INTRODUÇÃO: Apesar da terapia com toxina botulínica ser o tratamento de escolha para a distonia cervical, admite-se que um tratamento multidisciplinar, agregando a fisioterapia ao tratamento com toxina botulínica, poderia acrescentar maiores benefícios aos pacientes com distonia cervical; sendo assim, o objetivo primário deste estudo foi avaliar o efeito da associação da toxina botulínica a um protocolo de fisioterapia na gravidade da distonia cervical, incapacidade e dor; e o objetivo secundário foi avaliar o efeito desta associação na qualidade de vida de pacientes com distonia cervical. MÉTODOS: Participaram deste estudo controlado aberto quarenta de setenta pacientes com distonia cervical, tratados no Ambulatório de Distúrbios do Movimento do Departamento de Neurologia da Faculdade de Medicina do Hospital das Clínicas da Universidade de São Paulo. Antes de serem submetidos à aplicação da toxina botulínica, os pacientes foram avaliados por um médico da equipe, e esperava-se que neste dia os pacientes estivessem sem a ação da medicação. Todos os pacientes avaliados foram convidados a participar do programa de fisioterapia, e conforme a disponibilidade de aderir ao programa dos mesmos, chegou-se ao número de vinte pacientes em G1 (fisioterapia e toxina botulínica) e vinte pacientes em G2 (toxina botulínica), sendo esta amostra de conveniência. Para G2, foram escolhidos os primeiros vinte pacientes consecutivos que não poderiam aderir ao programa fisioterapêutico. Os pacientes de G1 e G2 foram reavaliados após quarenta e cinco dias. As escalas utilizadas foram a Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) e a Short-Form Health Survey (SF-36). Foi proposto um novo modelo de tratamento para pacientes com distonia cervical que seriam submetidos a um protocolo fisioterapêutico, baseado em três principais abordagens: aprendizagem motora, cinesioterapia e estimulação elétrica funcional na musculatura antagonista ao padrão distônico. Os pacientes de G1 foram tratados por um período de quatro semanas, a frequência era diária (cinco vezes por semana) e a duração da sessão em média uma hora e quinze minutos. RESULTADOS: As características demográficas iniciais dos indivíduos não diferiram significativamente entre os dois grupos tratados, em apenas um dos itens avaliados (tempo de tratamento) houve diferença entre grupos no momento inicial. Os resultados dos tratamentos na qualidade de vida foram avaliados pela escala SF-36, esta dividida em dois grandes domínios: aspectos físicos e aspectos emocionais. Em relação aos aspectos físicos, G1 apresentou melhora significativa comparando-se antes e depois do tratamento (intragrupo) em três subdomínios: capacidade funcional, limitação por aspectos físicos e dor; em G2 não houve melhora significativa em nenhum dos quatro subdomínios. Houve também uma diferença entre G1 e G2 depois dos tratamentos (entre grupos) em dois subdomínios: limitação por aspectos físicos e dor. Em relação aos aspectos emocionais, em G1, houve melhora significativa nos seguintes subdomínios depois do tratamento (intragrupo): vitalidade, aspectos sociais e saúde mental. Houve também uma diferença entre G1 e G2 depois dos tratamentos (entre grupos) em dois subdomínios: vitalidade e saúde mental. Não houve melhora em G2 nos subdomínios dos aspectos emocionais. A avaliação das características e gravidade da distonia cervical, medida pela TWSTRS, demonstrou melhora significativa de G1 e G2 após os tratamentos que foram submetidos (intra grupos) em duas subescalas: gravidade (I) e incapacidade (II). Na subescala de dor (III), apenas G1 apresentou melhora intragrupo após o tratamento a que foi submetido; houve também, neste mesmo subdomínio, diferença significativa entre G1 e G2 depois dos tratamentos, entre grupos. CONCLUSÕES: O presente estudo avaliou possibilidade de que a utilização da toxina botulínica, junto a um protocolo de fisioterapia facilmente reprodutível, poderia agregar melhoras em sintomas como gravidade da doença, incapacidade, dor e qualidade de vida de uma população de indivíduos com distonia cervical, e os resultados obtidos permitiram negar as hipóteses nulas. Novas pesquisas são necessárias para confirmar esses achados e solidificar a reabilitação neurológica como um tratamento eficaz no manejo da distonia cervical / INTRODUCTION: Despite the fact that therapy with botulinum toxin is considered the best treatment for cervical dystonia, it is assumed that a multidisciplinary treatment, adding physical therapy to the botulinum toxin treatment could provide additional gains to patients with cervical dystonia. The primary objective of this study was to evaluate the effect of the combination of botulinum toxin and physical therapy on severity of cervical dystonia, disability and pain. The secondary objective was to evaluate the effect of this combination on the quality of life in patients with cervical dystonia. METHODS: forty patients of seventy with cervical dystonia from the Ambulatório de Distúrbios do Movimento do Departamento de Neurologia da Faculdade de Medicina do Hospital das Clínicas da Universidade de São Paulo attended this open- controlled study. Before receiving an application of botulinum toxin, the patients were evaluated by a neurologist and it was assumed that patients were not under any effect of the medication (botulinum toxin). All patients were asked to participate in a physical therapy program, and according to the patients availability to join the program, we reached the number of twenty patients in G1 (physical therapy and botulinum toxin) and in G2 (botulinum toxin only), the first twenty consecutive patients who couldnt participate in the physical therapy program were chosen. This was a convenience sample. Patients of G1 and G2 were revaluated after forty five days, and the evaluation scales used was the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Short-Form Health Survey (SF-36). A new model of physical therapy treatment was applied to patients with cervical dystonia, and it was based on three main approaches: motor learning, kinesiotherapy and functional electrical stimulation on the antagonist muscles of the dystonic pattern. The patients in G1 were treated daily for a period of four weeks, and each session lasted one hour and fifteen minutes. RESULTS: The demographic characteristics of individuals didnt differ significantly between two treated groups, but there was a difference between groups in the initial moment (baseline) in only one feature evaluated (time of treatment). The SF-36 scale was used to evaluate the results of the treatments for quality of life, and was divided into two big domains: physical and emotional aspects. When analyzing physical aspects, G1 showed a significant improvement when comparing before and after the proposed treatment (inside group) in three subdomains: physical functioning, role-physical and body pain; in G2 there was no improvement in any of the four subdomains. A difference between G1 and G2, after the treatments (between groups), was also seen in two subdomains: role-physical and body pain. In relation to emotional aspects, in G1, after the treatment (intra-group), there was a significantly improvement in vitality, social functioning and mental health. There was also a difference between G1 and G2 after the treatment (between groups) in two subdomains: vitality and mental health. There was no improvement in G2 in any domains of the social aspects. Severity of cervical dystonia showed a significant improvement of G1 and G2 after treatments (intra-group) in two subdomains: severity (I) and disability (II). In subscale pain (III), only patients of G1 showed a significant improvement intra-group after the treatment; in this subdomain there was also a significant difference between groups after the treatments (G1 and G2). CONCLUSIONS: The present study showed that botulinum toxin, combined with an easily reproducible physical therapy protocol, could improve symptoms like severity of cervical dystonia, disability, pain and quality of life, in a population of individuals with cervical dystonia, and these results makes it possible to deny the null hypothesis. Other studies are needed to confirm these findings and solidify neurologic rehabilitation as an effective cervical dystonia treatment approach

INTRODUÇÃO: O blefaroespasmo essencial é uma distonia focal caracterizada por contrações involuntárias, espasmódicas e bilaterais dos músculos protratores das pálpebras. O glaucoma é a principal causa de cegueira irreversível em adultos de países desenvolvidos e a elevação da pressão intra-ocular é o maior fator de risco para o desenvolvimento da doença. A contração voluntária forçada das pálpebras pode causar aumentos da pressão intra-ocular de até 90 mmHg. Uma vez que pacientes com blefaroespasmo essencial apresentam contrações palpebrais freqüentes e de forte intensidade, eles poderiam compor um grupo de risco para o desenvolvimento do glaucoma. MÉTODOS: Vinte e oito pacientes com blefaroespasmo essencial e 28 pacientes de grupo controle, formado por indivíduos com doenças palpebrais ou no seu pós-operatório, foram submetidos a um exame oftalmológico completo. No grupo de pacientes com blefaroespasmo, a avaliação foi realizada em 8 a 11 dias após o tratamento com toxina botulínica. Efetuou-se exame de refração e medida de melhor acuidade visual corrigida com tabela de Snellen, biomicroscopia em lâmpada de fenda, tonometria de aplanação, campo visual computadorizado, teste de sobrecarga hídrica e biomicroscopia de fundo para avaliação da papila óptica. RESULTADOS: 1) A prevalência de glaucoma nos pacientes com blefaroespasmo foi significativamente maior do que nos indivíduos do grupo controle, sendo diagnosticada em 14,3% e 3,6% dos casos, respectivamente (p=0,008). 2) A pressão intra-ocular foi significativamente maior nos pacientes com blefaroespasmo (15,80 ± 3,80 mmHg) do que nos indivíduos do grupo controle (13,90 ± 2,75 mmHg) (p= 0,004). 3) O pico da pressão intra-ocular na prova de sobrecarga hídrica foi significativamente maior nos pacientes com blefaroespasmo essencial (18,82 ± 4,47 mmHg) do que nos indivíduos do grupo controle (16,27 ± 2,69 mmHg) (p=0,0421). DISCUSSÃO: Diversos estudos descreveram a influência da compressão palpebral sobre a pressão intra-ocular. A prova de sobrecarga hídrica tem sido considerada uma ferramenta indireta para se avaliar a capacidade do fluxo de drenagem do trabeculado, além de exibir correlação com os picos de pressão intra-ocular que muitas vezes não são detectados em exames de rotina. Os pacientes com blefaroespasmo essencial apresentaram pressões intra -oculares e picos de pressão intra-ocular na prova de sobrecarga hídrica mais elevados do que os pacientes do grupo controle, o que poderia indicar um baixo fluxo de drenagem. Estas altíssimas variações de pressão intra -ocular a que estes indivíduos são submetidos constantemente, em pacientes com menor fluxo de drenagem poderiam causar um aumento crônico da pressão intra -ocular e o desenvolvimento do glaucoma. CONCLUSÕES: Os resultados observados sugerem que estes pacientes compõem um grupo de risco para o desenvolvimento de glaucoma e esta doença deve ser pesquisada de maneira sistemática na avaliação inicial e durante o seguimento desses casos / INTRODUCTION: Essential blepharospasm is a focal distonia characterised by involuntary, spasmodic, bilateral contractions of eyelid protractors. Glaucoma is the most important cause of irreversible blindness in adults in developed countries and high intraocular pressure is the major risk factor for development of the disease. Voluntary forced eyelid closure can produce an intraocular pressure increase of 90 mmHg. As patients with essential blepharospasm present frequent and strong eyelid contractions, they could be at risk for glaucoma development. METHODS: Twenty eight patients with essential blepharospasm and 28 patients of a control group, with eyelid diseases or in the post-operative period, were submitted to a complete ophthalmic examination. In the group of patiens with blepharospasm, the evaluation was done between 8 to 11 days after botulinum toxin treatment. We performed refractometry and best corrected visual acuity with Snellen chart, slitlamp biomicroscopy, applanation tonometry, automated perimetry, water drinking test and dilated funduscopy to evaluate optic discs. RESULTS: 1) Prevalence of glaucoma in patients with blepharospasm (14,3%) was higher than in the individuals from control group (3,6%) (p=0,008). 2) Intraocular pressure was higher in patients with blepharospasm (15,80 ± 3,80 mmHg) than in the individuals from control group (13,90 ± 2,75 mmHg) (p=0,004). 3) Intraocular pressure peaks in the water drinking test were higher in patients with essential blepharospasm (18,82 ± 4,47 mmHg) than in the individuals from control group (16,27 ± 2,69 mmHg) (p=0,0421). DISCUSSION: Several studies reported the influence of eyelid compression over intraocular pressure. The water drinking test has been considered as an indirect tool to measure outflow facility and it has good correlation with intraocular pressure peaks which are frequently missed in routine examinations. Patients with essential blepharospasm had higher mean intraocular pressures and intraocular pressure peaks in the water drinking test than patients from control group, which could indicate low outflow facility. These high intraocular pressure variations in patients with low outflow facility could increase the intraocular pressure chronically and lead to development of glaucoma. CONCLUSION: Our results suggest that patients with essential blepharospasm be at higher risks for development of glaucoma and this disease should be always investigated at presentation and during follow-up of these cases

A distonia é uma síndrome que consiste de contrações musculares involuntárias que resultam em movimentos distorcidos e repetitivos e/ou posturas anormais. O tratamento pode ser por farmacoterapia, com drogas anticolinérgicas ou com a injeção de toxina botulínica no grupo de músculos afetados. O objetivo do trabalho foi avaliar a deglutição nos pacientes com distonia laríngea, antes e após o tratamento com a toxina botulínica. Nossa hipótese foi que a toxina botulínica modificaria a deglutição dos pacientes com distonia laríngea. Foram avaliados 17 indivíduos adultos, acima de 18 anos de idade, com diagnóstico clínico de distonia laríngea antes e após o tratamento com o uso de toxina botulínica do tipo A, e 20 indivíduos adultos saudáveis como controles. Os participantes foram submetidos à anamnese fonoaudiológica e avaliação videofluoroscópica da deglutição. Os pacientes com distonia foram avaliados antes e 30 dias após a injeção de toxina botulínica, guiada por eletromiografia. Na videofluoroscopia foram avaliadas 6 deglutições de 5mL, sendo 3 na consistência líquida (sulfato de bário 100%, e 3 na consistência pastosa (3g do espessante alimentar ThickenUp Clear, em 50 mL de sulfato de bário (100%) oferecidas em uma colher. A ordem das deglutições foi aleatória. Foram estudadas as fases oral e faríngea da deglutição, com registro de 30 quadros por segundo. Os pacientes com distonia laríngea apresentaram aumento de resíduos na região oral e em valécula e maior número de deglutições. Os pacientes apresentaram tempo de trânsito faríngeo (TTF) menor do que os controles (p<0,01), para os bolos nas consistências líquida e pastosa. O TTF foi menor após aplicação do que antes da aplicação da toxina botulínica, quando da deglutição do bolo pastoso. Portanto, concluiu-se que os pacientes com distonia laríngea, comparado a controles, têm trânsito mais rápido pela faringe, aumento de resíduos na região oral e em valécula e maior número de deglutições para o mesmo volume.Trinta dias após a aplicação da toxina botulínica foi observado diminuição da duração do trânsito pela faringe, com o bolo pastoso, e resposta tardia do movimento do osso hióide em relação à chegada do bolo na faringe. / Dystonia is a syndrome consisting of involuntary muscle contractions that result in distorted and repetitive movements and/or abnormal postures. Treatment may be by pharmacotherapy with anticholinergic drugs or with the injection of botulinum toxin in the affected muscle group. The aim of this study was to evaluate swallowing in patients with dystonia before and after treatment with botulinum toxin. Our hypothesis was that botulinum toxin modify the swallowing of patients with spastic dystonia. Seventeen adult subjects over the age of 18 years with clinically diagnosed dystonia were evaluated before and after treatment with botulinum toxin type A and compared to 20 healthy adults as controls. Participants underwent phonologic anamnesis and videofluoroscopy assessment of swallowing. Patients with dystonia were assessed before and 30 days after injection of botulinum toxin, guided by electromyography. In fluoroscopy, 6 swallows were evaluated of 5ml: 3 in a liquid consistency (100% barium sulfate) and 3 in a pasty consistency (3g of food thickener, ThickenUp Clear) in 50 mL of 100% barium sulfate, offered on a spoon. The oral and pharyngeal phases of swallowing were studied from swallows of random order, with registration of 30 frames per second. Patients with dystonia showed an increase of residue in the oral region and vallecula and greater number of multiple swallows. Patients had less pharyngeal transit time (PTT) than controls (p<0.01) for boluses of liquid and pasty consistencies. PTT was lower after the application of botulinum toxin than before with the swallowing of a pasty bolus. It was concluded that patients with dystonia, compared to controls, have more rapid transit through the pharynx, increased residues in the oral region and vallecula and a greater number of swallows for the same volume. Thirty days after the botulinum toxin, it was observed a shorter pharyngeal transit time with paste bolus, and delayed hyoid movement response to bolus presence in pharynx.

Although nitrite is a known inhibitor of Clostridium botulinum in cured meats, the mechanism of inhibition is not understood. The observation has been made that iron is required for growth of C. botulinum and that the role of nitrite may be to alter the pathway of iron uptake by these organisms. Since the color change in cured meats is due to the binding of nitrite to the heme group of meat pigments, it was hypothesized that nitrite may also be tying up an essential iron source, heme. This experiment was an investigation of the possibility that myoglobin added to a meat system would stimulate growth and toxin production by C. botulinum much more than myoglobin that had been nitrosylated before inclusion in the product. Treatments were included to compare the effects of a heme iron source, myoglobin, with that of an ionic source, ferric chloride. To help understand the role of free iron in botulinal growth, several treatments contained a metal ion chlator, ethylenediaminetetraacetic acid (EDTA). Nitrite caused a definite delay of growth, as evidenced by gas bubbles, when compared with a non-nitrite system. Addition of ferric chloride resulted in an increase in the rate of of appearance of swollen samples, although growth was enhanced even more when myoglobin was added. When nitrosylated myoglobin was included, growth was inhibited more than in the treatment with nitrite alone. EDTA inhibited growth of C. botulinum but a conclusion should not be made with respect to the chelation of iron since EDTA chelates many other metals. Residual nitrite levels had declined to below 10 ppm by the time swelling occurred. Although swelling did not occur until nitrite had declined in the products, the absence of nitrite alone did not allow growth and toxin production. Since nitrosylated myoglobin and EDTA inhibited botulinal growth even after residual nitrite had declined, it is possible that the inhibitory action of nitrite is creating a nutritional deficiency for C. botulinum.

The effect of added iron on the growth of Clostridium botulinum type A in a chemically defined medium was studied. Growth of C. botulinum was supported by an iron level of 0.05 ug/ml with maximum growth observed at a level of 3 ug iron/ml. Electron paramagnetic resonance (EPR) studies were conducted to detect the presence of iron-sulfur centers and iron-nitric oxide complexes in untreated and nitrite treated cell-free extracts of C. botulinum type A. Untreated extracts of C. botulinum exhibited EPR signals in the oxidized and reduced states characteristic of a "HiPiP-type" iron-sulfur center (g=2.02) in the oxidized state and a reduced signal at g=l.94, characteristic of a reduced iron-sulfur center. Extracts of C. botulinum treated with nitrite exhibited an EPR signal at g=2.035, characteristic of iron-nitrosyl complexes, with the simultaneous disappearance of the the signal at g=l.94. This indicates that nitrite reacts with the iron-sulfur centers in botulinal cells to form iron-nitrosyl complexes. Addition of ascorbate with nitrite intensified the EPR signal at g=2.035, probably by enhancing the reduction of nitrite to nitric oxide. A cytochrome c reduction method was used for the determination of ferredoxin activity in untreated and nitrite treated cells of C. botulinum type A from which ferredoxin had been partially purified. Untreated extracts of C. botulinum reduced cytochrome c which demonstrates ferredoxin activity within the cells. Treatment of the cells with nitrite at a level of 1000 ppm for 45 min was found to inhibit ferredoxin activity by 90%. Boiling the partially purified ferredoxin from the untreated cells for 5 min inactivated the protein. Pyruvate-ferredoxin oxidoreductase activity in partially purified extracts of nitrite treated and untreated cells of C. botulinum was determined by assaying for FAD reduction and acylhydroxamate formation. Nitrite treated cells exhibited an inhibition of 70% of FAD reducing activity and 80% inhibition of acylhydroxamate formation when compared to the untreated cells. Boiling inhibited the activity of partially purified oxidoreductase activity by more than 90% in both the assays.

[Truncared abstract] Introduction: The assessment of any therapy requires not only an understanding of how that therapy works but also how it affects health related quality of life (HRQOL). Botulinum Toxin A(BoNT-A) therapy for upper limb spasticity management in children with hemiplegic cerebral palsy(CP) is currently under trial. Despite its use for over a decade for lower limb spasticity, little is known about the mechanisms involved in improving motor function and the effect on the child and their familys HRQOL. Both central and peripheral mechanisms are hypothesised[1]. Whilst evidence of improved quality of movement and ability to perform tasks is emerging[2-4], this cannot be directly correlated with an improvement in HRQOL. In addition, the traditional method of assessing child HRQOL by parent proxy reports has come under question[5, 6]. The World Health Organisation now recommends the collection of both parent proxy and child self-reports[7]. Aims: 1. Investigate the corticomotor projections to the upper limb in school aged children with hemiplegic CP and the changes that occur with BoNT-A therapy by transcranial magnetic stimulation (TMS). 2. Investigate the effect of upper limb BoNT-A therapy on HRQOL of school aged children with hemiplegic CP by completion of the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 3. Determine the concordance between Child Self-Report and Parent Proxy Report scores for the PedsQL 4.0 Generic Core Scales and 3.0 CP Module. 4. Determine the concordance between PedsQL scores and function as assessed by the Melbourne Assessment of Unilateral Upper Limb Function (MUUL). Methods: Design: Prospective randomised pilot study. Setting: Department of Paediatric Rehabilitation, Princess Margaret Hospital, and Centre for Neurological and Neuromuscular Disorders, Perth. Participants: 22 school aged children with hemiplegic CP aged 7yr 0mth-13yr 11mth (12 treatment, 10 control). 3 Treatment: One episode BoNT-A injections (dose 1-2U/kg/muscle) into the upper limb for treatment group. The control group received usual care. ... Conclusion: This pilot study provides preliminary evidence of the effects of upper limb BoNT-A therapy at both a central physiological and a broader quality of life level in school aged children with hemiplegic CP. At a central level, corticomotor pathway reorganisation occurs in the setting of BoNT-A. However the reorganisation is not limited to the affected side pathways suggesting a systemic BoNT-A effect or developmental changes. Similarly, in this pilot study, there was no statistically significant effect of upper limb BoNT-A on the childs HRQOL as assessed by the PedsQL although positive trends were observed 4 for a number of physical and psychosocial domains. The collection of both child self-report and parent proxy reports when assessing HRQOL is recommended, and function needs to be assessed independently. Larger studies across the broader CP population, the design of CP specific HRQOL tools appropriate for use in the higher functioning CP cohort, and alternative better tolerated methods of investigating the motor system in children with movement disorders are recommended.

An evanescent wave fiber-optic biosensor was used in an effort to develop an assay for the rapid detection of two biological toxins: cholera toxin and botulinum toxin. The Analyte 2000 fiber-optic biosensor utilizes a sandwich immunoassay format. Gangliosides or liposomes are directly adsorbed to the surface of the fiber-optic waveguide through hydrophobic interactions. The waveguide is exposed to a sample containing the toxin of interest, then subsequently exposed to a polyclonal detection antibody conjugated to the fluorophore cyanine 5. Excitation light from a 635nm laser diode is propagated through the waveguide and fluorescent molecules within approximately 100nm of the waveguide are excited. The emission light from the excited cyanine 5 molecules reverberates into the waveguide and is quantitated in pico Amperes and displayed on a computer. The exotoxins of Vibrio cholerae and Clostridium botulinum, cholera and botulinum toxin, respectively, were used for pote ntial assay development. Assay development utilizing the biosensor was attempted for the detection of botulinum toxin in buffer. The limit of detection remained too high to generate a positive signal for the detection of botulinum toxin. Biosensor assays were developed to detect cholera toxin in buffer, oyster homogenate, pure culture and induction media. A cholera toxin standard curve was generated with a limit of detection of 1 ng/ml. The values were normalized by setting 100 ng/ml of cholera toxin to a value of 100. Signals were detected in oyster homogenate spiked at 5 ug/ml as well as unspiked oyster homogenate. A Western blot showed that there were cross reactive proteins in the oyster matrix at molecular weights different from those of the cholera toxin. Cholera toxin production by three strains of Vibrio cholerae with values estimated to range from 100 pg -- 100 ng was detected with the biosensor. Additionally, oysters were harvested from Tampa Bay and placed in a 10 gallon tank filled with different types of induction media. The tank was inoculated with Vibrio cholerae and the oysters and induction medium were analyzed at varying times for the presence of cholera toxin. Vibrio cholerae cells were viable through 24 hours but no toxin was detectable.

No description available.

A total of twenty-eight Bacillus spp. isolated from value-added surimi nuggets and their raw ingredients, were tested against each other and selected reference strains of Bacillus and Clostridium for their production of inhibitory substances using the deferred antagonism assay plating method. The isolated Bacillus strains showed inhibitory activity against all Bacillus strains, with the exception of the producer strain, as well as being effective against various strains of C. botulinum (type A, B and E). Subsequent studies showed that the inhibitory activity was detected in the culture supernatant in the late stationary phase of growth prior to sporulation. The inhibitory activity of two Bacillus strains (FN2A and FN33) were selected for further study. The inhibitory substances produced by these two strains were proteinaceous in nature, heat stable (100°C for 15min) and unaffected by organic solvents. A comprehensive study was conducted on the structural characterization of the inhibitor produced by B. subtilis FN2A using FPLC, FTIR, MS and MS/MS. Structural analysis of the inhibitor produced by B. subtilis FN2A showed that it was similar in structure to Surfactin. / Preliminary studies have shown that the Surfactin-like-compound from B. subtilis FN2A was produced in significant amounts during growth in bread with maximum production occurring in the late stationary phase (72h), at 30--35°C and at pH 6.5--7.0. Optimization studies on the production of the Surfactin-like-compound by B. subtilis FN2A in bread using a response surface methodology approach showed that temperature (33--36°C); autoclaving time (30 min); inoculum level (4%), alkali pre-treatment (0.16%), water activity (0.995) and pH 6.66 enhanced the production of the Surfactin-like-compound in bread. The compound produced under these optimal conditions also maintained its activity when subjected to various processing treatments (autoclaving, freezing and freeze drying). / Initial studies showed that low levels (1% w/w) of the Surfactin-like-compound inhibited the growth of B. cereus and proteolytic and non-proteolytic strains of C. botulinum in a model agar system. However, it had no effect on non-proteolytic strains of C. botulinum when bread, or methanol extracts of bread (1--20%), were added to formulated value-added sterile trout nuggets, with all nuggets being toxic after 28 days at 12°C. Furthermore, inoculation of B. subtilis FN2A directly into nuggets also failed to inhibit growth of non-proteolytic strains of C. botulinum. Omitting certain ingredients in the formulation failed to enhance the anti-botulinal effect of the bread or methanol extracts of the Surfactin-like-compound in the value-added nuggets. However, reducing the pH of the nuggets to ~5.5 enhanced the anti-botulinal effect of the Surfactin-like-compound. Further research is required to improve the dispersibility of the Surfactin-like-compound to inhibit the growth of C. botulinum in food systems.

Raktiniai žodžiai: spazminė diplegija, spazmiškumas, botulino toksinas, kineziterapija. Tyrimo objektas: botulino toksino ir kineziterapijos dažnumo efektyvumas 4-7 metų vaikams, sergantiems cerebriniu paralyžiumi. Tyrimo problema: Cerebrinis paralyžius – dažniausia vaikų judesių raidos problema, kuri sutrikdo individo santykį su aplinka ir apriboja jo dalyvumą. Apie 70-80% vaikų, sergančių cerebriniu paralyžiu, pasitaiko spazminės formos. Pastaruoju metu pasaulyje botulino toksinas plačiausiai taikomas spazmiškumui slopinti. Nors Lietuvoje šis preparatas taikomas jau šešeri metai, tačiau nėra nustatyta, kaip kineziterapijos dažnumas įtakoja vaikų su spazmine diplegija ir hemiplegija motorinių funkcijų pokyčius po botulino toksino panaudojimo. Darbo tikslas: Nustatyti kineziterapijos ir Botulino toksino (BTX-A) poveikį 4-7 metų vaikams, sergantiems cerebriniu paralyžiumi. Tiriamieji klausimai: Darbe palyginami vaikų su spazmine diplegija ir hemiplegija pasyvios dorzalinės fleksijos, selektyvių p�����dos judesių skalės, pusiausvyros skalės ir bendrosios motorikos funkcijų vertinimo skalės pokyčiai po botulino toksino panaudojimo, kineziterapiją taikant 5 kartus ir 2 kartus per savaitę. Darbe pateikiama gautų rezultatų analizė ir interpretacija. Išvados: 1. Nustatyta, kad čiurnos sąnario pasyvios dorzalinės fleksijos amplitudės padidėjo po BTX-A ir dažnos (5 kartai per savaitę) bei nedažnos (2 kartai per savaitę) kineziterapijos taikymo, tačiau skirtumas... [toliau žr. visą tekstą] / Keywords: spastic diplegia, spasticity, botulinum toxin, physiotherapy. Object: the effectiveness of intensive (5 times/week) and regular (2 times/week) physiotherapy for children with cerebral palsy after the use of botulinum toxin. Problem: Cerebral palsy is a frequent cause of children‘s motor disorder. It affects person‘s relationship with environment and limits his participation. Spasticity predominate for 70-80% of children with cerebral palsy. Botulinum toxin type A (BTX-A) is a relatively new and widely used method of spasticity management in children with cerebral palsy. Despite, that in Lithuania BTX-A has been used for 6 years for spasticity management, there is no evidence how intensivity of physiotherapy influence motor functions for children with cerebral palsy after botulinum toxin A injections. Purpose: to assess the effectiveness of intensive (5 times/week) and regular (2 times/week) physiotherapy for children with cerebral palsy after botulinum toxin A injections. Tasks: to evaluate the effectiveness of intensive and regular physiotherapy for passive ankle range of motions, for selective ankle movements, for balance and gross motor functions for children with cerebral palsy after botulinum toxin A injections. Investigative questions: the purpose of this study to compare the effifacy of botulinum toxin and intensive and regular physiotherapy by assessing changes in passive range of motions, selective movement scale, pediatric balance scale and gross motor... [to full text]