Medicare Reimbursement and Utilization Trends Within Skull Base Surgery.

Background: Medicare reimbursements for otolaryngology and neurosurgery procedures have generally declined since 2000. We explore Medicare reimbursement trends for anterior cranial fossa, middle cranial fossa, posterior cranial fossa, pituitary surgery, and skull base reconstruction surgery from 2000-2022.

Methods: Cross-sectional analysis of the Centers for Medicare and Medicaid Services Physician Fee Schedule was performed from 2000-2022 on approach, resection, and repair of the skull base (Current Procedural Terminology codes 31290-31291, 61546, 61548, 61575-61619, and 62165).

Medicaid Acceptance Varies by Physician Seniority and Specialty in California.

Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year.

Interim Analysis of Clinical Outcomes with Open versus Closed Conjunctival Implantation of the XEN45 Gel Stent.

Objective: To examine the longitudinal postoperative outcomes of open versus closed conjunctiva implantation of the XEN45 gel stent.

Design: Retrospective multicenter study.

Subjects: One hundred ninety-three patients with glaucoma underwent XEN45 implantation via an open or closed conjunctiva approach.

Emotional experiences and psychological well-being in 51 countries during the COVID-19 pandemic.

The COVID-19 pandemic presents challenges to psychological well-being, but how can we predict when people suffer or cope during sustained stress? Here, we test the prediction that specific types of momentary emotional experiences are differently linked to psychological well-being during the pandemic. Study 1 used survey data collected from 24,221 participants in 51 countries during the COVID-19 outbreak. We show that, across countries, well-being is linked to individuals' recent emotional experiences, including calm, hope, anxiety, loneliness, and sadness.

The Influence of Facility Volume and Type on Skull Base Chordoma Treatment and Outcomes.

Objective: To evaluate the influence of facility case volume and type on skull base chordoma treatment and overall survival (OS).

Methods: The 2004-2016 National Cancer Database was queried for skull base chordoma patients receiving definitive treatment. Facilities were categorized into 2 cohorts by calculating the mean number of patients treated per facility and using cutoff numbers that were 0.

Intranasal Anticholinergics for Treatment of Chronic Rhinitis: Systematic Review and Meta-Analysis.

Objective: Topical intranasal anticholinergics are commonly prescribed for the relief of chronic rhinitis and associated symptoms, warranting thorough assessment of the supporting evidence. The present study aimed to evaluate the safety and efficacy of anticholinergic nasal sprays in the management of allergic and non-allergic rhinitis symptom severity and duration.

Methods: A search encompassing the Cochrane Library, PubMed/MEDLINE, and Scopus databases was conducted.

Case Report: Chemotherapy-Associated Systemic Sclerosis: Is DNA Damage to Blame?

Systemic sclerosis, also known as scleroderma, is an autoimmune disease characterized by cutaneous and visceral fibrosis, immune dysregulation, and vasculopathy. Generally, the degree of skin fibrosis is associated with an increased likelihood of visceral organ involvement. Its pathogenesis is poorly understood; however, it is clear that changes in both the innate and adaptive immune responses are associated with fibroblast dysfunction and vascular damage.

Biomarkers of B cell activation in autoimmune connective tissue diseases: More than markers of disease activity.

B cells play a central role in the pathogenesis of many autoimmune diseases, acting as antigen-presenting cells, producing inflammatory cytokines, and acting as a source of autoantibodies after differentiating into plasma cells. In this review, we aim to summarize and synthesize the literature for the utility of biomarkers of B cell activation (plasma immunoglobulins (Ig), free light chains (FLCs), and beta-2 microglobulin (β2M)) in monitoring inflammatory rheumatic connective tissue diseases, such as Sjogren's syndrome (SS), systemic lupus erythematosus (SLE), dermatomyositis (DM), and systemic sclerosis (SSc). Clinically, it is quite difficult to gauge prognosis in these conditions as there, historically, have not been many quantitative markers of disease activity available.

Muffin Technique Micrographic Surgery for Non-melanoma Skin Cancer.

Mohs micrographic surgery (MMS) is the gold standard treatment for high-risk facial non-melanoma skin cancer. However, patients' access to MMS is limited by cost. The muffin technique micrographic surgery (MTMS) is an alternative micrographic technique wherein the entire excised margin is evaluated post-operatively by a pathologist using paraffin-embedded material.

Review of Machine Learning in Predicting Dermatological Outcomes.

Artificial intelligence is a broad branch of computer science that has garnered significant interest in the field of medicine because of its problem solving, decision making and pattern recognition abilities. Machine learning, a subset of artificial intelligence, hones in on the ability of computers to receive data and learn for themselves, manipulating algorithms as they organize the information they are processing. Dermatology is at a particular advantage in the implementation of machine learning due to the availability of large clinical image databases that can be used for machine training and interpretation.

Diagnostic challenge of aleukemic leukemia cutis preceding acute myelogenous leukemia: A case report.

Aleukemic leukemia cutis is a rare condition in which malignant white cells invade the skin before they appear in the peripheral blood or bone marrow. It is often associated with a poor prognosis. The condition presents a diagnostic challenge as its manifestations are quite variable terms of lesion type.

A contemporary medicolegal analysis of perioperative vision loss from 2007 to 2016.

Introduction: Perioperative vision loss (POVL) is a rare but catastrophic event. Closed claim databases are useful for investigating risk factors of POVL to help guide practices in risk mitigation and risk management strategies.

Methods: We retrospectively analyzed the Controlled Risk Insurance Company (CRICO) Comparative Benchmarking System database for perioperative nerve injuries from when claims were closed between 2007 and 2016.

Failures, Reoperations, and Improvement in Knee Symptoms Following Matrix-Assisted Autologous Chondrocyte Transplantation: A Meta-Analysis of Prospective Comparative Trials.

Objective: Though multiple high-level comparative studies have been performed for matrix-assisted autologous chondrocyte transplantation (MACT), quantitative reviews synthesizing best-available clinical evidence on the topic are lacking.

Design: A meta-analysis was performed of prospective randomized or nonrandomized comparative studies utilizing MACT. A total of 13 studies reporting 13 prospective trials (9 randomized, 5 nonrandomized) were included (658 total study participants at weighted mean 3.

Trends in the Explanatory or Pragmatic Nature of Cardiovascular Clinical Trials Over 2 Decades.

Importance: Pragmatic trials test interventions using designs that produce results that may be more applicable to the population in which the intervention will be eventually applied.

Objective: To investigate how pragmatic or explanatory cardiovascular (CV) randomized clinical trials (RCT) are, and if this has changed over time.

Data Source: Six major medical and CV journals, including New England Journal of Medicine, Lancet, JAMA, Circulation, European Heart Journal, and Journal of the American College of Cardiology.

Use of Extracorporeal Photopheresis in Scleroderma: A Review.

Background: Scleroderma is a heterogeneous group of diseases that can be localized or systemic. Localized scleroderma is a fibrosis of the skin characterized by inflammation and thickening due to excessive collagen deposition, and systemic sclerosis (SSc) is characterized by vasculopathy, immune dysregulation and skin fibrosis. In general, the prognosis of scleroderma highly depends on the degree of visceral involvement and relates to the degree of skin fibrosis.

Titration and Tolerability of Sacubitril/Valsartan for Patients With Heart Failure in Clinical Practice.

Little is known about the dosing and tolerability of sacubitril/valsartan (LCZ696; Entresto, Quebec, Canada) in a nonclinical trial population. This study was conducted to evaluate the use and tolerability of sacubitril/valsartan in patients followed at a multidisciplinary heart failure (HF) clinic. We performed a retrospective chart review of 126 patients with HF, initiated on sacubitril/valsartan, and seen at a specialty HF clinic between August 1, 2015, and August 1, 2017.

Return to Work or Sport After Multiligament Knee Injury: A Systematic Review of 21 Studies and 524 Patients.

Purpose: To systematically review multiligament knee injury (MLKI) outcome studies to determine overall rates of return to work or sport after MLKI and risk factors for lack of return to work or sport after MLKI.

Methods: A search was performed of MLKI outcome studies from 1950 to March 1, 2017. Ninety-two studies were identified.

Diversity-generating retroelements: natural variation, classification and evolution inferred from a large-scale genomic survey.

Diversity-generating retroelements (DGRs) are novel genetic elements that use reverse transcription to generate vast numbers of sequence variants in specific target genes. Here, we present a detailed comparative bioinformatic analysis that depicts the landscape of DGR sequences in nature as represented by data in GenBank. Over 350 unique DGRs are identified, which together form a curated reference set of putatively functional DGRs.

The MiRNA Journey from Theory to Practice as a CNS Biomarker.

MicroRNAs (miRNAs), small nucleotide sequences that control gene transcription, have the potential to serve an expanded function as indicators in the diagnosis and progression of neurological disorders. Studies involving debilitating neurological diseases such as, Alzheimer's disease, multiple sclerosis, traumatic brain injuries, Parkinson's disease and CNS tumors, already provide validation for their clinical diagnostic use. These small nucleotide sequences have several features, making them favorable candidates as biomarkers, including function in multiple tissues, stability in bodily fluids, a role in pathogenesis, and the ability to be detected early in the disease course.