模拟评分法(Visual analogue scale,VAS)]、患者满意度、血清转化生长因子β_(1)(Transforming growth factor-β_(1),TGF-β_(1))和骨成型蛋白7(Recombinant bone morphogenetic protein 7,BMP-7)水平及不良反应。结果:观察组VSS评分、瘢痕疼痛或瘙痒程度VAS评分低于对照组(P<0.05);观察组瘢痕临床防治有效率为90.47%,高于对照组的69.04%(P<0.05);观察组患者满意度高于对照组(P<0.05);观察组TGF-β_(1)水平低于对照组,BMP-7水平高于对照组(P<0.05);两组均未发生严重不良反应。结论:额部软组织外伤患者美容缝合拆线后伤口两侧注射A型肉毒毒素可抑制瘢痕形成,有效提升瘢痕防治有效率及患者满意度,其临床效果可能与调控血清TGF-β_(1)和BMP-7水平有关,且安全性较高,具有一定的临床应用价值。

超声联合球囊引导下注射A型肉毒毒素治疗脑卒中后环咽肌失弛缓症疗效

目的观察超声联合球囊引导下注射A型肉毒毒素(BTX-A)治疗脑卒中后环咽肌失弛缓症(CPA)的疗效。方法选取2021年4月至2023年4月脑卒中后CPA患者32例,将患者分为2组进行训练,对照组接受常规吞咽训练;观察组在常规吞咽训练的基础上采用超声联合球囊引导下注射BTX-A,每组各16例。治疗4周后,两组均采用标准吞咽功能评分量表(SSA)、吞咽障碍造影评估量表(VDS)和吞咽相关生活质量(SWAL-QOL)调查问卷评价患者的疗效。这些评估工具可以帮助我们了解患者的吞咽功能、吞咽障碍程度以及对生活质量的影响。结果观察组总有效率87.5%,对照组总有效率68.8%,两组比较差异有统计学意义(P<0.05)。治疗后,患者吞咽障碍评分和吞咽相关生活质量评分均有改善。观察组SSA评分、VDS评分和SWAL-QOL评分改善优于对照组,差异有统计学意义(P<0.05)。结论在常规吞咽训练基础上实施超声联合球囊引导下注射BTX-A治疗卒中后CPA疗效确切,安全简便,值得临床推广应用。

微砭耳针联合A型肉毒毒素治疗伴焦虑抑郁症的特发性眼睑痉挛的疗效观察

目的观察微砭耳针联合A型肉毒毒素(BTX-A)治疗特发性眼睑痉挛(BEB合并焦虑抑郁的临床疗效。方法纳入2021年12月—2022年12月佛山市中医院眼科和神经内科门诊诊治的BEB合并焦虑抑郁的患者63例(126只眼)。采用随机数字表法分为肉毒素组、耳针组和联合组,每组21例(42只眼),依次予BTX-A、微砭耳针、微砭耳针联合BTX-A治疗。3组均观察6个月。记录3组患者的起效时间和疗效持续时间,治疗前后分别检测患者的焦虑自评量表(SAS)和抑郁自评量表(SDS)得分,记录数据进行统计分析。结果(1)BEB的起效时间及疗效持续时间:3组起效时间比较,差异有统计学意义(F=5.058,P=0.012)。与耳针组比较,肉毒素组、联合组起效时间均提前,差异均有统计学意义(t肉毒素=3.193,P=0.003;t联合组=3.835,P=0.000)。联合组与肉毒素组起效时间比较,差异无统计学意义(P>0.05)。3组疗效持续时间比较,差异有统计学意义(F=29.079,P=0.000)。与耳针组比较,肉毒素组和联合组疗效持续时间均延长,差异均有统计学意义(t_(肉毒素)=4.391、t_(联合组)=7.729,均P=0.000)。与肉毒素组比较,联合组疗效持续时间延长,差异有统计学意义(t=2.638,P=0.012)。(2)SDS评分:3组治疗后SDS评分均较治疗前降低,差异均有统计学意义(t_(耳针组)=4.498、t_(肉毒素组)=5.758、t_(联合组)=11.489,均P=0.000)。治疗后3组间比较,差异有统计学意义(F=5.343,P=0.007)。联合组SDS评分低于耳针组和肉毒素组,差异均有统计学意义(t_(耳针组)=3.284,P=0.002;t_(肉毒素组)=2.253,P=0.030),肉毒素组和耳针组SDS评分比较,差异无统计学意义(P>0.05)。(3)SAS评分:3组治疗后SAS评分均较治疗前降低,差异均有统计学意义(t_(耳针组)=4.603、t_(肉毒素组)=7.617、t_(联合组)=10.585,均P=0.000)。治疗后3组间比较,差异有统计学意义(F=14.845,P=0.000)。肉毒素组和联合组治疗后SAS评分均低于耳针组,差异均有统计学意义(t_(肉毒素组)=2.351,P=0.024;t_(联合组)=5.446,P=0.000)。联合组治疗后SAS评分低于肉毒素组,差异有统计学意义(t=3.070,P=0.004)。(4)BEB临床疗效:耳针组、肉毒素组、联合组的总有效率依次为66.7%、76.2%和95.2%,3组总有效率比较,差异有统计学意义(χ^(2)=10.855,P=0.004)。肉毒素组总有效率与耳针组比较,差异无统计学意义(P>0.05),联合组总有效率高于耳针组和肉毒素组,差异有统计学意义(χ_(耳针组)^(2)=11.118,P=0.001;χ_(肉毒素组)^(2)=6.222,P=0.013)。(5)不良反应发生率:3组不良反应率比较,差异无统计学意义(P>0.05)。结论微砭耳针联合BTX-A注射治疗BEB起效快,疗效维持时间长,不良反应少,并能明显改善抑郁焦虑症状,值得临床推广。

乌灵胶囊联合注射用A型肉毒毒素治疗良性特发性眼睑痉挛合并失眠的临床效果

目的 观察乌灵胶囊联合注射用A型肉毒毒素治疗良性特发性眼睑痉挛(BEB)合并失眠的临床效果及对睡眠质量的影响。方法 选择2018年2月—2021年5月徐州市第一人民医院收治的BEB合并失眠患者60例,采用随机数字表法分为观察者和对照组各30例。对照组给予注射用A型肉毒毒素治疗,观察组在对照组基础上给予乌灵胶囊治疗,治疗时间为6周。比较2组痉挛治疗效果,焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)、世界卫生组织生活质量简表(WHOQOL-BREF)评分及不良反应。结果 观察组总有效率与对照组比较差异无统计学意义(93.33%vs. 86.67%,χ^(2)=0.185,P=0.667)。治疗后4、8周,2组SAS、SDS、PSQI评分均低于治疗前,且观察组低于对照组(P<0.05或P<0.01);治疗后6周,2组WHOQOL-BREF评分均高于治疗前,且观察组高于对照组(P<0.05或P<0.01);观察组与对照组不良反应总发生率比较差异无统计学意义(16.67%vs. 13.33%,P=1.000)。结论 乌灵胶囊联合注射用A型肉毒毒素治疗BEB伴失眠安全有效,能显著改善患者焦虑抑郁程度,提高睡眠及生活质量。

逼尿肌及尿道外括约肌A型肉毒毒素注射治疗儿童逼尿肌过度活动并收缩受损的疗效与安全性分析

目的初步评估逼尿肌及尿道外括约肌A型肉毒毒素(botulinum toxin A,BTX-A)注射治疗儿童逼尿肌过度活动并收缩功能受损(detrusor overactivity and impaired contractility,DOIC)的疗效与安全性。方法本研究为回顾性研究,以2022年5月至2023年6月在郑州大学第一附属医院接受逼尿肌及尿道外括约肌BTX-A注射治疗的25例DOIC患儿为研究对象,男18例、女7例,年龄(11.0±3.8)岁。分别于治疗前及治疗后1个月、6个月收集连续3 d排尿日记及尿失禁生活质量问卷评分表(incontinence specific quality of life,I-QOL)、生活质量评分量表、膀胱过度活动症评分量表(overactive bladder symptom score,OABSS)评分情况,于治疗前和治疗后1个月行影像尿动力学检查,术后6个月行自由尿流率和超声残余尿量测定,并收集治疗后不良事件。结果患儿术前平均每日尿失禁次数和排尿次数分别为(6.9±1.5)次和(10.8±1.7)次,生活质量评分(8.8±0.7)分,OABSS评分(10.5±1.8)分,I-QOL评分(43.6±4.6)分,每次排尿量(127.4±37.9)mL,功能性膀胱容量(functional bladder capacity,FBC)为(160.7±29.4)mL,最大尿流率(maximum flow rate,MFR)为(9.7±3.3)mL/s;导尿患儿每日导尿次数(8.0±0.5)次,残余尿量(postvoid residual,PVR)为(190.6±99.2)mL,膀胱排空效率(32.8±4.9)%。术后1个月和术后6个月随访中,每日尿失禁次数和排尿次数分别减少至(3.5±1.3)次、(4.9±1.4)次和(7.6±1.1)次、(8.5±1.4)次;生活质量评分减少至(5.8±0.9)分、(7.1±0.8)分;OABSS评分减少至(8.5±1.0)分、(9.0±1.3)分;每日导尿次数减少至(6.4±0.7)次、(7.3±0.8)次;PVR减少至(91.3±36.7)mL、(121.9±42.7)mL;I-QOL评分增加至(59.7±5.8)分、(50.1±4.7)分;每次排尿量增加至(164.9±31.1)mL、(146.0±24.5)mL;FBC增加至(198.3±27.5)mL、(176.2±24.3)mL;MFR增加至(13.8±3.1)mL/s、(11.0±2.5)mL/s;膀胱排空效率增加至(62.0±6.4)%、(47.8±6.7)%。术后1个月影像尿动力学随访情况与术前相比,最大膀胱压测定容量[(230.2±36.0)mL比(198.2±46.1)mL]、膀胱顺应性[(18.6±5.1)mL/cmH_(2)O比(14.4±6.6)mL/cmH_(2)O]显著增加,充盈期逼尿肌过度活动频率[(2.8±1.3)次比(4.4±1.7)次]、最大逼尿肌压力[(64.4±6.0)cmH_(2)O比(80.0±5.1)cmH_(2)O]、最大尿道压[(72.0±5.5)cmH_(2)O比(78.5±8.2)cmH_(2)O]、最大尿道闭合压[(59.1±5.2)cmH_(2)O比(64.1±7.2)cmH_(2)O]显著下降。4例术前存在一侧膀胱输尿管反流的患儿中,术后2例反流消失,2例获改善;11例术前存在逼尿肌外括约肌协同失调患儿中,5例术后恢复正常;7例术前存在逼尿肌膀胱颈协同失调患儿中,2例术后恢复正常。术后6个月随访情况与术后1个月相比,每日尿失禁次数[(4.9±1.4)次比(3.5±1.3)次]和排尿次数[(8.5±1.40)次比(7.6±1.1)次]、生活质量评分[(7.1±0.8)分比(5.8±0.9)分]及平均每日导尿次数[(7.3±0.8)次比(6.4±0.7)次]、PVR[(121.9±42.7)mL比(91.3±36.7)mL]均显著增加,每次排尿量[(146.0±24.5)mL比(164.9±31.1)mL]和FBC[(176.2±24.3)mL比(198.3±27.5)mL]、I-QOL[(8.5±1.0)分比(10.5±1.8)分]、MFR[(8.5±1.0)mL/s比(10.5±1.8)mL/s]、膀胱排空效率[(47.8±6.7)%比(62.0±6.4)%]均显著降低;差异均具有统计学意义(P<0.05)。随访期间,7例出现一过性肉眼血尿,2例出现尿路感染,无其他不良事件发生。结论逼尿肌联合尿道外括约肌BTX-A注射治疗儿童DOIC安全、微创、有效,能显著改善患儿排尿异常,降低上尿路损害的风险,提高患儿生活质量,其疗效至少可持续6个月。