Botulinum neurotoxin (BoNT), derived from Clostridium botulinum, has been used therapeutically for focal dystonia, spasticity, and chronic migraine. Its spectrum as a potential treatment for neuropathic pain has grown. Recent opinions on the mechanism behind the antinociceptive effects of BoNT suggest that it inhibits the release of peripheral neurotransmitters and inflammatory mediators from sensory nerves. There is some evidence showing the axonal transport of BoNT, but it remains controversial. The aim of this review is to summarize the experimental and clinical evidence of the antinociceptive effects, mechanisms, and therapeutic applications of BoNT for neuropathic pain conditions, including postherpetic neuralgia, complex regional pain syndrome, and trigeminal neuralgia. The PubMed and OvidSP databases were searched from 1966 to May 2015. We assessed levels of evidence according to the American Academy of Neurology guidelines. Recent studies have suggested that BoNT injection is an effective treatment for postherpetic neuralgia and is likely efficient for trigeminal neuralgia and post-traumatic neuralgia. BoNT could also be effective as a treatment for diabetic neuropathy. It has not been proven to be an effective treatment for occipital neuralgia or complex regional pain syndrome.

ObjectiveTo evaluate the analgesic effect of botulinum toxin type A (BTX‐A) on patients with spinal cord injury‐associated neuropathic pain.MethodsThe effect of BTX‐A on 40 patients with spinal cord injury‐associated neuropathic pain was investigated using a randomized, double‐blind, placebo‐controlled design. A 1‐time subcutaneous BTX‐A (200U) injection was administered to the painful area. Visual analogue scale (VAS) scores (0–100mm), the Korean version of the short‐form McGill Pain Questionnaire, and the World Health Organization WHOQOL‐BREF quality of life assessment were evaluated prior to treatment and at 4 and 8 weeks after the injection.ResultsAt 4 and 8 weeks after injection, the VAS score for pain was significantly reduced by 18.6 ± 16.8 and 21.3 ± 26.8, respectively, in the BTX‐A group, whereas it was reduced by 2.6 ± 14.6 and 0.3 ± 19.5, respectively, in the placebo group. The pain relief was associated with preservation of motor or sensory function below the neurological level of injury. Among the responders in the BTX‐A group, 55% and 45% reported pain relief of 20% or greater at 4 and 8 weeks, respectively, after the injection, whereas only 15% and 10% of the responders in the placebo group reported a similar level of pain relief. Improvements in the score for the physical health domain of the WHOQOL‐BREF in the BTX‐A group showed a marginal trend toward significance (p = 0.0521) at 4 weeks after the injection.InterpretationThese results indicate that BTX‐A may reduce intractable chronic neuropathic pain in patients with spinal cord injury. Ann Neurol 2016;79:569–578

Conventional geotechnical engineering soil binders such as ordinary cement or lime have environmental issues in terms of sustainable development. Thus, environmentally friendly materials have attracted considerable interest in modern geotechnical engineering. Microbial biopolymers are being actively developed in order to improve geotechnical engineering properties such as aggregate stability, strength, and hydraulic conductivity of various soil types. This study evaluates the geotechnical engineering shear behavior of sand treated with xanthan gum biopolymer through laboratory direct shear testing. Xanthan gum-sand mixtures with various xanthan gum content (percent to the mass of sand) and gel phases (initial, dried, and re-submerged) were considered. Xanthan gum content of 1.0% sufficiently improves the inter-particle cohesion of cohesionless sands 3.8 times and more (up to 14 times for dried state) than in the untreated (natural) condition, regardless of the xanthan gum gel condition. In general, the strength of xanthan gum-treated sand shows dependency with the rheology and phase of xanthan gum gels in inter-granular pores, which decreases in order as dried (biofilm state), initial (uniform hydrogel), and re-submerged (swollen hydrogel after drying) states. As xanthan gum hydrogels are pseudo-plastic, both inter-particle friction angle and cohesion of xanthan gum-treated sand decrease with water adsorbed swelling at large strain levels. However, for 2% xanthan gum-treated sands, the re-submerged state shows a higher strength than the initial state due to the gradual and non-uniform swelling behavior of highly concentrated biofilms.

This study shows that dysphagia is closely related to gross motor function in children with CP. Silent aspiration was observed in the moderate to severe CP groups. Aspiration is an important cause of medical problems such as acute and chronic lung disease, and associated respiratory complications contribute significantly in increasing morbidity and mortality in these patient groups. Therefore, the authors suggest that early dysphagia evaluation including videofluoroscopic swallow study is necessary in managing feeding problems and may prevent chronic aspiration, malnutrition, and infections.