bluuebunny/crossref_metadata_2025_split huggingface dataset:
Long-term X-ray temporal and spectral study of a Seyfert galaxy Mrk 6
Authors: Layek Narendranath , Nandi Prantik , Naik Sachindra , Kumari Neeraj , Jana Arghajit , Chhotaray Birendra 
Published: February 2024

ABSTRACT
We present a long-term X-ray study of a nearby Active Galactic Nucleus Mrk 6, utilizing observations from XMM–Newton, Suzaku, Swift, and NuSTAR observatories, spanning 22 years from 2001 to 2022. From timing analysis, we estimated variance, normalized variance, and fractional rms amplitude in different energy bands.The temporal study shows fractional rms amplitude (Fvar) below 10 per cent for the shorter time-scale (∼60 ks) and above 20 per cent for the longer time-scale (∼weeks). A complex correlation is observed between the soft (0.5–3.0 keV) and hard (3.0–10.0 keV) X-ray bands of different epochs of observations. This result prompts a detailed investigation through spectral analysis, employing various phenomenological and physical models on the X-ray spectra. Our analysis reveals a heterogeneous structure of the obscuring material surrounding Mrk 6. A partially ionized absorber exhibits a rapid change in location and extends up to the narrow-line regions or torus. In contrast, another component, located far from the central engine, remained relatively stable. During the observation period, the source luminosity in the 3.0–10.0 keV range varies between (3–15) × 1042 erg s−1.
Development of an Electronic Decision Aid Tool to Facilitate Mainstream Genetic Testing in Ovarian Cancer Patients
Authors: Shannon Kristen M , Patel Devanshi , Jonas Jessica M , Blouch Erica L , Hicks Stephanie R , Wooters Mackenzie , Seidel Meredith , Grant Carly F , Emmet Margaret M , Chung Daniel C , Sepucha Karen 
Published: February 2024

Abstract

Background
Multigene panel testing is an important component of cancer treatment plans and risk assessment, but there are many different panel options and choosing the most appropriate panel can be challenging for health care providers and patients. Electronic tools have been proposed to help patients make informed decisions about which gene panel to choose by considering their preferences and priorities.

Materials and Methods
An electronic decision aid (DA) tool was developed in line with the International Patient Decision Aids Standards collaboration. The multidisciplinary project team collaborated with an external health care communications agency and the MGH Cancer Center Patient and Family Advisory Council (PFAC) to develop the DA. Surveys of genetic counselors and patients were used to scope the content, and alpha testing was used to refine the design and content.

Results
Surveys of genetic counselors (n = 12) and patients (n = 228) identified common themes in discussing panel size and strategies for helping patients decide between panels and in identifying confusing terms for patients and distribution of patients’ choices. The DA, organized into 2 major sections, provides educational text, graphics, and videos to guide patients through the decision-making process. Alpha testing feedback from the PFAC (n = 4), genetic counselors (n = 3) and a group of lay people (n = 8) identified areas to improve navigation, simplify wording, and improve layout.

Conclusion
The DA developed in this study has the potential to facilitate informed decision-making by patients regarding cancer genetic testing. The distinctive feature of this DA is that it addresses the specific question of which multigene panel may be most suitable for the patient. Its acceptability and effectiveness will be evaluated in future studies.
Short-term stability and night-to-night variability of sleep parameters in nightmares comorbid with chronic insomnia Disorder across multiple nights of polysomnography
Authors: Paquet Caitlin , Lenker Kristina P , Calhoun Susan L , Bixler Edward O , Vgontzas Alexandros N , Fernandez-Mendoza Julio 
Published: February 2024

Abstract

Study Objectives
The purpose of this study was to examine the degree of short-term stability of polysomnographic (PSG) measured sleep parameters and the overall differences between individuals with comorbid nightmares and insomnia compared to those with chronic insomnia disorder alone or good sleeping controls across four nights in the sleep lab.

Methods
A total of 142 good sleeping controls, 126 chronic insomnia alone, and 24 comorbid insomnia/nightmare participants underwent four consecutive nights of 8-hour PSG recordings. Outcomes included sleep continuity, architecture, and REM-related parameters across nights one through four. Intraclass correlation coefficients with mixed-effect variances and repeated-measure analysis of covariance were used, respectively, to determine short-term stability as well as between-participants and time-by-group interaction effects.

Results
Wake after sleep onset and stage 1 showed “poor stability” in the comorbid insomnia/nightmare group compared to “moderate stability” in the good sleeping controls and chronic insomnia alone group. Significant between-group effects (all ps &lt; .05) showed that the comorbid insomnia/nightmare group took longer to fall asleep and had a greater first-night-effect in stage 1 compared to good sleeping controls and chronic insomnia alone group; in addition, the comorbid insomnia/nightmare and insomnia alone groups slept shorter, with fewer awakenings and REM periods, compared to the good sleeping controls.

Conclusions
Nightmares are associated with abnormal sleep above and beyond REM disruption, as sleep continuity was the primary aspect in which poor stability and group differences emerged. The greater inability to fall asleep and instability of sleep fragmentation in those with comorbid insomnia/nightmares compared to chronic insomnia alone may be attributed to the impact of presleep anticipatory anxiety and nightmare-related distress itself.

Clinical Trial Information
The data analyzed in this study does not come from any current or previous clinical trials. Therefore, there is no clinical trial information to report.
Neuropeptide substance P alters stem cell fate to aid wound healing and promote epidermal stratification through asymmetric stem cell divisions
Authors: Khalifa A , Xiao T , Abegaze B , Weisenberger T , Charruyer A , Sanad Samia , AbuElnasr Taher , Kashem S W , Fassett M , Ghadially R 
Published: February 2024

Abstract
Loss of sensory innervation delays wound healing and administration of the neuropeptide substance P improves re-epithelialization. Keratinocyte hyperproliferation post-wounding may result from symmetric stem cell (SC) self-renewal, asymmetric SC self-renewal, committed progenitor divisions, or a combination of these. However, the effects of sensory denervation and of neuropeptides on SC proliferation are not known. Here we show that early after wounding both asymmetric and symmetric SC self-renewal increase, without significant committed progenitor (CP) activation. Decreased sensory innervation is associated with a decrease in both SC and CP proliferation. Based on previous work showing that substance P is decreased in capsaicin-treated mice and improves wound healing in normal skin, we examined the effects of substance P on SC and CP proliferation during wound healing. Substance P restored asymmetric SC proliferation in skin with decreased sensory innervation, both at baseline and following wounding. Epidermis with decreased sensory innervation was severely thinned. Consistent with this, substance P-induced asymmetric SC proliferation resulted in increased stratification in skin with both normal and decreased innervation. Lapatinib prevented the substance P-induced increase in asymmetric SC divisions in murine epidermis, as well as the increase in epidermal stratification, suggesting that asymmetric SC divisions are required for epidermal stratification.
Follow-up Value of Hip Medial Ultrasound in Infants and Children With Developmental Dysplasia of the Hip Treated With Reduction and Spica Casting
Authors: Yu Jingmiao , Chen Tao , Fu Gang , Lyu Xuemin , Wang Chao , Wang Yukun , Yang Zheng , Guo Wen 
Published: February 2024

Objective:
Closed or open reduction and spica casting are common treatments for children aged 6 to 18 months, as well as infants aged 0 to 6 months whose harness treatment for developmental dysplasia of the hip (DDH) was unsuccessful. The study aimed to quantify the distance between the femoral head and the acetabulum after closed or open reduction and evaluate the dynamic docking progression of the femoral head using serial hip medical ultrasound.

Methods:
We retrospectively reviewed the medical records and hip medial ultrasound images of a consecutive series of patients with DDH who underwent spica casting after reduction and compared images obtained immediately after reduction and at follow-up. The first cast (stage I) was maintained for 2 to 3 months and scheduled for outpatient repeat ultrasound in 4 to 8 weeks. Then the second cast was placed (stage II), lasting for another 2 to 3 months. The triradiate cartilage-femoral head distance (TFD) was measured in the acetabulum coronal mid-sectional plane. The Wilcoxon signed-rank test was used to compare the TFD values.

Results:
This study included 49 patients. All patients underwent hip medial ultrasound 0 to 3 days after stage I (time 1) and 4 to 8 weeks (time 2) postoperatively, with 24 patients reviewed again 0 to 7 days after stage II. The TFD values in time 1 and time 2 were 6.0 (5.0, 9.0) mm and 5.0 (3.6, 7.0) mm, respectively. There was a statistically significant difference between times 1 and 2 regarding TFD values in 49 close-reduction hips (6.0 vs 5.0 mm, P < 0.001). Similar findings were also observed in 13 open-reduction hips (6.0 vs 5.0 mm, P = 0.023).

Conclusions:
Hip medial ultrasonography during the period of cast immobilization after reduction in children with DDH can objectively and quantitatively show the dynamic change of the distance between the femoral head and the acetabulum, and can be used to assess reduction of the hip and progression of femoral head docking.

Level of Evidence:
Level II—prognostic study.
Estimated Excess Deaths Due to COVID-19 Among the Urban Population of Mainland China, December 2022 to January 2023
Authors: Raphson Leon , Lipsitch Marc 
Published: February 2024

Background:
Mainland China experienced a major surge in SARS-CoV-2 infections in December 2022–January 2023, but its impact on mortality was unclear given the underreporting of coronavirus disease 2019 deaths.

Methods:
Using obituary data from the Chinese Academy of Engineering (CAE), we estimated the excess death rate among senior CAE members by taking the difference between the observed rate of all-cause death in December 2022–January 2023 and the expected rate for the same months in 2017–2022, by age groups. We used this to extrapolate an estimate of the number of excess deaths in December 2022–January 2023 among urban dwellers in Mainland China.

Results:
In December 2022–January 2023, we estimated excess death rates of 0.94 per 100 persons (95% confidence interval [CI] = −0.54, 3.16) in CAE members aged 80–84 years, 3.95 (95% CI = 0.50, 7.84) in 85–89 years, 10.35 (95% CI = 3.59, 17.71) in 90–94 years, and 16.88 (95% CI = 0.00, 34.62) in 95 years and older. Using our baseline assumptions, this extrapolated to 917,000 (95% CI = 425,000, 1.45 million) excess deaths among urban dwellers in Mainland China, much higher than the 81,000 in-hospital deaths officially reported from 9 December 2022 to 30 January 2023.

Conclusions:
As in many jurisdictions, we estimate that the coronavirus disease 2019 pandemic had a much wider impact on mortality than what was officially documented in Mainland China.
One-stage Intraconal Volume Modification for Exposed and Nonexposed Ball Implants
Authors: Vahdani Kaveh , Rose Geoffrey E. , Marjanovic Branka , Verity David H. 
Published: February 2024

Purpose:
To assess long-term outcomes and reinterventions for exposed and nonexposed intraconal orbital implants after single-stage socket revisional surgery.

Methods:
Retrospective case-note review of patients with exposed or nonexposed orbital ball implants, who underwent a single-stage ball exchange (Group I) or ball removal with dermis-fat graft (Group II); Group I was subdivided as having either exposed (A) or nonexposed (B) implants. Outcomes were compared with similar cohorts undergoing multistage surgery.

Results:
Of 172 patients (54% male), 153 (89%) underwent ball exchange (Group I) and 19 (11%) had dermis-fat graft (Group II). With a mean follow up of 7.8 years, Group I patients without ball exposure (Group IB) had a slightly higher rate of reintervention for persistent volume deficit (21% vs. 9%; p = 0.163) and implant migration (6% vs. 0%; p = 0.091), while Group IA patients—having surgery for exposed implants—had more reexposures (7% vs. 3%; p = 0.270). Single-stage and 2-stage surgery had similar reintervention rates, with the exception of a trend toward fewer volume enhancements for those with nonexposed implants (17% vs. 30%; p = 0.380), and a shorter time to (re)exposure for exposed implants after 2-stage procedures (mean 0.33 vs. 3.5 years; p = 0.571). Group II patients required further volume enhancement in 32% of 1-stage procedures, and one patient needed graft removal.

Conclusion:
Single-stage volume modification is effective and the results are comparable to staged surgery for either exposed or nonexposed implants. Most patients report a stable prosthesis and satisfactory cosmesis, after a faster rehabilitation.
Transcutaneous electric acupoint stimulation reduced consumption of profopol in patients undergoing laparoscopic surgery: A randomized clinical trial
Authors: Zhang Minjuan , Cairen Zhuoma , Liu Xiaoyu , Deng Jiao , Mu Xiaoxiao , Wang Yun , Lu Zhihong 
Published: February 2024

Background:
Propofol is a common regimen for general anesthesia maintenance. But propofol can dose-dependently generate cardiopulmonary depression. Thus, any strategy to reduce propofol dosage during laparoscopic surgery may have underlying beneficial effect for patient prognosis. Previous studies indicated both analgesic and sedative effect of acupoint stimulation. However, its main sedative effect on patients under general anesthesia remains unclear.

Objective:
The aim of this study was to investigate the sedative effect of transcutaneous electrical acupoint stimulation (TEAS) on patients scheduled for laparoscopic surgery under general anesthesia.

Design, setting, participants and interventions:
In this randomized clinical trial, patients scheduled for laparoscopic surgery under general anesthesia in Xijing hospital were randomly assigned to 3 groups, receiving electrical stimulation at the Shenmen (HT7)/Ximen (PC4) (TEAS group), stimulation at the shoulder (non-acupoint group) or no stimulation (control group), respectively.

Main outcome measures:
One hundred sixty-two patients completed the study. The primary outcome was the consumption of propofol, and secondary outcomes included features of recovery after surgery, major complications after surgery and by 1 year after surgery.

Results:
In patients undergoing laparoscopic surgery, the doses of propofol decreased significantly in the TEAS group compared (0.10 ± 0.02 mg·kg−1·min−1) with the other 2 groups (both 0.12 ± 0.02 mg·kg−1·min−1, P < .001). The mean differences (95% confidence interval) for non-acupoint versus TEAS and control versus TEAS were 0.021 (0.012, 0.030) and 0.024 (0.013, 0.034), respectively. Time to awake and to extubation were not significantly different among the groups. The incidences of major complications after surgery and by 1 year after surgery were not significantly different among the groups.

Conclusion:
TEAS could induce additional sedative effect in patients during laparoscopic surgery and reduce propofol consumption.
Cognitive and behavioral approaches to occupational stress management: The case of adult education administrative workers in Nigeria
Authors: Anyadike Nkechi , Ogiri Happiness Kodichinma , Agbo Solomon Uchenna , Osang Bessong Napoleon , Bessong Columbus Deku , Godwin Ozurumba Iheanyichukwu , Nkemjika Ogechi , Onyinye Ekere , Onyeodiri Imo Charity , Okengwu Mary , Nwabuko Linus Okechukwu , Otu Mkpoikanke Sunday , Victor-Aigbodion Vera , Ndille Roland 
Published: February 2024

Background:
Those in administrative positions in adult education are more likely to suffer from stress because of the hard work they do, long hours in the office, a lack of adequate medical and welfare packages, and a lack of financial aid. In this study, adult education workers in Nigeria were assessed on the effectiveness of a cognitive and behavioral approach to managing occupational stress in public administration.

Method:
This study was a group-randomized trial in which 94 adult education workers occupy public administrative positions within Enugu State, Nigeria, participated. Data were collected using 2 instruments, the Perceived Stress Scale, and the Workplace Stress Scale, which were validated by cognitive and behavioral psychologists at the University of Nigeria, Nsukka. The instruments contained internal construct and content validity as determined by Cronbach alpha. ANCOVA was employed to test for hypotheses and answer research questions.

Results:
This study demonstrates that cognitive and behavioral approaches are significantly effective in managing occupational stress among adult education workers who work for public agencies.

Conclusion:
To improve stress management capacity among adults in public administration positions, researchers recommend frequent exposure to cognitive and behavioral approaches.
Presentation of glomerulocystic disease in a young onset diabetes: A case report
Authors: Huang Wen-Hung , Tu Kun-Hua , Chen Tai-Di , Weng Cheng-Hao , Hsu Ching-Wei 
Published: February 2024

Rationale:
This case report presents a challenging medical scenario involving a young adult male who exhibited an unusual combination of symptoms, including abrupt weight loss, declining renal function, proteinuria, and concurrent onset of diabetes mellitus. Remarkably, the patient had no previous medical history or family history of similar conditions, necessitating a comprehensive investigation.

Patient Concerns:
On March 10, 2021, a 25-year-old male sought medical attention due to the aforementioned symptoms. Initial assessments revealed stage 5 chronic kidney disease, with elevated blood urea nitrogen (BUN) and serum creatinine (Cr) levels, as well as significant proteinuria. The only notable physical finding was obesity, and renal ultrasound showed normal-sized kidneys without cysts.

Diagnosis:
A treatment plan was initiated to stabilize creatinine levels, including medications such as Glimepiride, Glyxambi, Bisoprolol, Amlodipine, and Valsartan. However, despite diligent medication management, proteinuria persisted, prompting further evaluation. A renal biopsy was performed on April 12th, 2023, leading to the diagnosis of glomerulocystic kidney disease with early-stage changes indicative of diabetic nephropathy.

Interventions:
The patient continues to receive ongoing care and follow-up at our outpatient clinic to optimize therapeutic interventions and elucidate the underlying etiology of this complex clinical scenario.

Outcomes:
Ongoing investigations and therapeutic interventions are crucial to understand the underlying cause and optimize patient care in this intricate clinical scenario.

Lessons:
This case underscores the complexity of diagnosing and managing a young adult presenting with concurrent renal dysfunction, proteinuria, and diabetes mellitus in the absence of prior underlying conditions. It highlights the importance of comprehensive evaluation and ongoing care in such challenging cases.
A case of digoxin intoxication caused by short-term massive overdose: Case report
Authors: Li Hua , Zhang Chun-hai , Liu Ming-wei 
Published: February 2024

Rationale:
Digoxin is a frequently prescribed medication for the management of both acute and chronic cardiac insufficiency. The overdose ingestion of digoxin can result in a range of arrhythmias, with severe cases potentially leading to malignant arrhythmias and fatal outcomes. To date, there is a lack of documented cases related to acute digoxin intoxication resulting from the administration of massive digoxin overdose in the short term.

Patient concerns:
A 37-year-old female patient was admitted to the emergency department following a suicide attempt involving the administration of 330 tablets of digoxin (each tablet containing 0.25 mg). The patient exhibited symptoms of confusion, nausea, and vomiting for around 30 minutes. The patient had a history of depression.

Diagnoses:
The patient was diagnosed with digoxin intoxication.

Interventions:
The patient underwent many medical interventions including stomach lavage, administration of laxatives, correction of cardiac arrhythmias, provision of myocardial nutrition, diuresis, correction of acid-base balance, and management of electrolyte disturbances, among others.

Outcomes:
Following a treatment of 9 days, the patient exhibited no signs of discomfort, maintained consciousness, and the serum concentration of digoxin was indeterminable. Upon reevaluation of the electrocardiogram, it was determined that no arrhythmia was present. Consequently, the patient was authorized to be discharged from the hospital.

Conclusions:
There is currently no documented evidence of cases involving a significant overdose of digoxin resulting in intoxication. The patient had a comprehensive treatment regimen consisting of stomach lavage, administration of a laxative, correction of cardiac arrhythmias, provision of myocardial nutrition, fluid replacement, diuresis, and supportive therapy, resulting in successful outcomes.

Lessons:
There have been no known cases of intoxication resulting from a significant overdose of digoxin, specifically with the consumption of 330 tablets (0.25 mg/tablet). However, in the event of ingesting excessive amounts of digoxin, it is imperative to promptly administer stomach lavage, administration of a laxative, and arrhythmia correction. The administration of temporary pacemaker therapy is recommended for patients presenting with high atrioventricular block, whereas hemoperfusion is advised for patients with renal insufficiency as a means to eliminate digoxin from the body.
Cholera outbreaks among children in sub-Saharan Africa
Authors: Ubesie Agozie C. , Odimegwu Chioma L. , Ezeanolue Echezona Edozie 
Published: February 2024

Purpose of review
We review current knowledge on the burden, impact and prevention of cholera among children who bear the brunt of cholera outbreaks in sub-Saharan Africa.

Recent findings
Several studies have shown that recent outbreaks of cholera among African children are related to minimal progress in basic sanitation and infrastructural development. Poor hygiene practices such as open defecation and indiscriminate disposal of feces are still common in many parts of Africa

Summary
Cholera case fatality rates in sub-Saharan Africa remain unacceptably high. Children are disproportionately affected and bear the brunt of the disease. Controlling outbreaks of cholera among African children will require a synchronous implementation of the five levels of disease prevention.