Efficacy and safety of botulinum toxin type A for postoperative scar prevention and wound healing improvement: A systematic review and meta-analysis

Efficacy and safety of phototherapies for upper lip scars in cleft lip patients: a systematic review and meta-analysis

OBJECTIVE

Cleft lip is a prevalent congenital developmental defect, and its surgical repair often results in scarring that adversely impacts facial esthetics, function, and mental health. Numerous studies have examined the efficacy and safety of phototherapy for scar treatment. However, definitive evidence is lacking. This study aims to evaluate the effectiveness and safety of phototherapies for treating upper lip scars in cleft lip patients.

METHODS

The authors searched PubMed, Cochrane Library, Embase, and Web of Science databases using specific search terms. The authors collected clinical trials on laser or other phototherapy treatments for upper lip scars after cleft lip surgery published up to the end of March 2024. Two researchers independently screened the literature, extracted data, and assessed quality based on inclusion and exclusion criteria. The data were analyzed by using RevMan 5.4 statistical software.

RESULTS

A total of nine studies were included. 1 Analysis of the clinical efficacy rate between the control group (routine care) and the intervention group (phototherapy) showed that laser or intense pulsed light (IPL) treatment significantly reduced total VSS scores ( P <0.0001). 2 Analysis of the Pretest-Post-test cohort showed that total VSS scores were significantly reduced after phototherapy ( P <0.00001). 3 Timing of phototherapy intervention analysis: early postoperative phototherapy intervention had a better effect. None of the literature reported permanent complications, nor were there any serious adverse events, only localized temporary erythema or blisters.

CONCLUSION

Phototherapy can effectively improve the total VSS scores of upper lip scars after cleft lip surgery (including skin color, vascular distribution, softness, and thickness) with no apparent adverse reactions or serious complications. Early phototherapy intervention for upper lip scars has a better effect.

Single-port plus one in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux, a comparative analysis with short-term outcomes

OBJECTIVE

To observe the safety and short-term outcomes of a new way of laparoscopic trocar placement in pediatric robotic-assisted Lich-Gregoir ureteral reimplantation for vesicoureteral reflux.

METHODS

The retrospective study included 32 patients under 14 years diagnosed with primary vesicoureteral reflux (VUR). All these patients underwent robotic-assisted Lich-Gregoir ureteral reimplantation in our department from December 2020 to August 2022. These patients were divided into the following groups according to the different ways of trocar placement: 13 patients in group single-port plus one (SR) and 19 patients in group multiple-port (MR). Patients' characteristics as well as their perioperative and follow-up data were collected and evaluated.

RESULTS

There was no significant difference in the data regarding patients' characteristics and preoperative data. These data included the grade of vesicoureteral reflux according to the voiding cystourethrogram (VCUG), and the differential degree of renal function (DRF) at the following time points: preoperative, postoperative, and comparison of preoperative and postoperative. There was no difference between the two groups. During surgery, the time of artificial pneumoperitoneum establishment, ureteral reimplantation time, and total operative time in the SR group were longer than those in the MR group. Yet only the time of artificial pneumoperitoneum establishment shows a statistical difference (P < 0.0001). Also, the peri-operative data, including the volume of blood loss, fasting time, hospitalization, and length of time that a ureteral catheter remained in place, and the number of postoperative complications demonstrate no difference. In addition, the SFU grade and VCUG grade at the following time point also show no difference between the two groups.

CONCLUSION

The study demonstrates that SR in robotic-assisted Lich-Gregoir ureteral reimplantation has reached the same surgical effects as MR. In addition, the single-port plus one trocar placement receives a higher cosmetic satisfaction score from parents and did not increase the surgical time and complexity.

Structural basis of botulinum neurotoxin serotype A1 binding to human SV2A or SV2C receptors

Botulinum neurotoxin A1 (BoNT/A1) is the most potent natural poison in human. BoNT/A1 recognize the luminal domain of SV2A (LD-SV2A) and its glycosylation at position N573 (N573g) or the luminal domain of SV2C (LD-SV2C) and its glycosylation at position N559 (N559g) to bind neural membrane. Our computational data suggest that the N-glycan at position 480 (N480g) in the luminal domain of SV2C (LD-SV2C) indirectly enhanced the contacts of the neurotoxin surface with the second N-glycan at position 559 (N559g) by acting as a shield to prevent N559g to interact with residues of LD-SV2C. The absence of an N-glycan homologous to N480g in LD-SV2A leads to a decrease of the binding of N573g to the surface of BoNT/A1. Concerning the intermolecular interactions between BoNT/A and the protein part of LD-SV2A or LD-SV2C, we showed that the high affinity of the neurotoxin for binding LD-SV2C are mediated by a better compaction of its F557-F562 part provided by a π-π network mediated by residues F547, F552, F557 and F562 coupled with the presence of two aromatic residues at position 563 and 564 that optimize the binding of BoNT/A1 via cation-pi and CH-pi interaction. Finally, in addition to the well-known ganglioside binding site which accommodates a ganglioside on the surface of BoNT/A1, we identified a structure we coined the ganglioside binding loop defined by the sequence 1253-HQFNNIAK-1260 that is conserved across all subtypes of BoNT/A and is predicted to has a high affinity to interact with gangliosides. These data solved the puzzle generated by mutational studies that could be only partially understood with crystallographic data that lack both a biologically relevant membrane environment and a full glycosylation of SV2.