Ultrasound-guided botulinum toxin injections

One of the key conditions for achieving the desirable result during botulinum toxin therapy for muscular dystonia, spasticity, and other diseases accompanied by spasm, pain, and autonomic dysfunction (dystonias, spasticity, etc.) is the proper administration of the agent into the muscles directly involved in the pathological process. The exact entry of botulinum toxin into the target muscles is essential for successful and safe treatment because its injection into a normal muscle may cause side effects. The most common errors are the incorrect depth and incorrect direction of a needle on insertion. Therefore, the exact injection of the agent particularly into the shallow and deep muscles is a difficult task even for an experienced specialist and requires the use of controlling methods.The European Consensus on Botulinum Toxin Therapy points out that various injection techniques are needed for the better identification of necessary muscles. However, there are currently no reports on the clear advantage of any technique. In our country, injections using palpation and anatomical landmarks have been widely used in routine practice so far; electromyographic monitoring and electrostimulation have been less frequently applied. In recent years, the new method ultrasound-guided injection has continued to grow more popular. This effective, accessible, and easy-to-use method makes it possible to manage a real-time injection process and to ensure the exact entry of the agent into the muscle. This paper is dedicated to a comparative analysis of different injection methods and to a description of the ultrasound-guided technique and its advantages over others

The Study of the Competitive Aspect in the Segment of Biotechnological Drugs on the Example of Monoclonal Antibodies

Currently, close attention is attracted by the drugs obtained by the method of biotechnology and genetic engineering, belonging to the group of monoclonal antibodies. The change in the concept of treatment from non-specific to specific therapy raises great hopes in various fields of medicine associated with this group of drugs. In Russia, more than 50 such drugs are used, produced in different countries. In the current political situation, the competitive aspect in this segment of biotechnological drugs has been studied.В настоящее время пристальное внимание привлекают полученные методом биотехнологии и генной инженерии лекарственные препараты, относящиеся к группе моноклональных антител. Смена концепции лечения от неспецифической к специфической терапии вызывает большие надежды в разных областях медицины, связанные с данной группой препаратов. В России используется свыше 50 таких препаратов, производимых в разных странах. В текущей политической ситуации изучен конкурентный аспект в данном сегменте биотехнологических препаратов

Courage at the Border-Line: Balder, Hemingway, and Lawrence’s \u3cem\u3eThe Captain’s Doll\u3c/em\u3e

Briefly compares Captain Hepburn of The Captain’s Doll (1923) to Krebs of “Soldier’s Home,” noting that both men seek healing from their traumatic war experiences through self-imposed isolation and emotional detachment

The Novel

This chapter provides readers with a sense of the various ways Mailer experimented with and contributed to the novel form, as he tried his hand at everything from political allegory to detective novel to spy thriller to ancient epic, among other novelistic genres. The chapter contextualizes Mailer’s novels within their various genres and offers an overview of his development within the form

From Relativity to Paraphrenia in D.H. Lawrence\u27s “The Man Who Loved Islands”: Speculations on Einstein, Freud, Gossamer Webs, and Seagulls

The development of D.H. Lawrence\u27s The Man Who Loved Islands through Cathcart\u27s consecutive ownership of three islands engages the consequences of Cathcart\u27s intense isolation from humanity. In the process of charting the steps in this character\u27s collapse of body, mind, and spirit, Lawrence employs metaphors that explicitly connect to Einstein\u27s notions of relativity and spacetime. In addition to this fictionalized adaptation of contemporary research in astrophysics, Lawrence cumulatively relates the palpable decline of Cathcart\u27s equilibrium, the pattern of his anxiety, and the context of his depression to precise pathologies outlined in Freud\u27s work the previous decade about obsessional neurosis, melancholia, and ultimately, paraphrenia. Lawrence\u27s awareness of the work of an innovative psychiatrist and writer, Trigant Burrow, provides additional insight into Lawrence\u27s personal preoccupations and doctrinal emphasis in the tale

D.H. Lawrence and the Marriage Matrix: Intertextual Adventures in Conflict, Renewal, and Transcendence

This innovative study of eight major works of fiction by D. H. Lawrence examines the dominant presence of what is here termed a “marriage matrix.” It reveals how this intense pattern of preoccupation not only structures the symbology and plot development of these powerful stories, but also consistently engages with such important subjects in Lawrence’s life as depression, illness, friendship, renewal, transcendence, and impotence. As a compelling interpretation of Lawrence’s craft and a provocative foray into the intimations of psychobiography, the book’s notions of “synergistic criticism” integrate various approaches to this modernist writer to reveal provocative linkages between his visionary art and turbulent career and marriage. The volume contains well-grounded speculations on the sexual life of Lawrence and Frieda, on the oedipal residue of Lawrence’s relation to his parents, on the complex friendships with Cynthia Asquith, J. Middleton Murry, and Katherine Mansfield, and on the theories of James Frazer, Sigmund and Anna Freud, James W. Pryse, Peter Ouspensky, and Norman Mailer. The Marriage Matrix also reproduces six paintings by Lawrence and one by Georgia O’Keeffe within pertinent discussions of Lawrence’s practice and theory of visual art and how they further enhance the priorities of his fiction. To further contextualize the book’s eclectic approach to impinging issues about the current province of research, teaching, and literature, the texts of two of the author’s controversial presentations to the academy are also included, as well as relevant correspondence with the late writer, Norman Mailer, on the subject of Lawrence’s genius and influence.https://digitalcommons.trinity.edu/mono/1061/thumbnail.jp

Module 2: Nonsurgical management of Spasticity

Spasticity management should be part of a well-coordinated and comprehensive rehabilitation program that is patient-centric and goal-specific. There are a variety of options available for the treatment of spasticity. A usual approach is starting with the least invasive treatment modalities initially and gradually increasing to more complex interventions as this is required. This curriculum considers oral antispasticity drugs in terms of mechanism of action, clinical use, efficacy, and adverse events. It also presents other treatment options, such as chemical neurolysis using phenol and alcohol and chemodenervation using botulinum toxin A (BoNT-A). Therapeutic intramuscular injections of BoNT-A require sound patient selection, accurate muscle selection, and precise localization. The common methods for achieving these are described. The importance of physiotherapy is explained, along with the necessity to combine treatment modalities to address spasticity and the various components of the upper motor neuron syndrome. Recognizing differences in various health-care systems across countries and regions, the authors aim to present various treatment options. While this section of the curriculum highlights the importance of an interdisciplinary effort in managing spasticity, it is understandable that not all treatment options are available uniformly. The challenge to clinicians is to make the most of the management options on hand to optimize outcomes