bluuebunny/crossref_metadata_2025_split huggingface dataset:
Microneedling With Topical Insulin Versus Microneedling With Placebo in the Treatment of Postacne Atrophic Scars: A Randomized Control Trial
Authors: Abdelhay Rania Mounir , Ali Manar Saeed , Gad Leila Zeiad , Mahran Nahla Maher 
Published: October 2024

BACKGROUND
Among the treatment modalities for post-acne scars, microneedling is considered a safe and effective method.

OBJECTIVE
To compare the efficacy and safety of combined microneedling with topical insulin versus microneedling with placebo (topical saline) in treating atrophic acne scars.

METHODS and MATERIALS
Twenty-one patients with atrophic post-acne scars were randomized and treated in a split face manner with 4 sessions at 3-week intervals of microneedling using dermapen, followed by application of insulin on one side of the face and saline (placebo) on the other side. Evaluation of response was done before the sessions and after 1 month of the last session using the Global Scarring Grading System of Goodman & Baron and Lipper & Perez scores, Patient reported acne scar improvement using a 4-point scale, patient satisfaction, and the facial acne scar quality of life tools.

RESULTS
Both therapeutic modalities yielded a statistically significant improvement of atrophic acne scars. By comparing both modalities, there was no statistical significance regarding clinical improvement and side effects.

CONCLUSION
Using topical insulin combined with microneedling may have a value in improving atrophic acne scars, suggesting further evaluation using different delivery systems, insulin formulations, and assessment modalities.
Study on the event-related potential in recognition of emotional words between typical “five-state personality”
Authors: Yang Qian , Yang Qiuli , Sun Yalun , Fu Yanyan , Du Jian 
Published: October 2024

Objective:
To explore the event-related potential (ERP) differences of people with typical traditional Chinese medicine (TCM) “five-state personality” in the task of judging the emotional attributes (positive, neutral, and negative) of Chinese words.

Methods:
The “five-state personality test” was applied to screen the typical TCM “five-state personality,” and 3 groups were established, including positive personality, negative personality, and atypical personality. The differences in electroencephalogram (EEG) components in the task of judging the emotional attributes of Chinese words were collected using ERPs. The 3 personality groups ×3 words with emotional attributes were analyzed by two-way analysis of variance (ANOVA).

Results:
The N1 and P300 components were induced successfully. The analysis of the mean values of corresponding electrodes in the left frontal lobe, right frontal lobe, frontal lobe, and parietal lobe showed that in the typical negative personality group, the absolute value of N1 amplitude was smaller in the prefrontal and frontal lobes, and the latency was shorter in the left frontal lobe, while in the typical positive personality group, the absolute value of N1 amplitude was larger in the left frontal lobe. In the prefrontal and frontal lobes, the N1 peak absolute value of negative words was higher, the latency was longer, and the N1 latency of neutral words was shorter. The N1 latency of positive words was shorter in the parietal lobe. In the right frontal and frontal lobes, the P300 peak of negative words was higher, and the latency was longer, while the latency of positive words was longer in the parietal lobe. In addition, there was some interaction between personality groups and emotional attributes of words.

Conclusions:
When people with typical “five-state personality” judge the emotional attributes of words, the absolute value of N1 amplitude in the left prefrontal lobe of typical positive personality group is high, while that of typical negative personality group is small, and the latency is short. The P300 latency of negative words is longer in the right frontal and frontal lobes, and that of positive words is longer in the parietal lobes, with a more significant difference in the positive personality group.
Increasing Utilization of Intratympanic Injections among Medicare Fee-for-Service Providers
Authors: Fujiwara Rance J.T. , Tan Donald , Kutz Joe Walter 
Published: October 2024

Objective
To characterize national practice patterns and geographic variations in intratympanic injections among Medicare providers.

Study Design
Retrospective cross-sectional analysis of intratympanic injections performed in the Medicare fee-for-service population from 2013 to 2021.

Setting
Center for Medicare & Medicaid Services Physician and Other Practitioners database.

Participants
Providers performing outpatient intratympanic injections, documented by Current Procedural Terminology code 69801.

Intervention(s)
Intratympanic injections.

Main Outcome Measure(s)
The number of intratympanic injections performed by individual providers, states, and geographic regions, as well as reimbursements, was analyzed annually.

Results
A total of 159,236 in-office intratympanic injections were performed. The Center for Medicare & Medicaid Services reimbursed $25,407,086; out-of-pocket patient costs were $6,591,514. The mean Medicare reimbursement rate and out-of-pocket cost per injection were $159.56 and $41.38, respectively. From 2013 to 2021, the number of intratympanic injections increased from 13,117 to 20,711 injections, representing a 57.9% increase. On linear regression, an additional 989.9 injections were performed each year (95% CI 766.4–1,213.4, p < 0.001). The number of providers performing injections also increased from 1,828 to 2,834 from 2013 to 2021 (b = 125.6 [95% CI 111.3–140.0], p < 0.001). The population-controlled annual mean number of injections varied substantially across the United States, ranging from 12.0 injections per 100,000 beneficiaries in Oklahoma to 255.2 injections per 100,000 beneficiaries in Alabama.

Conclusions
The number of intratympanic injections administered in the Medicare population has increased from 2013 to 2021. There is variability in practice patterns and utilization of intratympanic injections among otolaryngologists in the United States.
Otolithiasis in the Animal Kingdom: A Retrospective Analysis
Authors: Pender Daniel J. 
Published: October 2024

Hypothesis
If otolithiasis can be demonstrated to affect multiple species, it may be possible to identify an experimental animal for prospective study of this entity.

Background
Otolithiasis refers to dislodged otolithic matter within the confines of the membranous labyrinth that has the potential to cause clinical symptoms. The mechanism involves separation of free-floating otoconia that can affect the hearing and balance functions of the ear. While this process is known to occur in humans, it is uncertain if other species are affected.

Methods
The published images of 37 whole-mount specimens of mammalian labyrinths were identified for retrospective examination. These were evaluated stereographically for the presence of calcareous material in abnormal locations within the membranous labyrinth.

Results
Thirty normal labyrinth specimens were found, exemplified by that of the Cape sea lion. Seven pathologic specimens were found, including a human, a black ape, a yellow-faced baboon, a hocheur monkey, a collie dog, a common sheep, and a common hare. Abnormal accumulations of calcareous material were found at one or more sites, more frequently in the utricle and canal system and less frequently in the endolymphatic and cochlea ducts.

Conclusions
Otolithiasis appears to occur in other animal species besides the human. Abnormal calcareous material was found in various locations within the membranous labyrinth of affected animals. One or more of these might serve as an animal model to prospectively study the phenomenon of otolithiasis.
Deep Phenotyping of a Mouse Model for Hearing Instability Disorders
Authors: Johns J. Dixon , Adadey Samuel Mawuli , Strepay Dillon , Olszewski Rafal , Hoa Michael 
Published: October 2024

Hypothesis
Hearing instability in Slc26a4-insufficiency mice may be due to differential expression of genes related to ion homeostasis and activated macrophages.

Background
Hearing instability (HI) disorders, defined by either hearing fluctuation or sudden loss, remain incompletely understood. Recent studies have described a Slc26a4 (pendrin)-insufficiency mouse model (DE17.5) that offers a genetically driven model for HI, although deep audiometric and immunohistologic phenotyping of this model remains poorly characterized.

Methods
Homozygous DE17.5 mice with (F) and without (NF) HI were delineated by serial auditory brainstem responses (ABR) between postnatal days 30 and 60 and compared with adult phenotypically wild-type Slc26a4-heterozygous controls without evidence of HI (Het). HI was defined as a change in threshold of at least 15 dB in at least two frequencies or at least 20 dB in at least one frequency from the previous week. Stria vascularis (SV) cell type–specific gene expression, endolymphatic hydrops (EH), endocochlear potential (EP), and macrophage activation were analyzed and compared between the cohorts.

Results
F mice demonstrated significant reductions in the expression of cell type–specific genes related to ion homeostasis and increased macrophage activation within the SV compared with NF and Het cohorts. Both F and NF DE17.5 homozygous mice demonstrated reductions in EP and increased EH compared with the Het cohort.

Conclusions
Deep phenotyping of DE17.5 mice demonstrates changes in EP and EH compared with control; however, the HI phenotype was associated with differential ion homeostasis gene expression and increased macrophage activation in the SV. This provides potential further insights into the underlying pathogenesis and possible immunologic contributions of HI in humans.
Long-Term Outcomes of Sigmoid Sinus Wall Reconstruction for Pulsatile Tinnitus Due to Sigmoid Sinus Wall Anomalies
Authors: Ahanotu Adaobi Eleanor , Oslin Kimberly , Rasooly Marjohn , Eisenman David J. 
Published: October 2024

Objective
To assess the long-term outcomes of sigmoid sinus wall reconstruction (SSWR) in patients with pulsatile tinnitus (PT) with sigmoid sinus wall anomalies (SSWAs).

Study Design
Single-center retrospective review.

Setting
Tertiary referral center.

Patients
Patients who underwent SSWR for PT with SSWAs more than 5 years prior to study initiation.

Intervention(s)
Therapeutic—all patients underwent sinus wall reconstruction for pulsatile tinnitus with sigmoid sinus anomalies.

Main Outcome Measure(s)
The primary outcomes were complete or partial resolution of PT lasting at least 5 years postoperatively and short-term relief from PT after surgery with long-term recurrence as determined by a self-assessment questionnaire and corroborated by the medical record.

Results
Thirty-five patients (37 ears) out of 58 eligible patients 5 years postoperatively from SSWR completed the survey. Short-term and long-term success rates of SSWR are 97.3% (36/37 ears) and 83.8% (31/37 ears), respectively. Of the patients, 13.5% (5/37 ears) experienced recurrence of PT on the same side following initial resolution. Of our patients, 8.6% had a confirmed diagnosis of idiopathic intracranial hypertension (IIH) after a follow-up period of more than 5 years.

Conclusions
Sinus wall reconstruction is an effective procedure for long-term control of PT in patients with SSWAs, with an acceptable safety profile and very low additional risk of exacerbating or provoking complications associated with IIH.
Incidental Findings on MRIs for Asymmetric Sensorineural Hearing Loss: A Clinical and Economic Analysis
Authors: Lee Lawrance , Islam Albina S. , Sterlin Lauren , Coelho Daniel H. 
Published: October 2024

Background
The gold-standard assessment of asymmetric sensorineural hearing loss (ASNHL) is contrast-enhanced MRI. Although rates of identifying a vestibular schwannoma are low (<5%), it is generally accepted as cost-effective. Yet, the impact of incidentalomas is rarely considered. This study aims to characterize the incidence of incidentalomas in the workup of ASNHL and quantify the associated socioeconomic burden.

Study Design
Retrospective cohort study.

Setting
Single academic institution in a midsized city in the United States.

Methods
Radiology records were queried for MRI's ordered for ASNHL between January 2012 and November 2022. Results were characterized as “group 1: normal,” “group 2: abnormal read/normal variant,” “group 3: abnormal—likely cause of ASNHL,” or “group 4: abnormal—follow-up needed.” Subsequent costs of workup for group 4 were estimated using Medicare Physician Fee Schedule for Medicare costs, US Congressional Budgeting Office data for private insurer costs, and USC-Brookings Schaeffer Initiative for Health Policy estimates for uninsured individuals.

Results
Six hundred patients met the inclusion criteria. Eighteen (3.0%) were categorized in group 3, whereas 40 (6.7%) were categorized in group 4. Of these patients, 7.5% (n = 3) had interventions to manage their incidental findings. Estimated per patient cost for further workup of incidental findings amounted to approximately $744, $1,534, and $2,260 for Medicare, private insurance, and uninsured costs, respectively.

Conclusion
Incidentalomas occur over twice as often as retrocochlear pathologies responsible for ASNHL. Although the number of patients requiring treatment for incidentaloma is low, the economic impact is not insubstantial and should be considered for both individual patients and health system payers.
The diagnostic challenge of differentiating tumefactive multiple sclerosis (TMS) from other brain lesions: a case report and literature review on a rare subtype of MS
Authors: Gill Anosh , Eltawansy Sherif , Karamat Riyan Imtiaz , Nadeem Zain Ali , Esposito Sarah , Karamat Shayan Imtiaz , Aamir Minahil , Anwaar Adeel , Akilimali Aymar 
Published: October 2024

Introduction and importance:
This case report is a clinical diagnosis walk through of a rare subtype of multiple sclerosis (MS). It gives an overview of how tumefactive multiple sclerosis (TMS) is systematically narrowed down as the definitive diagnosis.

Case presentation:
This 29-year-old male patient presented to the emergency department. He collapsed after experiencing pain over his right frontotemporal region followed by a seizure witnessed by his family. Magnetic Resonance Imaging of the brain displayed diffuse enlargement and abnormal T2 weighted and FLAIR hyperintense signals in the diagnostic impressions described by the radiologist of the right temporoparietal region.

Clinical discussion:
Liquefactive multiple sclerosis, also known as tumefactive multiple sclerosis or Marburg-type multiple sclerosis, is a rare subtype of the neurological disorder that can be difficult to diagnose. Unlike the traditional form of MS, TMS can present as a brain tumor and must be diagnosed with a biopsy rather than via MRI and clinical findings alone. Patients can typically present with headache, cognitive abnormalities, mental confusion, aphasia, apraxia, seizures, and weakness. Here, the authors discuss the presentation, disease diagnosis process and patient management.

Conclusion:
The patient was stabilized and discharged with a referral to the neurosurgery and neurology departments for outpatient consultation for future clinical management and treatment of their condition.
Spinal hydatid disease: a case report – an uncommon differential diagnosis in LMICs
Authors: Avetis A Kirakosyan , Emma S Maghakyan , Chavda Vishal , Chaurasia Bipin 
Published: October 2024

Background and Importance:
With a 0.2–1% incidence, spinal hydatid disease is a very uncommon diagnosis. While it is uncommon in affluent nations, it should be taken into account when making a differential diagnosis for spinal cord compression syndrome, particularly in regions where it is prevalent.

Case Presentation:
The authors report a case of hydatid illness of the spine. A 52-year-old man presented with lower extremity discomfort and spastic paraparesis, trouble urinating, and back pain and edema. He had at the level of the 12th thoracic to third lumbar vertebrae (Th12-L3) with paraspinal extension. The patient was treated with 4 months of antiparasitic therapy and two surgical resections performed by general surgeons. Histological analysis showed pieces of fibrous tissue exhibiting granulomatous inflammation; however, no evidence of acid-resistant bacteria or PAS-positive chitin membrane was found. The existence of bacteria following therapy has not been confirmed by the parasitological investigation of the lesions.

Clinical Discussion:
Primary spinal hydrodatidosis is a rare condition that affects about 0.2–1% of the population.

Conclusion:
Due to the rarity of this disease, early discovery and timely treatment are critical, and this diagnosis should be considered when generating a differential diagnosis for spinal cord compression syndrome.
The risk and distribution of second primary cancers according to subsite of primary stomach cancer: a retrospective cohort population-based study
Authors: Hemade Ali , Hallit Souheil 
Published: October 2024

Background:
The development of second primary cancers (SPCs) following a diagnosis of stomach cancer presents a significant clinical challenge, with varying risks depending on the anatomic subsite of the primary tumor, patient demographics, and treatment modalities. This study aims to assess the risk of SPCs in stomach cancer survivors, focusing on differences across anatomic subsites, sex, age, and treatment periods.

Methods:
The authors conducted a retrospective cohort study using data from stomach cancer patients, analyzing the incidence of SPCs based on the anatomic location of the primary tumor, with stratifications by sex, age, latency period, and year of diagnosis. Standardized incidence ratios (SIRs) were calculated to compare the observed SPC rates with those expected in the general population.

Results:
Elevated stomach SPC risk was observed across most anatomic subsites, particularly in the body (SIR 8.84) and fundus (SIR 7.34). Females exhibited higher SIRs compared to males, especially in the fundus (SIR 13.33 for females vs. 4.55 for males). Younger patients (<50 years) had significantly higher SPC risks, particularly for cancers originating in the fundus (SIR 49.56). Notably, patients diagnosed after 2010 showed the highest SIRs, indicating a potential impact of advances in diagnostic and therapeutic modalities. Nonstomach SPCs, including colorectal, lung, and thyroid cancers, were significantly elevated, with distinct patterns based on the primary tumor site.

Conclusions:
The study highlights the critical role of primary tumor location, sex, age, and treatment era in determining SPC risk in stomach cancer survivors. These findings underscore the need for tailored surveillance strategies to manage long-term cancer risks in this population.
Gather “Round”
Authors: Feld April , Carollo Matt , Freeman-Reyes Jere , McCarthy Susan , Lind Mary Ann , Weinstein Robert , O’Dea Caitlin , Joy Maria , Morley Eric J. , Aitken Paul , Schwaner Robert , Giarraputo Dominic , Heslin Samita M. 
Published: October 2024

Purpose:
Emergency departments (EDs) are a vital component of the United States healthcare system and care for over 130 million patient visits annually. Nonurgent ED visits can contribute to crowding, delays in care, and adverse effects. Many high-utilizing ED patients may present with complex medical, behavioral, and social needs that are not necessarily emergent or urgent in nature. The authors created an Integrated Care Model, called the Multi-Visit Patient (MVP) program, for patients with 5 or more visits to the ED in a rolling 12-month period. The MVP program incorporated an interdisciplinary group of ED leadership and case management (CM) to identify, engage, and intervene with ED MVPs, aiming to improve their ED utilization. Patients received comprehensive screenings for depression, falls, alcohol use disorder, caregiver support, social determinants of health, and more. Based on these screenings, the CM team implemented interventions such as connecting patients with outpatient specialists and linking patients to community-based organizations to optimize stability, wellness, and reduce ED utilization.

Primary Practice Setting:
The collaboratively developed MVP program was implemented in the ED of a large, suburban, tertiary care academic hospital.

Findings/Conclusions:
The MVP program identified 221 MVP patients over a 20-month period and successfully connected with 89% of them. Of these 221 patients, 78% (172 patients) chose to engage in the MVP program, with 160 completing their engagement with an outcome. Among the patients who completed their engagement and for whom the study could match separate utilization data (151 patients), the study observed a 57% reduction in ED visits.

Implications for Case Management Practice:
Case managers play a crucial role in the effectiveness of the MVP program by coordinating comprehensive care for high-utilizing ED patients. The MVP program includes transition of care initiatives designed to improve patient outcomes. Through screenings and targeted interventions, case managers identify and address the complex medical, behavioral, and social needs of MVP patients. This collaborative, interdisciplinary approach underscores the importance of timely and coordinated care, benefiting both patients and the health system. The MVP program exemplifies the critical role of case managers in reducing unnecessary ED visits and enhancing overall patient care.
Prognostic Value and Clinical Implication of Lymph Node-to-Primary Tumor SUV Ratio in Node-Positive Hypopharyngeal Squamous Cell Carcinoma Treated With Radiotherapy With or Without Chemotherapy
Authors: Yap Wing-Keen , Lin Chia-Hsin , Hsu Ken-Hao , Lin Shin-Nan , Lin Huan-Chun , Chang Kai-Ping , Kang Chung-Jan , Hu Yu-Feng , Shih Ming-Chieh , Tsai Tsung-You 
Published: October 2024

Purpose
The aim of this was to evaluate the prognostic significance of the nodal-to-primary tumor SUVmax ratio (NTR) in patients with node-positive hypopharyngeal squamous cell carcinoma (HPSCC) treated with radiotherapy with or without concurrent chemotherapy. The study aims to enhance prognostic accuracy by incorporating NTR into the American Joint Committee on Cancer (AJCC) staging system.

Patients and Methods
This retrospective study included 191 patients with biopsy-proven node-positive HPSCC treated from 2005 to 2013. NTR was calculated as the ratio of SUVmax of metastatic lymph nodes to the primary tumor’s SUVmax. Survival analyses were conducted using Cox regression models and Kaplan-Meier analysis. Receiver operating characteristic analysis compared the prognostic performance of the modified and AJCC staging systems.

Results
The median follow-up was 8.27 years, with 135 deaths (70.7%). High NTR (≥0.63) was significantly associated with worse overall survival (OS) and was an independent prognostic factor in multivariable analysis (adjusted hazards ratio [HR] = 1.63, P = 0.007). Median OS for high NTR was 17.4 months, compared with 75.2 months for low NTR. High NTR significantly predicted worse OS within AJCC stage IVA patients (HR = 6.09, P = 0.014). Patients in modified stage IVA (AJCC stage IVA with low NTR) had significantly longer OS than those in modified stage IVB (AJCC stage IVA with high NTR and AJCC stage IVB) (HR = 8.62, P = 0.003). The modified staging system incorporating NTR showed superior prognostic performance compared with the AJCC staging system.

Conclusions
NTR is a significant independent prognostic factor for OS in node-positive HPSCC patients. Integrating NTR into the AJCC staging system improves prognostic accuracy.