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Botulinum toxin (BTX), an exotoxin produced by the bacteria Clostridium botulinum, occurs naturally in nature BTX induces a bilaterally symmetric descending neuroparalytic condition called botulism The word botulinum is derived from the Latin word for sausage, botulus Botulism was so named during the Napoleonic Empire in the early 1800s when it was noted to be triggered by the ingestion of spoiled sausages Later, German physician Justinus Kerner described food-borne botulism and its clinical symptoms during the period between 1817 and 1822 In 1946, Schantz reported isolating BTX type A in its crystalline form, and nearly a quarter of a century later, Alan Scott became the first to harness the effects of BTX for medicinal use in monkey strabismus1 The use of C botulinum A exotoxin, commonly known as botulinum toxin type A (BTX-A), has emerged over the last decade as one of the most popular methods of combating cutaneous signs of aging, particularly the dynamic wrinkles of the face The therapeutic application of this potent neurotoxin has carved a comfortable niche in the cosmetic realm of dermatology practice for practical reasons: Results appear within several days of administration, the procedure itself is short in duration and relatively uncomplicated, and side effects are minimal Although medicinal use of BTX by physicians is widespread, professional opinions vary as to the best ways to administer the treatment For instance, the ideal dilution of the toxin, the number of units to inject, and the longevity of prepared and refrigerated BTX remain debated issues (Box 22-1) The methods described in this chapter are those used most frequently by the primary author The novice injector should try the various methods espoused by experienced specialists to determine which yields the best results in his/her own practice BOX 22-1 Units of Botulinum Toxin One unit (U) of BTX is the dose that would be lethal to 50% (LD50) of the speci c mouse species tested For a 70-kg person, the LD50 of Botox is 2500 to 3000 U However, manufacturers use different mouse models, so a unit of one brand is not equivalent to a unit of another brand Because of these variations, it is important to know which type of BTX was used when evaluating dosing information in the literature For cosmetic indications, injection of approximately 20 to 75 U doses of Botox is typical Practitioners have used doses as high as 1000 Botox units to treat cerebral palsy and other neurologic conditions TABLE 22-1 Binding Sites of Various Toxin Serotypes TOXIN SEROTYPE BTX-A BTX-B BTX-C1 BTX-D BTX-E BTX-F BTX-G BINDING SITE SNAP-25 Synaptobrevin SNAP-25 and syntaxin Synaptobrevin SNAP-25 Synaptobrevin Synaptobrevin.

Just remember to give a second or two before you shout Cut!

Normally, DBMSs like Oracle control concurrent data access with locking. For example, locking is necessary to prevent database users from updating rows with pending (uncommitted) changes from other database users. This section gives some information about how the Oracle DBMS handles locking and concurrency.

To understand how the Oracle DBMS handles locking, we need to identify a difference between two categories of database users: Readers: Users retrieving data (issuing SELECT statements) Writers: Users changing data (issuing INSERT, UPDATE, DELETE, and MERGE commands) The Oracle DBMS does not lock any data for retrieval. This means that readers never block readers. Moreover, this also means that writers never need to wait for readers, and vice versa.

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MySpace accepts a wider variety of video formats than most upload sites accept, including those listed in Figure 3-11 Now that you have an account, this section shows you how to put video on MySpace: 1 Login to your MySpace account 2 In your greeting area, click Add/Change Videos 3 Select the Upload tab, shown in Figure 3-12 4 Fill in the information Remember, tags are search keywords Also, make sure to check the Public/Private options See Figure 3-13 Check back to the previous section about YouTube, so you don t mistake these actions for dej vu

cle movement BTX achieves chemical denervation of striated muscles by cleaving one or more of the proteins required for the release of ACh (Fig 22-1) The target protein depends on the serotype of toxin used (Table 22-1) The result is temporary flaccid paralysis of the injected muscles, which persists approximately 3 to 5 months As new neuromuscular junctions form, muscle function returns There are seven BTX serotypes (A G) Serotype A is the most potent and was the first to be made

Note The Oracle DBMS s handling of data locking does not mean that readers and writers do not hinder

each other in any way. Readers and writers can cause delays for each other by contending for certain system resources.

FIGURE 3-11

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