The conditions responsible for the preparation of crude, activated and purified toxins of Clostridium botulinum Type E and the antigenic properties of toxoids prepared from these toxins, are described. Optimum toxin production and toxin activation are seen to be critically dependent on conditions such as hydrogen-ion concentration, and incubation time and temperature. Immunization of human volunteers with the formolized toxoids demonstrated that the highest level of immunity occurred in those individuals who received the crude toxoids. / Science, Faculty of / Microbiology and Immunology, Department of / Graduate

Syftet med studien var att undersöka patienters upplevelse av smärtlindring och livskvalitet efter botoxbehandling i smärtlindrande syfte samt patienternas inställning till Botox. Metod: En kvalitativ intervjustudie med en deskriptiv och explorativ design. Urvalet bestod av sju patienter, sex kvinnor och en man, vilka behandlas men botoxbehandling vid Smärtcentrum på Akademiska sjukhuset i Uppsala. Resultat: Materialet analyserades enligt syftet under tre kategorier: smärtlindring, oro/nedstämdhet samt inställning till Botox. Samtliga informanter har fått en minskad smärta till följd av botoxbehandlingen och upplever att livskvaliteten förbättrats. Trots biverkningar känner sig patienterna nöjda med behandlingen så länge fördelarna är fler än nackdelarna. Ingen av informanterna förutom en kände någon oro/nedstämdhet. Några informanter upplevde en viss oro inför eventuella biverkningar i framtiden. Slutsats: Botox kan vara ett bra behandlingsalternativ för patienter som lider av långvarig smärta. Samtliga studiedeltagare upplever smärtlindring även om inte smärtan försvinner helt. Behandlingen förbättrar patienternas livskvalitet vilken mäts genom upplevelse av rörlighet, hygien, aktivitet, oro/nedstämdhet och smärta. Hälso- och sjukvården har en viktig roll i att behandla sjukdom och främja hälsa och ge patienterna förutsättningar får att nå hälsorelaterad livskvalitet. / The aim of this study is to explore patients'experience of pain relief and quality of life after Botox treatment of pain-relieving purposes and patients' attitudes to Botox. Method: A qualitative interview study with a descriptive and explorative design. The sample consisted of seven patients, six women and one man, which is treated with the treatment of Botox at Center of pain at the University hospital in Uppsala. Results: The material was analyzed in three categories: pain, anxiety/depression, and attitude to Botox. All informants have experienced a reduction in pain as a result of Botox treatment and feel a higher quality of life. Despite the side effects patients feel satisfied with the treatment so long as the advantages outnumber the disadvantages. None of the respondents except one felt no anxiety/depression. Some respondents felt some concern for possible adverse events in the future. Conclusion: Botox may be a good treatment option for patients suffering from chronic pain. All study participants experienced pain relief even if the pain does not disappear completely. The treatment improves patients' quality of life which is measured by the experience of mobility, hygiene, activity, anxiety/depression and pain. The health service has an important role in treating disease and promoting health and providing patients with conditions, to achieve health-related quality of life.

Syfte Syftet med föreliggande litteraturstudie är att jämföra behandlingseffekten av kliniska studier som utgår från patienter med käkledssjukdomar, temporomandibulär dysfunktion, TMD och bruxism  där behandlingsalternativen stabiliseringsskena och/eller läkemedlet botulinumtoxin (botox) inkluderats.    Material och metod Litteraturstudien genomfördes via PICO-systemet, med litteratursökning i databaserna Medline/PubMed, Web of Science och Scopus. Insamlad data bearbetades genom en granskningsprocess på titel-, sammanfattnings- och slutligen fulltextnivå, utifrån förutbestämda inklusions- och exklusionskriterier.   Resultat Två studier uppfyllde urvalskriterierna. Behandlingsterapin med botox och stabiliseringsskena kunde följas under sex månaders tid i båda studierna. Ena studien bestod av 40 patienter som delades in i två grupper, en för varje behandlingsmetod med fyra uppföljnings- och behandlingstillfällen. Den andra studien bestod av 73 patienter som delades in i tre grupper, en för respektive behandlingsmetod och en grupp som inkluderade båda behandlingsmetoderna, med tre uppföljningstillfällen. Antal enheter och placering av botoxinjektioner skilde sig åt i studierna, tillika antal timmars användning av stabiliseringsskena. Studierna presenterade trots skillnader liknande resultat.    Slutsats  Behandling med stabiliseringsskena är inte nödvändig för patienter som behandlats med botulinumtoxin, eftersom de statistiska resultaten inte påvisade någon större skillnad i effekt. Behandling med botulinumtoxin och dess effekt på patientens besvär beror på antal enheter av läkemedlet och placering vid injektion samt i jämförelse med omfattningen av hur mycket patienten använder stabiliseringsskenan. Botulinumtoxin kan användas som behandlingsmetod när patienten av olika anledningar inte kan använda stabiliseringsskena. / Purpose The purpose of this literature study is to compare clinical studies that have included the treatment options of using stabilization appliances and/or medication with botulinum toxin. The included studies must have included and treated patients with temporomandibular disorders, temporomandibular dysfunction, TMD and bruxism.    Material and method The literature study was executed based on the PICO system and through searches in the databases Medline/PubMed, Web of Science and Scopus. Subsequently, a review process was carried out at title, abstract and finally full text level, based on predetermined inclusion and exclusion criteria.   Results Two studies met the selection criteria. The treatment therapy could be followed for a period of six months in both studies. One study consisted of 40 patients who were divided into two groups, one for each treatment method with four follow-up and treatment sessions. The second study consisted of 73 patients who were divided into three groups, one for each treatment method and one group that included both treatment methods and three follow-up sessions. Units and location of botulinum toxin injections and the hours of use of the stabilization appliance differed slightly in the two studies. However, the studies reported similar outcomes.   Conclusion The treatment with stabilization appliance is not necessary for patients who are being treated with botulinum toxin due to non-statistical significance reported. The outcome of botulinum toxin treatment may depend on the location and number of units of the medication in comparision to the extent to which the patient uses the stabilization appliance. Botulinum toxin may gain as a treatment method when the patient is unable to use a stabilization appliance for various reasons.

This study investigated factors associated with two mortality events: avian botulism in waterfowl and mortality associated with hatching asynchrony in prefledgling Franklins gulls (Larus pipixcan). The initial focus of my research was on the spatiotemporal relationship between mortality of Franklins gulls and the onset of botulism outbreaks in waterfowl, and the suitability of gull carcasses for proliferation and toxigenesis of Clostridium botulinum. From 1999 to 2001, dead hatch-year Franklins gulls were by far the most abundant carcasses, and the only source of toxin-laden maggots found on transects prior to the occurrence of avian botulism in waterfowl. Nest density was a significant predictor of hatch-year gull carcass density. High density of toxic material from gull carcasses prior to the onset of botulism in waterfowl coincided with high densities of susceptible birds; hence, mortality of Franklins gulls has the potential to be a major initiating factor for botulism outbreaks at Eyebrow Lake, Saskatchewan. The causes of gull mortality were conditions or diseases associated with starvation, stress, or immunosuppression, and most mortality occurred in third-hatched chicks. To separate effects of laying order from effects of hatching asynchrony on prefledgling survival, a cross-fostering experiment was conducted to create clutches containing asynchronously hatching eggs of the same laying order, and of similar egg mass, egg volume, and female quality. Hatching order, independent of laying order, significantly affected survival to fledging, whereas laying order had no observable effect, indicating that intraclutch variation in egg quality does not predetermine the fate of prefledglings, and may be less important than hatching asynchrony for survival of prefledgling Franklins gulls. Relationships among hatching asynchrony, laying order, mass, corticosterone, immune function, growth, and survival at two stages of development were complex. Hatching asynchrony significantly affected early and late prefledgling survival, and was directly or indirectly associated with mass, corticosterone level, and cell-mediated immune responses at early and later stages of development. Both hatching asynchrony and mass appeared to play key roles in mediating life history trade-offs among cell-mediated immune function, growth, and survival. In contrast to cell-mediated immune responses, primary humoral immune response was not directly affected by hatching order or mass, nor was it associated with survival to fledging. Rather, it was associated with laying order, neonatal testosterone, corticosterone at 2 weeks, growth of leg length, and clutch initiation date, illustrating the importance of examining more than one branch of the immune system in studies of life history trade-offs. This study is a step toward using a multipronged and multidisciplinary approach to demonstrate interactions and trade-offs among life history traits, the physiological mechanisms that produce these relationships, and how these relationships may change depending on stage of development.

This study investigated factors associated with two mortality events: avian botulism in waterfowl and mortality associated with hatching asynchrony in prefledgling Franklins gulls (Larus pipixcan). The initial focus of my research was on the spatiotemporal relationship between mortality of Franklins gulls and the onset of botulism outbreaks in waterfowl, and the suitability of gull carcasses for proliferation and toxigenesis of Clostridium botulinum. From 1999 to 2001, dead hatch-year Franklins gulls were by far the most abundant carcasses, and the only source of toxin-laden maggots found on transects prior to the occurrence of avian botulism in waterfowl. Nest density was a significant predictor of hatch-year gull carcass density. High density of toxic material from gull carcasses prior to the onset of botulism in waterfowl coincided with high densities of susceptible birds; hence, mortality of Franklins gulls has the potential to be a major initiating factor for botulism outbreaks at Eyebrow Lake, Saskatchewan. The causes of gull mortality were conditions or diseases associated with starvation, stress, or immunosuppression, and most mortality occurred in third-hatched chicks. To separate effects of laying order from effects of hatching asynchrony on prefledgling survival, a cross-fostering experiment was conducted to create clutches containing asynchronously hatching eggs of the same laying order, and of similar egg mass, egg volume, and female quality. Hatching order, independent of laying order, significantly affected survival to fledging, whereas laying order had no observable effect, indicating that intraclutch variation in egg quality does not predetermine the fate of prefledglings, and may be less important than hatching asynchrony for survival of prefledgling Franklins gulls. Relationships among hatching asynchrony, laying order, mass, corticosterone, immune function, growth, and survival at two stages of development were complex. Hatching asynchrony significantly affected early and late prefledgling survival, and was directly or indirectly associated with mass, corticosterone level, and cell-mediated immune responses at early and later stages of development. Both hatching asynchrony and mass appeared to play key roles in mediating life history trade-offs among cell-mediated immune function, growth, and survival. In contrast to cell-mediated immune responses, primary humoral immune response was not directly affected by hatching order or mass, nor was it associated with survival to fledging. Rather, it was associated with laying order, neonatal testosterone, corticosterone at 2 weeks, growth of leg length, and clutch initiation date, illustrating the importance of examining more than one branch of the immune system in studies of life history trade-offs. This study is a step toward using a multipronged and multidisciplinary approach to demonstrate interactions and trade-offs among life history traits, the physiological mechanisms that produce these relationships, and how these relationships may change depending on stage of development.