bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combination therapy of acupuncture and herbal medicine for heart failure: A systematic review and meta-analysis
Authors: Jeong Seong Hoon , Lee Han-Gyul , Kim Gyeongmuk , Kwon Seungwon , Cho Seung-Yeon , Jung Woo-Sang , Park Seong-Uk , Moon Sang-Kwan , Park Jung-Mi , Ko Chang-Nam 
Published: August 2024

Background:Heart failure (HF) is characterized by functional or structural dysfunction of the heart, resulting in impaired blood ejection or ventricular filling. Conventional Western Medicine (CWM) remains the mainstay of treatment for HF; however, the occurrence of adverse events (AEs) necessitates the exploration of alternative treatments. Herbal medicine and acupuncture are adjunctive therapies for HF and have shown potential for improving heart function. This systematic review and meta-analysis aimed to assess the effectiveness and safety of acupuncture and herbal medicine in treating HF.Methods:PubMed, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Citation Information by National Institute of Informatics, KoreaMed, Research Information Sharing Service, and DBpia were searched for randomized controlled trials (RCTs) evaluating the effects of acupuncture and herbal medicine along with CWM as adjunctive treatments for HF, published from inception to May 31, 2024. Treatment effectiveness was determined by evaluating the left ventricular ejection fraction as the primary metric, along with the measurement of the total effective rate, brain natriuretic peptide level, N-terminal prohormone of brain natriuretic peptide level, left ventricular end-diastolic volume, and left ventricular end-systolic volume; the administration of the Minnesota Living with Heart Failure Questionnaire; and the conduct of a 6-minute walk test. Treatment safety was evaluated based on the incidence of AEs. The methodological quality of all included RCTs was assessed using the Cochrane risk of bias tool. A meta-analysis was performed using Review Manager, version 5.4.1.Results:Of the 133 publications identified, 8 RCTs met the inclusion criteria. The meta-analysis showed significant improvements in left ventricular ejection fraction, brain natriuretic peptide levels, N-terminal prohormone of brain natriuretic peptide levels, left ventricular end-systolic volume, left ventricular end-diastolic volume, and 6-minute walk test results. Additionally, significant differences were observed in the total effective rate and Minnesota Living with Heart Failure Questionnaire responses. No significant medication-related AEs occurred in the intervention group. Conversely, 7 control patients developed well-known AEs associated with CWM.Conclusion:Acupuncture combined with herbal medicine and CWM is more effective than CWM alone, indicating a safe treatment approach. Consequently, the proactive administration of acupuncture alongside herbal medicine to patients with HF can be undertaken without concerns regarding AEs.
The efficacy of low/lactose-free milk powder in the treatment of lactose intolerance in infants: A protocol for systematic review and meta analysis
Authors: Aierken Kalibinuer , Xu Zhiwei , Ma Jianbao , Kawuli Gulibahaer 
Published: August 2024

Background:
The aim of this study was to evaluate the efficacy and safety of formula milk powder in the treatment of lactose intolerance in children, and to provide an evidence-based medicine basis for the rational use of drugs in children with lactose intolerance caused by various reasons by meta-analysis.

Methods:
Use computers to search major databases, including Web of Science, PubMed, CNKI, Wanfang Data Knowledge Service Platform, and other databases, the retrieval time is from the establishment of the database to April 2023. The collected literatures were screened, data extracted and processed, and then meta-analysis was performed by Review-Manager 5.4 statistical software.

Results:
A total of 10 randomized controlled trials were included, with 1112 patients, including 562 patients in the treatment group and 550 patients in the control group. The control group was treated with conventional therapy, and the treatment group was treated with lactose-free/low-lactose milk powder on the basis of conventional therapy. The results of the meta-analysis showed that the clinical efficacy of the treatment group was significantly better than that of the control group [odds ratio=6.01, 95% confidence interval (CI): 3.94–9.18, P<0.00001], the course of disease in the treatment group was shorter than that in the control group (mean difference=−1.45, 95% CI: −1.76 to −1.13, P<0.0001). The antidiarrhea time of the treatment group was shorter than that of the control group, and the difference between the 2 groups was statistically significant (mean difference=−1.41, 95% CI: −1.67 to −1.15, P<0.0001).

Conclusion:
Low/lactose-free milk powder can improve clinical efficacy and shorten the course of treatment in infants with lactose intolerance, which can be demonstrated by further large-scale clinical studies.
Treatments for pathogen infection rescued 2 patients with renal artery rupture after kidney transplantation: A case report
Authors: Lian Xin , Liu Si , Zhang Jie , Pang Lei , Yi Xuemei , Wang Gang 
Published: August 2024

Rationale:
Renal artery rupture due to allograft infection, especially by fungi, is a serious clinical complication that can occur after kidney transplantation, and may lead to graft loss and death.

Patient concerns:
Two kidney recipients from China who developed renal artery rupture at our hospital on 5 days (47-year-old female) and 45 days (39-year-old male) after surgery.

Diagnoses:
The male had immunoglobulin A nephropathy as a primary disease, and experienced a postoperative attack of vascular rejection and mixed infection by Mucor and bacteria. The female had chronic glomerulonephritis as a primary disease, and experienced renal artery rupture near the anastomosis site with infection by fungi and other pathogens.

Interventions:
The male received resection of the implanted kidney and antibiotic therapy with intravenous vancomycin (0.5 g, 2 days) and amphotericin B (530 mg in 33 days). The female received replacing the segment of renal arterial and internal iliac artery by saphenous vein, as well as antibiotic therapy with amphotericin B (320 mg in 8 days).

Outcomes:
The male was recovered and received a second transplantation, while the female was discharged on postoperative day 19.

Lessons:
In both patients, prompt surgery and aggressive treatment with an antifungal drug (amphotericin B) and antidrugs led to successful rescue.
Delayed diagnosis of TAFRO syndrome: A case report
Authors: Qiao Yumeng , Zhang Xin , Xu Rong , Jia Xiaoyu , Wang Qian 
Published: August 2024

Rationale:
TAFRO syndrome is a systemic inflammatory disorder, manifesting as thrombocytopenia (t), anasarca (a), fever (f), reticulin myelofibrosis/renal insufficiency (r), and organomegaly (o), and considered as a unique clinical subtype of idiopathic multicentric Castleman disease (iMCD). Such syndrome gave rise to a clinical picture similar to that of either a connective tissue disease or an autoimmune disease.

Patient concerns:
A Chinese young female initially presenting with arthralgia, Raynaud phenomenon, generalized edema, and a positive anti-small nuclear ribonucleoprotein particle antibody was diagnosed as mixed connective tissue disease. The kidney biopsy showed thrombotic microangiopathy. Bone marrow smear showed bone marrow hyperplasia and biopsy revealed suspected light chain restricted expression, megakaryocyte proliferation, and moderate to severe bone marrow fibrosis. A lymph node biopsy was conducted and the histopathological findings were consistent with the subtype of mixed Castleman disease. The clinical symptoms were relieved after regular chemotherapy.

Diagnoses:
After above examination results and clinical manifestations, the final diagnoses was TAFRO syndrome.

Intervention:
The she was started on chemotherapy with bortezomib, cyclophosphamide, and dexamethasone.

Outcome:
After chemotherapy, symptoms such as thrombocytopenia, hematuria and proteinuria disappeared, lymphadenopathy and VEGF level decreased, and bone marrow fibrosis relieved.

Lessons:
Our case illustrated the first cases of shared characteristics of mixed connective tissue disease and iMCD-TAFRO syndrome. Cytokines may play a role in the shared pathogenicity of the iMCD-TAFRO syndrome and systemic autoimmune diseases. Therapy directly against inflammatory factors such as corticosteroids or chemotherapy have an important therapeutic implication.
Central lung adenocarcinoma in a young male mimicking pneumonia with nonrecurrent polyserous effusions of negative cytology: A case report
Authors: Aljuba Ayat A. , Shawer Balqis Mustafa , Aljuneidi Roa’a M. , Halman Safa , Jobran Afnan W.M. , Abdulrazzak Mohammed , Al Fallah Orwa , Al Jebrini Nidal E.M. , Bakri Izzeddin A. , Abu Asbeh Yousef 
Published: August 2024

Introduction and Importance:
Lung adenocarcinoma may resemble the clinical presentation of an infectious or inflammatory lung disease. The coexistence of lung cancer, and polyserous effusions is uncommon, which may cause a diagnostic challenge. However, any polyserous effusions at a young age must always be suspicious for malignancy.

Case presentation:
We report a case of 38-year-old male patient with polyserous effusions and pneumonia who was treated accordingly and showed clinical improvement with a significant reduction of pericardial and pleural effusions. Subsequent testing and a biopsy resulted in the histopathological diagnosis of an adenocarcinoma of the lung.

Clinical Discussion:
Nonrecurrent polyserous effusions in lung adenocarcinoma are uncommon, and negative cytology results may not exclude malignancy due to the moderate sensitivity of pleural and pericardial fluid cytology. Clinicians should remain vigilant for false-negative results, especially in younger patients. Malignancy should not be ruled out because pleural and pericardial fluid cytology have a sensitivity of 60% and 92%, respectively.

Conclusion:
Our case highlights the diagnostic challenges posed by atypical presentations of lung adenocarcinoma and emphasizes the importance of considering malignancy in the differential diagnosis of polyserous effusions, even when initial cytology results are negative. Clarifying the rationale for this study enhances its relevance and impact.
Kawasaki disease with shock as the primary manifestation: How to distinguish from toxic shock syndrome?: A case report and literature review
Authors: Wang Weijuan , Wang Huixia , Wang Huijiao , Cheng Jun 
Published: August 2024

Rationale:
Kawasaki disease (KD) is a vasculitis syndrome of small to medium-sized arteries that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. Cardiac manifestations, including coronary artery aneurysms, myocarditis, myocardial infarction, and sudden cardiac death, are the most serious complications observed in KD. On rare occasions, it may accompanied with reduced organ perfusion due to systolic hypotension, a condition known as Kawasaki disease shock syndrome (KDSS). KDSS is a serious complication that can be presented to the emergency department as an initial feature when typical clinical symptoms of KD have not be detected.

Patient concerns:
We report the case of a 12-year-old boy admitted with prolonged fever, bilateral non-purulent conjunctivitis, and signs of shock such as hypotension and tachycardia. Laboratory findings showed elevated inflammatory markers, hypoalbuminemia, and sterile pyuria. He was initially treated with intravenous cefotaxime and vancomycin considering the possible diagnosis of toxic shock syndrome, while the treatment was not effective. Subsequent chest computerized tomography and ultrasound identified pulmonary consolidation and polyserous effusion. Echocardiography revealed mild biatrial dilatation and mild valvular regurgitation with preserved left ventricular function.

Diagnosis:
After a multidisciplinary consultation, a diagnosis of KDSS was made.

Interventions:
To prevent coronary artery lesions and other severe complications, the patient immediately received immunoglobulin, corticoid, and acetylsalicylic acid.

Outcomes:
Soon afterwards, he showed significant improvement, with the temperature dropped to normal and hypotension corrected about 24 hours post-intravenous immunoglobulin therapy. Polyserous effusions also disappeared before discharge. Follow-up echocardiography revealed normal results.

Lessons:
Clinicians should maintain a high index of suspicion for KD and consider pulmonary involvement and polyserous effusions as potential complications. For children with KD, any symptoms pointing to infection should be carefully considered. When there is no etiologic evidence, antibiotics should be used with caution. Our case also highlights the importance of considering KDSS as a differential diagnosis in children presenting with prolonged fever and shock. Early recognition, timely treatment, and close monitoring are key to preventing severe complications and ensuring favorable outcomes in patients with KDSS.
Sulfasalazine’s potential in managing rheumatoid nodules: Insights from a case report
Authors: Alaswad Mohammed , Hamsho Suaad , Sultan Enas , Al-Ibrahim Muhammad , Merza Ahmed , Al-Baroudi Yamen 
Published: August 2024

Rationale:
Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by joint inflammation and various extra-articular manifestations, including rheumatoid nodules (RNs). This case study aims to explore the effectiveness of alternative treatments for RNs, particularly highlighting the therapeutic potential of sulfasalazine.

Patient concerns:
A 52-year-old male with established RA presented with worsening joint pain and firm nodules on his elbows, feet, and fingers.

Diagnoses:
The patient fulfilled the diagnostic criteria for RA and was diagnosed with methotrexate-induced RNs based on their temporal association with methotrexate initiation.

Interventions:
Methotrexate was discontinued and a combination of leflunomide and sulfasalazine was initiated. Sulfasalazine led to improvement in both joint pain and nodule size. However, due to cost concerns, the patient discontinued sulfasalazine, resulting in a resurgence of both symptoms and nodule enlargement. Reintroduction of methotrexate resulted in significant improvement in joint inflammation, and notably, no new nodules developed at 6 months follow-up.

Outcomes:
Sulfasalazine demonstrated efficacy in managing RA nodules, suggesting a potential alternative therapy.

Lessons:
The case highlights the complex etiology of nodules in RA and emphasizes the importance of individualized treatment approaches and close monitoring for optimal management.
Rehabilitation systems: trauma centers Asia–Pacific (Australia and Japan)
Authors: Landale Keith , Sonntag Jesper , Kitada Shimpei , Miyamoto Takashi , Balogh Zsolt J. 
Published: August 2024

Abstract
Rehabilitation systems in Australia and Japan represent a multidisciplinary team approach that have similarities and differences. Treatment is based on a goal-driven, holistic, patient-centered approach. This article provides an overview of the structure of the rehabilitation systems in Australia and Japan, including written guidelines, in-hospital programs, and postdischarge options.
Tear α-synuclein as a biomarker for Parkinson's disease: A systematic review and meta-analysis
Authors: Akowuah Prince Kwaku , Owusu Ebenezer , Totoe David 
Published: August 2024

BACKGROUND
Parkinson's disease symptoms mostly manifest after significant and irreversible neuropathology. Hence, there is a need to identify biomarkers that can provide indications of disease before significant neuronal degeneration occurs.

OBJECTIVE
To estimate the difference in the concentration of α-synuclein protein in tears between individuals with Parkinson's disease and healthy controls.

DATA SOURCES
PubMed, Scopus, and Web of Science. The last database search was on December 20, 2023.

STUDY ELIGIBILITY CRITERIA
Primary prospective studies in humans measuring the level of α-synuclein in tears and clinical outcomes reported using mean or median.

PARTICIPANTS AND INTERVENTIONS
Individuals with Parkinson's disease and healthy controls.

STUDY APPRAISAL AND SYNTHESIS METHODS
The risk of bias was assessed using the Newcastle-Ottawa Scale. The I
2 statistic was used to estimate heterogeneity. The outcome measure was the difference in tear total and oligomeric α-synuclein. Mean difference (MD) was used to assess the outcome. The certainty of evidence was rated following the Grading of Recommendations Assessment and Development and Evaluation (GRADE) system.

RESULTS
Three hundred twenty-seven Parkinson's disease and 312 healthy control subjects from five studies and 177 Parkinson's disease and 166 healthy control subjects from two studies were included in total α-synuclein levels and oligomeric α-synuclein levels analysis, respectively. Total α-synuclein level was not different between Parkinson's disease and healthy controls (MD = 0.02 ng/mL [95% confidence interval {CI}: 0.00 to 0.05 ng/mL; I
2 = 90%; Z = 1.79; p=0.07; number of studies = 5; GRADE rating = very low]). Stratifying the data based on disease duration, total α-synuclein was higher in subjects with Parkinson's disease duration ≥7 years compared with healthy controls (MD = 0.04 ng/mL [95% CI: 0.03 to 0.05 ng/mL; I
2 = 0%; Z = 8.24, p<0.00001; number of studies = 2; GRADE rating = low]) but not different between the two groups (MD = −0.12 ng/mL (95% CI: −0.38 to 0.15 ng/mL; I
2 = 93%; Z = 0.84, p=0.40; number of studies = 3; GRADE rating = very low]). Oligomeric α-synuclein level was higher in Parkinson's disease compared with controls (MD = 6.50 ng/mL [95% CI: 2.79 to 10.20 ng/mL; I
2 = 94%; Z = 3.44; p=0.0006; number of studies = 2; GRADE rating = very low]).

LIMITATIONS
High heterogeneity between studies. Potential sources of heterogeneity could not be explored due to the limited number of studies.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS
Tear α-synuclein has the potential to be a noninvasive biomarker for Parkinson's disease. Studies are, however, needed to increase certainty in the biomarker and establish how the protein's changes in tears correlate with Parkinson's disease progression and severity.
The Mechanism of Death in Electrocution
Authors: Kroll Mark W. , Luceri Richard M. , Efimov Igor R. , Calkins Hugh 
Published: August 2024

Abstract
Our present understanding of electrocution followed a long path of detours and speculation. It is now hard to appreciate how mysterious was an unexpected sudden death—without visible trauma—and we should be sympathetic to the surprising theories that came from well-intentioned attempts to find something in the autopsy of an electrocution victim.
The early hypotheses (1880s) tended to favor effects on the central nervous system, but the emphasis switched to arterial and hematological mechanisms as well as respiratory arrest (ie, asphyxia) along with a widespread publication debate. While careful animal experimentation slowly established that electrocution was due to the induction of VF (ventricular fibrillation), the older hypotheses held sway for many decades. Even today, the neurogenic and asphyxial explanations reappear occasionally.
Despite 170 years of research, the phenomenon of electrocution continues to generate new hypotheses for its mechanism.
No More Excuses: Strategies for Inclusive Pediatric Physical Therapy Education
Authors: Rundell Shawn M. , Wentzell Erin M. , Wynarczuk Kimberly D. , Catalino Tricia , Hernandez Meghan , Lent Kathryn , Young Allison N. , Rapport Mary Jane 
Published: August 2024

Purpose:
The purpose of this special communication is to provide practical, evidence-based recommendations and examples of inclusive and accessible teaching practices that can be effectively used in pediatric physical therapy (PT) education to: (1) ensure equity in education, (2) elevate all voices, and (3) facilitate anti-oppressive learning environments.

Summary of Key Points:
Concrete action items and strategies addressing these 3 recommendations are provided at all levels of the ecological model framework.

Statement of Conclusions and Recommendations for Clinical Practice:
Pediatric PT clinical and academic educators must work proactively to ensure learning environments are inclusive of everyone. Pediatric PT educators need to take the time to self-reflect, change their behaviors, and use inclusive, accessible, and anti-oppressive education practices. This will create equitable learning opportunities to successfully meet the needs of our learners, children, and families with whom we engage regularly in our personal and professional lives.
Resection of Fourth-to-Fifth Metacarpal Synostosis and Fascial Interposition for Creation of a Functional Grip/Pinch in the Apert Hand
Authors: Upton Joseph , Khouri Kimberly S. 
Published: August 2024

Background:
Fourth-to-fifth metacarpal synostosis, present in a majority of Apert hands, flattens the metacarpal arch, restricts metacarpal descent, may prevent opposition of border rays, and negates any functional flexion. Restoration of position and mobility with arthroplasty changes the plane of flexion and enables both pinch and grip. This report summarizes the evolution of the authors’ technique over 5 decades.

Methods:
In a cohort of 184 Apert patients (368 hands), the presence, anatomy, and level of metacarpal synostosis with a classification was determined. The present technique consists of incision along the ulnar border of the hand, wide excision of the skeletal coalition, release of dorsal structures, and soft-tissue interposition. Data consisted of clinical records, serial molds, radiographs, and occupational therapy records. Follow-up ranged from 3 to 44 years.

Results:
A total of 147 patients (80% of hands) had bilateral fourth-to-fifth metacarpal synostoses, the extent of which correlated with the Apert hand classification. In 72 patients, the synostosis was resected and cadaveric fascia interposed. Synostosis refusion occurred in 38 hands, all of which were treated early in the series and in patients younger than 6 years old. Despite refusion, the position of the fifth digit had improved, and the flat transverse arch was in a more curved or cupped posture. The distance between the opposing border rays was always improved, and a new grip and pinch mechanism created.

Conclusions:
Aggressive ostectomy of synostosis and fascial interposition places the ulnar side of the hand in a much more functional position. In conjunction with thumb lengthening, opposition between the thumb and fifth finger becomes a clinical reality in children with Apert syndrome.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.