bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigating the Mass of the Black Hole and Possible Wind Outflow of the Accretion Disk in the Tidal Disruption Event AT2021ehb
Authors: Xiang Xin , Miller Jon M. , Zoghbi Abderahmen , Reynolds Mark T. , Bogensberger David , Dai Lixin , Draghis Paul A. , Drake Jeremy J. , Godet Olivier , Irwin Jimmy , Miller M. Coleman , Mockler Brenna , Saxton Richard , Webb Natalie 
Published: August 2024

Abstract
Tidal disruption events (TDEs) can potentially probe low-mass black holes (BHs) in host galaxies that might not adhere to bulge or stellar-dispersion relationships. At least initially, TDEs can also reveal super-Eddington accretion. X-ray spectroscopy can potentially constrain BH masses, and reveal ionized outflows associated with super-Eddington accretion. Our analysis of XMM-Newton X-ray observations of the TDE AT2021ehb, around 300 days post-disruption, reveals a soft spectrum and can be fit with a combination of multicolor disk blackbody and power-law components. Using two independent disk models with properties suited to TDEs, we estimate a BH mass at M ≃ 105.5
M
⊙, indicating AT2021ehb may expose the elusive low-mass end of the nuclear BH population. These models offer simple yet robust characterization; more complicated models are not required, but provide important context and caveats in the limit of moderately sensitive data. If disk reflection is included, the disk flux is lower and inferred BH masses are ∼0.35 dex higher. Simple wind formulations imply an extremely fast v
out = −0.2c outflow and obviate a disk continuum component. Assuming a unity filling factor, such a wind implies an instantaneous mass outflow rate of

M

̇

≃
5

M

⊙

yr

−
1

. Such a high rate suggests that the filling factor for the ultrafast outflow (UFO) must be extremely low, and/or the UFO phase is ephemeral. We discuss the strengths and limitations of our analysis and avenues for future observations of TDEs.
Velocity-resolved Ionization Mapping of Broad Line Region. I. Insights into Diverse Geometry and Kinematics
Authors: Li Sha-Sha , Feng Hai-Cheng , Liu H. T. , Bai J. M. , Ji Xiang , Pang Yu-Xuan , Cheng Cheng , Lu Kai-Xing , Wang Jian-Guo , Li Rui 
Published: August 2024

Abstract
Broad emission lines of active galactic nuclei (AGNs) originate from the broad-line region (BLR), consisting of dense gas clouds in orbit around an accreting supermassive black hole. Understanding the geometry and kinematics of this region is crucial for gaining insights into the physics and evolution of AGNs. Conventional velocity-resolved reverberation mapping may face challenges in disentangling the degeneracy between intricate motion and geometry of this region. To address this challenge, new key constraints are required. Here, we report the discovery of an asymmetric BLR using a novel technique: velocity-resolved ionization mapping, which can map the distance of emitting gas clouds by measuring Hydrogen line ratios at different velocities. By analyzing spectroscopic monitoring data, we find that the Balmer decrement is anticorrelated with the continuum and correlated with the lags across broad emission line velocities. Some line ratio profiles deviate from the expectations for a symmetrically virialized BLR, suggesting that the redshifted and blueshifted gas clouds may not be equidistant from the supermassive black hole (SMBH). This asymmetric geometry might represent a formation imprint, provide new perspectives on the evolution of AGNs, and influence SMBH mass measurements.
ϵ Sagittarii: An Extreme Rapid Rotator with a Decretion Disk
Authors: Bailey Jeremy , Lewis Fiona , Howarth Ian D. , Cotton Daniel V. , Marshall Jonathan P. , Kedziora-Chudczer Lucyna 
Published: August 2024

Abstract
We report high-precision, multiwavelength linear-polarization observations of the bright B9 (or A0) star ϵ Sagittarii. The polarization shows the distinctive wavelength dependence expected for a rapidly rotating star. Analysis of the polarization data reveals an angular rotation rate ω (=Ω/Ωcrit) of 0.995 or greater, the highest yet measured for a star in our Galaxy. An additional wavelength-independent polarization component is attributed to electron scattering in a low-density, edge-on gas disk that also produces the narrow absorption components seen in the spectrum. Several properties of the star (polarization due to a disk, occasional weak Hα emission, and multiple periodicities seen in space photometry) resemble those of Be stars, but the level of activity in all cases is much lower than that of typical Be stars. The stellar properties are inconsistent with single-rotating-star evolutionary tracks, indicating that it is most likely a product of binary interaction. The star is an excellent candidate for observation by interferometry, optical spectropolarimetry to detect the Öhman effect, and ultraviolet polarimetry, any of which would allow its extreme rotation to be tested and its stellar properties to be refined.
FAST Detection of OH Emission in the Carbon-rich Planetary Nebula NGC 7027
Authors: Ouyang Xu-Jia , Zhang Yong , Zhang Chuan-Peng , Jiang Peng , Nakashima Jun-ichi , Chen Xi , Qiao Hai-Hua , Zhang Xu-Ying , Sun Hao-Min , Li Xiao-Hu , Zijlstra Albert 
Published: August 2024

Abstract
We present the first detection of the ground-state OH emission line at 1612 MHz toward the prototypical carbon-rich planetary nebula (PN) NGC 7027, utilizing the newly installed ultrawideband (UWB) receiver of the Five-hundred-meter Aperture Spherical radio Telescope (FAST). This emission is likely to originate from the interface of the neutral shell and the ionized region. The other three ground-state OH lines at 1665, 1667, and 1721 MHz are observed in absorption and have velocities well matched with that of HCO+ absorption. We infer that the OH absorption is from the outer shell of NGC 7027, although the possibility that they are associated with a foreground cloud cannot be completely ruled out. All the OH lines exhibit a single blueshifted component with respect to the central star. The formation of OH in carbon-rich environments might be via photodissociation-induced chemical processes. Our observations offer significant constraints for chemical simulations, and they underscore the potent capability of the UWB receiver of FAST to search for nascent PNe.
D2 MTE3 Case 7: Localising parathyroid gland
Authors: Badgandi Mohan 
Published: August 2024

A 56 year old lady walked into our clinic with history of bilateral renal calculi and generalised weakness of 6 months duration. She was known to have well- controlled hypertension on medications. Clinical examination did not reveal any positive findings. She had been seen by a visiting Endocrinologist in Maldives twice, administered calcium and vitamin D. She also underwent tests to rule out osteoporosis, (17/09/2019) PTH- 180 pg/mL [10.0-65.0] and Serum Calcium levels: Total-11.3 mg/dl [8.0-10.5], Ionised-6.12 mg/dl [4.40-5.30], Vitamin D: 38.6 ng/ml [30-80], renal function was normal. She underwent CT Contrast for Neck & Thorax for Parathyroid adenoma on 28/09/2019 which showed suspicious nodular enhancing lesion in the left lobe of the thyroid (7x4 mm in the trachea-oesophageal groove). In view of her raised PTH, Sestamibi scan done revealed no definite evidence but Methyl-Choline scan showed hypodense area in the left lobe of the thyroid. She therefore underwent surgical exploration of left minimally invasive Parathyroidectomy on 28/09/2019. Frozen section showed Parathyroid hyperplasia hence underwent 3 and a half parathyroid excision on 30/09/2019. HPE report did not reveal any parathyroid adenoma. Post-operatively, Serum PTH and Calcium levels remained high (229.5 and 11.5 mg/dl, Ionised-5.97 mg/dl). Patient later underwent excision of lymph node and left lobe of thyroid on 02/01/20 in view of persistent hyperparathyroidism. However, on biopsy it showed reactive nodes and thyroid tissue with colloid filled follicles. We still faced persistent elevation of Serum PTH and Calcium. Hence it was decided to start the patient on Cincalcet 30 mg daily after a joint meeting with surgical and nephrology consultants. Patient was not able to follow up due to the covid pandemic. Presently, her PTH -288.2, Serum Calcium-11, Vitamin D- 33.2, Phosphorus-2.9 (October 2021). This clearly shows the treatment has not been effective and we are dealing with persistent hypercalcaemia, hyperparathyroidism and no localisation. We are also faced with the problem of post-operative management of hypercalcaemia.
How to manage persistent hypercalcaemia and hyperparathyroidism?
How to proceed with localisation of the primary source of PTH?
Family History of Stuttering among Kurdish Children Who Stutter Near the Age of Onset
Authors: Mohammadi Hiwa , Bakhtiary Parya 
Published: August 2024

Abstract

Background:
The family history of stuttering is one of the most important factors for the prediction of recovery from stuttering. There is a high controversy about the rate of positive family history of stuttering among people who stutter (PWS). In the present study, the family history of stuttering in the first-, second-, and third-degree relatives was investigated among a group of Kurdish children who stuttered (CWS) close to the onset of the disorder.

Materials and Methods:
One hundred and seventy-two CWS, including 46 females (24.60%) aged 2–5 years (mean age: 3.71 years, SD = 0.75) were consecutively recruited. They were first examined close to the onset of the stuttering. Data about current and former stuttering among first-, second-, and third-degree relatives were collected using interviews with both parents. Data was described and analyzed by independent sample t test or Chi-square.

Results:
Among 172 CWS (mean age: 3.71 years, SD = 0.75), 119 (69.20%) reported a family history of stuttering. According to the result, the most family history of stuttering was reported among third-degree relatives (32.60%). Sixty-five participants (37.80%) reported just one relative with stuttering. CWS with a positive family history of stuttering had no significant difference with CWS without a positive family history of stuttering in sex (P = 0.48) and age of stuttering onset (P = 0.96).

Conclusion:
The rate of positive family history of stuttering among Kurdish CWS is similar to previously reported data in the same age group. There was no significant association of family history of stuttering with sex and age on the onset of the disorder.
A risk prediction model for vasovagal reactions in whole blood donors including the physical and psychological factors: Results from a case–control study done in a regional blood transfusion center
Authors: Shaiji P. S. , Indu Pillaveetil Sathyadas , Meena D. , Surendran Anish Thekkumkara 
Published: August 2024

Abstract:

BACKGROUND AND OBJECTIVES:
Blood centers strive to maintain a safe and adequate supply of blood products from healthy volunteer donors. Primary responsibility of a medical officer is to assess donor risk for vasovagal reaction (VVR) and alert the phlebotomist. The study attempts to identify the significant risk factors of VVR which may help in decision-making.

METHODS:
This was a case–control study including blood donors donating 350 ml Whole blood in Department of Transfusion Medicine, Medical College, Thiruvananthapuram from December 19, 2017 to June 31, 2018. Donors who suffered VVRs during or after blood donation were considered as cases and compared with controls. The prevalence of risk factors such as age, sex, number of previous donations, body mass index (BMI), blood volume, sleep duration, food intake, fear and anxiety, and pain perception was compared between the groups.

RESULTS:
174 cases and 348 controls were studied. Most of the donors were < 35 years of age (63.2%) younger age groups (18–25 year) had a higher odds of VVR (5.54 with 95% confidence interval [CI] 2.4–12.5). First time donations carried an increased risk of VVR with an ODDs ratio of 5.8 (3.81–9.131) compared to repeat donors. Around 45% of cases were first timers whereas only 12% of controls were first time donors. There was a significantly higher rate of reactions in donors who had episodes of VVRs in the previous donations. Odds 1.99 (CI 1.09–3.74) other risk factors identified were female gender (6.3, 95% CI 2–20), lack of sleep at previous night (32.9; CI 16.17–67.18), and high BMI > 27.5/m2 with odds ratio 2.5 (1.4–4.3). Having an estimated blood volume < 3500 ml also was associated with higher odds of VVRs.

CONCLUSION:
In spite of having a strict criteria for donor deferral based on risk factors, vasovagal reactions still occur and risk factors are prevalent in blood donor population. Special attention should be given to donors having one more of such risk factors and attempts should be made to avert VVRs.
“When less is more and more is less” red cell alloimmunization in multitransfused patients attending a medical institution with a newly developed blood center in North India: A multifactorial study
Authors: Mukherjee Ranjan , Negi Gita , Kaur Daljit , Nath Uttam Kumar , Chaturvedi Yatendra , Bava Davood 
Published: August 2024

Abstract:

INTRODUCTION:
Multiple blood transfusions with one or more nonself, genetically mismatched donor red blood cells (RBCs) may result in the production of alloantibodies, complicating future transfusions and increasing patient morbidity. This could be averted if adequate prophylactic measures are implemented in the vulnerable group. Due to the paucity of data in our region, we planned this study to identify the alloimmunization pattern in relation to clinical and demographic patient factors.

MATERIALS AND METHODS:
A prospective observational study was carried out in a newly developed Medical Institution of National importance in Northern India, for 1 year. The red cell antibody screening and identification were done for 770 patients receiving two or more transfusions. The patient and transfusion-related factors were statistically compared between alloimmunized and nonalloimmunized cases.

RESULTS:
The overall seroprevalence of RBC alloimmunization among the multi-transfused patients was 4.02% (31/770). Thirty-six alloantibodies were identified in the 31 alloimmunized patients, which comprised 13 different alloantibody specificities. Most of them belonged to the Rh system (38.8%), followed by MNS (25%) and Lewis (27.7%) blood group systems. On Multivariate logistic regression analysis, the highest risk was found to be associated with recipients having more than three transfusions with an odds ratio of 8.4.

CONCLUSIONS:
The highest alloimmunization risk was found in multi-transfused patients receiving more than three transfusions and with female gender. Rh blood group system was found to be predominating the alloantibody specificity pattern. This highlights the need for the provision of extended Rh (DCcEe) matched packed red cells for susceptible patients.
Therapeutic plasma exchange for COVID-19 acute respiratory distress syndrome complicated by myasthenia gravis
Authors: Krishna Aparna , Pandey Hem Chandra , Coshic Poonam , Nair Parvathy Ramachandran , Haritha Damarla , Rajan Roopa , Mehta Vikas 
Published: August 2024

Abstract:
The role and safety of therapeutic plasma exchange (TPE) in COVID-19-induced severe acute respiratory distress remains unclear, especially in the wake that a specific and effective treatment modality has not been discovered for the treatment of COVID-19. Here, we report a case where a patient presenting with severe COVID-19 acute respiratory distress syndromes (ARDS) complicated by myasthenia gravis showed significant improvement after the third session of TPE and was subsequently weaned off from the ventilator and shifted to the ward from intensive care unit. TPE can be considered an efficient and safe treatment modality in severe COVID-19 ARDS.
Multifaceted approach to successful management of pediatric acute liver failure: High-volume plasma exchange as a pivotal intervention
Authors: Yadav Anshika , Sharma Ravi , Gupta Supriya , Vaishnav Sandeep , Bansal Rajiv , Gupta Gajendra Nath 
Published: August 2024

Abstract:
Pediatric acute liver failure (pALF) poses a formidable clinical challenge characterized by rapid hepatocyte necrosis and pro-inflammatory events. The urgency of pALF necessitates advanced therapeutic modalities, prompting the exploration of high-volume plasma exchange (HVPE) as a sophisticated intervention. This case report delves into the intricate management of a 16-year-old female with hyperacute liver failure secondary to hepatitis A, highlighting the critical need for nuanced and multidisciplinary approaches. The case unfolds through a detailed description of symptoms, clinical decision-making, and the therapeutic journey. The management includes a calculated deferral of liver transplantation in favor of HVPE, with a focus on the rationale for choosing HVPE over continuous renal replacement therapy. Technical aspects of the procedure, such as blood volume calculations and procedural details, are meticulously outlined. Laboratory investigations track the patient’s progress, showcasing the profound impact of HVPE on clinical and laboratory recovery. The patient’s response to HVPE is evident in the comprehensive clinical and laboratory recovery observed after the intervention. The resolution of encephalopathy, successful extubation, and eventual discharge highlight the positive outcomes achieved through the judicious application of HVPE. However, the procedure is not without challenges, as the emergence of hypertension during the second and third cycles and a lone episode of seizure require swift and careful management. The management of pALF demands a sophisticated and multidimensional approach, especially when liver transplantation is not immediately feasible. This case report underscores the nuanced decision-making involved in selecting extracorporeal therapies, with a focus on the successful application of HVPE. HVPE, as recommended by the American Society for Apheresis, emerges as a promising intervention in the context of pALF, offering a viable option when liver transplantation is deferred due to advanced encephalopathy. The favorable outcomes and considerations of cost-effectiveness and procedural simplicity further accentuate the potential of HVPE as a cornerstone in the critical care of pediatric patients with acute liver failure.
Red cell serological characterization of autoimmune hemolytic anemia in systemic lupus erythematosus patients
Authors: Chinnapureddy Vinay Kumar , Bonagiri Shanthi 
Published: August 2024

Abstract:

INTRODUCTION:
Autoimmune hemolytic anemia (AIHA) is a clinical condition with increased red cell destruction or decreased red cell survival due to autoantibodies against self-antigens on red blood cells. AIHA may be primary or secondary to other underlying illness. Systemic lupus erythematosus (SLE) is the most common secondary cause of AIHA. Although the incidence of AIHA in SLE patients is low (5%–10%), sometimes, it causes severe anemia which requires blood transfusion. Characterization of these autoantibodies in AIHA is very important, because the clinical condition and treatment of the patient depend on the optimal temperature reactivity, class, and subclass of immunoglobulin responsible.

AIM AND OBJECTIVES:
The aim and objective of this study are to perform detailed characterization of red cell autoantibodies for accurate diagnosis of AIHA in SLE patients, to find out specific class (immunoglobulin G [IgG]/IgM/IgA) of immunoglobulin and/or complement (C3c/C3d) responsible for AIHA, and their association with severity of hemolysis.

MATERIALS AND METHODS:
This was a prospective analytical study, done at a tertiary care hospital in Hyderabad, conducted between February 2021 and May 2022. SLE patients with AIHA were included in the study. Monospecific direct antiglobulin test (DAT) was performed to identify the specificity of autoantibody or complement. Based on hematological laboratory values, the study population was divided into three groups, i.e., mild, moderate, and severe hemolysis. DAT strength, hemolytic parameters, and severity of hemolysis were compared between different types of AIHA in SLE patients. Correlation statistics were used to know the association of severe hemolysis with DAT strength and different combinations of autoantibodies.

RESULTS:
Among 150 patients enrolled, 16 (10.6%) patients had severe hemolysis, 51 (34%) patients had moderate hemolysis, and 83 (55.3%) patients had mild hemolysis. Only IgG was positive in 109 (72.6%) patients, both IgG and C3d were positive in 37 (24.6%) patients, C3d was positive in 4 patients, and IgM was positive in 19 patients. High DAT reaction strength (3+–4+) and presence of C3d or IgM along with IgG were moderately correlated with severe hemolysis.

CONCLUSION:
Warm AIHA is the most common type of AIHA in SLE patients mediated by IgG. Mild and moderate hemolysis was seen in most cases. Severe hemolysis was moderately correlated with the presence of C3d or IgM. Further studies are warranted to find the predisposing factors leading to severe hemolysis.
A 10/14 French silicone urinary catheter with inflatable balloon used as novel expansion device in lid reconstruction surgery
Authors: Mandal Salil K , Honavar Santosh G , Mukhopadhyay Asrik , Maitra Anwesha , Sarkar Oishik , Gayen Mausree , Mallick Nazibul H 
Published: August 2024

Purpose:
To describe the surgical technique using a 10/14 French silicone urinary catheter as a novel tissue expander for repair of defects after removal of eyelid tumors. This device recruits additional tissue by tissue expansion for repair of large eyelid defects.

Methods:
A prospective noncomparative, interventional case study was conducted over a period of 3 years in which 30 patients were enrolled. All the 30 patients were selected for upper or lower lid Tenzel rotational flap after removal of large malignant tumor, using the tissue expander.

Results:
A 10/14-French silicone urinary catheter was placed in the periocular region and expanded by graded inflation with normal saline to a total volume of 10 or 14 ml, respectively, over a period of 3 days. On the fourth day before the planned surgery, the catheter balloon was deflated and a modified Tenzel rotational flap was performed to close the defect. Postoperative blink reflex was preserved. There were no cases of wound dehiscence. There was a significant reduction of incision length in upper and lower lid reconstruction with modified Tenzel flap reconstruction.

Conclusion:
This approach allows for temporary tissue expansion, permitting the closure of large eyelid defects, typically not possible with a conventional Tenzel flap. This also provides excellent functional outcomes without closing patients’ eyelids (which limits vision for weeks to months) as is typical of other reconstructive modalities (e.g. Cutler Beard procedure). The device is cost-effective and readily available. The authors believe it is an excellent alternative in the developing world where access to more expensive options is limited.