Efficacy and Safety of Fillers for the Treatment of Nasolabial Folds: A Network meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Nasolabial fold formation is increasingly becoming a cause of concern for many people. However, no network meta-analysis has compared the efficacy of different fillers in treating nasolabial folds. This network meta-analysis simultaneously compared the efficacy and safety of various fillers. METHODS: We included randomized controlled trials (RCTs) that used fillers to treat nasolabial folds. We extracted data of Wrinkle Severity Rating Scale (WSRS), Global Esthetic Improvement Scale (GAIS, investigator) scores, GAIS scores (self-reported) and adverse events. RESULTS: We included 13 RCTs. WSRS scores at 6 months were higher in patients receiving HA than those receiving poly (L-lactic acid) (mean difference [MD] 0.630, 95% confidence interval [CI] 0.275, 0.985) but significantly lower in patients receiving HA than in those receiving bovine collagen (MD - 0.580, 95% CI - 0.777, - 0.383) and porcine collagen (MD - 0.525, 95% CI - 0.790, - 0.260). Regarding adverse events, HA was significantly less likely to cause nodule formation compared with bovine collagen (RR 0.593, 95% CI 0.438, 0.803). CONCLUSION: HA is a safe filler for correcting nasolabial folds, and poly (L-lactic acid) showed potential in treating nasolabial folds. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The functional change of the P2X7R containing the Ala348 to Thr polymorphism is associated with the pathogenesis of gout.

Our previous study has shown that ATP action on P2X7R could be the second signal to induce the onset of gouty arthritis. However, the functional changes of P2X7R single nucleotide polymorphisms (SNPs) on the effects of ATP-P2X7R-IL-1ß signaling pathway and uric acid remained unknown. We aimed to investigate the association between the functional change of P2X7R containing the Ala348 to Thr polymorphisms (rs1718119) and the pathogenesis of gout. First, 270 gout patients and 70 hyperuricemic patients (without gout attack history in recent 5 years) were recruited for genotyping. In addition, the changes of ATP-induced pore formation were assessed in HEK-293T cells overexpressing different mutants in P2RX7, and the effects on P2X7R-NLRP3-IL-1ß pathway activation were explored in P2RX7 overexpression THP-1 cells. The risk allele for gout was A at rs1718119, and the AA and AG genotypes exhibited a higher risk of gout. Furthermore, Ala348 to Thr mutants increased P2X7-dependent ethidium+ bromide uptake, upregulated IL-1ß and NLRP3 levels as compared to the wild-type. We suggest that genetic polymorphisms of P2X7R containing the Ala348 to Thr are associated with the increased risk of gout, showing an enhanced gain-of-function effect on the development of this disease.

Effectiveness and Safety of Energy-Based Devices for Acne Scars: A Network Meta-Analysis of Randomized Controlled Trials.

Background: Acne vulgaris is an inflammatory disease of the pilosebaceous unit in teenagers. Acne-induced inflammation leads to acne scarring. Scholars have discussed acne scar treatments; however, energy-based devices with satisfactory outcomes remain unidentified. Objective: To measure quartile grading scale and visual analog scale (VAS) to study the difference between energy-based devices. Methods: We included randomized controlled trials that evaluated patients with acne scars. The primary outcomes were the quartile grading scale and VAS scores. We used Confidence in Network Meta-Analysis to evaluate indirectness, imprecision, heterogeneity, and incoherence. Results: A total of 26 studies met the inclusion criteria. The quartile grading scale results revealed that ablative fractional laser was significantly more effective than nonablative fractional laser (standard mean difference [SMD]: 0.516, confidence interval [95% CI]: 0.281-0.750) and radiofrequency treatment (SMD: 0.941, 95% CI: 0.540-1.342). Moreover, nonablative fractional laser was significantly more effective than radiofrequency treatment (SMD: 0.426, 95% CI: 0.049-0.802). No significant difference in VAS score was found among the devices. Conclusion: Ablative fractional laser is an effective treatment for acne scars although it is associated with more pain.

Effectiveness of Botulinum Toxin Type A Injection on Scars: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Scars can cause pain, long-term physical dysfunction, and psychological harm. Botulinum toxin type A (BoNT-A) is one treatment choice for scars, but further evidence is needed to confirm its efficacy. METHODS: This systematic review included randomized controlled trials that investigated the effectiveness of BoNT-A on scars. The mean and standard deviation for the Vancouver Scar Scale, Stony Brook Scar Evaluation Scale, visual analog scale for appearance evaluation, visual analog scale for scar pain evaluation, and scar width were extracted for subgroup analysis. RESULTS: Twenty-one randomized controlled trials were included. The BoNT-A group had a lower Vancouver Scar Scale score than the saline group (standardized mean difference, -0.73; 95 percent CI, -1.12 to -0.35; p = 0.0002) but a higher score than the steroid group (standardized mean difference, 0.85; 95 percent CI, 0.27 to 1.43; p = 0.004). The BoNT-A group exhibited a higher Stony Brook Scar Evaluation Scale grade than the saline group (standardized mean difference, 1.42; 95 percent CI, 0.83 to 2.00; p < 0.00001). The visual analog scale for appearance evaluation revealed higher scores in the BoNT-A group than in the saline group (standardized mean difference, 1.14; 95 percent CI, 0.69 to 1.60; p < 0.00001). As for pain evaluation, the BoNT-A group had a lower visual analog scale score than the steroid group (standardized mean difference, -2.57; 95 percent CI, -4.40 to -0.74; p = 0.006). Furthermore, scar width was significantly shorter in the BoNT-A group than in the control group (standardized mean difference, -1.11; 95 percent CI, -1.38 to -0.83; p < 0.00001). CONCLUSIONS: BoNT-A is more effective in treating scars than saline, although steroids may exhibit higher potency. Therefore, it can be considered an alternative in patients not amenable to steroid treatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.