bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the efficacy and safety of Chinese medicine Cang-Er-Zi-San in the treatment of allergic rhinitis in children: A meta-analysis and systematic review
Authors: Zeng Qiaoqiao , Li Jingnan , Wu Qin , Li Xiaojie , Yan Huixin , Bi Yunpeng , Gao Yixin , Zhuo Yue 
Published: December 2024

Background:
More and more studies have shown that Chinese medicine can effectively and safely treat allergic rhinitis (AR) in children. This meta-analysis aims to compare the efficacy and safety differences between conventional therapy and the Chinese herbal medicine Cang-Er-Zi-San (CEZS) from an evidence-based perspective, and guide the clinical treatment of pediatric AR.

Methods:
This study aims to compare the effects of intervention with traditional Chinese medicine formula CEZS on the clinical symptoms of pediatric AR, determine the effectiveness and safety of CEZS in treating pediatric AR, and obtain high-quality clinical evidence. Research method: based on the preferred reporting item (PRISMA) statement of systematic review and meta-analysis, inclusion and exclusion criteria were established. Retrieve 7 mainstream medical databases to obtain randomized controlled trials (RCTs) of traditional Chinese medicine CEZS for the treatment of pediatric AR. Include RCTs that meet research requirements. Then extract the data information and evaluate the quality using the Cochrane bias risk assessment tool. Meta-analysis was conducted using RevMan software on the effective rate, clinical symptom relief time, recurrence rate, and adverse event indicators. Calculate relative risk (RR) and 95% confidence interval (95% CI), test heterogeneity identify its source, evaluate publication bias through funnel plots.

Results:
15 RCTs and 1361 patients were included. The results of meta-analysis showed that the efficacy of Chinese herbal compound CEZS in the treatment of children with AR was significantly superior to other therapies. Effective rate (RR = 1.21; 95% CI = 1.15, 1.26) The difference was statistically significant, and the symptom relief time, Recurrence rate, adverse event, the time of symptom relief in the treatment group were all better than those in the control group. It is suggested that CEZS therapy is more suitable for the clinical treatment of children with AR.

Conclusion:
CEZS has a definite therapeutic effect on children with AR and is an effective method for treating it. However, due to biased results and limited research, a large number of high-quality studies are needed to validate the effectiveness of CEZS and provide new treatments for clinical reference.
Survival analysis of clear cell renal cell carcinoma based on radiomics and deep learning features from CT images
Authors: Lu Zhennan , Wu Sijia , Ni Dan , Zhou Meng , Wang Tao , Zhou Xiaobo , Huang Liyu , Yan Yu 
Published: December 2024

Purpose:
To create a nomogram for accurate prognosis of patients with clear cell renal cell carcinoma (ccRCC) based on computed tomography images.

Methods:
Eight hundred twenty-two ccRCC patients with contrast-enhanced computed tomography images involved in this study were collected. A rectangular region of interest surrounding the tumor was used to extract quantitative radiomics and deep-learning features, which were filtered by Cox proportional hazard regression model and least absolute shrinkage and selection operator. Then the selected features formed a fusion signature, which was assessed by Cox proportional hazard regression model method, Kaplan–Meier analysis, receiver operating characteristic curves, and concordance index (C-index) in different clinical subgroups. Finally, a nomogram constructed with this signature and clinicopathologic risk factors was assessed by C-index and survival calibration curves.

Results:
The fusion signature performed better than the radiomics signature. Then we combined this signature and 2 clinicopathologic risk factors. This nomogram showed an increase of about 20% in C-index values when compared to clinical nomogram in both datasets. Its prediction probability was also in good agreement with the actual ratio.

Conclusion:
The proposed fusion nomogram provided a noninvasive and easy-to-use model for survival prognosis of ccRCC patients in future clinical use, without the requirement to perform a detailed segmentation for radiologists.
Acupuncture and electroacupuncture for cyclic vomiting syndrome with tachygastria in an adult: A case report
Authors: Ha Na-Yeon , Kim Jinsung 
Published: December 2024

Rationale:
Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of acute vomiting lasting <1 week, occurring independently and chronically. Management typically involves lifestyle interventions, supportive care, and preventative medication. In rare cases, CVS persists for decades in adults, requiring a multidisciplinary approach to improve symptoms and quality of life.

Patient concerns:
A 30-year-old male patient presented with a 7-year history of recurrent nausea and vomiting, which initially began in 2017. The episodes occurred without identifiable triggers such as alcohol or overeating, increasing in frequency from once every 4 months to 2 months. He expressed fear of severe deterioration, impacting his ability to eat freely, work, and enjoy his hobbies.

Diagnoses:
He was diagnosed with CVS based on the Rome criteria. Cutaneous electrogastrography showed postprandial power decrease and tachygastria.

Interventions:
Regular acupuncture treatments, including electroacupuncture at ST36 with 3 Hz, were administered twice a week for 3 weeks, followed by weekly sessions for 5 additional weeks.

Outcomes:
Over 11 treatment sessions across 8 weeks, no nausea or vomiting was observed. The visual analog scale (VAS) score for subjective gastrointestinal discomfort decreased from 67 to 0 after 4 weeks. The Nausea Severity Scale (NSS) score dropped from 14 to 0 after 4 weeks. The Functional Dyspepsia-related QoL score decreased from 16 to 0 after 8 weeks. The Nepean Dyspepsia Index-Korean version decreased from 80 to 8 after 8 weeks. Furthermore, the patient expressed high satisfaction with the treatment, and no adverse events were observed.

Lessons:
Acupuncture offers a significant and safe approach to relieving symptoms and enhancing the quality of life for patients with nausea and vomiting. Although this is a single case report, the findings suggest that acupuncture can improve treatment compliance and manage symptoms in adults with CVS. Further research, including clinical trials, is required to confirm these findings and understand the underlying mechanisms.
The impact of multidisciplinary collaborative bundled care on analgesia and sedation in ICU patients with endotracheal intubation
Authors: Wu Xiaohui , Yu Longping 
Published: December 2024

Background:
Effective analgesia and sedation management play a crucial role in reducing the intensity of coughing in patients with endotracheal intubation and improving clinical outcomes. However, current approaches are predominantly singular and lack comprehensive management strategies based on multidisciplinary collaboration. This study aims to evaluate the impact of multidisciplinary collaborative bundled care on analgesia and sedation in intensive care unit (ICU) patients with endotracheal intubation, providing evidence to inform clinical practice.

Methods:
Seventy ICU patients were enrolled with endotracheal intubation, admitted between January and August 2024. They were divided into a control group (n = 35) receiving routine care (admitted from January to April) and an intervention group (n = 35) receiving multidisciplinary collaborative bundled care (admitted from May to August). Outcomes measured included physical restraint use, analgesic dosage, cough strength, delirium incidence, and duration of mechanical ventilation.

Results:
The intervention group had significantly lower doses of remifentanil (8.37 ± 1.50 mg) and midazolam (21.43 ± 3.74 mg) compared to the control group (9.92 ± 1.58 and 31.12 ± 7.89 mg; P < .05). The incidence of delirium was also lower in the intervention group (11.4%) than in the control group (31.4%; P < .05). Delirium onset was delayed in the intervention group (3.02 ± 1.05 days) compared to the control group (2.58 ± 0.79 days), and its duration was shorter (3.43 ± 1.74 vs 5.12 ± 1.89 days; P < .05). Additionally, physical restraints were significantly lower in the intervention group (22.9% vs 45.7%; P < .05). Cough strength was notably higher in the intervention group (4.74 ± 0.82 vs 3.36 ± 0.76; P < .05), and the duration of mechanical ventilation was reduced (4.77 ± 1.42 vs 5.92 ± 1.66 days; P < .05).

Conclusion:
Multidisciplinary collaborative bundled care improves sedation and analgesia outcomes in ICU patients with endotracheal intubation, reducing medication dosage, incidence of delirium, physical restraint use, and duration of mechanical ventilation while enhancing cough strength.
Application of high-quality targeted temperature management guided by multimodal brain monitoring in brain protection of patients with cardiac arrest: A case series
Authors: Xia Weiping , Ai Meiling , Ma Xinhua , Hu Chenhuan , Peng Qianyi , Zhao Chunguang , Liu Qi , He Shixiong , Huang Li , Zhang Lina 
Published: December 2024

Rationale:
Cardiac arrest (CA) is an acute emergency with high mortality and is closely associated with the risk of brain damage or systemic ischemia–reperfusion injury, post-traumatic stress symptoms.

Patient concerns:
Targeted temperature management in the intensive care unit can improve the neurological outcomes of patients who are comatose after resuscitation from CA. However, there is often a lack of specific evaluation methods for optimal target temperature settings.

Diagnoses:
From November 2021 to October 2022, 9 CA patients received prompt cardiopulmonary resuscitation and return of spontaneous circulation after approximately 10 to 30 minutes of cardiopulmonary resuscitation in Xiangya Hospital, Central South University.

Interventions:
We retrospectively reviewed 9 CA patients’ medical data, including demographic characteristics, hemodynamic change, clinically relevant score, imageological examination, transcranial Doppler ultrasonography, electroencephalogram (EEG), somatosensory-evoked potential, and laboratory data.

Outcomes:
According to the result of each patient’s transcranial Doppler ultrasonography, somatosensory-evoked potential, and EEG to formulate an individualized target temperature. Contrary to the internationally recommended target of hypothermia, we found that not all patients require hypothermia therapy to maintain normal cerebrovascular autonomic regulation function. And neuron-specific enolase and S100β in patients showed a downward trend after hypothermia therapy. Compared with before hypothermia treatment, clinically relevant scores were reduced in patients with good prognosis. Intracranial congestion or ischemia was improved and intracranial pressure was reduced in all patients during hypothermia treatment. For patients with good EEG response, the ratio of gray matter in the brain increased and the neurological prognosis was significantly improved. Finally, after 6 months of follow-up, we found 3 patients died and 1 patient had a long-term vegetative state, the other patients had a good prognosis.

Lessons:
Individualized targeted temperature management under the guidance of multimodal brain monitoring plays an important role in brain protection of patients with CA.
A case of posterior urethral valve diagnosed by ultrasound in antenatal and pathology: A case report
Authors: Gao Jinmei , Guan Yunping , Kang Junling , Zhang Wei 
Published: December 2024

Rationale:
Posterior urethral valve is a rare disease, prenatal diagnosis and prognosis evaluation are particularly important.

Patient concerns:
A 25-year-old pregnant woman was found enhanced parenchymal echo in both kidneys, subcapsule urinary cyst formation in both kidneys, bladder enlargement of the fetus during prenatal ultrasonography at 25 W + 4 of gestation. It was accompanied by fetal pericardial effusion and oligohydramnios.

Diagnoses:
Fetal posterior urethral valve.

Interventions:
After detailed prenatal evaluation, labor was induced and fetal autopsy was performed.

Outcomes:
Fetal autopsy pathology confirmed the prenatal judgment.

Lessons:
Prenatal ultrasonography can diagnose posterior urethral valve through typical image manifestations and can make a certain judgment for prognosis evaluation.
Bilateral thalamic infarction with posterior cerebral artery variant (the arcade artery): A case report
Authors: Ling Langping , Xu Lingjia , Zhou Yang 
Published: December 2024

Rationale:
Bilateral thalamic infarction is a rare type of posterior circulation stroke, and it often presents with a reduced level of consciousness in the elderly. Arteriosclerosis is the primary etiology of bilateral thalamic infarction, including conditions such as native vessel stenosis or arterial-to-arterial embolism. Cardiogenic or paradoxical embolism can also lead to thrombosis of the perforator branches innervating the thalamus, and these emboli tend to disintegrate and lead to multiple lesions, even in elderly patients.

Patients concerns:
A 69-year-old man presented to our emergency room with sudden onset of drowsiness lasting for 2 days. A computed tomography scan revealed bilateral hypodense thalamic lesions, which resembled artery of Percheron infarcts. Magnetic resonance imaging confirmed cerebral infarction in the posterior circulation. Magnetic resonance angiography and diagnostic digital subtraction angiography suggested a suspicious embolus obstructing the junction between the arcade artery and the left posterior cerebral artery, which had further migrated. Echocardiography, 24-hour Holter monitoring, and deep venous ultrasonography were all negative; however, transesophageal echocardiography revealed a patent foramen ovale.

Diagnosis:
Paradoxical embolism is a rare occurrence in older adults. However, when considering the etiology of stroke in this patient, paradoxical embolism should remain a priority in the diagnostic process following a multifactorial risk assessment.

Intervention:
The patient was treated with antiplatelet, statin therapy, and foramen ovale closure.

Outcome:
He recovered well after the interventional closure surgery and is currently under follow-up.

Lessons:
The elderly experiencing a sudden drop in consciousness should be evaluated for thalamic lesions, primarily cerebral infarction in the posterior circulation. Anatomical artery variations may be helpful in attributing multiple and bilateral lesions to a single source of embolism. Digital subtraction angiography and transesophageal echocardiography can help to clarify the etiological categorization and formulate a secondary prevention strategy for cerebral infarction. Paradoxical embolism is a diagnostic dilemma in the elderly population, and treatment principles must be integrated with guidelines, the prospectively validated patent foramen ovale-associated stroke causal likelihood risk stratification system, interdisciplinary collaboration and customized analysis.
High-grade biliary intraepithelial neoplasia localized in the distal bile duct diagnosed via peroral cholangioscopy: A rare case report
Authors: Kato Naohiro , Yamaguchi Atsushi , Kamada Hiroki , Semba Shigeaki , Teraoka Yuji , Mizumoto Takeshi , Tamaru Yuzuru , Hatakeyama Tsuyoshi , Kouno Hirotaka , Shibata Yoshiyuki , Tazuma Sho , Sudo Takeshi , Kuraoka Kazuya , Yoshida Shigeto 
Published: December 2024

Rationale:
Biliary intraepithelial neoplasm (BilIN) is characterized by a microscopically identifiable preinvasive neoplasm of the biliary tract. BilIN is rarely diagnosed intentionally and is often detected incidentally in surgical specimens obtained via surgical resection for other types of cancers. Herein, we report a rare case of high-grade BilIN localized in the distal bile duct.

Patient concerns:
A 67-year-old female patient presented with epigastric discomfort approximately 1 month earlier. The patient underwent a blood test on the previous day at a local hospital. Results revealed abnormal liver function. Thus, the patient was referred to our hospital for further examination and treatment.

Diagnoses:
Blood tests showed elevated hepatic and biliary enzyme levels. However, jaundice was not noted, and the patient’s tumor marker levels were normal. Contrast-enhanced computed tomography scan revealed dilatation of the common bile duct and diffuse wall thickening of the bile duct and gallbladder walls. Tissue samples obtained via bile juice cytology showed a poorly differentiated adenocarcinoma. However, the bile duct walls were thick, and the tumor location was unclear. Hence, peroral cholangioscopy was performed. Results revealed an irregular mucosal surface and low papillary protuberances in the lower bile duct. Based on these findings, the patient was diagnosed with distal bile duct carcinoma.

Interventions:
She underwent surgical resection.

Outcomes:
Histological findings showed high-grade BilIN with scattered low-grade BilIN in the surrounding area.

Lessons:
We present a rare case of high-grade BilIN in the lower bile duct that was detected without other types of cancers and diagnosed via peroral cholangioscopy.
Uncovering a lymphoplasmacytic lymphoma/Waldenström macroglobulinemia initially manifesting as dizziness detected through abnormal serum lipemia index: A case report
Authors: Wang Kun , Yi Bin 
Published: December 2024

Rationale:
Automated serum index is widely used in biochemical testing, enabling the observation of sample characteristics to a certain extent. The differences between serum lipemia index and sample characteristics can, to a certain extent, facilitate early detection of certain diseases.

Patient concerns:
This is a case report of an elderly patient who was admitted to cardiology outpatient clinic due to dizziness.

Diagnoses:
Basic tests were normal, but hidden lab tests found abnormal serum index. After discussion, further tests showed high immunoglobulin levels.

Interventions:
We performed a lymph node color Doppler ultrasound, blood light chain determination, blood immunization fixed electrophoresis, and urine immunofixation electrophoresis detection. Flow cytometry (lymphoma), FISH (MM + IGH) and MYD88 were detected.

Outcomes:
Consequently, the patient was advised to be transferred to the hematology department and was ultimately diagnosed with Lymphoplasmacytic Lymphoma/Waldenström Macroglobulinemia.

Lessons:
This case was facilitated by the early detection of discrepancies between lipemia indices and sample appearance despite normal examination results. Additionally, close collaboration between clinical laboratory technicians and clinicians facilitated the uncovering of subtle early disease changes, thereby aiding in precise diagnoses.
Expanded phenotypes and pathogenesis of geleophysic dysplasia 3 resulted from a de novo LTBP3 mutation: A case report
Authors: Liang Jie , Han Yu , Tao Huimin , Wang Xuezhen , Zhang Bei , Wu Jiebin , Zhai Jingfang 
Published: December 2024

Rationale:
The aim of this study is to investigate the de novo mutation and clinical features of latent transforming growth factor-beta-binding protein 3 (LTBP3) gene-associated geleophysic dysplasia 3, and possible mechanisms of action.

Patient concerns:
A nonconsanguineous couple was recruited for this study due to the presence of intrauterine growth restriction. The pregnant woman and her elder daughter presented with skeletal abnormalities with diabetes. The pregnant woman underwent amniocentesis for cytogenetic analysis and copy number variation sequencing. Furthermore, we employed a combination of pedigree whole exome sequencing and bioinformatics analysis to predict the effects of mutations.

Diagnoses:
The results of karyotyping and copy number variation sequencing were normal. And the whole exome sequencing results indicated that the family carried a de novo mutation c.852_853insAGG (p.L284_P285insR) in the LTBP3 gene (NM_001130144.3) inherited from the mother. The results of bioinformatics prediction demonstrated the mutation influenced the stability of the LTBP3 gene, thereby enhanced the transforming growth factor β signaling pathways.

Interventions:
The couple terminated the pregnancy after comprehensive consideration.

Outcomes:
A de novo non-frameshift mutation of the LTBP3 gene might enhance the transforming growth factor β signaling pathways, thereby leading to geleophysic dysplasia 3.

Lessons:
As a rare multi-system musculoskeletal disorder, geleophysic dysplasia 3 necessitates early prenatal diagnosis and multidisciplinary consultation in order to facilitate further diagnosis and evaluation of the patient and the fetus.
Injection of an allodermal matrix and leukocyte-rich platelet-rich plasma mixture improved the tendon integrity in cases of full-thickness common extensor tendon tears of the elbow: Two case reports
Authors: Yoon Eun-Ji , Lee Jung-Woo , Kim Jong-Ho 
Published: December 2024

Rationale:
Lateral epicondylitis, commonly known as tennis elbow, is a chronic condition characterized by tendinosis at the insertion site of the lateral epicondyle. Various treatment methods are available, ranging from conservative to surgical options for refractory lateral epicondylitis. Recently, platelet-rich plasma (PRP) injections have shown effectiveness for treating this condition. This study aimed to evaluate the effectiveness of injecting a mixture of allodermal matrix (ADM) and leukocyte-rich PRP (LRPRP) for tendon regeneration.

Patient concerns:
A 59-year-old man and a 62-year-old man, both with full-thickness tears in the common extensor tendon, presented persistent elbow pain despite undergoing several conservative treatments, including steroid injections, extracorporeal shock wave therapy, physical therapy, and medication previously.

Diagnoses:
The patients were diagnosed with refractory lateral epicondylitis using ultrasonography and magnetic resonance imaging (MRI).

Interventions:
We performed injections of a mixture of ADM and LRPRP into the full-thickness tear of the common extensor tendon.

Outcomes:
One year after the procedure, visual analogue scale pain scores, patient-rated tennis elbow evaluation scores, quick disabilities of the arm, shoulder, and hand scores, and Nirschl scores had all improved significantly from baseline. In case 1, MRI scans obtained at 6 and 12 months postinjection demonstrated improved tendon integrity in full-thickness tear of the common extensor tendon. In case 2, similar improvements were observed on the 6-month postinjection MRI.

Lessons:
Injection of a mixture of ADM and LRPRP at the site of full-thickness tears in the common extensor tendon of the elbow can enhance tendon integrity. This treatment also improves functional status in cases of recalcitrant lateral epicondylitis.