Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

Botulism has been known for about three centuries, and since its discovery, botulinum toxin has been considered one of the most powerful toxins. However, throughout the 20th century, several medical applications have been discovered, among which the treatment of spasticity stands out. Botulinum toxin is the only pharmacological treatment recommended for spasticity of strokes and cerebral palsy. Although its use as an adjuvant treatment against spasticity in spinal cord injuries is not even approved, botulinum toxin is being used against such injuries. This article describes the advances that have been made throughout history leading to the therapeutic use of botulinum toxin and, in particular, its application to the treatment of spasticity in spinal cord injury.     

痉挛对双瘫型脑瘫儿童下肢肌肉相关性的影响

为了探究双瘫脑性瘫痪儿童下肢肌肉相关性,并分析痉挛特性对双瘫患者下肢肌肉相关性的影响,文章采用表面肌电信号作为信息来源。对 12 例脑瘫患儿进行下肢腓肠肌和胫骨前肌肌电信号采集以及肌张力测试。信号经过 Acqknowledge 软件进行滤波处理,所得数据采用 SPSS 19.0 软件进行统计学分析。实验结果表明,痉挛特性减弱了双瘫患儿下肢肌肉相关性。该研究为脑瘫患儿的基础研究及康复训练提供了参考依据。     

双光气法合成中枢松弛剂氯唑沙宗

研究了新的具有工业生产价值的中枢松弛剂--氯唑沙宗的合成新工艺.该法以氯甲酸三氯甲酯(俗称双光气)和2-氨基-6-氯苯酚为原料,通过对影响反应的多种因素进行研究以及反应条件的优化得到比较合理的工艺条件:双光气和2-氨基-6-氯苯酚的投料摩尔比为0.525:1,无须加催化剂,以甲苯为溶剂,在回流的条件下滴加双光气反应1h,即能以92%的高收率得到氯唑沙宗,产品纯度达到99.5%(HPLC).该过程条件温和,操作方便,后处理简单,具有工业化应用前景.     

He-Ne激光穴位照射治疗阵发性面肌痉挛的疗效观察

目的 :观察激光治疗阵发性面肌痉挛的疗效。方法 :将 12 0例患者随机分为 3组 ,冶疗组 40例 ,采用激光穴位照射治疗 ,针刺组 40例 ,采用常规针刺治疗 ,药物组 40例 ,采用口服苯妥英钠等药物治疗。结果 :治疗组及针刺组的有效率与药物组比较差异显著 (P <0 .0 5 )。治疗组的愈显率与针刺组比较差异显著 (P <0 .0 5 )。结论 :激光穴位照射治疗阵发性面肌痉挛疗效显著     

基于经验模态分解的牵张反射起始点检测研究

针对痉挛状态患者表面肌电信号易出现虚假的肌电峰值,引起牵张反射起始点前后的信号差异变小,提出经验模态分解去噪与改进样本熵识别的牵张反射起始点检测方法。首先用经验模态分解对肌电信号进行分解;然后以受试者静息状态下的表面肌电信号为参考,设定软阈值对分解的信号进行去噪;最后用改进样本熵识别牵张反射起始点。实验结果表明,经验模态分解算法可以有效地去除肌电信号噪声,而且在改进样本熵的最优参数下牵张反射起始点平均识别率为94%。     

基于肢体加速度和关节角度参数检测的痉挛状态定量评定研究

针对脑卒中患者痉挛状态难以精准量化评定的问题,提出了基于加速度和角度信号的痉挛状态量化评定方法,并研制了痉挛状态量化评定装置。通过分析患者肢体加速度和关节角度信号数据,提取加速度突变点对应的关节角度θ_p及关节活动度θ_(rom),计算θ_p/θ_(rom)值用于痉挛状态等级评定。使用改良Ashworth量表(modified Ashworth scale, MAS)和本装置对27名受试者进行临床实验,并针对不同肌肉群采用不同的痉挛状态检测方法。将MAS等级与θ_p/θ_(rom)值进行相关性分析,结果表明θ_p/θ_(rom)值可用于痉挛状态评估,且该装置具有很好的效度,相关性满足r=-0.869,P0.05。基于MAS和θ_p/θ_(rom)值重新修正表示痉挛状态的MAS等级,结果表明修正后的MAS各等级之间具有显著差异(P0.001),可以实现痉挛状态量化评定。     

Repurposing of FDA-Approved Drugs for Treating Iatrogenic Botulism: A Paired 3D-QSAR/Docking Approach†

Botulinum neurotoxin (BoNT) is widely used for the treatment of spasticity, focal dystonia, chronic migraine, facial hemispasm, and facial aesthetic treatments. Generally, treatment with botulinum toxin is a safe procedure when conducted by clinicians with expertise, and local side effects are rare and transient. However, occasionally adverse effects can occur due to the spread of the drug to nontargeted muscles and organs, producing dry mouth, fatigue, and flu-like symptoms, up to signs of systemic botulism, which appears to be more frequent in children treated for spasticity than in adults. In silico 3D-QSAR and molecular docking studies were performed to build a structure-based model on selected potent known botulinum neurotoxin type A inhibitors; this was used to screen the US Food and Drug Administration (FDA) database. Thirty molecules were identified as possible light-chain BoNT/A inhibitors. In this study, we applied a well-established ligand- and structure-based methodology for the identification of hit compounds among a database of FDA-approved drugs. The identification of budesonide, protirelin, and ciclesonide followed by other compounds can be considered a starting point for investigations of selected compounds that could bypass much of the time and costs involved in the drug approval process.     

Flexible Pressure Sensors for Objective Assessment of Motor Disorders

Monitoring body motion is relevant to motor control disorders as well as assessment of fine motor skills in child development. Furthermore, motion tracking is necessary for rehabilitation monitoring and injury prevention and benefits both sick and healthy individuals. Flexible pressure sensors based on resistors, capacitors, inductors, or transistors are reviewed in the context of healthcare measurements, ranging from physiological signals to body movement characteristics such as grip and gait. To demonstrate the use of flexible pressure sensors for motor assessment, a touch sensing glove that evaluates fine motor skills in autism research is developed. The results show that autistic children perform fewer taps per minute compared to typically developing children, with larger variations in tap durations. In a second example, a force and motion sensing glove is developed to assess spasticity, a neuromuscular disorder that causes muscle stiffness/resistance and jerky movement. Analyses of force versus velocity show movement‐dependent muscle resistance in a patient with spasticity. Through these flexible sensor systems, the shift from subjective scores to objective measurement will promote better diagnosis and dramatically improve the accuracy in tracking patient response to therapy.     

基于肌电与肌动同步解析的肌肉痉挛评测方法

肌肉痉挛是常见的运动功能障碍疾病,通过肌电与肌动双模信息同步解析进行肌肉痉挛定量评估具有重要意义。本文针对同步获取高信噪比肌电与肌动信号的难点,提出一种抗工频干扰、轻量加速度计信号校正的肌电与肌动双模信息同步解析方法,设计了无线多通道肌电和肌动信号同步采集系统。与常见科学仪器Delsys系统对比,所提系统肌电信噪性能与Delsys相似(均20 d B左右),肌动信号有效频带(0～20 Hz)能量显著高于Delsys;对所提系统进行临床测试,健康志愿者主动屈肘时屈肌肌电信噪比约20 d B; 3名改良Ashworth评分(MAS)分别为1级,1+级与2级患者归一化肌电指标分别为0. 54±0. 05,0. 59±0. 04和0. 62±0. 01,屈肌肌动信号均方根值分别为2. 69±1. 04 m·s-2,3. 19±1. 13 m·s-2,4. 89±1. 19 m·s-2,肌电与肌动信息均可有效区分患者痉挛等级。因此所提方法可用于肌肉痉挛评测及肢体运动功能监测。     

基于改进样本熵的牵张反射起始点检测研究

针对痉挛状态患者表面肌电(sEMG)信号质量差、易出现尖锐毛刺噪声且信号时序较短的问题,提出基于改进样本熵的牵张反射起始点(SRO)判定方法,利用固定长度的滑动窗对sEMG信号进行分帧,计算每帧信号改进样本熵,设定自适应阈值确定SRO,并分析对比了基于标准样本熵的SRO检测性能。实验结果表明,基于改进样本熵SRO最大识别率为89.06%,SRO识别能力优于标准样本熵(最大识别率为48.18%),且数据长度依赖性优于标准样本熵,在短时序列与含尖锐毛刺噪声sEMG信号处理上表现出更好的鲁棒性,为定量与细化上肢痉挛状态提供了基础。