bluuebunny/crossref_metadata_2025_split huggingface dataset:
The impact of von Willebrand factor on fibrin formation and structure unveiled with type 3 von Willebrand disease plasma
Authors: Martinez-Vargas Marina , Courson Justin , Gardea Luis , Sen Mehmet , Yee Andrew , Rumbaut Rolando , Cruz Miguel A. 
Published: May 2024

Normally, von Willebrand factor (VWF) remains inactive unless its A1A2 domains undergo a shear stress-triggered conformational change. We demonstrated the capacity of a recombinant A2 domain of VWF to bind and to affect fibrin formation, altering the fibrin clot structure. The data indicated that VWF contains an additional binding site for fibrin in the A2 domain that plays a role in the incorporation of VWF to the polymerizing fibrin. This study is to examine the hypothesis that active plasma VWF directly influence fibrin polymerization and the structure of fibrin clots.
The study used healthy and type 3 von Willebrand disease (VWD) plasma, purified plasma VWF, fibrin polymerization assays, confocal microscopy and scanning electron microscopy.
The exposed A2 domain in active VWF harbors additional binding sites for fibrinogen, and significantly potentiates fibrin formation (P < 0.02). Antibody against the A2 domain of VWF significantly decreased the initial rate of change of fibrin formation (P < 0.002). Clot analyses revealed a significant difference in porosity between normal and type 3 VWD plasma (P < 0.008), further supported by scanning electron microscopy, which demonstrated thicker fibrin fibers in the presence of plasma VWF (P < 0.0003). Confocal immunofluorescence microscopy showed punctate VWF staining along fibrin fibrils, providing visual evidence of the integration of plasma VWF into the fibrin matrix.
The study with type 3 VWD plasma supports the hypothesis that plasma VWF directly influences fibrin polymerization and clot structure. In addition, a conformational change in the A1A2 domains exposes a hidden fibrin(ogen) binding site, indicating that plasma VWF determines the fibrin clot structure.
Hematological ratios in patients with acute decompensation and acute-on-chronic liver failure: prognostic factors
Authors: Lashen Sameh A. , Salem Perihan , Ibrahim Esraa , Abd Elmoaty Dalia , Yousif Walid I. 
Published: May 2024

Background and aimsAcute-on-chronic liver failure (ACLF) is the most severe form of acutely decompensated cirrhosis and is characterized by the presence of intense systemic inflammation. Leucocyte quantification can serve as an indirect indicator of systemic inflammation. In our study, we investigated the predictive value of hematological ratios (neutrophils to lymphocytes, monocyte to lymphocytes, platelets to lymphocytes, lymphocytes to C-reactive protein, and neutrophils to lymphocytes and platelets) in acute decompensation (AD) and ACLF patients and their relation to disease severity and early mortality.Patients and methodsWe included 60 patients with ACLF and AD, and 30 cirrhotic controls. Clinical data were collected, and survival was followed for 1 and 6 months. Blood samples were analyzed at admission for differential leucocytes and assessed for liver and renal function tests. The leukocyte ratios were calculated and compared, and their correlation with liver function indicators and prognosis was assessed.ResultsAll ratios were significantly higher in AD and ACLF patients compared to control (except for lymphocyte to C-reactive protein ratio which was significantly lower), and were positively correlated with Child-Pugh score, model for end-stage liver disease (MELD)-Na, and ACLF severity scores. Multivariate regression revealed that neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and MELD-Na were independent prognostic factors of 1-month and 6-month mortality. A unique prognostic nomogram incorporating MELD-Na, neutrophil to lymphocyte ratio, and monocyte to lymphocyte ratio could be proposed for predicting prognosis in AD and ACLF patients.ConclusionsCheap, easy, and noninvasive hematological ratios are introduced as a tool for early identification and risk stratification of AD and ACLF patients.
Symptoms of functional dyspepsia and irritable bowel syndrome among medical students in Slovakia and their relation to diet and exercise
Authors: Liptak Peter , Duricek Martin , Schnierer Martin , Ziaciková Ivana Liptak , Rosolanka Robert , Baranovicova Eva , Sturdik Igor , Jackuliak Peter , Veseliny Eduard , Varady Alena , Banovcin Peter 
Published: May 2024

Introduction
There is a substantial lack of data regarding the prevalence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the region of Central/Eastern Europe. It is a well-described and known fact that environmental, ethnic, dietary, and cultural factors can influence the reporting of symptoms. Therefore, we aim to provide the first data documenting the prevalence of specific disorders of gut-brain interaction in Slovakia.

Methods
This is a multicenter-based study. The study population consists of medical students from three medical faculties in Slovakia, mainly with Slovakian and Scandinavian permanent residency. Data collection was performed by means of anonymous questionnaires consisting of several demographic questions. Two forms of questionnaires were used. One was in paper form, and the second was distributed via email.

Results
Altogether, 1061 students participated in this study. Symptoms of IBS were presented in 7.3% of students, and FD in 13%. In the Slovakian group, these were FD 12%, and IBS 7%. The subgroup from Scandinavia shows a prevalence of IBS of 11.7% and FD of 14.0%. A lack of exercise and a vegan diet are related to a higher presence of FD.

Conclusion
The results of this multicentre study represent the first published data for the presence of symptoms of IBS and FD in Slovakia. Our data also show a significantly higher prevalence of IBS in students from Scandinavia compared with those from Central/Eastern Europe. A higher frequency of physical exercise is associated with a lower presence of symptoms of FD. On the other hand, the symptoms of FD were mostly prevalent in the group adhering to a vegan and vegetarian type diet.
Impacts of rifaximin and midodrine on morbidity, mortality, and quality of life in patients with decompensated liver cirrhosis
Authors: Elsabaawy Maha Mohammad , Assem Medhat , Badran Hanaa , Mahmoud Asmaa , Elsabaawy Dalia , Ragab Amr 
Published: May 2024

Background
Vasodilatation and bacterial dislocation are the main contributors to the catastrophic events in patients with decompensated liver cirrhosis (DLC).

Aim
The aim of this study was to evaluate the impacts of adding midodrine and rifaximin on morbidity, mortality, and quality of life in patients with DLC.

Methods
This interventional clinical study included 100 consecutively enrolled DLC patients randomized 1 : 1 into two groups. Group A received oral midodrine (5 mg/8 h) and rifaximin (550 mg/12 h) with standard diuretic therapy, while group B received only standard diuretic therapy. Clinical and laboratory data, including the McGill Quality of Life Questionnaire, were evaluated over a 3-month treatment period.

Results
In the study group, there was a significant reduction in Child–Pugh and Model for End-Stage Liver Disease scores, international normalized ratio, and mean arterial blood pressure at 2, 6, and 12 weeks (P < 0.05). Ascites, spontaneous bacterial peritonitis incidence, hematemesis, paracentesis need, and hepatic encephalopathy showed improvement after 12 weeks compared with the control group. McGill Quality of Life Questionnaire significantly improved after 6 and 12 weeks (P < 0.05). Survival rates demonstrated a noteworthy improvement (P = 0.014), substantiated by evidence in both univariate and multivariate regression analyses.

Conclusion
Combined midodrine with rifaximin represents an endowment to patients with DLC with spectacular improvements in synthetic liver functions, along with improved quality of life, and survival.
Veno-Occlusive Disease: A Life-Saving Novel Approach With Plasma Exchange, IVIG, and Steroid, Without Defibrotide
Authors: Katlan Banu , Erkasar Funda , Topdemir Mesut , Günaydin Gulçin , Ozen Alptug 
Published: May 2024

Introduction:
Hepatic veno-occlusive disease (VOD) is a critical medical emergency with a high mortality rate of up to 90% if not promptly treated. Defibrotide is the only approved medication for VOD treatment, exhibiting anti-inflammatory, antithrombotic, and anti-ischemic properties. This report presents a case of severe VOD in a patient undergoing acute lymphoblastic leukemia (ALL) treatment.

Case Presentation:
We describe the successful and rapid treatment of severe VOD in an ALL patient using therapeutic plasma exchange (TPE), intravenous immunoglobulin (IVIG), and methylprednisolone (MPZ). The patient showed significant clinical and laboratory improvement after this combined therapeutic approach.

Conclusion:
This case highlights the effectiveness of TPE, IVIG, and MPZ in the treatment of severe VOD in ALL patients, providing insights into alternative therapeutic strategies in the absence of Defibrotide.
Comparing Leadership Skills of Senior Emergency Medicine Residents in 3-Year Versus 4-Year Programs During Simulated Pediatric Resuscitation
Authors: Schoppel Kyle , Keilman Ashley , Fayyaz Jabeen , Padlipsky Patricia , Diaz Maria Carmen G. , Wing Robyn , Hughes Mary , Franco Marleny , Swinger Nathan , Whitfill Travis , Walsh Barbara ,   Improving Pediatric Acute Care Through Simulation (ImPACTS)
Published: May 2024

Objectives
The majority of pediatric patients in the United States (US) are evaluated and treated at general emergency departments. It is possible that discrepancies in length of emergency medicine (EM) residency training may allow for variable exposure to pediatric patients, critical resuscitations, and didactic events. The goal of this pilot study was to compare leadership skills of graduating EM residents from 3- to 4-year programs during simulated pediatric resuscitations using a previously validated leadership assessment tool, the Concise Assessment of Leader Management (CALM).

Methods
This was a prospective, multicenter, simulation-based cohort pilot study that included graduating 3rd- and 4th-year EM resident physicians from 6 EM residency programs. We measured leadership performance across 3 simulated pediatric resuscitations (sepsis, seizure, cardiac arrest) using the CALM tool and compared leadership scores between the 3rd- and 4th-year resident cohorts. We also correlated leadership to self-efficacy scores.

Results
Data was analyzed for 47 participating residents (24 3rd-year residents and 23 4th-year residents). Out of a total possible CALM score of 66, residents from 3-year programs scored 45.2 [SD ± 5.2], 46.8 [SD ± 5.0], and 46.6 [SD ± 4.7], whereas residents from 4-year programs scored 45.5 [SD ± 5.2], 46.4 [SD ± 5.0], and 48.2 [SD ± 4.3] during the sepsis, seizure, and cardiac arrest cases, respectively. The mean leadership score across all 3 cases for the 3-year cohort was 46.2 [SD ± 4.8] versus 46.7 [SD ± 4.5] (P = 0.715) for the 4-year cohort.

Conclusions
These data show feasibility for a larger cohort project and, while not statistically significant, suggest no difference in leadership skills between 3rd- and 4th-year EM residents in our study cohort. This pilot study provides the basis of future work that will assess a larger multicenter cohort with the hope to obtain a more generalizable dataset.
Low Prevalence of Clinically Significant Hyponatremia following Cranial Vault Reconstruction for Single-Suture Craniosynostosis
Authors: Breuler Christopher , Lynn Jeremy V. , Buchman Lauren , Matusko Niki , Makar Katelyn , Ranganathan Kavitha , Mouch Charles , Muraszko Karin , Buchman Steven R. 
Published: May 2024

Background:
Patients are commonly monitored for hyponatremia after intracranial procedures, yet the prevalence of hyponatremia after cranial vault reconstruction (CVR) remains unclear. The purpose of this study is to define the prevalence, risk factors, and complications of hyponatremia after CVR to optimize postoperative sodium surveillance protocols.

Methods:
Patients with nonsyndromic, single-suture craniosynostosis who underwent primary CVR between 2009 and 2020 at Michigan Medicine were included (n = 231). Demographic, intraoperative, and postoperative characteristics were compared by postoperative hyponatremia status at P < 0.05 significance. Hyponatremia was defined as mild (<135 mEq/L), moderate (<130 mEq/L), or severe (<125 mEq/L) based on the lowest postoperative laboratory draw.

Results:
Twenty-three patients (10.0%) developed mild postoperative hyponatremia. No patient developed moderate or severe postoperative hyponatremia. On multivariable regression, decreased preoperative sodium level (P = 0.03) and decreased preoperative weight (P = 0.02) were significantly associated with mild postoperative hyponatremia. No patient developed complications or required hospital readmission because of hyponatremia.

Conclusions:
This large retrospective cohort study of patients with nonsyndromic single-suture craniosynostosis demonstrated a 10% prevalence of mild, clinically inconsequential hyponatremia and 0% prevalence of moderate or severe, clinically significant hyponatremia after primary CVR. Patients with low preoperative sodium level or weight were at increased risk for developing mild postoperative hyponatremia. The results suggest that patients with preoperative sodium greater than 140 mEq/L or preoperative weight greater than 10 kg may be candidates for limited postoperative sodium surveillance; however, future prospective studies are warranted before implementation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Simultaneous Injection of Contrast and Saline Using Spiral Flow-Generating Tube for Hepatic Dynamic Computed Tomography: Effect on Enhancement of Liver Parenchyma and Metastases to the Liver
Authors: Nagata Hiroji , Iori Hisako , Yoshida Shiori , Kawashima Hiroki , Nishino Yuka , Sakasai Ryo , Yamamura Hiroshi , Minami Tetsuya 
Published: May 2024

Purpose
Recently, there have been a few reports regarding the usefulness of a novel saline injection technique using a spiral flow-generating tube. The purpose of this study was to evaluate whether simultaneous saline injection using a spiral flow-generating tube was able to improve hepatic contrast enhancement and lesion conspicuity of metastatic liver tumors.

Methods
We randomized a total of 411 patients with various liver diseases including metastases by total body weight (A, n = 204) and contrast dilution protocol (B, n = 207). Group A received 400 mgI/kg of contrast medium alone without a spiral flow-generating tube; group B received contrast medium 400 mgI/kg simultaneous with injection of a 0.57-ml/kg physiologic saline solution through a spiral flow-generating tube. Abdominal aorta computed tomography (CT) number, hepatic enhancement (ΔHU), percentage of tests demonstrating an enhancement effect of the liver parenchyma exceeding Δ50 HU in 3 measured segments (S2, S6, and S8), and the contrast-to-noise ratio of the metastatic liver tumors were measured.

Results
The mean aortic CT number of group B (417.0 HU ± 61.7; P < 0.01) was approximately 10% higher than that of group A (384.6 ± 79.1 HU). The average ΔHU was 59.8 ± 11.4 HU for group A and 61.7 ± 11.7 for group B. The ΔHU for group B was significantly higher than that for group A (P = 0.017). The percentage of tests demonstrating with the enhancement effect of group B was more than 80% in all subgroups; however, that of group A was less than 80% in all subgroups. The contrast-to-noise ratio of group B (7.8 ± 3.3 HU) was significantly higher compared to that of group A (6.5 ± 2.8 HU) (P < 0.05).

Conclusions
Because of the volume effect, injecting a contrast medium diluted with normal saline improved the degree of hepatic and aortic contrast enhancement and achieved better visualization of liver metastases.

Clinical Impact
The use of spiral flow-generating tube may help diagnostic of hepatic and aortic contrast enhancement and liver metastases.

Importance
The use of a spiral flow-generating tube improved the degree of hepatic and aortic contrast enhancement and achieve better visualization of liver metastases.

Points
The use of low-concentration syringe formulations is limited by body weight. However, the use of spiral flow-generating tube provides low-concentration contrast medium regardless of body weight
Cause Analysis and Surgical Treatment of Aponeurotic Ptosis With Upper Eyelid Depression
Authors: Hou Dan , Tian Bingyu , Wang Xiaoyu , Wang Qianyu , Zhu Yuan 
Published: May 2024

Background:
Ptosis and upper eyelid depression were previously diagnosed as 2 separate diseases. The authors found that in patients with aponeurotic ptosis accompanied by upper eyelid depression, the main cause of upper eyelid depression was impaired dynamic transmission of the levator aponeurosis.

Objective:
To analyze the causes of upper eyelid depression in patients with aponeurotic ptosis accompanied by upper eyelid depression and to introduce the best treatment methods.

Methods:
The authors enrolled 15 eyes (11 patients) with aponeurotic ptosis accompanied by upper eyelid depression from October 2021 to August 2022. The authors analyzed the causes of upper eyelid depression in those patients and performed aponeurotic ptosis correction surgery and orbital septum fat release surgery. After 6 to 12 months of follow-up, the authors reviewed the patient’s medical records and photographs to evaluate the treatment outcomes.

Results:
After surgery, ptosis was corrected and upper eyelid depression significantly improved in all the patients. One patient had poor eyelid morphology and upper eyelid depression due to habitual brow lifting, which was relieved after an injection of botulinum toxin into the frontalis muscle. One patient had overcorrection of the upper eyelid depression on the affected side and no other complications.

Conclusion:
The main cause of upper eyelid depression in patients with aponeurotic ptosis is impaired dynamic transmission of the levator aponeurosis. Aponeurotic ptosis repair surgery and orbital septum fat release surgery are simple surgical procedures that restore the normal anatomy and physiology of the upper eyelid and maintain the normal structure of the eyelid, with good post-operative outcomes.
Biomechanical Analysis of Orbital Development: A Finite Element Analysis by an Experimentally Validated Model
Authors: Wang Mingyang , Jiang Xue , Song Dongyu , Li Dongmei 
Published: May 2024

Aims:
Constructing orbital finite element models capable of simulating the development process and analyzing the biomechanical mechanism.

Methods:
Four normal orbits from 1-month-old New Zealand white rabbits were used in this study. Toshiba Aquilion Prime was used to determine the computed tomography scan and direct orbital pressure manometry using an improved manometer based on the TSD104 pressure sensor transducer. The finite element analysis was conducted using the ANSYS Workbench platform.

Results:
The biomechanics of each orbital wall improved to varying degrees as the rabbit orbit grew and developed. The von Mises stress in both rabbits initially concentrated at the lower edge of the posterior orbital wall, expanded to the entire orbit, and ultimately became more significant in the biomechanics of the region that consisted of the posterior orbital and superior orbital walls. During the expansion phase, the biomechanics of both rabbits gradually developed from the nasal side to the occipital side for radial displacement. It is evident that the finite element model is a good fit for simulating the physiological development of the rabbit orbit. The maximum radial displacement and maximum von Mises stress appeared 2 intermissions during the development of the orbit, at about 50 to 60 days and 80 to 90 days.

Conclusion:
This study establishes a theoretical foundation for the creation of a biomechanical model of human orbital development by offering the first finite element model to simulate orbital development and analyze the biomechanical mechanism of orbital pressure on orbital development.
Etiology and Management of 800 Patients With Facial Palsy at a Private Practice Setting Over a 5-Year Period
Authors: Melhem Antonio M. , Leshgold Nicole , Pokress Henry , Younan Robert A. , Haddad Mario , Kantar Rami S. , Azizzadeh Babak 
Published: May 2024

Introduction:
Very few papers investigated the etiologic breakdown and demographic characteristics of patients with facial nerve (FN) palsy. Our paper aims to present the etiologic breakdown and demographic characteristics of patients with FN palsy, presenting at a private care center between 2014 and 2019, along with the treatment modalities that were offered to them.

Methods:
Charts of 800 patients with facial palsy (FP) were reviewed. Data included the etiology of their diagnosis, family history, recurrent FP, demographic information, and treatment provided before and after presentation.

Results:
Seventy-five percent of our study population were females. The average period between diagnosis with FP and presentation at our center was 10.8 years. The most commonly identified etiology was Bell’s palsy, followed by acoustic neuroma. Eighty-one percent of the study subjects were prescribed steroids and/or antivirals. Facial neuromuscular retraining, electrical stimulation, chemodenervation, and surgical intervention were also part of some treatment plans for our population.

Discussion:
Recommendations for the treatment of idiopathic FP include steroids with adjuvant antiviral medications. Data remains uncertain whether the combination therapy of steroids and antivirals has better results compared to steroids alone. Electrical stimulation is still a controversial therapeutic tool for facial paralysis with a potential role in exacerbating synkinesis. The difference in referral patterns between tertiary and private care centers can explain the disparity in the ranking of the etiologies between our study and what has been published.

Conclusion:
Management of FP is a complex process. The FN community must develop a common database to improve its understanding of the different presentations.