bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multivariate Determinants of Emotional Compromise and Subjective Functional Quality of Life in Surgery-Naïve Patients With Keratoconus as Measured With the Keratoconus End Points Assessment Questionnaire
Authors: Balparda Kepa , García-Onrubia Luis , Valentín-Bravo Francisco Javier , Acera Arantxa , Merayo-Lloves Jesus , Fernández-Vega-Cueto Luis , Franco-Sánchez Isabela , López-Velásquez Mariana , Galarreta David J. 
Published: February 2025

Purpose:
Keratoconus affects patients' quality of life. No study has assessed the multivariate determinants of quality of life using the keratoconus end points assessment questionnaire (KEPAQ).

Methods:
This study included patients with keratoconus with no history of ocular surgery, who underwent clinical evaluation and tomographic imaging using a dual Scheimpflug/Placido device (Galilei G6). Emotional and functional quality of life was assessed using the KEPAQ. Multiple linear regression models were constructed for each KEPAQ subscale to adjust for confounding variables.

Results:
A total of 140 surgery-naïve patients with keratoconus were included, with a median age of 39 years and a male predominance (57.1%). For the KEPAQ-E subscale, the multivariate model was significant [F(84,10) = 2.79; adjusted R2 = 0.160, P = 0.005], showing that female sex (β = −0.41) and worse corrected distance visual acuity in the better-seeing eye (β = −0.29) were associated with lower quality of life. Including the functional subscale score significantly enhanced the model's performance (adjusted R2 = 0.464, β = 0.60). For the KEPAQ-F subscale, the model was also significant [F(84,10) = 2.37; adjusted R2 = 0.127, P = 0.016], with corneal astigmatism in the better-seeing eye (β = −0.30) reducing quality of life. Adding the emotional subscale score improved the model (adjusted R2 = 0.442, β = 0.62).

Conclusions:
Female sex, reduced vision, and corneal astigmatism negatively affect quality of life in patients with keratoconus. Nonetheless, patients' perceived impairment as measured in 1 subscale is a stronger predictor of overall quality of life than clinical and tomographic factors alone.
Clinical Factors Predicting Favorable Response to Intense Pulsed Light Therapy for Refractory Meibomian Gland Dysfunction: A 6-Month Cohort Study
Authors: Yang Chi-Chun , Chen Meng-Jou , Cheng Ming-Hsuan , Fan Nai-Wen 
Published: February 2025

Purpose:
Meibomian gland dysfunction (MGD) is a global health disorder, which can have a deleterious effect on visual function and quality of life. Intense pulsed light (IPL) therapy has been shown to ameliorate MGD. However, the optimal candidates who would benefit most from IPL remain undetermined. Therefore, we aimed in this study to identify the clinical factors associated with favorable outcomes in patients with MGD after IPL therapy.

Methods:
This single-center retrospective study included patients with refractory MGD treated with a course of IPL therapy combined with meibomian gland expression, with a follow-up period of 6 months. The outcome measures were the standardized patient evaluation of eye dryness (SPEED) score, tear breakup time, lid telangiectasia, meibum quality, and expressibility. Good responders were defined as those with at least a 1-point reduction in SPEED score and a 1-grade decrease in meibum quality at 6 months. Data were analyzed using the t test, chi-square test, and binary logistic regression analysis.

Results:
A total of 90 eyes in 90 patients (good responders: 48 eyes, nonresponders: 42 eyes) were included. Univariate analysis revealed that the good responders had a higher SPEED score at baseline than the nonresponders. Multivariate logistic regression analysis showed that more severe symptoms, more inspissated meibum, better expressibility, and milder degree of lid telangiectasia were independently associated with a favorable response.

Conclusions:
Our findings suggest that patients with worse symptoms, poorer meibum quality, milder telangiectasia, or less obstruction are more likely to have a good response to IPL therapy.
Centering Survivor Experiences in Human Trafficking and Sexual Exploitation Simulation Training to Improve Patient Care
Authors: Ellis Stephanie , Heisterkamp Breanna , Fliegel Abigail , Puckett Brittany 
Published: February 2025

ABSTRACT

Background
Human trafficking and sexual exploitation are pervasive issues in society. Forensic nurse examiners are skilled at identifying and assisting victims of trafficking and exploitation, who frequently seek healthcare. However, forensic nurse examiners often lack specialized training for trafficking cases, unlike their training for sexual assault, and may hold biases regarding a trafficking victim's appearance, complicating their response.

Aim
To bridge this knowledge gap, a Human Trafficking/Sexual Exploitation (HT/SE) Skills Lab was created and piloted by a multistate forensic nurse education program in a Midwest metropolitan area.

Methods
A survivor-centered approach was employed by collaborating with a human trafficking advocacy agency and a youth survivor panel to design curriculum, review scenarios, and co-instruct the lab. The lab used a combination of didactic and hands-on training to address gaps in both knowledge and skill.

Results
Nearly all participants reported an increase in knowledge, and over half showed skill improvement. Self-assessments showed 25% of learners progressed from “advanced beginner” to “competent” in handling trafficking cases. Facilitators rated learners' competence, with most participants showing advancement.

Conclusions
The pilot lab's success indicates that this HT/SE Clinical Skills Lab can be replicated across healthcare disciplines, potentially improving responses to HT/SE survivors beyond sexual assault contexts, but more practice is needed to reach true competence.
Quality of Information Provided by Artificial Intelligence Chatbots Surrounding the Management of Vestibular Schwannomas: A Comparative Analysis Between ChatGPT-4 and Claude 2
Authors: Borsetto Daniele , Sia Egidio , Axon Patrick , Donnelly Neil , Tysome James R. , Anschuetz Lukas , Bernardeschi Daniele , Capriotti Vincenzo , Caye-Thomasen Per , West Niels Cramer , Erbele Isaac D. , Franchella Sebastiano , Gatto Annalisa , Hess-Erga Jeanette , Kunst Henricus P.M. , Marinelli John P. , Mannion Richard , Panizza Benedict , Trabalzini Franco , Obholzer Rupert , Vaira Luigi Angelo , Polesel Jerry , Giudici Fabiola , Carlson Matthew L. , Tirelli Giancarlo , Boscolo-Rizzo Paolo 
Published: February 2025

Objective
To examine the quality of information provided by artificial intelligence platforms ChatGPT-4 and Claude 2 surrounding the management of vestibular schwannomas.

Study design
Cross-sectional.

Setting
Skull base surgeons were involved from different centers and countries.

Intervention
Thirty-six questions regarding vestibular schwannoma management were tested. Artificial intelligence responses were subsequently evaluated by 19 lateral skull base surgeons using the Quality Assessment of Medical Artificial Intelligence (QAMAI) questionnaire, assessing “Accuracy,” “Clarity,” “Relevance,” “Completeness,” “Sources,” and “Usefulness.”

Main Outcome Measure
The scores of the answers from both chatbots were collected and analyzed using the Student t test. Analysis of responses grouped by stakeholders was performed with McNemar test. Stuart-Maxwell test was used to compare reading level among chatbots. Intraclass correlation coefficient was calculated.

Results
ChatGPT-4 demonstrated significantly improved quality over Claude 2 in 14 of 36 (38.9%) questions, whereas higher-quality scores for Claude 2 were only observed in 2 (5.6%) answers. Chatbots exhibited variation across the dimensions of “Accuracy,” “Clarity,” “Completeness,” “Relevance,” and “Usefulness,” with ChatGPT-4 demonstrating a statistically significant superior performance. However, no statistically significant difference was found in the assessment of “Sources.” Additionally, ChatGPT-4 provided information at a significant lower reading grade level.

Conclusions
Artificial intelligence platforms failed to consistently provide accurate information surrounding the management of vestibular schwannoma, although ChatGPT-4 achieved significantly higher scores in most analyzed parameters. These findings demonstrate the potential for significant misinformation for patients seeking information through these platforms.
Bacteriophage Therapy for Chronic Mastoiditis
Authors: Casazza Julia , Tan Donald , Newcomer Mark , Sakano Hitomi , Isaacson Brandon , Hunter Jacob B. 
Published: February 2025

Objective
To provide the first description of intratympanic bacteriophage therapy for chronic mastoiditis from multidrug-resistant Pseudomonas aeruginosa in the United States.

Patients
A 47-year-old woman with chronic mastoiditis in the setting of ciliary dysfunction from cystic fibrosis and immunosuppression from lung transplantation.

Interventions
Ten concurrent parenteral and intratympanic doses of two custom phages targeting P. aeruginosa followed by IV antibiotic therapy.

Main Outcome Measures
Resolution of infection confirmed by symptomatology, cultures, and imaging.

Results
At 5 months after phage treatment, the patient reported resolution of otorrhea, headaches, and hearing impairment. Subsequent cultures showed no growth.

Conclusions
Bacteriophages can enhance antibiotic activity in cases of drug-resistant chronic mastoiditis.
Dynamic Cone-Beam CT of the Middle Ear for Determining Excursion of the Ossicles: Technical Proof of Concept
Authors: Andersen Steven Arild Wuyts , Akram Bilal Hussain 
Published: February 2025

Objective
Conductive hearing loss can be caused by fixation or discontinuity of the ossicles. Current noninvasive methods such as tympanometry and conventional clinical imaging might indicate mobility and/or pathology but cannot quantify the excursion. The objective of this study is to measure the excursion of the malleus and incus using timed pressurization during clinical cone-beam CT (CBCT) of the middle ear.

Patients
Five human cadaveric heads.

Intervention
CBCT imaging obtained at an isotropic resolution of 0.08 mm of five cadaveric heads (10 ears). A tympanometer was used to pressurize the ear drum and change pressure during the scan.

Main Outcome Measures
The excursion of the manubrium of malleus and the long process of incus was determined based on manual segmentation of the imaging series.

Results
It was technically feasible to change pressure midways during scan and use 180° virtual reconstructions of the negative and positive pressure phase to quantify the mobility of the malleus and incus. In ears with normal impedance of the tympanic membrane (type A tympanogram), we found an average excursion of the manubrium of malleus of 0.61 mm and the long process of incus of 0.27 mm.

Conclusion
Dynamic CBCT of the middle ear can be used to quantify the excursion of malleus and incus in ears with normal ear drum impedance. This might provide additional information compared with conventional static imaging at atmospheric pressure and other current in vivo methods such as wideband tympanometry. Further studies are needed to explore the clinical value of the method.
Transnasal Fluoroscopic-Guided Eustachian Tube Obliteration With a Liquid Embolic Agent for a Recurrent Cerebrospinal Fluid Leak After Translabyrinthine Schwannoma Surgery: A Case Series
Authors: Suutari Angelica , Isokangas Juha-Matti , Palosaari Kari , Tikkakoski Tapani , Nieminen Peter , Knuutinen Oula , Laitakari Jaakko 
Published: February 2025

Objective
Postoperative cerebrospinal fluid (CSF) leak after schwannoma surgery occurs in up to 10% of patients. Conventional surgical treatment including fat and muscle packing can prove unsuccessful. We describe a minimally invasive, imaging-guided approach to CSF fistula treatment.

Patients
We describe two patients and three procedures with recurrent CSF rhinorrhea after translabyrinthine vestibular or facial nerve schwannoma surgery. First-line procedures including CSF diversion and repeat middle ear packing failed to close the leaks.

Intervention
Endonasal endoscopic, fluoroscopic-guided obliteration of the Eustachian tube with n-butyl cyanoacrylate.

Main Outcome Measure
Recurrence of a CSF leak.

Results
After treatment, the CSF leak ceased with no recurrence. One patient's facial nerve dysfunction worsened after the procedure.

Conclusions
This case series highlights a recently described technique of imaging-guided Eustachian tube obliteration using liquid embolic agent. The procedure was effective in treating recurrent CSF leaks but might cause facial nerve dysfunction.
Remote Care: The Future of Cochlear Implants
Authors: Holcomb Meredith A. , Coto Jennifer , Stern Tina , Sarangoulis Christina M. , Cejas Ivette , Sanchez Chrisanda M. 
Published: February 2025

Objective
The aims of this study were to 1) evaluate whether remote cochlear implant (CI) programming has comparable outcomes to traditional in-person CI management, 1) determine the effects of remote programming on family burden and associated costs, and 1) demonstrate feasibility and satisfaction of remote programming by patients and families for both the adult and pediatric CI populations.

Study design
Prospective study of one CI program.

Patients and intervention
Adult and pediatric patients with at least one CI underwent CI programming via in-person and remote visits.

Main outcome measures
CI programming parameters (impedances, neural response telemetry, upper and lower stimulation levels, datalogging), technology comfort self-report, visit burden and satisfaction, mental health and quality of life.

Results
Fifteen pediatric participants (mean age: 4.17 yr; SD = 3.24) and 15 adult participants (mean age: 56.73 yr; SD = 21.11) were enrolled. In-person and remote programming sessions yielded comparable results for measuring CI programming parameters. Adult and parent participants were highly satisfied with remote programming and reported receiving excellent care. Listening effort was significantly less for the remote visit as compared to the in-person visit for adults. Burden of care to attend the in-person visit was greater for the pediatric population in terms of expenses incurred, unpaid time off work, and coordination of care for other children.

Conclusions
Remote programming is a feasible and effective service delivery model for the adult and pediatric CI population. Inclusion of remote services into postoperative CI protocols should be considered as a means of reducing barriers to hearing healthcare.
A Massive Ear Canal Mass Resulting from an Embedded Arthropod
Authors: Grimes Rachel , Stockton Savannah , Barrett Amanda , Moideen Pramila , Hodge Sarah 
Published: February 2025

Objective
To describe a case of a massive ear mass obstructing the external auditory canal (EAC) attributed to an embedded arthropod, highlighting the diagnostic and therapeutic challenges posed by unusual etiologies of ear masses.

Patients
The case was a 35-year-old female prisoner who presented with a 5 × 5.5 cm palpable exophytic mass obstructing the right EAC, accompanied by progressive hearing loss, bloody discharge, and persistent tinnitus.

Interventions
Surgical excision of the infiltrating mass involving mastoidectomy and canaloplasty.

Main Outcome Measures
Initial pathology suggested a pyogenic granuloma, but further analysis revealed a degenerating arthropod within reactive myofibroblastic and vascular changes. The patient was lost to follow-up despite a multidisciplinary treatment approach and primary surgical excision of the mass.

Results
After surgical excision, the mass was confirmed as a florid reactive myofibroblastic and vascular mass enveloping a degenerating arthropod. The patient responded well to treatment without signs of infection or recurrence during follow-up.

Conclusions
We report a case that emphasizes the importance of considering unusual etiologies for ear masses, especially in at-risk populations. It underscores the necessity for refined diagnostic and therapeutic strategies to manage similar clinical scenarios in the future.
Patterns of Pneumatization of Parts of Temporal Bone in High-Resolution Computed Tomography and Its Implications
Authors: Eugine Reshma , Bhardwaj Abhishek , Malhotra Manu , Priya Madhu , Saxena Sudhir , Semwal Ankita , Vetrivel G , Kumar Anil 
Published: February 2025

Abstract

Objective
Investigate the pneumatization pattern of parts of the temporal bone in high-resolution computed tomography (HRCT) and their associations with age, gender, and squamous chronic otitis media (COM) in the contralateral ear. To investigate the symmetry of pneumatization and correlations between pneumatization patterns of parts of the temporal bone.

Study design
Prospective study.

Setting
Tertiary care center.

Patients
Two hundred sixty patients who underwent HRCT temporal bone.

Interventions and main outcome measures
Evaluation of pneumatization of mastoid and petrous apex as per Han et al. and infralabyrinthine as per Marchioni et al. classification.

Results
The commonest pneumatization patterns were group 4 (32.8%), group 1 (69.7%), and type C (76%) for mastoid, petrous apex, and infralabyrinthine parts, respectively. Group 4 pneumatization of the petrous apex (w = 0.487) and type A infralabyrinthine pneumatization (w = 0.315) were significantly associated with group 4 mastoid pneumatization (p < 0.001) but not vice versa. Significant association was observed between age and pattern of mastoid pneumatization (w = 0.25; p = 0.002) but not for other parts. No significant gender difference was observed in the temporal bone's pneumatization pattern. A significant symmetry was seen in the pneumatization of two ears for all parts. COM in the contralateral ear was significantly associated with group 3 mastoid pneumatization (w = 0.16; p = 0.036).

Conclusion
Mastoid shows hyperpneumatization, and other parts show absent pneumatization as commonest pattern, with only one-way correlation between increased pneumatization of other parts and mastoid. COM in the contralateral ear and age show a significant association with the type of mastoid pneumatization, but not other parts.
Silk Devices for Tympanic Membrane Repair Show No Ototoxicity in a Rat Model
Authors: Barry Kristin M. , Redmond Sharon L. , Mulders Wilhelmina H.A.M. , Valente Filippo 
Published: February 2025

Hypothesis
Implantation of ClearDrum®, a biodegradable silk fibroin device, into the middle ear (ME) cavity in a rat model will not affect hearing thresholds as measured by auditory brainstem response.

Background
Chronic otitis media (COM) is a recurrent middle ear infection often accompanied by tympanic membrane perforation. Our laboratory has developed a biodegradable silk fibroin device (ClearDrum®) designed to treat tympanic membrane perforations in COM. ClearDrum® acts as a prosthetic eardrum, providing a substrate on which tympanic membrane cells can grow and acts as a long-lasting implant.

Methods
Two formulations were tested based on silk/glycerol and silk/polyurethane blends. Animals were anesthetized, and either a ClearDrum® formulation or an autologous cartilage graft was surgically implanted into the middle ear. Thresholds of the auditory brainstem response (ABR) were measured at the time of implantation and at 4 and 12 weeks post-implantation to assess hearing after the implantation. After the final measurements at 12 weeks, middle ear and cochlea were harvested for histological assessment.

Results
No significant differences in ABR thresholds between male and female animals were found at any timepoint. Results showed that there were no detrimental effects of either Cleardrum® formulation on ABR thresholds as compared with implantation of autologous cartilage and no presence of inflammation within the middle ear or cochlea.

Conclusion
Our ABR data suggest no substantial ototoxic effects on outer or inner hair cells and provides some support toward clinical translation of ClearDrum devices.
Improving the quality of donor human milk to take advantage of more of the health benefits of mother's own milk composition
Authors: Beggs Megan R. , Unger Sharon , O’Connor Deborah L. 
Published: February 2025

Purpose of review
Pasteurized donor human milk (PDHM) is the recommended supplement when there is inadequate volume of mother's own milk (MOM) for very low birth weight (<1500 g, VLBW) infants. Differences in the composition of these milks may impact growth, morbidities or long-term development of infants. The aim of this review is to highlight current trends in understanding compositional differences between MOM and PDHM, technological advances in processing PDHM, and infant outcomes when VLBW infants are fed these milks.

Recent findings
Reported differences in the composition between MOM and PDHM are due to several factors including when and how milk is collected, sampled for analysis, and processed. Systematic reviews and primary research studies demonstrate that PDHM reduces the risk of necrotizing enterocolitis in VLBW infants but is also associated with slower postnatal growth. Work is ongoing to determine if alternative approaches to processing PDHM can improve milk composition and thereby infant growth and neurodevelopment and reduce morbidity.

Summary
PDHM is a key component of feeding VLBW infants when there is inadequate volume of MOM. Recent developments aim to optimize this source of nutrition and bioactive compounds for VLBW infants while further understanding limitations of its use.
Isolated adrenocorticotrophic hormone (ACTH) deficiency presenting with recurrent hypoglycemia and hyponatremia
Authors: Rehman Saif Ur , Aisha Marium , Badshah Aliena , Hassan Laila , Noor Habiba , Khan Qaisar Ali , Verma Ravina 
Published: February 2025

Introduction:
Isolated adrenocorticotropic deficiency (IAD) is a rare disorder characterized by secondary adrenal insufficiency (AI) with low or absent cortisol production, normal secretion of pituitary hormones other than ACTH, and the absence of structural pituitary defects. This case report highlights the atypical presentation of IAD, presenting with recurrent hypoglycemia and hyponatremia.

Case presentation:
A 20-year-old female presented to the emergency department with a loss of consciousness. Initial laboratory evaluation revealed hypoglycemia and hyponatremia. She had a history of recurrent hospitalization for the same problem for 4 months. Further investigations showed deceased cortisol and adrenocorticotrophic (ACTH) levels. The rest of the pituitary hormones were normal. The patient was diagnosed with a case of Isolated ACTH deficiency and was started on oral prednisolone, and her symptoms resolved with no recurrence of the symptoms.

Clinical Discussion:
The etiology of acquired IAD remains largely unclear. However, it is sometimes associated with other autoimmune diseases, such as Hashimoto’s thyroiditis. Idiopathic isolated ACTH deficiency (IIAD) is a rare condition that can present either congenitally (CIIAD) or later in life as adult idiopathic isolated ACTH deficiency (AIIAD).

Conclusion:
Isolated ACTH deficiency can rarely present with hyponatremia concurrent with recurrent hypoglycemic episodes and hypotension. However, further research is needed to find the pathophysiology behind it.