bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maturational trend of daytime sleep propensity in adolescents
Authors: Campbell Ian G , Figueroa Jessica G , Bottom Vincent B , Cruz-Basilio Alejandro , Zhang Zoey Y , Grimm Kevin J 
Published: October 2023

Abstract

Study Objectives
The teenage increase in sleepiness is not simply a response to decreasing nighttime sleep duration. Daytime sleepiness increases across adolescence even when prior sleep duration is held constant. Here we determine the maturational trend in daytime sleep propensity assessed with the multiple sleep latency test (MSLT) and assess the trend’s relation to pubertal maturation and changes in the sleep electroencephalogram. We also evaluate whether the relation of daytime sleep propensity to prior sleep duration changes between ages 10 and 23 years.

Methods
Participants (n = 159) entered the study between ages 9.8 and 22.8 years and were studied annually for up to 3 years. Annually, participants kept each of three sleep schedules in their homes: 7, 8.5, and 10 hours in bed for 4 consecutive nights with polysomnography on nights 2 and 4. MSLT-measured daytime sleep propensity was assessed in the laboratory on the day following the fourth night.

Results
A two-part linear spline model described the maturation of daytime sleep propensity. MSLT sleep likelihood increased steeply until age 14.3 years, after which it did not change significantly. The maturational trend was strongly associated with the adolescent decline in slow-wave (delta, 1–4 Hz) EEG power during NREM sleep and with pubertal maturation assessed with Tanner stage measurement of breast/genital development. The effect of prior sleep duration on sleep likelihood decreased with age.

Conclusions
Adolescent brain changes related to pubertal maturation and those reflected in the delta decline contribute to the adolescent increase in daytime sleep propensity.
Comparison of different scores as predictors of mechanical ventilation and intensive care unit admission in acute theophylline poisoning
Authors: Sagah Ghada Attia , Elmansy Alshaimma Mahmoud 
Published: October 2023

AbstractBackgroundTheophylline is commonly used to control respiratory diseases, especially in developing countries. Theophylline has a narrowed therapeutic index, and its toxicity is associated with morbidity and mortality. Physicians should be aware of the early prediction of the need for intensive care unit admission (ICU) and mechanical ventilation (MV).AimThis study aimed to assess the power of the Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS) and Simple Clinical Score (SCS) in predicting the need for ICU admission and/or MV in acute theophylline-poisoned patients.Patients and methodsThis cross-sectional study included 58 patients with acute theophylline poisoning who were admitted to our Poison Control Center from the 1st of July 2022 to the 31st of January 2023. The REMS, MEWS and SCS were calculated for all patients on arrival at the hospital. The area under the curve (AUC) and receiver operating characteristics were tested to compare scores.ResultsThe median values of all studied scores were significantly high among patients who needed MV and/or ICU admission. The AUC of SCS was &gt;0.9, with a sensitivity of 92.9% and specificity of 90.9% for the prediction of ICU admission. Meanwhile, MEWS was an excellent predictor of the need for MV (AUC = 0.996, 95% CI = 0.983–1.000).ConclusionsWe recommend using SCS as an early predictor for ICU admission in acute theophylline-poisoned patients. However, MEWS could effectively predict MV requirements in acute theophylline-poisoned patients.
Exploring Factors That Contribute to the Success of Rehabilitation With Hearing Aids
Authors: Lansbergen Simon E. , Versfeld Niek , Dreschler Wouter A. 
Published: October 2023

Objectives:
Hearing aids are an essential and important part of hearing rehabilitation. The combination of technical data on hearing aids and individual rehabilitation needs can give insight into the factors that contribute to the success of rehabilitation. This study sets out to investigate if different subgroups of (comparable) hearing aids lead to differences in the success of rehabilitation, and whether these differences vary between different domains of auditory functioning.

Design:
This study explored the advantages of including patient-reported outcome measures (PROMs) in the process of purchasing new hearing aids in a large sample of successful hearing aid users. Subject data were obtained from 64 (commercial) hearing aid dispensers and 10 (noncommercial) audiological centers in the Netherlands. The PROM was a 32-item questionnaire and was used to determine the success of rehabilitation using hearing aids by measuring auditory disability over time. The items were mapped on six domains of auditory functioning: detection, discrimination, localization, speech in quiet, speech in noise, and noise tolerance, encompassing a variety of daily-life listening situations. Hearing aids were grouped by means of cluster analysis, resulting in nine subgroups. In total, 1149 subjects were included in this study. A general linear model was used to model the final PROM results. Model results were analyzed via a multifactor Analysis of Variance. Post hoc analyses provided detailed information on model variables.

Results:
Results showed a strong statistically significant effect of hearing aids on self-perceived auditory functioning in general. Clinically relevant differences were found for auditory domains including detection, speech in quiet, speech in noise, and localization. There was only a small, but significant, effect of the different subgroups of hearing aids on the final PROM results, where no differences were found between the auditory domains. Minor differences were found between results obtained in commercial and noncommercial settings, or between novice and experienced users. Severity of Hearing loss, age, gender, and hearing aid style (i.e., behind-the-ear versus receiver-in-canal type) did not have a clinically relevant effect on the final PROM results.

Conclusions:
The use of hearing aids has a large positive effect on self-perceived auditory functioning. There was however no salient effect of the different subgroups of hearing aids on the final PROM results, indicating that technical properties of hearing aids only play a limited role in this respect. This study challenges the belief that premium devices outperform basic ones, highlighting the need for personalized rehabilitation strategies and the importance of evaluating factors contributing to successful rehabilitation for clinical practice.
Postoperative Bleeding Complications Associated With Novel Oral Anticoagulants in Mohs Micrographic Surgery
Authors: Fahmy Lauren M. , Dowd Margaret L. , Loesch Eric , Denson Elizabeth M. , Pisano Catherine E. , Samie Faramarz H. 
Published: October 2023

BACKGROUND
Novel oral anticoagulants (NOACs) are commonly prescribed, recently developed anticoagulants, but limited data exist on NOAC-related bleeding complications in Mohs micrographic surgery (MMS).

OBJECTIVE
To assess the risk of postoperative bleeding in patients taking NOACs compared with patients taking no antithrombotic medications.

METHODS/MATERIALS
A 5-year retrospective chart review of all MMS cases performed by a single surgeon was conducted. Patient and surgery characteristics, anticoagulant use, and bleeding complications were recorded.

RESULTS
Two thousand one hundred eighty-one MMS cases in 1,545 patients were included. There were 696/2,181 cases in which patients were taking at least 1 antithrombotic medication, with 149 on NOAC monotherapy and 15 on NOAC and aspirin combination therapy. Bleeding complications occurred in 22/2,181 cases. Patients on NOAC monotherapy did not have an increased risk of bleeding complications compared with patients on no antithrombotic medications (odds ratio [OR]:1.70, 95% confidence interval [CI]: 0.36–7.97, p = .50). In contrast, patients on NOAC and aspirin combination therapy exhibited an increased bleeding risk (OR: 20.5, 95% CI: 3.99–105.7, p < .001).

CONCLUSION
Novel oral anticoagulant use alone during MMS was not associated with an increased postoperative bleeding risk, supporting the safety of continuing NOAC therapy during MMS. However, NOAC and aspirin combination therapy was associated with a high postoperative bleeding risk. Nonetheless, these bleeding events did not lead to adverse long-term outcomes.
A case report of a patient with panuveitis following COVID-19 infection
Authors: Khalayli Naram , Shahada Zienab , Kudsi Maysoun 
Published: October 2023

Introduction:
Panuveitis is intraocular inflammation of all layers of the uvea and may be isolated or associated with systemic inflammatory diseases affecting one eye or both eyes. Uveitis and conjunctivitis are noted in coronavirus disease 2019 (COVID-19) infection but have been listed as a major adverse event in case reports for COVID-19.

Importance:
To describe the clinical profile of a Syrian patient presenting with panuveitis following COVID-19 infection.

Case presentation:
A 32-year-old Syrian computer programmer, a previously healthy nonsmoker male, presented with pain, photophobia, and red eye with no irritation or discharge in eyes, decreased vision, and seeing floaters for 5 days. His only notable mention on review of systems was a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection 8 weeks prior. Ocular examination revealed panuveitis involvement. No muscle weakness or neurological positive findings were found. There was no relevant medical history or previous personal or family history. Laboratory tests, including QuantiFERON-TB, immune profile, and viral serology, were negative. Serum angiotensin-converting enzyme levels were normal. Interleukin-1 receptor was negative. Human leukocyte antigen B51/B27 typing was negative. Chest radiograph was normal. Thoracic, abdominal, and pelvic computerized tomography were normal. Based on the negative review of systems and the first panuveitis event, the presumptive diagnosis was isolated bilateral SARS-CoV-2-induced panuveitis.

Clinical discussion:
In December 2019, COVID-19 became a global health issue. Studies assumed that ocular manifestations of COVID-19 were rare and ranged between 3 and 30%. Moreover, it rarely happened as an initial manifestation of the disease, and it was reported during the following weeks. To our knowledge, in the literature review, panuveitis was reported after COVID infection only in our case and in Benito-Pascual et al.’s case, which described panuveitis and optic neuritis after COVID-19 infection.

Conclusion:
We must be aware of the possible panuveitis manifestations following COVID-19 infection.
Glucagon-like peptide-1/glucose-dependent insulinotropic polypeptide receptor co-agonists for cardioprotection, type 2 diabetes and obesity: a review of mechanisms and clinical data
Authors: Goldenberg Ronald M. , Teoh Hwee , Verma Subodh 
Published: October 2023

Purpose of review
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are approved for the management of type 2 diabetes (T2D) and obesity, and some are recommended for cardiorenal risk reduction in T2D. To enhance the benefits with GLP-RA mono-agonist therapy, GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor co-agonists are in development to capitalize on the synergism of GLP-1 and GIP agonism. We review the mechanisms of action and clinical data for GLP-1/GIP receptor co-agonists in T2D and obesity and their potential role in cardiovascular protection.

Recent findings
Tirzepatide, a first-in-class unimolecular GLP-1/GIP receptor co-agonist, is approved for T2D and is awaiting approval for obesity management. Phase 3 trials in T2D cohorts revealed significant reductions in glycemia and body weight and superiority compared with GLP-1R mono-agonism with semaglutide. Tirzepatide has demonstrated significant body weight reductions in individuals with obesity but not diabetes. It enhances lipid metabolism, reduces blood pressure, and lowers liver fat content. Pooled phase 2/3 data showed cardiovascular safety in T2D while a post hoc analysis suggested tirzepatide slows the decline of kidney function in T2D.

Summary
GLP-1/GIP receptor co-agonists are a novel addition to the diabetes and obesity armamentarium. The cardiorenal-metabolic benefits position them as promising multiprong tools for metabolically complex individuals with chronic vascular complications.
Radiation Protection Considerations for Cancer Patients with End-stage Renal Disease Receiving 131I Treatment
Authors: Louis Matthew , Mate-Kole Emmanuel M. , Aziz Landon , Dewji Shaheen A. 
Published: October 2023

Abstract
Differentiated thyroid cancer (DTC) is commonly treated first with a partial or complete thyroidectomy, followed by radioiodine (RAI) ablative therapy to eliminate remaining cancer cells. In such treatments, physical decay and urinary excretion are the primary means of 131I. As such, patients with impaired urinary ability clearance, such as patients with end-stage renal disease (ESRD) whose urinary ability is impaired by dysfunction, can retain abnormally high activities of RAI, posing a concern to both the patient and those with whom the patient interacts. Additionally, ESRD patients are commonly administered dialysis therapy, wherein their blood is externally cycled through a dialyzer (hemodialysis) or filtered by instilling a dialysate fluid into the peritoneum (peritoneal dialysis) to filter uremic toxins from their blood that accumulate due to kidney dysfunction. These factors make determining release and dosing for ESRD patients receiving RAI therapy dependent on a plurality of variables. An evaluation of the current patient release guidelines, as given in US Nuclear Regulatory Commission (US NRC) Regulatory Guide 8.39 Rev. 1 for ESRD patients receiving RAI, has yet to be addressed. In this study, a biokinetic model for 131I in ESRD patients receiving dialysis has been developed, improving on traditional two-compartment models, reflective of kinetics from multi-compartment models with updated transfer coefficients modified to reflect the different physiological functions of compartments. This updated biokinetic model was integrated with Monte Carlo radiation transport calculations using stylized computational hermaphroditic phantoms to calculate dose rate coefficients in exposure scenarios and compared with those of the point source models of NRC Reg Guide 8.39 Rev. 1 (and the proposed verbiage in Rev. 2). Results demonstrated that the baseline models of Rev. 1 and Rev. 2 overestimated the effective dose rate to an exposed individual for the majority of time post-administration, where both models overestimated the total dose to the maximally exposed individual. However, the application of several patient-specific modifying factors to the Rev. 2 model resulted in an overestimation by only a factor of 1.25, and in general, the results produced with the patient-specific modifications provide improved convergence with the dose rate coefficients computed in this study for ESRD patients.
The Effect of Ptosis Surgery on Meibomian Glands and Dry Eye Syndrome
Authors: Hamed Azzam Shirin , Nama Amir , Hartstein Morris , Habib Haneen Jabaly , Mukari Abed 
Published: October 2023

Purpose:
To investigate the effect of ptosis surgery on dry eye disease as measured by dry eye parameters and meibomian gland function.

Methods:
This prospective, case series study included patients with involutional ptosis with no prior history of dry eye disease who were scheduled for a levator aponeurosis advancement procedure. Dry eye evaluation included the ocular surface disease index (OSDI) questionnaire as well as objective measurements, which included meibomian gland loss measured by meibography, meibomian gland disease grading, tear breakup time (TBUT), corneal and conjunctival fluorescein staining, tear meniscus height, and Schirmer testing. All dry eye measurements were recorded preoperatively and repeated 21–28 days postoperatively.

Results:
A total of 30 eyes were included with a mean age of 65.6 ± 11.9 years. There was a significant improvement in margin reflex distance1 (MRD1) postoperatively (p < 0.001) and a significant decrease in upper lid margin thickening (p = 0.022). There were no significant differences between the pre- and postoperative measurements in meibomian gland loss, TBUT, corneal and conjunctival fluorescein staining, tear meniscus height, and the Schirmer test. OSDI was increased nonsignificantly postoperatively (16.094 vs. 24.296, respectively, p = 0.107).

Conclusion:
The levator aponeurosis advancement procedure does not affect the eyelid meibomian glands, nor does it cause an increase in dry eye signs and symptoms, according to the measured parameters.
Ischemia-reperfusion injury in human AC16 cardiomyocytes is modulated by AXIN1 depending on c-Myc regulation
Authors: Li Jun , Wang Hao , Chen Li , Zhong Jialin , Wang Junsheng , Xiao Jun 
Published: October 2023

Objective:
A major consequence of acute myocardial infarction is myocardial ischemia-reperfusion (I/R) injury. Collecting proof demonstrates that AXIN1 assume a basic part in different disease; however, the role of AXIN1 in I/R injury remains to a great extent obscure.

Methods:
The I/R injury model on AC16 cells was constructed. siRNA transfection was used to knockdown AXIN1. The qRT-PCR assays and western blot assays were used to detect the expression level of AXIN1 and other key proteins. CCK-8 assays and cell apoptosis assays were used to detect cell proliferation and cell apoptosis.

Results:
AXIN1 was significantly overexpressed in an in vitro model of I/R injury. Knockdown of AXIN1 significantly restored the cell proliferation inhibition caused by IR injury, while inhibiting apoptosis and inflammation. Further mechanistic studies revealed that the transcription factor c-Myc could regulate the expression of AXIN1. The effects of I/R injury on AC16 cells after overexpression of c-Myc were reversed by knockdown of AXIN1. Meanwhile, AXIN1 could regulate the SIRT1/p53/Nrf 2 pathway.

Conclusion:
Our results show an important role for AXIN1 and provide new targets for avoiding and treating I/R injury.
Worm infestation as a cause of severe anemia in a frail older adult: a case report
Authors: Shah Suveksha S. , Shah Raju , Basnet Rohan , Patel Dhruvit , Bhattarai Urza , Shah Bhupendra , Sharma Sanjib K. 
Published: October 2023

Introduction:
Worm infestations are a common occurrence in low-income countries. Anemia due to iron deficiency can be brought on by human intestinal worms. The authors report a case of an 86-year-old frail older adult with upper gastrointestinal (GI) bleeding caused by a worm infestation most likely to be hookworm.

Case presentation:
An 86-year-old male, presented to the Emergency Department with complaints of bilateral lower limb swelling and shortness of breath for 4 days associated with melena for 2 months. The authors made a provisional diagnosis of heart failure precipitated by anemia. Upper GI endoscopy revealed multiple whitish exudates, which are resistant to water jets. Multiple worms were noted in the second part of the duodenum. Based on clinical evaluation and endoscopy, the diagnosis of oesophagial candidiasis and iron deficiency anemia secondary to upper GI bleeding due to Hookworm infestation was made.

Clinical discussion:
In low-income countries, especially those involving the tropical area, worm infestation should be considered as an important cause of obscure acute GI bleeding and severe anemia. Usually, malignancy is suspected in an older adult with severe anemia but hookworm infestation is a treatable disease with a good prognosis and complete recovery. The most commonly used drugs for treatment are mebendazole and albendazole. In a low-income country with a high burden of worm infestations, empirical treatment of iron deficiency anemia with single dose albendazole has been recommended.

Conclusion:
Usually, severe anemia in an older adult is mostly attributed to an underlying malignancy. Our case serves as a good example of how a treatable condition can improve the quality of life in a frail older adult. Normally, there is a tendency to defer UGI endoscopy in frail elderly due to ageism. However, the diagnosis of a treatable cause of upper GI bleeding can be made by a simple upper GI endoscopy. Severe anemia due to hookworm infestation is treated effectively and quickly with albendazole and iron therapy.
Antineutrophil cytoplasmic antibody-associated vasculitis with systemic sclerosis: a fatal case report
Authors: Khalayli Naram , Ibrahim Raghad , Ibrahim Rahaf , Kudsi Maysoun 
Published: October 2023

Introduction and importance:
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis is a rare co-occurrence with systemic sclerosis, in around 2.5–9% of patients. The clinical manifestations and prognosis of vasculitis in systemic sclerosis depend on organ involvement. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers get along with purpuric vasculitis in some cases reports. Reports had found that survival in those with pulmonary-renal syndrome is poor. However, high-dose corticosteroids and cyclophosphamide increase the survival percent in those patients.

Case presentation:
An 81-year-old female was admitted for newly diagnosed acute renal failure and highly elevated C-reactive protein levels. She was diagnosed with systemic sclerosis 8 years previously, with a 3-year history of interstitial lung disease, and a 2-year history of pulmonary hypertension. Treatment included home oxygen on demand, prednisone 5 mg/day, and azathioprine 75 mg daily. On physical examination, she had sclerodactyly, both extremities ulcers, severe livedo reticularis, and hyperpigmented papules on her hand and feet. Laboratory findings included a markedly positive MPO (p-ANCA), and anti-Scl-70. She was treated with pulse methylprednisolone without any improvement. After a day, she developed anuria and became comatose. Then, she developed cardiac arrest, leading to death.

Clinical discussion:
The presence of ANCA in systemic sclerosis patients ranges from 2.5 to 9% of systemic sclerosis patients. It presented with rapidly progressive acute renal failure without malignant hypertension, and with pitting hand and foot ulcers. The treatment with high-dose corticosteroids and cyclophosphamide is benefit. Survival in those with pulmonary-renal syndrome is poor.

Conclusion:
The presence of ANCA-associated vasculitis is rarely reported with scleroderma. It occurs most commonly in women with limited or Calcinosis, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia (CREST) variants of scleroderma, as well as those with overlap features. Severe manifestations including pulmonary-renal syndrome and death may occur.