bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ixekizumab in radiographic axial spondyloarthritis with and without elevated C-reactive protein or positive magnetic resonance imaging
Authors: Maksymowych Walter P , Bolce Rebecca , Gallo Gaia , Seem Emily , Geneus Vladimir J , Sandoval David M , Østergaard Mikkel , Tada Kurisu , Baraliakos Xenofon , Deodhar Atul , Gensler Lianne S 
Published: February 2022

Abstract

Objective
To evaluate response rates at week 16 with ixekizumab in patients with radiographic axial SpA (r-axSpA) and elevated or normal/low baseline inflammation measured by serum CRP or spinal MRI using data from two randomized, double-blind, placebo (PBO)-controlled phase III trials.

Methods
Biologic-naïve (COAST-V) or TNF inhibitor-experienced (COAST-W) adults with active r-axSpA received 80 mg ixekizumab every 2 weeks (IXEQ2W) or 4 weeks (IXEQ4W) or PBO or active reference [40 mg adalimumab every 2 weeks (ADAQ2W) in COAST-V. At week 16, patients receiving ixekizumab continued as assigned and patients receiving PBO or ADA were rerandomized 1:1 to IXEQ2W or IXEQ4W through week 52. Assessment of SpondyloArthritis international Society 40% (ASAS40) response rates were examined by baseline CRP (≤5 or &gt;5 mg/l) and Spondyloarthritis Research Consortium of Canada (SPARCC) MRI spine inflammation score (&lt;2 or ≥2).

Results
In the COAST-V/W integrated dataset (N = 567), significantly more patients treated with ixekizumab achieved ASAS40 response at week 16 by CRP ≤5 mg/l (27% IXEQ4W, P &lt; 0.05; 35% IXEQ2W, P &lt; 0.01 vs 12% PBO), CRP &gt;5 mg/l (39% IXEQ4W, P &lt; 0.001; 43% IXEQ2W, P &lt; 0.001 vs 17% PBO), SPARCC MRI spine score &lt;2 (40% IXEQ4W P &lt; 0.01, 52% IXEQ2W P &lt; 0.001 vs 16% PBO), and SPARCC MRI spine score ≥2 (44% IXEQ4W P &lt; 0.001, 47% IXEQ2W P &lt; 0.001 vs 19% PBO). ASAS40 response was observed with CRP ≤5 mg/l and SPARCC MRI spine score &lt;2 with IXEQ4W (29%) and was significant with IXEQ2W (48%; P &lt; 0.05) vs PBO (13%).

Conclusion
Ixekizumab demonstrated efficacy in the treatment of AS/r-axSpA in patients with and without elevated CRP or evidence of spinal inflammation on MRI.

Trial registration
ClinicalTrials.gov (https://clinicaltrials.gov): NCT02696785, NCT02696798
AaTAS1 and AaMFS1 Genes for Biosynthesis or Efflux Transport of Tenuazonic Acid and Pathogenicity of Alternaria alternata
Authors: Sun Fan , Cao Xueqiang , Yu Dianzhen , Hu Dongqiang , Yan Zheng , Fan Yingying , Wang Cheng , Wu Aibo 
Published: February 2022

Taking tenuazonic acid (TeA) synthetase 1 (TAS1) in Pyricularia oryzae as a reference, the homolog AaTAS1 was first anchored in Alternaria alternata via de novo sequencing. Subsequently, AaMFS1, as a major facilitator superfamily (MFS) protein–encoding gene in the adjacent upstream region, was followed with interest. As hypothesized, AaTAS1 is required for TeA biosynthesis, while AaMFS1 is an efflux pump for the transmembrane transport of TeA. Comparatively, the TeA yield of ΔAaTAS1 and ΔAaMFS1 dropped significantly compared with that of the wild-type strain. Specifically, the A domain of AaTAS1 catalyzed the start of TeA biosynthesis in vitro. Simultaneously, the pathogenicity of ΔAaTAS1 was also significantly decreased. Transcriptome analysis confirmed the abovementioned consistency between the TeA-producing phenotypes and related gene expression. Moreover, the proteins AaTAS1 and AaMFS1 were found present in the cytoplasm, plasma membrane, and intracellular membrane system, respectively, by fluorescence localization. Namely, AaTAS1 was responsible for the biosynthesis of TeA, and AaMFS1 was responsible for the efflux transport of TeA. Certainly, AaTAS1 indirectly regulated the expression of AaMFS1 through the level of synthetic TeA. Overall, data on the novel AaTAS1 and AaMFS1 genes mainly contribute to theoretical advances in mycotoxin biosynthesis and the pathogenicity of phytopathogens to agricultural foods. [Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Dealing with the Displaced Nipple–Areola Complex in Macromastia Using a Superomedial Pedicle and Inverted T Pattern
Authors: Hudson Donald A. , Lelala N. Bruce 
Published: February 2022

Background:
In macromastia, especially in patients with a raised BMI, the nipple areola complex (NAC) may be displaced from the breast midline/meridian. This is poorly documented, and there is little published on surgical management. The aim of the study was to identify the incidence of displaced NAC in macromastia and discuss the management using the superomedial pedicle, by canting the vertical limbs of the inverted T/keyhole. The study also aimed to postulate a theory of pathogenesis.

Methods:
The study is a retrospective review for a two-and-a-half year period. For study inclusion, the NAC had to be displaced 3 cm or more from the breast meridian. A superomedial pedicle was used with an inverted T pattern. The vertical limbs of the keyhole were canted medially for medially displaced NACs and laterally for laterally displaced NACs.

Results:
Fifteen patients were identified: three with medial and 12 with laterally displaced NAC. Mean age was 35 years (range 21–61) with a mean BMI of 31 (range 27–37). The mean mass of tissue excised was 1158 g (range 330–1969 g). The mean follow up is 7 months (range 2–21 months). One patient suffered partial areola loss, and 2 patients had a breakdown at the angle of sorrow/inverted T junction.

Conclusions:
The displaced NAC is not uncommon in women with a raised BMI presenting for breast reduction. Canting the vertical limbs of the keyhole away from the deviated NAC yields satisfactory results in treating patients with a displaced NAC using a superomedial pedicle. A theory of possible pathogenesis is postulated; global attenuation of the breast footplate occurs, leading to lateral and inferior displacement of the NAC.
Median Nerve Traction Caused by Palmaris Profundus Muscle: A Case Report
Authors: Flores Tonatiuh , Sabitzer Hugo , Bergmeister Konstantin D. , Schatten Philipp , Pollhammer Michael , Metzger Gerald , Schrögendorfer Klaus F. 
Published: February 2022

Summary:
The palmaris longus muscle is one of the most variant muscles in the human body. Its variations such as the palmaris profundus can cause nerve compression symptoms. Here, we present a case of severe nerve affection due to a palmaris profundus muscle. The palmaris profundus tendon was partially resected at intervention. Pain symptoms started immediately after wearing off of the local anesthetic, and revision surgery had to be performed. Severe traction on the median nerve by the palmaris profundus tendon could be observed at revision. The resection of the palmaris profundus tendon instantly eased the patient’s severe pain. At preoperative examination and planning of surgery, the palmaris profundus was not detected. As there is no test for the detection of anatomic variations of the palmaris longus muscle at physical examination, discovering such anomalies is not possible without imaging tools. Ultrasonographic examinations aid in preoperative planning of carpal tunnel release, especially at revision surgeries.
Supercharging the Smile: A Novel Dual Nerve Transfer for Facial Reanimation
Authors: Kuta Victoria , Taylor S. Mark 
Published: February 2022

Background:
Facial paralysis has profound effects on the functional and psychosocial well-being of patients. Various surgical facial reanimation techniques have been described to address this devastating condition. While traditional surgical approaches have proved successful in restoring either facial tone or facial movement, newer combination nerve transfer techniques are addressing the limitations of the traditional single nerve transfer approaches.

Methods:
This study aimed to describe a promising new surgical approach to facial reanimation utilizing a dual nerve transfer to maximize both resting and active symmetry while minimizing postoperative synkinesis. Here, we use the masseteric nerve to selectively innervate the midface in combination with a hypoglossal facial nerve graft to reanimate the remaining facial regions.

Results:
To date, we have performed this operation on four patients, all of whom tolerated the procedure well. Our patients are showing significant improvements in both resting facial tone and facial movement with no signs of synkinesis at 9 months postoperative.

Conclusions:
We believe this dual nerve transfer to be superior in restoring the combination of tone, symmetry, and movement to the paralyzed face when compared with traditional single nerve transfer approaches.
Unilateral Cleft Lip Repair: Technical Maneuvers to Achieve Vermilion and Mucosal Height
Authors: Chiang Sarah N. , Zubovic Ema , Skolnick Gary B. , Patel Kamlesh B. 
Published: February 2022

Background:
Patients with unilateral cleft lip often require secondary procedures due to asymmetric fullness or deficiencies along the mucosal free margin of the upper lip. Here, we describe our technique for mucosal advancement and repair to attain symmetry.

Methods:
Maneuvers to obtain vermilion and mucosal height include (1) use of a tailored vermilion flap; (2) supraperiosteal release of the lesser segment; (3) backcut “poker incision” to mobilize the mucosal flap on the lesser segment; (4) transverse release of mucosa across the greater segment; (5) accurate reduction along vermilion-mucosal junction; and (6) bilateral medial mucosal advancement. To examine postoperative outcomes, photographic data were available for 14 patients with unilateral complete cleft lip. The Cleft Lip Component Symmetry Index was then calculated as a ratio of upper lip height on cleft to noncleft sides, where an index of 1 indicates symmetry.

Results:
Sixteen consecutive patients underwent unilateral cleft lip repair with this technique over a 3-year period, none of whom have required secondary operations. The symmetry index for 14 of 16 patients was 1.02 ± 0.11 (95% confidence interval [0.96, 1.08], P = 0.56), demonstrating satisfactory upper lip symmetry.

Conclusions:
Postoperative asymmetry after unilateral cleft lip repair, particularly along the free margin, continues to be a common problem, necessitating secondary procedures. The technique of mucosal repair merits more careful attention than it has previously received, and here we describe in detail a method that has allowed for improved symmetry.
Ventricular Infusion and Nanoprobes Identify Cerebrospinal Fluid and Glymphatic Circulation in Human Nerves
Authors: Pessa Joel E. 
Published: February 2022

Background:
Growing evidence suggests that cerebrospinal fluid circulates in human nerves. Several conditions encountered by the plastic surgeon may be related to dysregulation of this system, including nerve transection, stretch injuries, and peripheral neuropathy. The purpose of this study was to show how ventricular infusion and nanoprobes identify CSF and glymphatic circulation in neural sheaths of human nerves.

Methods:
The technique of ventricular infusion using buffered saline was developed in 2017. The technique was used in a series of eight fresh cadavers before dissection of the median nerve, and combined with fluorescent imaging and nanoprobe injections in selected specimens.

Results:
Eight cadaver specimens underwent ventricular infusion. There were six female and two male specimens, ages 46–97 (mean 76.6). Ventricular cannulation was performed successfully using coordinates 2 cm anterior to coronal suture and 2.5 cm lateral to sagittal suture. Depth of cannulation ranged from 44 to 56 mm (mean 49.7). Ventricular saline infusion complemented by nanoprobe injection suggests CSF flows in neural sheaths, including pia meninges, epineurial channels, perineurium, and myelin sheaths (neurolemma).

Conclusions:
Ventricular infusion and nanoprobes identify CSF flow in neural sheaths of human nerves. CSF flow in nerves is an open circulatory system that occurs via channels, intracellular flow, and cell-to-cell transport associated with glial cells. Neural sheaths, including neurolemma, may participate in glucose and solute transport to axons. These techniques may be used in anatomic dissection and live animal models, and have been extended to the central nervous system to identify direct ventricle-to-pia meninges CSF pathways.
Management of Acute Complicated Mastoiditis
Authors: Kaufmann Matthew R. , Shetty Kunal , Camilon P. Ryan , Shetty Anisha , Levi Jessica R. , Devaiah Anand K. 
Published: February 2022

Background:
The objective of our study was to evaluate the efficacy of treatment options for the most frequently reported complications of acute mastoiditis in the English literature. PubMed, EMBASE, and The Cochrane Library were searched from database inception through March 29, 2019.

Methods:
Two independent reviewers (M.R.K., K.S.) evaluated search results for study inclusion. References cited in publications meeting inclusion criteria were reviewed. Twenty-three included studies were published from 1998 through 2018. Treatment efficacy was determined by comparing the change in number of complication subtypes in each treatment subgroup (medical, conservative, or surgical) from admission to discharge (range: 5–30 days) or postdischarge follow-up (range: 1–27.5 months) with a random effects model.

Results:
Among 733 identified articles, 23 met inclusion criteria. Of the 883 included patients, 203 were managed medically (23%), 300 conservatively (34%) and 380 surgically (43%). Conservative patients had more extracranial complications (ECC, P = 0.04) and intratemporal complications (IT, P = 0.04) at follow-up compared with medical patients. Medical patients had more total number of complications (TNC, P = 0.03), ECC (P = 0.02), and IT (P = 0.01) at discharge compared with surgical patients. Conservative patients had more of all complications except intracranial/extracranial abscess and “other” at discharge and follow-up compared with surgical patients.

Conclusions:
There were larger reductions in TNC, ECC, and IT at discharge and follow-up among surgical patients compared with medical and conservative patients. There were greater reductions in TNC, ECC, IT, intracranial complications, subperiosteal abscess and lateral sinus thrombosis at discharge and follow-up among surgical patients compared with conservative patients.
Spyramicine and Trimethoprim-Sulfamethoxazole Combination to Prevent Mother-To-Fetus Transmission of Toxoplasma gondii Infection in Pregnant Women: A 28-Years Single-center Experience
Authors: Buonsenso Danilo , Pata Davide , Turriziani Colonna Arianna , Iademarco Mariella , De Santis Marco , Masini Lucia , Conti Guido , Molle Fernando , Baldascino Antonio , Acampora Anna , Luciano Rita , Gallini Francesca , Valentini Piero 
Published: February 2022

Background:
There is weak evidence on the best treatment of pregnant women with Toxoplasma gondii infection to prevent the vertical transmission to the fetus.

Methods:
We conducted a 28-year retrospective study aiming to compare the efficacy of three therapeutic regimens [Spiramicyn alone (Spy) vs. Pyrimethamine-Sulfadiazine (P/S) vs. Spiramicyn with Trimethoprim-Sulfamethoxazole (Spy+TMP-SMX)] for the prevention of mother-to-fetus transmission of T. gondii infection.

Results:
170 women were included: 58 (34.1%) had certain congenital toxoplasmosis (CT), 61 (35.9%) a probable infection and 41 (24.1%) possible infection. In total 97 mothers (57.1%) were treated with the Spy+TMP-SMX combination, 64 mothers (37.6%) were treated with Spy only and 8 mothers (4.7%) with P/S. Infected infants were 20/170 (11.7%). However, 8.2% (8/97) of infants born to mothers treated with Spy+TMP-SMX were infected, 20% (11/55) of infants born to women treated with Spy and 12.5% (1/8) of infants born to mothers treated with P/S were infected. Logistic regression analysis demonstrated that Spy treatment alone was associated with an increased risk of CT compared to the Spy+TMP-SMX combination (OR, 2.78, 95% CI 1.04-7.41, P value 0.041). No difference was observed when the Spy+TMP-SMX was compared with the P/S combination (OR 1.59; 95% CI 0.17 - 14.58; P value 0.682). Results were confirmed when the analyses were corrected by trimester of infection and by type of maternal treatment (OR 7.72; 95% CI 3.40-17.53, P value <0.001).

Conclusions:
The combination of Spy+TMP-SMX may be more effective in reducing the risk of maternal-fetal transmission of Toxoplasmosis compared to Spy alone; furthermore, this combination is not inferior to P/S, the current international standard-of-care maternal treatment for the prevention of CT. A prospective trial comparing the combination Spy+TMP-SMX with P/S would be necessary to provide definitive evidence on the best regimen for pregnant women with T. gondii infection.
The Effects of Experiential Learning on Perceived Clinical Reasoning and Self-efficacy of Doctor of Physical Therapy Students
Authors: Lowe Leah , Flowers Meredith , Fletcher James , Yates Charlotte 
Published: February 2022

Introduction and Review of the Literature.
Experiential learning (EL) is an instructional method that is increasingly being used to teach Doctor of Physical Therapy (DPT) pediatric content. However, there remains a paucity of research describing student outcomes resulting from EL courses compared with outcomes resulting from traditional instruction-based courses. The purpose of this study was to evaluate the change in perceived clinical reasoning and self-efficacy experienced by DPT students from the same DPT program who completed either high (at least 15 hours) or low (3 hours or less) pediatric EL as a component of their required, semester-long pediatric course.

Subjects and Methods.
The study was a pretest–posttest comparison group design. Second-year DPT students (n = 58; male: 19 and female: 39) enrolled in fall 2018 (high EL group) and students (n = 53; male: 18 and female: 35) enrolled in fall 2020 (low EL group) completed the Self-Assessment of Clinical Reflection and Reasoning (SACRR) and the Physical Therapy Self-Efficacy Scale (PTSE) during the first and last week of the pediatrics course.

Results.
A significant interaction effect between EL dosage and time was found for the SACRR (F
1,106 = 51.03, P = .000, partial eta squared = 0.33), suggesting that the change in scores was influenced by the dosage of EL. There was no significant interaction effect between EL dosage and time for the PTSE (F
1,104 = 1.13, P = .29, partial eta squared = .01). There was a significant main effect for time (F
1,104 = 225.61, P = .000, partial eta squared = .68), with both groups showing an improvement in pediatric physical therapy self-efficacy.

Discussion and Conclusion.
The results of this study suggest that the perceived self-efficacy abilities of students improved with all instructions, but the addition of high EL may enhance traditional instruction methods when used to aid DPT students in the development of self-perceived clinical reasoning and reflection skills.
Beyond the Musculoskeletal System: Considering Whole-Systems Readiness for Running Postpartum
Authors: Donnelly Gráinne M. , Brockwell Emma , Rankin Alan , Moore Isabel S. 
Published: February 2022

Background:
Postpartum women frequently engage in running. In the absence of official guidance on returning-to-running postpartum, physical therapists rely on clinical experience alongside the available literature. Subsequently, the traditional evaluation of postpartum readiness for running tends to focus on musculoskeletal factors. This clinical commentary addresses how to evaluate and manage postpartum return-to-running in a systematic order by discussing relevant whole-systems considerations beyond the musculoskeletal system, while also highlighting possible interactions between relevant considerations.

Discussion:
Using a whole-systems biopsychosocial approach, physical therapists should consider the following when managing and evaluating readiness to return-to-running: physical deconditioning, changes to body mass, sleeping patterns, breastfeeding, relative energy deficiency in sport, postpartum fatigue and thyroid autoimmunity, fear of movement, psychological well-being, and socioeconomic considerations. Undertaking a risk-benefit analysis on a case-by-case basis using clinical reasoning to determine readiness to return-to-running postpartum should incorporate these considerations and their possible interactions, alongside considerations of a musculoskeletal evaluation and graded exercise progression.

Conclusions:
Return-to-running postpartum requires an individualized, whole-systems biopsychosocial approach with graded exercise progression, similar to the management of return to sport following musculoskeletal injuries.

A video abstract for this article is available at:
http://links.lww.com/JWHPT/A51
Pelvic Health Physical Therapy Improves Pelvic Floor Symptoms in Women With Obstetric Anal Sphincter Injury
Authors: Kim Lisa , Weeks Karen , Geynisman-Tan Julia 
Published: February 2022

Background:
Following obstetric anal sphincter injuries (OASISs), women commonly report symptoms of pelvic floor dysfunction such as fecal incontinence. Few studies have looked at pelvic health physical therapy (PHPT) as a treatment for women with OASIS and its associated symptoms.

Objectives:
To assess the outcomes of early PHPT on the presence and severity of symptoms in women with OASIS.

Study Design:
Retrospective cohort study.

Methods:
We assessed the records of 70 subjects with third- or fourth-degree OASIS who had undergone clinical evaluation and PHPT in the institution's pelvic health clinic between 2017 and 2019. PHPT assessment focused on pelvic and abdominal muscle strength, neuromuscular control, soft and connective tissue/scar mobility, and functional movement. Outcome measures assessed changes in the Pelvic Floor Distress Inventory-20 (PFDI-20), subjective symptom reports of pelvic floor dysfunction, and manual muscle testing of pelvic floor muscle strength. These changes were calculated using the t test, McNemar's test, and Wilcoxon rank sum test, respectively.

Results:
PHPT started within an average of 6.2 weeks resulted in a reduction across all subjective complaints. Pelvic floor muscle strength improved from an initial Modified Oxford Grading system (MOS) score of 1 (1-2) to 2 (1-3), (P < .01). Subjects who received PHPT within 2 months postpartum had a greater reduction in subjective symptoms than those who started after 2 months (2.4 ±1.7 vs 1.1 ± 1.3, P = .02).

Conclusion:
PHPT intervention is associated with a reduction in subjective complaints reported by women who experienced OASIS in a single tertiary center. Earlier initiation of PHPT may lead to a greater improvement in symptoms.