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Background: Botulinum Toxin (BoNTA) is the most used nonsurgical aesthetic procedure to treat facial expression lines. Aims: This study compared the efficacy of Prabotulinum toxin‐A, a novel BoNTA that originates from Clostridium botulinum Hall‐A, with onabotulinum toxin‐A in treating facial expression lines using the Facial Wrinkle Scale (FWS) and FACE‐Q questionnaires. Methods: This was an experimental, comparative, longitudinal, open‐label, and prospective study. Patients aged between 25 and 40 years with upper‐third facial expression lines were included. Follow‐ups were made at three, seven, 30, and 120 days. Results: A total of 26 patients were included: 20 female, and six males, with a mean age of 28.26 years. An average of 31.00 IU and 31.38 IU were administered to the onabotulinum and prabotulinum groups, respectively. The prabotulinum group demonstrated superiority in FWS and Face‐Q scores between the first and third days (p ≤ 0.001, p < 0.001, respectively), which continued on day 7. By day 30, there were no differences in the scores of the two questionnaires. Conclusions: Prabotulinum toxin‐A is a safe and effective treatment for upper‐third facial wrinkles. On day three and seven, the results suggest that prabotulinum toxin‐A has a quicker onset of action than onabotulinum toxin‐A. On days 30 and 120, both groups showed similar FWS and Face‐Q scores. [ABSTRACT FROM AUTHOR]

Objectives: Evaluating the effectiveness and safety of repeated high‐dose intradetrusor abobotulinumtoxin A (Dysport®) injections for the treatment of pediatric neurogenic bladders refractory to medications. Design: Retrospective interventional study. Participants: The cohort included 37 children (22 boys and 15 girls) of median age 9.2 years. Inclusion criteria were diagnosis of neurogenic bladder and failure to respond to medical treatment. Exclusion criteria were augmented bladder, insufficient data, and interval of > 11 months between video‐urodynamic study and Dysport injection. Interventions: All participants were treated with an intra‐detrusor injection of Dysport 30 IU/kg (up to 1000 IU) under general anesthesia. Repeated (second and third) injections were scheduled (6–12 months) in patients who demonstrated an improvement in cystometric parameters. All participants underwent video urodynamic testing before onset of treatment and 4–5 months after subsequent injection. Main Outcome Measures: Success of treatment was defined as a decrease in end filling pressure (EFP) to < 40 cm H2O and/or a 20% increase in maximal cystometric capacity (MCC). These parameters along with initial bladder features were evaluated for ability to predict treatment success. Results: No side effects of Dysport were observed or reported. The overall success rate was 62%. MCC increased by a median of 30% (IQR 200–300, p < 0.001), 37% (IQR 197–310, p = 0.001) and 45% (IQR 245–300, p = 0.025) after the first, second and third injections, respectively. Median EFP decreased from 45 cm H2O to 34 cm H2O (IQR 20–45, p = 0.029), 23 cm H2O (IQR 20–37, p = 0.004), and 20 cm H2O (IQR 12–32, p = 0.049) after the first, second, and third injections, respectively. No predicting factor of success of treatment were found; However, three of five cases of "end stage" bladder showed improvement. Conclusions: High‐dose Dysport injection is safe and effective for the treatment of neurogenic bladder. Studies with larger cohort and a control group would further elucidate which bladders would benefit most. At present, we recommend treating also bladders with "end stage" features with botulinum toxin before considering augmentation. [ABSTRACT FROM AUTHOR]

Introduction: Overactive bladder (OAB) is a syndrome of the lower urinary tract characterized by urinary urgency, frequency, and nocturia, with or without urgency urinary incontinence. OAB significantly impacts all aspects of life—social, psychological, physical, professional, domestic, and sexual—for both women and men. The aim of this study was to investigate sexual dysfunction in both women and men with OAB treated with intravesical onabotulinumtoxinA (Botox) injections using the Sexual Quality of Life questionnaire in two versions: female (SQoL-F) and male (SQoL-M). Methods: Forty sexually active patients (thirty women and ten men) with idiopathic OAB were recruited. Patients completed the SQoL-F or SQoL-M questionnaire before treatment, and again at 3 and 6 months after treatment with intravesical onabotulinumtoxinA injections. Results: All 40 patients completed the study (30 women and 10 men). There were no statistically significant differences in SQoL results before the procedure or at 3- and 6-months post-treatment. Conclusions: OAB treatment with onabotulinumtoxinA did not significantly affect the quality of sexual life in either women or men. Further research is needed using questionnaires specifically designed to assess the sexual life of patients with OAB, especially in men. [ABSTRACT FROM AUTHOR]

Preoperative injection of Botulinum Toxin A (Botox) has been described as an adjunctive therapy to facilitate fascial closure of large hernia defects in abdominal wall reconstruction (AWR). The purpose of this study was to evaluate the impact of Botox injections on fascial closure and overall outcomes to further validate its role in AWR. A prospectively maintained database was retrospectively reviewed to identify all patients undergoing AWR at our institution between January 2014 and March 2022. Patients who did and did not receive preoperative Botox injections were analyzed and compared. A total of 426 patients were included (Botox 76, NBotox 350). The Botox group had significantly larger hernia defects (90 cm2 vs 9 cm2, p < 0.01) and a higher rate of component separations performed (60.5% vs 14.4%, p < 0.01). Despite this large difference in hernia defect size, primary fascial closure rates were similar between the groups (p = 0.49). Notably, the Botox group had higher rates of surgical-site infections (SSIs)/surgical-site occurrences (SSOs) (p < 0.01). Following propensity score matching to control for multiple patient factors including age, sex, diabetes, chronic obstructive pulmonary disease (COPD), and hernia size, the Botox group still had a higher rate of component separations (50% vs 26.3%, p = 0.03) and higher incidence of SSIs/SSOs (39.5% vs 13.5%, p = 0.01). Multimodal therapy with Botox injections and component separations can help achieve fascial closure of large defects during AWR. However, adding these combined therapies may increase the occurrence of postoperative SSIs/SSOs. [ABSTRACT FROM AUTHOR]

Background: OnabotulinumtoxinA (onabotA), is assumed to achieve its therapeutic effect in migraine through blocking activation of unmyelinated meningeal nociceptors and their downstream communications with central dura-sensitive trigeminovascular neurons in the spinal trigeminal nucleus (SPV). The present study investigated the mechanism of action of onabotA by assessing its effect on activation and sensitization of dura-sensitive neurons in the SPV by cortical spreading depression (CSD). It is a follow up to our recent study on onabotA effects on activation and sensitization of peripheral trigeminovascular neurons. Methods: In anesthetized male and female rats, single-unit recordings were used to assess effects of extracranial injections of onabotA (five injections, one unit each, diluted in 5 μl of saline were made along the lambdoid (two injection sites) and sagittal (two injection sites) suture) vs. vehicle on CSD-induced activation and sensitization of high-threshold (HT) and wide-dynamic range (WDR) dura-sensitive neurons in the SPV. Results: Single cell analysis of onabotA pretreatment effects on CSD-induced activation and sensitization of central trigeminovascular neurons in the SPV revealed the ability of this neurotoxin to prevent activation and sensitization of WDR neurons (13/20 (65%) vs. 4/16 (25%) activated neurons in the control vs. treated groups, p = 0.022, Fisher's exact). By contrast, onabotA pretreatment effects on CSD-induced activation and sensitization of HT neurons had no effect on their activation (12/18 (67%) vs. 4/7 (36%) activated neurons in the control vs. treated groups, p = 0.14, Fisher's exact). Regarding sensitization, we found that onabotA pretreatment prevented the enhanced responses to mechanical stimulation of the skin (i.e. responses reflecting central sensitization) in both WDR and HT neurons. In control but not treated WDR neurons, responses to brush (p = 0.004 vs. p = 0.007), pressure (p = 0.002 vs. p = 0.79) and pinch (p = 0.007 vs. 0.79) increased significantly two hours after CSD. Similarly, in control but not treated HT neurons, responses to brush (p = 0.002 vs. p = 0.79), pressure (p = 0.002 vs. p = 0.72) and pinch (p = 0.0006 vs. p = 0.28) increased significantly two hours after CSD. Unexpectedly, onabotA pretreatment prevented the enhanced responses of both WDR and HT neurons to mechanical stimulation of the dura (commonly reflecting peripheral sensitization). In control vs. treated WDR and HT neurons, responses to dural stimulation were enhanced in 70 vs. 25% (p = 0.017) and 78 vs. 27% (p = 0.017), respectively. Conclusions: The ability of onabotA to prevent activation and sensitization of WDR neurons is attributed to its preferential inhibitory effects on unmyelinated C-fibers. The inability of onabotA to prevent activation of HT neurons is attributed to its less extensive inhibitory effects on the thinly myelinated Aδ-fibers. These findings provide further pre-clinical evidence about differences and potentially complementary mechanisms of action of onabotA and calcitonin gene-related peptide-signaling neutralizing drugs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Botulinum toxin, commonly referred to as botox, is frequently used in facial aesthetics, but also has therapeutic applications in various medical and surgical conditions such as bruxism treatment. OBJECTIVE: The aim of this research is to evaluate the information quality of only English resources available on the Internet regarding the use of botulinum toxin in the treatment of bruxism. METHODS: The terms "Botox + Tooth Grinding" selected for this study were searched on the Internet using the Google Search Engine, and the URLs of the top 150 websites containing only English pages were recorded and examined. The websites were assessed using DISCERN tools, the Journal of the American Medical Association (JAMA) benchmark, and HONcode tools. The website readability evaluation involved utilizing the Flesch Reading Ease Score (FRES) and the Flesch-Kincaid Grade Level (FKGL). RESULTS: A total of 130 websites met the inclusion criteria. The total mean DISCERN score (section 1 + section 2) for all websites was 39.75/75 (range: 15–67). The average FRES of all websites was 52.79, and the average FKGL score of all websites was 10.72. Internet blog websites had significantly higher DISCERN (Section 1) scores than other websites (p = 0.007). Only one website had the HON code. Internet blog websites showed better compliance with JAMA (authorship and currency) benchmarks. No statistically significant difference was determined related to FRES and FKGL scores between groups (p > 0.05). CONCLUSIONS: There is moderate and difficult-to-read information on the Internet about masseter botox injection for bruxism. Relevant guidelines are needed to improve the quality of websites about botulinum toxin for the treatment of bruxism. [ABSTRACT FROM AUTHOR]

Cerebral palsy (CP) is a common neurodevelopmental disorder characterized by pronounced motor dysfunction and resulting in physical disability. Neural precursor cells (NPCs) have shown therapeutic promise in mouse models of hypoxic-ischemic (HI) perinatal brain injury, which mirror hemiplegic CP. Constraint-induced movement therapy (CIMT) enhances the functional use of the impaired limb and has emerged as a beneficial intervention for hemiplegic CP. However, the precise mechanisms and optimal application of CIMT remain poorly understood. The potential synergy between a regenerative approach using NPCs and a rehabilitation strategy using CIMT has not been explored. We employed the Rice–Vannucci HI model on C57Bl/6 mice at postnatal day (PND) 7, effectively replicating the clinical and neuroanatomical characteristics of hemiplegic CP. NPCs were transplanted in the corpus callosum (CC) at PND21, which is the age corresponding to a 2-year-old child from a developmental perspective and until which CP is often not formally diagnosed, followed or not by Botulinum toxin injections in the unaffected forelimb muscles at PND23, 26, 29 and 32 to apply CIMT. Both interventions led to enhanced CC myelination and significant functional recovery (as shown by rearing and gait analysis testing), through the recruitment of endogenous oligodendrocytes. The combinatorial treatment indicated a synergistic effect, as shown by newly recruited oligodendrocytes and functional recovery. This work demonstrates the mechanistic effects of CIMT and NPC transplantation and advocates for their combined therapeutic potential in addressing hemiplegic CP. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aims to summarize and synthesize the evidence that investigates the secondary effects of the application of botulinum toxin (BT) into the masticatory muscles and its effects on bone density. Materials and methods: Database searches were conducted until March 19th, 2024. The quality of the studies was assessed by the Cochrane tool risk of bias for the randomized controlled trials and the ROBINS-I tool for non-randomized studies. The Cochrane Grading of Recommendations Assessment Development and Evaluation (GRADE) was used to evaluate the confidence in the overall evidence. Results: Five studies looking at the effects of botulinum toxin on bone density and resorption when applied to masticatory muscles were found. No significant changes were observed in most of the studies when looking at the effects of botulinum toxin on mandibular condyle volume, density, mandibular angle thickness, and coronoid process volume. The only finding that was statistically and clinically relevant was the difference between patients who received a double application of BT when compared with patients who received a single application (SMD: -0.99 [95%CI: -1.94,-0.05]) on the volume of the mandibular angle. Conclusions: There is no clear pattern on whether the application of botulinum toxin is associated with bone resorption or not. Although some studies show statistical significance of the findings, the magnitude of the changes in bone density and their clinical significance are not completely clear. Clinical relevance: To understand the effectiveness of the use of botulinum toxin into the masticatory muscles and its possible secondary adverse effects on the density of the mandible. [ABSTRACT FROM AUTHOR]

With the development of strabismology, the issues of using Botox in various eye movement pathologies are gaining relevance. The literature analysis shows that the data concerning the effectiveness of Botox are ambivalent and as a rule, are based on short-term results. The review presents the data on the efficiency of the botulinum toxin in the treatment of various oculomotor system diseases in comparison with traditional surgical interventions. Indications for such therapy, application techniques, doses and complications are discussed. The generalized modern data on the functional features of the onset of various pathologies in strabismology help assess the potentials of optimizing strabismus treatment with type A botulinum toxin. To search for the data published between 1973 and 2022, select and summarize them we used Google Scholar, PubMed and eLibrary databases.

Chemodenervation by botulinum neurotoxin (BoNT) has significantly evolved over years since Alan Scott first described its use in 1970s for treatment of strabismus. It has been used for a wide variety of diseases. It has surpassed other treatment options to become the first line of therapy among oculoplasty surgeons for facial dystonias and as an aesthetic agent. The effect of BoNT is temporary but as a well-maintained therapeutic effect even after repeated injections. The side effects and complications are very rare, and it is often temporary. In this article, we review the pharmacology, indications in ophthalmic plastic surgery, techniques, and adverse effects of BoNT.

Introduction: Preoperative botolinum toxin A (BTA) administration to the lateral abdominal wall has been widely used since its introduction for treating complex abdominal wall defects and loss of domain (LOD) hernias. Intraoperative fascial traction (IFT) is an established technique for complex abdominal wall hernias exceeding a width of 10 cm and has also shown auspicious results. We present our single center data including 143 consecutive cases combining both techniques from 2019 to 2023. Aim of the study was to develop an algorithm for a tailored approach for very large and complex ventral abdominal wall hernias. Methods: Consecutive patients treated with preoperative BTA and IFT from August 2019 to December 2023 were identified in our prospectively maintained database and reviewed retrospectively. Metrics included intraoperative findings and short-term (30 days) postoperative outcomes. Results: 143 patients were included in our retrospective analysis. The mean age was 58.9 years and 99% of all patients had an ASA Score of II or III with a mean body mass index of 32.4 kg/m2. The mean intraoperative reduction of fascia-to-fascia after BTA and IFT was 9.81 cm. 14 patients either had a lateral defect or a combination of a midline and lateral hernia. An additional uni- or bilateral transverse abdominis release (TAR) was necessary in 43 cases (30.1%). The overall surgical site occurrence rate (SSO) was 30.1% of which 13.8% were surgical site infections (SSI). Re-operation and SSO rates were significantly higher if an additional TAR was performed (both p = 0.001; α = 0.05). Conclusions: IFT in combination with BTA is a transformative and clinically proven tool in the surgeons' toolbox. It might be an easier, and less invasive alternative to other available techniques in many cases, but it should not be looked at as an ultimate stand-alone method to treat all complex W3 hernias. [ABSTRACT FROM AUTHOR]

Objective:The study aims the evaluation the content on the YouTubeTM platform about botulinum toxin injection for the treatment of bruxism regarding information quality.Methods: The YoutubeTM database was scanned using the keyword "masseter botox." According to the study criteria, 33 videos were included and the number of views, likes, dislikes, comments, duration, and the number of days since uploading were recorded. According to their quality, the information content was divided into four groups (bad, poor, good, excellent). Shapiro-Wilk, Kruskal-Wallis, and post-hoc Tamhane-T2 tests were used to analyze the study data, and Fleiss Kappa analysis was used to evaluate the agreement between researchers. Statistical significance was determined as p

Abstract Introduction Recent advancements in androgenetic alopecia (AGA) treatment have highlighted the efficacy of botulinum toxin (BoNT). However, inconsistencies in injection sites and depths warrant attention. It remains unclear which injection strategy is most beneficial for patients. Methods This split-scalp randomized controlled trial divided each enrolled participant’s scalp along the midline: one side was randomized to receive intramuscular BoNT injections in the surrounding muscles, while the other side received intradermal BoNT injections directly into the balding areas. This study evaluated the impact of treatment on hair density and diameter through trichoscopic examinations conducted at baseline and 12 weeks post treatment. Additionally, assessments of pain and overall safety were integrated into the study protocol. Results Twenty-nine patients completed the study, with significant improvements in hair density observed in the intramuscular injection group compared to the intradermal group (p

Abstract Background Chronic scrotal pain is a common condition with a prevalence of 2.5–4.8% in male outpatients. Up to 40% of these patients report depressive symptoms and many feel isolated. Minimal invasive treatment is lacking, while spermatic cord injections of Botox® (BTX) have been proposed to offer long‐term pain relief. Study Design This research protocol comprises a prospective multicentre, randomized, double‐blinded clinical trial drawing patients from other urological departments in the region of Southern Denmark. End Points The primary end point will be reduction in pain evaluated by visual analogue score for pain at 3 months. Secondary end point will be length of effect of BTX injections along with changes in quality of life. Patients and Methods The study will include 50 patients for randomization to either spermatic cord block with 100 IE BTX or sterile saline. All patients will prior to randomization undergo physical examination and will be asked to fulfil multiple questionnaires regarding pain and impact in daily life, that is, (1) visual analogue score for pain, (2) quality of life (EQ‐5D‐5L), (3) Chronic Prostatitis Symptom Index (NIH‐CPSI), (4) ICD‐10 depression questionnaire (MDI), (5) Likert global assessment scale, and (6) International Index of Erectile Function questionnaire. Physical examination and fulfilment of the questionnaires will be repeated multiple times throughout the study period of 12 weeks. After this time point, patients will be unblinded, and the control arm will be given the opportunity of cross‐over.

Background: Botulinum toxin is an effective treatment for hemifacial spasm in elderly patients. However, some patients do not tolerate the side effects and frequency of botulinum toxin treatments. Objectives: The purpose of this study was to evaluate the characteristics and outcomes of a cohort of elderly patients referred by neurologists for surgical decompression of the facial nerve following botulinum toxin treatment. Methods: In a prospective cohort study, logistic regression was used to detect potential predictors of spasm‐freedom after surgical decompression of the facial nerve in elderly patients that received ≤8 and >8 botulinum toxin treatments for hemifacial spasm before surgery. Age, sex, side, preoperative symptom duration, and preoperative botulinum toxin treatment were assessed as potential predictors of spasm‐freedom at last follow‐up. Results: Of 76 elderly patients with hemifacial spasm treated with botulinum toxin and microvascular decompression, with at least 2‐years of follow‐up (median, 44.5 months), 84.2% were spasm‐free at last follow‐up. Age (P = 0.38), sex (P = 0.59), side (P = 0.15), preoperative symptom duration (P = 0.7), and number of preoperative botulinum toxin treatments (P = 0.3) were not predictors of long‐term spasm‐freedom. Permanent ipsilateral hearing loss was the most frequent complication (3.9%). Conclusion: This study provides evidence that elderly patients can undergo botulinum toxin treatment for hemifacial spasm without compromising their likelihood of achieving spasm‐freedom with future surgical decompression. Therefore, surgical decompression of the facial nerve is an effective therapy for elderly patients with hemifacial spasm refractory to botulinum toxin. [ABSTRACT FROM AUTHOR]

Every year, the United States records about 200 cases of botulism. Those who inject substances such as heroin, use homemade alcohol, and eat improperly prepared canned food are at risk of contracting this extremely rare disease. As seen in this case, those treated with Clostridium Botulinum Toxin are also considered to be in the risk group. However, iatrogenic botulism cases are much rare; and in the literature, case reports of botulism after intragastric Clostridium Botulinum Toxin administration are rare. We aimed to present these cases to draw attention to this rare condition in patients who presented to the emergency department with complaints such as weakness, dyspnea, and diarrhea. [ABSTRACT FROM AUTHOR]

The article examines how facial Botox injections impact the quality of life and happiness of nondepressed patients seeking cosmetic improvements. Topics discussed include the use of Botox for reducing facial wrinkles and its potential effects on mood, the impact on happiness scores versus quality of life, and the implications for using Botox in therapeutic settings for mood disorders.

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Copyright of Die Urologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Recent advancements in androgenetic alopecia (AGA) treatment have highlighted the efficacy of botulinum toxin (BoNT). However, inconsistencies in injection sites and depths warrant attention. It remains unclear which injection strategy is most beneficial for patients. Methods: This split-scalp randomized controlled trial divided each enrolled participant's scalp along the midline: one side was randomized to receive intramuscular BoNT injections in the surrounding muscles, while the other side received intradermal BoNT injections directly into the balding areas. This study evaluated the impact of treatment on hair density and diameter through trichoscopic examinations conducted at baseline and 12 weeks post treatment. Additionally, assessments of pain and overall safety were integrated into the study protocol. Results: Twenty-nine patients completed the study, with significant improvements in hair density observed in the intramuscular injection group compared to the intradermal group (p < 0.001). Both groups exhibited increases in hair diameter, but no significant difference was found between the two methods (p = 0.433). Pain evaluation revealed that intradermal injections in balding areas were more painful than intramuscular injections (p = 0.036), with no severe adverse reactions reported except for a single case of alopecia areata following injection. Conclusion: Our research revealed that both BoNT injection strategies enhanced hair diameter 12 weeks post-treatment, with intramuscular injections significantly improving hair density more effectively. Despite the promising outcomes, the variability in patient responses underscores the necessity for personalized approaches and further research to refine injection protocols for optimized efficacy and safety. Trial Registration Number: ChiCTR2400080190. [ABSTRACT FROM AUTHOR]

Osseointegration is a complex biological cascade that regulates bone regeneration after implant placement. Implants possessing complex multiscale surface topographies augment this regenerative process through the regulation of bone marrow stromal cells (MSCs) that are in contact with the implant surface. One pathway regulating osteoblastic differentiation is Wnt signaling, and upregulation of non-canonical Wnts increases differentiation of MSCs on these titanium substrates. Wnt16 is a non-canonical Wnt shown to regulate bone morphology in mouse models. This study evaluated the role of Wnt16 during surface-mediated osteoblastic differentiation of MSCs in vitro and osseointegration in vivo. MSCs were cultured on Ti substrates with different surface properties and non-canonical Wnt expression was determined. Subsequently, MSCs were cultured on Ti substrates +/−Wnt16 (100 ng/mL) and anti-Wnt16 antibodies (2 μg/mL). Wnt16 expression was increased in cells grown on microrough surfaces that were processed to be hydrophilic and have nanoscale roughness. However, treatment MSCs on these surfaces with exogenous rhWnt16b increased total DNA content and osteoprotegerin production, but reduced osteoblastic differentiation and production of local factors necessary for osteogenesis. Addition of anti-Wnt16 antibodies blocked the inhibitor effects of Wnt16. The response to Wnt16 was likely independent of other osteogenic pathways like Wnt11-Wnt5a signaling and semaphorin 3a signaling. We used an established rat model of cortical and trabecular femoral bone impairment following botox injections (2 injections of 8 units/leg each, starting and maintenance doses) to assess Wnt16 effects on whole bone morphology and implant osseointegration. Wnt16 injections did not alter whole bone morphology significantly (BV/TV, cortical thickness, restoration of trabecular bone) but were effective at increasing cortical bone-to-implant contact during impaired osseointegration in the botox model. The mechanical quality of the increased bone was not sufficient to rescue the deleterious effects of botox. Clinically, these results are important to understand the interaction of cortical and trabecular bone during implant integration. They suggest a role for Wnt16 in modulating bone remodeling by reducing osteoclastic activity. Targeted strategies to temporally regulate Wnt16 after implant placement could be used to improve osseointegration by increasing the net pool of osteoprogenitor cells. [ABSTRACT FROM AUTHOR]

Sleep bruxism, characterized by involuntary grinding or clenching of teeth during sleep, poses significant challenges in management due to its potential to induce temporomandibular joint disorders (TMDs) and other related symptoms. The use of Botulinum toxin Type A (BoNT-A), also known as Botox®, has been proposed as a therapeutic intervention. This systematic review aims to evaluate the efficacy and safety of BoNT-A in the management of sleep bruxism, focusing on pain reduction, improvement in jaw function, reduction in bruxism episodes, and the incidence of adverse effects. An exhaustive search was conducted across PubMed, Scopus, and Embase databases up to January 2024, adhering to the PRISMA guidelines. Nine randomized clinical trials (RCTs) involving 137 participants were analyzed for efficacy and safety outcomes. The studies demonstrated a significant reduction in mean pain scores (from 7.1 to 0.2 at 6 months and 1 year post-treatment in one study) and a notable decrease in the number of bruxism events (from 4.97/h to 1.70/h in the BoNT-A group in another study). Additionally, improvements were observed in jaw stiffness and total sleep time. Adverse effects varied but were generally mild and transient, including injection site pain in 20% of participants in one study and cosmetic changes in smile in 15.4% of patients in another. These findings suggest that BoNT-A injections may provide some benefits for treating nocturnal bruxism, potentially reducing TMD symptoms like pain and improving jaw function. However, these findings are preliminary due to variability in study designs and the absence of detailed statistical analysis. [ABSTRACT FROM AUTHOR]

Excessive gingival display (EGD) is defined as more than 2 mm of gingiva display above the maxillary incisors at maximum smile. Various skeletal, dental, and soft tissue etiological factors for EGD have been suggested. This study assessed the effectiveness and stability of surgical (SX) and nonsurgical (NSX) interventions for correction of EGD through a systematic review and meta-analysis following PRISMA 2020 guidelines. An electronic search of Ovid MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science, and LILACS was conducted (2010–2023). Results were expressed as mean change in gingival display using the random-effects model at 1, 3, 6, and 12-month follow-up. At 1 month, SX and NSX treatments yielded a comparable mean reduction of 3.50 mm (2.13–4.86) and 3.43 mm (2.67–4.19) in gingival display, respectively. However, by 6 months, NSX treatments showed a reduction of 0.51 mm compared to 2.86 mm with SX treatments. SX outcomes remained stable past 6 months, while NSX outcomes partially relapsed at 6 months and returned to baseline levels at 12 months. Notably, NSX treatments were more effective in cases with mild initial EGD, while SX treatments showed a better outcome in severe cases. To draw more robust conclusions regarding the treatment outcomes, future primary studies of greater rigor are required. [ABSTRACT FROM AUTHOR]

Introduction and purpose: Migraines are one of the most common neurological conditions in the world. They are characterized by recurring, intense headaches, often on one side of the head, which may be accompanied by symptoms such as nausea, vomiting, and sensitivity to light and sound. Migraines affect overall well-being and are an indicator of health, as well as potentially causing difficulties in normal functioning. One of the most effective methods of treating migraines in recent times has become botulinum toxin. This literature review will discuss how botulinum toxin affects the body and the course of treatment for chronic migraines. Material and methods: The literature was conducted using "Pub Med" and "Google Scholar" databases with the keywords „botulinum toxin”, „botox”, „migraine”, „botulinum toxin type A”. Brief description of the state of knowledge: Treatment of chronic migraines with type A botulinum toxin preparations was a breakthrough discovery. This medication demonstrates high effectiveness and better tolerance compared to other preparations used in the treatment of chronic migraines. Results and conclusions: Type A botulinum toxin has emerged as a versatile therapeutic tool with approved indications for treating chronic migraines and various other medical conditions. Despite its widespread application, gaps in research persist, particularly concerning its use during pregnancy, lactation, and among individuals under 18 years old. Further comprehensive studies in these demographics hold the potential to revolutionize chronic migraine treatment approaches. The administration method of botulinum toxin, exemplified by the Botox (Allergan) preparation, is meticulously defined and substantiated by extensive research validating its efficacy over the years.

Purpose:: While intradetrusor botulinum neurotoxin (BoNT) injection is a well-established treatment of neurogenic detrusor overactivity, its administration in individuals with complex genitourinary (GU) reconstruction can be difficult. The objective of this report is to highlight our institution’s experience with challenges and practical solutions in delivering BoNT to this unique patient population. Materials and Methods:: We performed a retrospective review of our institution’s database of adults with congenital neurogenic lower urinary tract dysfunction (NLUTD) with history of complex GU reconstruction who received intradetrusor BoNT injections performed by a single surgeon between 2016 and 2023. In patients with multiple injections, the most recent procedure was used as the index case for analysis. Results:: A total of 17 patients were included, with a mean age of 27 years (range 21–46). The most common diagnosis was myelomeningocele (n=13), followed by sacral agenesis (n=2), Williams syndrome (n=1), and urethral atresia (n=1). The most common GU reconstruction was augmentation cystoplasty (n=11). 75% (12/16) of the patients had a continent catheterizable channel (CCC) and 31% (5/16) had undergone prior bladder neck reconstruction or closure. Conclusion:: Additional considerations and instruments are required for safe and effective BoNT injections in individuals with congenital NLUTD and reconstruction. Adequate preparation by the staff and the provider may be needed. Our recommendation generally favors the utilization of a flexible cystoscope or a rigid scope with a smaller sheath size to minimize trauma to the CCC, bladder neck, or urethra. Additionally, it is advisable to consider reconstituting BoNT in higher concentrations to enable the administration of fewer injections. Furthermore, performing these procedures in the operating room under anesthesia allows for the development of a well-considered strategy prior to any attempts in the office setting We hope that this manuscript sparks discussion between pediatric urologists and adult urologist to expand our knowledge on strategies needed for delivering BoNT to individuals with complex and restricting GU surgeries.

Objective: This study aims to evaluate the forensic dimension of damages arising from cosmetic applications and determine the issues to be considered in this regard. Methods: Forensic cases who applied to our forensic medicine clinic between 2015 and 2022 to obtain a forensic report due to damage arising from cosmetic applications were retrospectively examined. Results: Out of 26 cases, 20 were women and 6 were men. The procedures were performed in beauty centers in 19 cases and hairdressers/ beauty salons in 7 cases. The complained application was laser epilation in 15, hair dyeing in 4, peeling in 2, botox in 1, tattoo removal in 1, hair transplant in 1, eyebrow microblading in 1, and cryolipolysis in 1. Of the cases, 15 complained of burns on their skin, 6 of skin redness, allergic reaction and scarring, and 5 of lack of dyeing, hair loss, sparse hair growth and burning at the base of the hair. Conclusion: When providing forensic expertise in the damage allegations arising from cosmetic procedures, many factors should be taken into consideration in the evaluation, such as whether there is an official license of the performer, whether there is an indication for the procedure, the method’s suitability for the applied area, hygiene conditions of the application environment, the way of the complication management, the patient’s adherence to the medical recommendations after the procedure.

Background: Since its discovery as a facial aesthetic treatment >30 years ago, onabotulinumtoxinA has received worldwide approval for dynamic upper facial line treatment. Objective: Meta-analysis examining the safety of onabotulinumtoxinA for treatment of glabellar lines (GL), crow’s feet lines (CFL), and forehead lines (FHL). Methods: Participants (N = 5298) with moderate to severe GL, CFL, or FHL at maximum contraction received onabotulinumtoxinA or placebo in 1 of 18 registration studies (14 double-blind, placebo-controlled [DBPC]; 1 double-blind; 3 open-label). Adverse events (AEs) were analyzed by descriptive statistics and fixed-effects meta-analysis. Results: In the overall double-blind placebo-controlled (DBPC) population, AEs were reported in 1443 (42.1%) and 486 (35.8%) participants in the onabotulinumtoxinA (n = 3431) and placebo (n = 1359) groups, respectively. Serious AEs were reported in 54 (1.6%) and 17 (1.3%) participants; 1 (spontaneous abortion) was considered possibly treatment related by the investigator. Using fixed-effects statistical meta-analysis, AEs of interest that were found to be statistically higher for onabotulinumtoxinA than placebo in the DBPC population were eyelid ptosis, eyelid sensory disorder, skin tightness, brow ptosis, eyelid edema, and facial pain (P ≤ .05). Limitations: Retrospective, ad hoc analysis. Conclusion: This meta-analysis confirms the onabotulinumtoxinA safety profile for GL, CFL, and FHL treatment, with no new onabotulinumtoxinA-associated AEs.

Botox treatment has become a popular method for reducing facial lines and wrinkles and rejuvenating the signs of aging. However, like any procedure, Botox can lead to temporary and minor complications. In the presence of certain systemic diseases such as diabetes mellitus, it is essential to take additional precautionary measures that should not be ignored, as it could turn into a life-threatening situation which may need to surgical intervention. Therefore, the key to success lies in ensuring that the procedure is carried out by skilled professionals, conducting a comprehensive medical history assessment, despite the simplicity of the procedure. Thus, we present a case of A 52-year-old diabetic woman came with a severe facial phlegmon persisting for 7 days and mentioned a previous Botox treatment 8 days ago. Drainage of the phlegmon was performed under general anesthesia using an intraoral vestibular approach.

Objective. Cosmetic procedures are popular in the world and practiced by both male and female. The origin of Botox is botulinum toxin of Clostridium botulinum, two main commercial types of botulinum (A and B) have been used in cosmetic clinics. The present study studied the distribution of the women according to types of cosmetic procedures, age groups, marital status, job status, and their knowledge about these procedures and its side effects. Methods. A total of 100 women were included with age group between (≤30 - >30) years. 54 (54%) have obtained cosmetic procedures (Botox, Filler, and plasma injections) while 46 (46%) have not obtained any cosmetic procedure. Platelets rich plasma was done by cosmetic specialized physician in private cosmetic clinic by using (Regen Kit BCT A-PRP). Platelets count was done in private Hematology laboratory by specialized Hematology physician. The device used for platelet count was (System XS 500). Collected data was subjected to statistical analysis by using SPSS version 20. Results. 51.85% women obtained their cosmetic procedures at a doctor clinic, (37.04%) at a Beauty Salon, and (11.11%) at both doctor clinic and Beauty Salon. Women within age group (≤30), (12%) have Botox only, (20%) have Filler only, (20%) have plasma injections only, (32%) Botox and Filler, (16%) have Botox, Filler, and plasma injections. 24.14% of women within age group (> 30), have Botox only, (6.90%) have Filler only, (13.79%) have plasma injections only, (31.03%) Botox and Filler, (6.90%) have Botox and plasma injections, (17.24%) have Botox, Filler, and plasma injections. Platelets count in PRP samples in stage 1 sample from woman no.1 was 373 × 109 /L, while in (stage 2) sample was 724 × 109 /L. Platelets count in whole blood of woman no.1 was (202 × 109 /L). Platelets count in stage 1 sample from woman no.2 was 413x 109 /L, while in (stage 2) sample was 808 × 109 /L, Platelets count in whole blood of woman no.1 was 320 × 109 /L. There was statistically significant increase in platelets count in stage 1 and stage 2 in both samples (P-value=0.05). Conclusions. Women within age group (≤30) prefer to do cosmetic treatment even if they do not need that. Many women have awareness and confidence in doing these cosmetic treatments in doctor clinic rather than beauty salon. PRP platelets count indicated that using (Regen Kit BCT A-PRP) was successful in obtaining concentrated PRP from woman’s blood sample, comparing with the normal platelets count in whole blood. Results also explained that increasing the speed and period of centrifugation in the method of (Regen Kit BCT A-PRP) might give high concentrate of PRP. [ABSTRACT FROM AUTHOR]

The management of giant inguinoscrotal hernias remains a challenge as a result of the loss of the intra-abdominal domain from long-standing hernia contents within the scrotum. Multiple techniques have been described for abdominal wall relaxation and augmentation to allow the safe return of viscera from the scrotum to the intraperitoneal cavity without adversely affecting cardiorespiratory physiology. Preoperative progressive pneumoperitoneum, phrenectomy, and component separation are but a few common techniques previously described as adjuncts to the management of these massively large hernias. However, these strategies require an additional invasive stage, and reproducibility remains challenging. Botulinum toxin A (BTA) has been successfully used for the management of complex ventral hernias. Its use for these hernias has shown reproducibility and a low side effect profile. In the present report, we describe our institutional experience with BTA for giant inguinal hernias in two patients and present a review of the literature. In one case, a 77-year-old man with a substantial cardiac history presented with a giant left inguinal hernia that was interfering with his activities of daily living. He had BTA six weeks prior to inguinal hernia repair. Repair was performed via an inguinal incision with a favorable return of the viscera into the peritoneum. He was discharged on the same day of the operation. A second patient, 78 years of age, had a giant right inguinoscrotal hernia. He had a significant cardiac history and was treated with BTA six weeks prior to inguinal hernia repair via a groin incision. Neither patient had complaints nor recurrence at 7- and 3-month follow-ups. While the literature on this topic is scarce, we found 13 cases of inguinal hernias treated with BTA as an adjunct. BTA might be a promising adjunct for the management of giant inguinoscrotal hernias in addition to or in place of current strategies. [ABSTRACT FROM AUTHOR]

Botulinum toxin type A (BONT-A) has shown promise in improving the mood-related symptoms of psychiatric disorders by targeting muscles linked to the expression of negative emotions. We conducted a systematic review of past and ongoing efficacy trials of BONT-A therapy for psychiatric disorders to identify relevant trends in the field and discuss the refinement of therapeutic techniques. A comprehensive search for published clinical trials using BONT-A injections for psychiatric disorders was performed on 4 May 2023 through OVID databases (MEDLINE, Embase, APA PsycINFO). Unpublished clinical trials were searched through the ClinicalTrials.gov and International Clinical Trial Registry Platform public registries. The risk of bias was assessed using the JBI Critical Appraisal tools for use in systematic reviews. We identified 21 studies (17 published, 4 unpublished clinical trials) involving 471 patients. The studies focused on evaluating the efficacy of BONT-A for major depressive, borderline personality, social anxiety, and bipolar disorders. BONT-A was most commonly injected into the glabellar area, with an average dose ranging between 37.75 U and 44.5 U in published studies and between 32.7 U and 41.3 U in unpublished trials. The results indicated significant symptom reductions across all the studied psychiatric conditions, with mild adverse effects. Thus, BONT-A appears to be safe and well-tolerated for psychiatric disorders of negative affectivity. However, despite the clinical focus, there was a noted shortage of biomarker-related assessments. Future studies should focus on pursuing mechanistic explorations of BONT-A effects at the neurobiological level. [ABSTRACT FROM AUTHOR]

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Objectives: Studies examining electromyography (EMG)‐guided laryngeal onobotulinumtoxinA (BTxA) injection for chronic cough reveal promising efficacy, however, are limited by small cohorts and absent quantifiable outcomes. It further remains unclear if pulmonary disease limits efficacy, or if vagal motor neuropathy prognosticates response. We hypothesize BTxA injection results in qualitative improvement in cough, decrease in Cough Severity Index (CSI), no change in Voice Handicap Index‐10 (VHI‐10), and complication rates comparable to historical data. We also examine the correlation of pulmonary comorbidities and vocal fold hypomobility with treatment efficacy. Study Design: Retrospective review. Methods: Charts for patients receiving percutaneous adductor compartment BTxA injection for cough were reviewed for the binary outcome of patient‐reported presence or absence of improvement. Generalized estimating equations regression models were used to analyze the change in CSI (ΔCSI) and the correlation of ΔCSI with qualitative outcomes. Multivariable analyses were used to examine correlation of vocal fold hypomobility and pulmonary disease with qualitative outcomes and ΔCSI. Results: Forty‐seven patients underwent 197 BTxA injections from June 2012 to June 2022. A statistical proportion of 0.698 (0.599–0.813, p < 0.0001) or 69.8% of injections resulted in subjective improvement. Mean ΔCSI was −2.12 (0.22–4.02, p < 0.05), indicating overall improvement. With and without subjective improvement, estimated ΔCSI was −4.43 and +2.68, respectively (p < 0.0001). VHI‐10 did not change (0.69, p = 0.483). Neither pulmonary disease nor vocal fold hypomobility correlated with subjective improvement or ΔCSI. Dysphagia occurred following 15 (7.6%) injections with no aspiration pneumonia or hospitalization. Conclusions: BTxA injection to the laryngeal adductors may effectively treat cough with limited risk for serious complications. Level of Evidence: 4 Laryngoscope, 134:1749–1756, 2024 [ABSTRACT FROM AUTHOR]

This paper introduces the Botox Optimization Algorithm (BOA), a novel metaheuristic inspired by the Botox operation mechanism. The algorithm is designed to address optimization problems, utilizing a human-based approach. Taking cues from Botox procedures, where defects are targeted and treated to enhance beauty, the BOA is formulated and mathematically modeled. Evaluation on the CEC 2017 test suite showcases the BOA's ability to balance exploration and exploitation, delivering competitive solutions. Comparative analysis against twelve well-known metaheuristic algorithms demonstrates the BOA's superior performance across various benchmark functions, with statistically significant advantages. Moreover, application to constrained optimization problems from the CEC 2011 test suite highlights the BOA's effectiveness in real-world optimization tasks. [ABSTRACT FROM AUTHOR]

Introduction The botulinum toxin is a widely used therapeutic agent. It is used for aesthetic reasons in treatment of glabellar wrinkles. Therapeutic indications include cervical dystonia, hyperhidrosis or migrenes. Also, it can be used in pain management, especially back pain. Back pain is one of the most common pain syndromes decreasing quality of life. Treatment involves various methods such as conservative and surgical approach. One of the methods is botulinum toxin. Objectives This article aims to evaluate usage, mechanism and treatment effects of back pain using botulinum toxin. Methods A Literature review of articles published in Pubmed between 2000 and 2024 using following words “botulinum toxin”, “botulinum”, “back pain” and “treatment”. Results Botulinum toxin injections are one of the pain management methods used especially in low back pain and myofascial pain syndrome. Treatment relies on its myorelaxant properties and inhibition of neuromodulator secretion such as substance P or acetylocholine. Pain relief effects are noted after three weeks and can last up to six months. In the initial stages a significant amount of patients report relief of pain. Conclusion Botulinum toxin is one of the treatment methods for lower back pain. It is a safe, minimally invasive and effective treatment. Patients can feel the relief even in three weeks and the effects might persist even up to six months.

Every year, the United States records about 200 cases of botulism. Those who inject substances such as heroin, use homemade alcohol, and eat improperly prepared canned food are at risk of contracting this extremely rare disease. As seen in this case, those treated with Clostridium Botulinum Toxin are also considered to be in the risk group. However, iatrogenic botulism cases are much rare; and in the literature, case reports of botulism after intragastric Clostridium Botulinum Toxin administration are rare. We aimed to present these cases to draw attention to this rare condition in patients who presented to the emergency department with complaints such as weakness, dyspnea, an [ABSTRACT FROM AUTHOR]

There is a need for a specialist pathway or progression in esthetic medicine for esthetic physicians. A structured program for specialized training in nonsurgical facial esthetics to empower physicians is the need of the hour. The pharmaceutical companies currently provide training sessions, taking considerable initiatives to train esthetic professionals. "Leaders of the future" is a global thought leadership program by the Allergan Aesthetics. The program was designed to support and nurture the next generation of leaders by focusing on science and evidence. It aimed to help practitioners grow, evolve, learn, share, and connect with leading international experts. The sessions were focused on the importance of science and sensibility in esthetic medicine, as well as critical thinking and leadership skills. Mentorship is one of the most effective approaches for transforming the lives of young esthetic practitioners and, in turn, future patients. In addition, the importance of in-depth knowledge of injection anatomy for safe practice was emphasized. As esthetic surgeons and physicians, we must commit to incorporating evidence-based medicine into our life-long practice. "Leaders of the Future" program aims to build a solid foundation for esthetic surgeons and physicians to grow and evolve as thought leaders. The program would also aid in the pursuit of a best esthetic practice that incorporates professional identity formation, clinical competence, and evidence-based management in nonsurgical esthetics. [ABSTRACT FROM AUTHOR]

Obesity is a global health problem, however, there is no consensus on the treatment for patients with a BMI between 30 and 35. Intragastric botulinum toxin injection (IGBT) has been proposed as a new endoscopic treatment for obesity, with the potential to delay gastric emptying and increase satiety by temporarily paralyzing the injected area. A retrospective study was conducted on 157 patients who received antral or fundus dominant IGBT and were followed up for 6 months with a diet program from January 2020 to December 2022. The patients were divided into three groups: Group 1 consisted of patients who received more injections in the fundus during IGBT, group 2 consisted of patients who received more injections in the antrum during IGBT, and group 3 consisted of patients who were only followed up with a diet program. Group 1 patients received 10 fundus and 10 antrum injections, while group 2 patients received 18 antrum and 2 fundus injections. Group 3 patients were only followed up with a diet program. Both antral and fundus dominant IGBT were effective in reducing body weight, and there was a significant difference between the two groups in terms of weight loss. Both groups 1 and 2 had significantly greater weight loss than group 3 (p [Med-Science 2023; 12(4.000): 1019-23]

This longitudinal study aimed to assess the quality of life in patients with anal fissures treated with botulinum toxin (Botox) injections over a one-year period. The study hypothesized that Botox injections would significantly improve quality of life and that these improvements would be sustained over a year. Conducted as a cross-sectional study, it assessed adults diagnosed with chronic anal fissures unresponsive to conventional treatments. Participants received 25 U of Botox in two sessions and their quality of life was assessed using the WHOQOL-BREF, COPE-60, Hospital Anxiety and Depression Scale (HADS), and SF-36 surveys. Data were collected at baseline six months and one year post-treatment. The study involved 113 patients, with a mean age of 38.1 years. Significant improvements were observed in the WHOQOL-BREF scores across all domains from baseline to 12 months (physical domain: 49.4 ± 10.5 to 70.2 ± 10.6, p < 0.001; mental domain: 34.8 ± 11.2 to 61.9 ± 11.5, p < 0.001). SF-36 scores also showed significant enhancements in physical and mental health components (physical: 44.3 ± 7.5 to 56.9 ± 5.9, p < 0.001; mental: 41.1 ± 7.2 to 54.4 ± 6.3, p < 0.001). Additionally, significant improvements were noted in patient perception on quality of life from the perspective of various aspects including physical discomfort, pain management, and mood and emotional well-being. The study demonstrated that Botox injections significantly improved the quality of life in patients with chronic anal fissures, with sustained benefits observed over a year. These findings suggest Botox as an effective treatment modality for enhancing life quality in patients with this condition, highlighting the potential for broader applications in managing chronic anal fissures. [ABSTRACT FROM AUTHOR]