Effects of lidocaine incorporation (without epinephrine) on pain and 2-week complications of botulinum toxin: a double-blind randomized placebo-controlled clinical trial.

No study has assessed the effects of the incorporation of isolated lidocaine into botulinum toxin for reducing its pain or complications. Studies on the dilution of botulinum toxin with other materials are as well extremely few, small, and limited methodologically. Therefore, we aimed to evaluate, for the first time, the effects of the incorporation of lidocaine alone into botulinum toxin type A on post-injection pain and complications. In this 2-week prospective, multicenter, double-blind randomized placebo-controlled clinical trial, 729 participants (667 females) were enrolled. They were randomized into placebo and lidocaine dilutions (about 2:1), and then into two brands of toxins (Dysport versus Xeomin). Hence, there were 4 subgroups. In the 2 experimental subgroups, botulinum toxin was diluted with 2% lidocaine without adrenaline; in the 2 control subgroups, botulinum toxin was diluted with normal saline as a placebo. After injection, the pain level was recorded (as an 11-scale numerical rating scale from 0 to 10). After 2 weeks, post-injection complications were assessed based on the participants' reports and the surgeon's observations. Data were analyzed using 3-way ANCOVA, multiple binary logistic regression, and bivariable analyses (α = 0.05, ß ≤ 0.1). The mean ± SD pain levels in the lidocaine group (n = 263) and the placebo group (n = 466) were 3.51 ± 2.04 and 4.15 ± 2.35, respectively. The mean ± SD pain levels in the subgroups 'Xeomin-Lidocaine (n = 61), Dysport-Lidocaine (n = 202), Xeomin-Placebo (n = 133), and Dysport-Placebo (n = 333)' were respectively 3.39 ± 1.86, 3.55 ± 2.09, 4.61 ± 2.49, and 3.97 ± 2.24. Lidocaine incorporation (P = 0.001), Dysport brand (P = 0.030), and younger age (P = 0.032) [but not sex (P = 0.406)] reduced pain. The only significant findings for 2-week complications were for the associations observed between aging with increased asymmetry (P = 0.022, OR = 1.032) and a need for a retouch (P = 0.039, OR = 1.021). Botulinum toxin dilution with lidocaine alone (without adrenaline or other ingredients) can reduce pain without affecting postinjection complications. Toxin brands may cause different extents of pain. Aging, but not sex, may increase pain. Two-week complications were not affected by any factors, except aging in the case of asymmetry and the need for a botulinum toxin retouch.

Extracellular vesicles biogenesis, isolation, manipulation and genetic engineering for potential in vitro and in vivo therapeutics: An overview.

The main goals of medicine consist of early detection and effective treatment of different diseases. In this regard, the rise of exosomes as carriers of natural biomarkers has recently attracted a lot of attention and managed to shed more light on the future of early disease diagnosis methods. Here, exosome biogenesis, its role as a biomarker in metabolic disorders, and recent advances in state-of-art technologies for exosome detection and isolation will be reviewed along with future research directions and challenges regarding the manipulation and genetic engineering of exosomes for potential in vitro and in vivo disease diagnosis approaches.

Low oxygen tension promotes invasive ability and embryo implantation rate.

Low oxygen concentrations during in vitro embryo development not only improving the embryo quality but also can lead to successful implantation. Yet, there is no investigation at the molecular level to indicate the association between increased implantation rate and invasive ability of blastocyst and its inner cell mass quality with in vitro culture under a hypoxic condition. Therefore, the present study was designed to investigate blastocyst formation, total cell number, hatching and implantation rates. In addition we assessed the transcription levels of invasion-(Mmp-9 and uPA) and pluripotency-related genes (Pou5f1, Nanog) in mouse blastocyst under hypoxic condition. In vivo two-cell embryos were randomly divided into two groups; 5% O2 and 20% O2. Embryos were then cultured to the blastocyst stage and evaluated in terms of cellular parameters. The expression levels of selected genes were also analyzed both in experimental group and in vivo blastocysts recovered from uteri as control group. Results indicated the blastocyst formation, hatching and implantation rates were improved when the embryos were cultured in hypoxic condition. Furthermore, the expression levels of Mmp-9, Nanog and Pou5f1 showed an increase in 5% O2 in comparison with 20% O2 group. In conclusion, it seems that hypoxic condition by increasing the quality and invasion ability of the blastocyst can improve implantation rate.