bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment efficacy and safety of adalimumab versus tocilizumab in patients with active and severe Takayasu arteritis: an open-label study
Authors: Wang Jinghua , Kong Xiufang , Ma Lili , Ding Zhenqi , Chen Huiyong , Chen Rongyi , Jin Xuejuan , Chen Caizhong , Lin Jiang , Jiang Lindi 
Published: August 2023

Abstract

Objective
This study aimed to compare the efficacy and safety of adalimumab (ADA) vs tocilizumab (TCZ) in patients with Takayasu arteritis (TAK).

Methods
This was a randomized, controlled, open-label study. Forty patients with active and severe TAK were enrolled. They were treated with ADA (n = 21) combined with glucocorticoids (GCs) and MTX or TCZ (n = 19) combined with GCs and MTX. The planned follow-up duration was 12 months. The primary end point was the efficacy rate (ER) at 6 months. The secondary end points included ER at 9 and 12 months, relapse rate, GC tapering, adverse effects, and life quality changes during treatment.

Results
In the intention-to-treat (ITT) population, the ER at 6 months was higher in the ADA group (85.71% vs 52.63%, P = 0.02). A similar direction of effect was noted in the per-protocol set (89.47% vs 62.50%, P = 0.06). The percentages of patients who achieved a GC dose of ≤10 mg/day at 6 months were similar between the ADA and TCZ groups (47.37% vs 43.75%, P = 0.83). The ERs at 9 and 12 months were similar between the two groups (P &gt; 0.05). During the first 12 months of treatment, the relapse rate and adverse event incidence were comparable between the two groups (ADA vs TCZ: 9.52% vs 10.53%, P = 0.96; 38.10% vs 47.37%, P = 0.55, respectively).

Conclusion
ADA combined with GCs and MTX may be more efficacious than TCZ combined with GCs and MTX among patients with active and severe TAK.

Trial registration
Clinicaltrials.gov; NCT04300686.
Cerebrospinal-fluid biomarkers for predicting phenoconversion in patients with isolated rapid-eye movement sleep behavior disorder
Authors: Fernandes Mariana , Maio Silvia , Eusebi Paolo , Placidi Fabio , Izzi Francesca , Spanetta Matteo , De Masi Claudia , Lupo Clementina , Calvello Carmen , Nuccetelli Marzia , Bernardini Sergio , Mercuri Nicola Biagio , Liguori Claudio 
Published: August 2023

Abstract

Study Objectives
Patients with isolated rapid-eye-movement sleep behavior disorder (iRBD) have an increased risk of developing neurodegenerative diseases. This study assessed cerebrospinal-fluid (CSF) biomarkers of neurodegeneration and blood-brain barrier (BBB) alteration in patients with iRBD compared to controls and ascertain whether these biomarkers may predict phenoconversion to alpha-synucleinopathies (Parkinson’s Disease (PD), Dementia with Lewy bodies (DLB), Multiple System Atrophy (MSA)).

Methods
Patients and controls underwent between 2012 and 2016 a neurological assessment, a lumbar puncture for CSF biomarker analysis (β-amyloid42 - Aβ42; total-tau, and phosphorylated tau), and BBB alteration (CSF/serum albumin ratio). All patients with iRBD were followed until 2021 and then classified into patients who converted to alpha-synucleinopathies (iRBD converters, cRBD) or not (iRBD non-converters, ncRBD).

Results
Thirty-four patients with iRBD (mean age 67.12 ± 8.14) and 33 controls (mean age 64.97 ± 8.91) were included. At follow-up (7.63 ± 3.40 years), eight patients were ncRBD and 33 patients were cRBD: eleven converted to PD, 10 to DLB, and two to MSA. Patients with iRBD showed lower CSF Aβ42 levels and higher CSF/serum albumin ratio than controls. Cox regression analysis showed that the phenoconversion rate increases with higher motor impairment (hazard ratio [HR] = 1.23, p = 0.032). CSF Aβ42 levels predicted phenoconversion to DLB (HR = 0.67, p = 0.038) and BBB alteration predicted phenoconversion to PD (HR = 1.20, p = 0.038).

Discussion
This study showed that low CSF Aβ42 levels and high BBB alteration may predict the phenoconversion to DLB and PD in patients with iRBD, respectively. These findings highlight the possibility to discriminate phenoconversion in iRBD patients through CSF biomarkers; however, further studies are needed.
Cooling Down Inflammation in the Cardiovascular System via the Nicotinic Acetylcholine Receptor
Authors: Kaplan Abdullah , Lakkis Bachir , El-Samadi Lana , Karaayvaz Ekrem Bilal , Booz George W. , Zouein Fouad A. 
Published: August 2023

Abstract:
Inflammation is a major player in many cardiovascular diseases including hypertension, atherosclerosis, myocardial infarction, and heart failure. In many individuals, these conditions coexist and mutually exacerbate each other's progression. The pathophysiology of these diseases entails the active involvement of both innate and adaptive immune cells. Immune cells that possess the α7 subunit of the nicotinic acetylcholine receptor on their surface have the potential to be targeted through both pharmacological and electrical stimulation of the cholinergic system. The cholinergic system regulates the inflammatory response to various stressors in different organ systems by systematically suppressing spleen-derived monocytes and chemokines and locally improving immune cell function. Research on the cardiovascular system has demonstrated the potential for atheroma plaque stabilization and regression as favorable outcomes. Smaller infarct size and reduced fibrosis have been associated with improved cardiac function and a decrease in adverse cardiac remodeling. Furthermore, enhanced electrical stability of the myocardium can lead to a reduction in the incidence of ventricular tachyarrhythmia. In addition, improving mitochondrial dysfunction and decreasing oxidative stress can result in less myocardial tissue damage caused by reperfusion injury. Restoring baroreflex activity and reduction in renal damage can promote blood pressure regulation and help counteract hypertension. Thus, the present review highlights the potential of nicotinic acetylcholine receptor activation as a natural approach to alleviate the adverse consequences of inflammation in the cardiovascular system.
Vomer Flaps Support Velopharyngeal Competency, Fistula Free Repair, and 3D Construction of Normal Anatomy in Patients with Cleft Palate
Authors: Schmidt Gül , Toubekis Evjenia , Koch Hubertus , Schlabe Jürgen , Hunn-Stohwasser Christa , Beck-Broichsitter Benedicta , Heiland Max , Matuschek Carsten 
Published: August 2023

Background:
Cleft palate repair comprises the surgical creation of a congenitally nonexistent normal anatomy, to establish physiological function by moving tissues into their normal anatomical positions. In patients with isolated incomplete (IICP) or submucous (SMCP) cleft palate, the vomer is usually not completely attached to the palatal plate in the midline. This condition, which is visible through surgical access radiologically or via endoscope, is often disregarded during hard palate repair. This can lead to “hypernasality” despite a well-functioning velopharyngeal mechanism. The general practice of hard palate repair by suturing merely the nasal layers together separates the oral and nasal cavities. However, without incorporation of the vomer, it is impossible to build two separate nasal floors on the left and right sides. We consider that achieving normal speech and separation of the nasal cavities are mutually dependent and have to be considered equally.

Methods:
We described hard palate repair involving the vomer for construction of both nasal floors. We presented the occlusal relationship, hypernasality, and fistula rates in 37 patients operated on between January 1, 2017 and June 30, 2018.

Results:
One child presented minimal hypernasality; all others had normal resonance/voice. Fistula rate was zero, and no cross bites were observed.

Conclusions:
The implicit connection between the inner nose, resonance/voice, and prevention of fistulae has not yet been acknowledged. The correct usage of vomer flaps in IICP and SMCP creating separate nasal floors supports the velopharyngeal competency, avoids fistula formation, and should be incorporated regularly, like in other cleft forms.
Reinforced Biologic Mesh Reduces Postoperative Complications Compared to Biologic Mesh after Ventral Hernia Repair
Authors: Sivaraj Dharshan , Henn Dominic , Fischer Katharina S. , Kim Trudy S. , Black Cara K. , Lin John Q. , Barrera Janos A. , Leeolou Melissa C. , Makarewicz Nathan S. , Chen Kellen , Perrault David P. , Gurtner Geoffrey C. , Lee Gordon K. , Nazerali Rahim 
Published: August 2023

Background:
The use of biologic mesh to reinforce the abdominal wall in ventral hernia repair has been proposed as a viable alternative to synthetic mesh, particularly for high-risk patients and in contaminated settings. However, a comparison of clinical outcomes between the currently available biologic mesh types has yet to be performed.

Methods:
We performed a retrospective analysis of 141 patients who had undergone ventral hernia repair with biologic mesh, including noncross-linked porcine ADM (NC-PADM) (n = 51), cross-linked porcine ADM (C-PADM) (n = 17), reinforced biologic ovine rumen (RBOR) (n = 36), and bovine ADM (BADM) (n = 37) at the Stanford University Medical Center between 2002 and 2020. Postoperative donor site complications and rates of hernia recurrence were compared between patients with different biologic mesh types.

Results:
Abdominal complications occurred in 47.1% of patients with NC-PADM, 52.9% of patients with C-PADM, 16.7% of patients with RBOR, and 43.2% of patients with BADM (P = 0.015). Relative risk for overall complications was higher in patients who had received NC-PADM (RR = 2.64, P = 0.0182), C-PADM (RR = 3.19, P = 0.0127), and BADM (RR = 2.11, P = 0.0773) compared with those who had received RBOR. Furthermore, relative risk for hernia recurrence was also higher in all other mesh types compared with RBOR.

Conclusion:
Our data indicate that RBOR decreases abdominal complications and recurrence rates after ventral hernia repair compared with NC-PADM, C-PADM, and BADM.
The Modified M-plasty Approach to Mastectomy: Avoiding the Lateral Dog-ear
Authors: Meybodi Farid , Pham My , Sedaghat Negin , Elder Elisabeth , French James 
Published: August 2023

Summary:
Postmastectomy “dog-ears” are cosmetically displeasing, can contribute to a poorly fitting bra, and may cause discomfort for patients. They occur most commonly in patients with high body mass index and/or large breasts and can be challenging to manage. To avoid the lateral dog-ear following simple mastectomy, we describe the M-plasty with the addition of a lipodermal flap. We demonstrate that the addition of a lipodermal flap not only flattens the lateral contour of the chest wall but also facilitates a tension-free closure. This helps reduce wound-healing issues in high-risk patients with multiple comorbidities, high body mass index, and large breast size.
Successful Restoration of Elbow Extension Using the Latissimus Dorsi Flap: Case Report
Authors: Ozaniak Andrej , Hladik P. , Lischke R. 
Published: August 2023

Summary:
The latissimus dorsi (LD) myocutaneous flap is heavily used in reconstructive plastic surgery as either a local or distant flap, and mostly for coverage of large defects. To date, only a limited number of studies have described the use of an LD flap for functional reconstruction. Restoration of the extensor mechanism remains an unexplored area, and several issues remain to be addressed. First, generally accepted recommendations for the surgical technique do not include specific steps to achieve functional qualities of the upper extremity after complete removal of the triceps brachii muscle. Second, to date, it has not been clarified whether elbow extension requires correction because the movement can be naturally compensated for by gravity. To contribute to the current knowledge base in this field, the authors describe a technique for the reconstruction of an extensor mechanism of the elbow by transferring a pedicled functional LD flap while maintaining an intact insertion. Reconstruction was performed in a patient who experienced a second recurrence of a malignant peripheral nerve sheath tumor and underwent complete excision of the triceps brachii muscle. After excision, a meshed epidermal graft was used for wound closure. The patient’s postoperative course was uneventful. His elbow was immobilized for 3 weeks using an elbow splint, followed by intensive rehabilitation. The functional result was excellent, with an Enneking limb function score of 26. During the 16-month follow-up, no signs of local recurrence or systemic spread were observed.
Use of Double Myocutaneous Flap after Extended Resection of Locally Advanced Ulcerated Breast Carcinoma
Authors: Vieira René Aloisio da Costa , Oliveira Luiz Carlos Navarro de , Ching An Wan , de Oliveira-Junior Idam 
Published: August 2023

Summary:
Locally advanced ulcerated breast neoplasm is a condition that frequently occurs in developing countries. Generally, it is centrally localized and submitted to neoadjuvant therapy; thereafter, upon disappearance of the ulceration, it is submitted to radical mastectomy. Presence of axillary infiltration and ulceration with incomplete response makes it necessary for the use of surgical flaps for skin closure. We report a case in which primary reconstructive surgical procedure and skin closure was necessary, where we used double myocutaneous flaps—the latissimus dorsi and VRAM (vertical rectus abdominis myocutaneous) flap. We discussed treatment of the ulcerated lesions, possible surgical solutions, and the conditions associated with the use of double flaps. For primary closure of extensive areas, double myocutaneous flaps can be used as a solution in cases where skin grafts or surgical microsurgical flaps are not able to serve as a surgical solution. Myocutaneous flaps are associated with lower rates of complication, allowing for rapid recovery without increasing the time necessary before the next adjuvant therapy.
Tongue Flap for Total Full Thickness Upper Lip with Vermillion Reconstruction: Case Report
Authors: Mrad Mohamed A. , AlMarshad Felwa A. , AlMarghoub Mohammed A. , Mahabbat Nehal , AlMubarak Sultan K. 
Published: August 2023

Summary:
Lips play an important role in the function of the oral stoma. Lips also have a vital aesthetic role in the face. Lips are typically reconstructed by local, regional, or free flaps. Tongue flaps have been used for reconstruction of oral and palate defects resulting from congenital disorders, trauma, infection, and surgery. Because of its versatility, rich blood supply, and position, the tongue flap is reliable for defect reconstruction. In this study, we report a case of an upper lip full thickness defect managed with a tongue flap. The results were functionally and aesthetically excellent. To the best of our knowledge, this is the first attempt to reconstruct a full upper lip defect using the tongue.
Operation-related Musculoskeletal Injuries among United States Surgeons: A Gender-stratified National Survey
Authors: Tran Maria , Kortz Michael W. , Johnson Britt , Janis Jeffrey E. 
Published: August 2023

Background:
Operation-related musculoskeletal injury (ORMI) among surgeons is a well-described phenomenon. Our study aimed to determine the prevalence of self-reported ORMI among surgeons of various subspecialties and preliminarily investigate the role of gender.

Methods:
An anonymous survey, querying information pertinent to ORMIs, was distributed online through the American College of Surgeons community membership forum. Nonparametric univariate analysis and a multivariate regression model were conducted. A P value of 0.05 determined significance.

Results:
A total of 624 male and female surgeons responded to the survey, with 50.8% reporting having an injury related to operating. Among the entire cohort, the prevalence of ORMI was significantly higher among female surgeons than male surgeons (P = 0.01), although there was no significant difference among the genders in ORMI prevalence when stratifying by age group (all P > 0.05).

Conclusion:
Female surgeons are more likely to report an ORMI, although the impact of confounding variables such as age, operative case volume, and surgical subspecialty remain to be fully elucidated.
Trends, Gaps, and Collaboration in Facial Transplantation: A Bibliometric Study
Authors: Hoffman Alexandra F. , Rodriguez Colon Ricardo , Diep Gustave K. , Berman Zoe P. , Kimberly Laura L. , Trilles Jorge , Boczar Daniel , Chaya Bachar F. , Rodriguez Eduardo D. 
Published: August 2023

Background:
Facial transplantation (FT) has advanced extensively over the past two decades, with over 40 transplants performed to date. Over this time, the FT literature has evolved as well, from early discussions on ethics and feasibility of FT to functional outcomes reports more recently. We aimed to evaluate the entire body of FT literature to identify trends in publications over time in addition to current existing gaps in the field.

Methods:
We conducted a comprehensive bibliometric analysis of the published FT literature from 1994, the first year FT was mentioned in the literature, through July 2020. Co-authorship and keyword information were analyzed using VOSviewer. Articles were manually categorized based on keywords and their aim to provide insight on trends.

Results:
A total of 2182 articles were identified. Analysis identified the top 50 publishing authors in the field and demonstrated co-authorship linkage between 84.8% of the top 1000 authors. Clinical surgical techniques, protocols, and experiments were the most frequently published category. Within clinical outcomes, immunologic outcomes were most frequent, while psychosocial were the lowest. Gaps were identified in long-term outcomes reporting and patient-reported outcomes, with physician-reported outcomes heavily outweighing patient-reported outcomes.

Conclusions:
As the field continues to evolve, rigorous tracking of publication patterns over time will encourage development of a more robust evidence base, identify gaps in the published literature, and highlight opportunities to enhance collaboration in the field. This data will provide surgeons and research institutions with information to further improve this life-changing procedure.
Targeted Nipple Areola Complex Reinnervation in Gender-affirming Double Incision Mastectomy with Free Nipple Grafting
Authors: Gfrerer Lisa , Winograd Jonathan M. , Austen William G. , Valerio Ian L. 
Published: August 2023

Background:
Restoration of breast sensation has become an important goal in autologous and implant-based breast reconstruction after cancer-related mastectomy. Although gender-affirming mastectomy with free nipple grafting (FNG) results in similar sensory deficits, chest reinnervation concepts have not been applied to this procedure.

Methods:
This article describes a novel technique to reinnervate the FNG in patients undergoing double incision gender mastectomy.

Results:
Our technique differs from previously described reinnervation techniques in several aspects: (1) the donor axon count is maximized by preserving the third to fifth lateral cutaneous nerves for coaptation to the nipple areola complex, (2) the reinnervation approach varies and is based on patient anatomy, (3) the distal graft or donor nerve is split into fascicles to increase the reinnervation zone, and (4) the split fascicles are coapted to the dermatosensory peripheral nerve elements of the dermis.

Conclusion:
Chest reinnervation is technically feasible in patients undergoing double incision gender mastectomy with FNG (please also see the video abstract).
The Application of Medical Tattooing in Cosmetic Breast Surgery
Authors: Becker Stacie , Proctor Miranda , Cassisi Jeffrey E. 
Published: August 2023

Summary:
Historically, medical tattooing has mainly been applied to correct or simulate the nipple areola complex among breast cancer survivors postmastectomy. Our purpose was to extend the application of medical tattooing to other cosmetic breast surgeries in a complimentary fashion and to improve aesthetic outcomes through scar blending, areola extension, and/or decorative appliques. Two case studies in which medical tattooing was applied following breast augmentation or reduction are presented. Our clinical procedures are described, including assessment, treatment planning, equipment, inks, and considerations for topical anesthesia. The two cases illustrate the range of applications of medical tattooing in cosmetic breast surgery from minor touch-up, to using elaborate decorative appliques for camouflage. Preoperative photographs, and postoperative patient photographs illustrating good aesthetic outcomes are presented. The field of medical tattooing is effective and is expanding rapidly but needs professional direction. We suggest plastic and cosmetic surgery practices develop active and intentional relationships with professional tattoo artists. Professional medical organizations should lead the development of medical tattoo assistant training and credentialling. Priorities for future research are described.
What is new with irritable bowel syndrome
Authors: Kamal Hebat Y. , Morneault-Gill Kayla , Chadwick Christina B. 
Published: August 2023

Purpose of review
This review aims to summarize the most up-to-date criteria for diagnosis of pediatric irritable bowel syndrome (IBS) and treatment options. It also explores recent research that has been performed evaluating risk factors, pathophysiology, and treatment designed to improve quality of life for those who suffer from IBS. IBS is a common disorder in pediatrics and one of the most common causes of abdominal pain for children; thus, it can be quite debilitating for individuals to achieve a satisfactory quality of life on a routine basis. Reliable, available treatment is needed but can be challenging to find, given the variety of symptoms and triggers involved and lack of a clear understanding of how IBS develops.

Recent findings
There are multiple pharmacologic and nonpharmacologic treatment options being explored and studied globally but further, larger, and well controlled studies are needed to confirm these outcomes.

Summary
Because pediatric IBS is one of the most common functional disorders associated with abdominal pain and can be brought on by multiple factors, management often involves addressing these individual triggers with a multifaceted treatment plan, which could include dietary changes, probiotics, medication, or psychotherapy and should be tailored to each affected individual.