bluuebunny/crossref_metadata_2025_split huggingface dataset:
An anastomosing hemangioma mimicking a renal cell carcinoma in a kidney transplant recipient: a case report
Authors: Kim Chang Seong , Choi Soo Jin Na , Kim Sung-Sun , Suh Sang Heon , Bae Eun Hui , Ma Seong Kwon , Kim Soo Wan 
Published: July 2021

Abstract
Background
Although anastomosing hemangiomas are very rare and benign vascular neoplasms, these tumors are more common among patients with end-stage kidney disease. Incidental finding of these tumors in the kidney or adrenal gland has been reported. Herein, we describe a case in which an anastomosing hemangioma was misdiagnosed as a renal cell carcinoma before kidney transplant.

Case presentation
A 35-year-old woman with lupus nephritis was admitted to our emergency department for suspected uremic symptoms of nausea and general weakness. She had received hemodialysis due to end-stage kidney disease, and a living-donor kidney transplantation from her father was planned. On pre-operative contrast-enhanced computed tomography and magnetic resonance imaging, a 1.7 cm renal cell carcinoma was observed in the right kidney. On staining after radical nephrectomy, irregularly shaped vascular spaces of various sizes were observed, with these spaces having an anastomosing pattern. As the findings of the anastomosing hemangioma are similar to those of a renal cell carcinoma on imaging, histology examination was necessary to confirm the diagnosis of anastomosing hemangioma and to prevent delay in listing for kidney transplantation. Good kidney function was achieved after transplantation, with no tumor recurrence.

Conclusion
Our case underlines the importance for prompt surgical resection of an enhancing renal mass to confirm diagnosis in patients scheduled for kidney transplantation to avoid any delay.
Distinct nitrogen isotopic compositions of healthy and cancerous tissue in mice brain and head&neck micro-biopsies
Authors: Straub M. , Sigman D. M. , Auderset A. , Ollivier J. , Petit B. , Hinnenberg B. , Rubach F. , Oleynik S. , Vozenin M.-C. , Martínez-García A. 
Published: July 2021

Abstract
Background
Cancerous cells can recycle metabolic ammonium for their growth. As this ammonium has a low nitrogen isotope ratio (15N/14N), its recycling may cause cancer tissue to have lower 15N/14N than surrounding healthy tissue. We investigated whether, within a given tissue type in individual mice, tumoral and healthy tissues could be distinguished based on their 15N/14N.

Methods
Micro-biopsies of murine tumors and adjacent tissues were analyzed for 15N/14N using novel high-sensitivity methods. Isotopic analysis was pursued in Nude and C57BL/6 mice models with mature orthotopic brain and head&neck tumors generated by implantation of H454 and MEERL95 murine cells, respectively.

Results
In the 7 mice analyzed, the brain tumors had distinctly lower 15N/14N than healthy neural tissue. In the 5 mice with head&neck tumors, the difference was smaller and more variable. This was at least partly due to infiltration of healthy head&neck tissue by tumor cells. However, it may also indicate that the 15N/14N difference between tumoral and healthy tissue depends on the nitrogen metabolism of the healthy organ in question.

Conclusions
The findings, coupled with the high sensitivity of the 15N/14N measurement method used here, suggest a new approach for micro-biopsy-based diagnosis of malignancy as well as an avenue for investigation of cancer metabolism.
Iron overload and iron chelating agent exposure in anemia-associated outer retinal degeneration: a case report and review of the literature
Authors: Belmouhand Mohamed , Eckmann-Hansen Christina , Ilginis Tomas , Leinøe Eva Birgitte , Mortensen Bo Kok , Larsen Michael 
Published: July 2021

Abstract
Background
Deferoxamine retinopathy is the informally designated term used to describe a characteristic pattern of outer retinal degeneration in iron-overloaded chronic anemia patients who are treated with deferoxamine. We hypothesize that insufficiently treated iron overloading and not only deferoxamine is the cause of the retinal degeneration. Our case report is based on exposure histories of two anemia patients and literature review.

Case presentation
Both anemia patients presented with bilateral visual loss secondary to photoreceptor and retinal pigment epithelium degeneration. Chart review showed that visual loss came after a year-long slow, and rather monotonous rise in plasma ferritin concentrations, with no obvious relation to iron chelator exposure. In one patient, the onset of symptomatic visual loss came after a bout of fever followed by two additional febrile episodes, all accompanied by plasma ferritin spikes. Adjustment of iron chelation therapy did not improve visual function. Experimental studies clearly show that both systemic and intraocular exposure to iron ions can induce retinal degeneration.

Conclusion
The available evidence indicates that retinal degeneration in chronic anemia patients treated by deferoxamine is cause by insufficient iron chelation, not by deferoxamine. The actual role of iron chelating agents may be to promote a long enough survival to allow the slow development of retinal siderosis.
The effect of implementation of evidence-based eye care protocol for patients in the intensive care units on superficial eye disorders
Authors: Pourghaffari Lahiji Azam , Gohari Mohsen , Mirzaei Samaneh , Nasiriani Khadijeh 
Published: July 2021

Abstract
Background
Superficial eye disorders are one of the most common complications of improper eye care in intensive care units that can lead to corneal ulcers and permanent eye damage. The aim of this study was to determine the effect of the implementation of eye care protocol on the incidence of infection and superficial eye disorders in patients admitted to intensive care units.

Methods
This study was a cross-over clinical trial that was performed on 32 patients admitted to the intensive care unit with reduced or no blink reflex following loss of consciousness or receiving sedatives. The eye of the test group received eye care according to the protocol and the eye of the control group received the routine care of the ward. The data collection form included demographic and clinical information and the clinical score scale of superficial eye disorders, which were completed in 7 days for both eyes. Data analysis was performed by McNemar and Cochran tests with a 95 % confidence interval.

Results
In the study of superficial eye disorders, the frequency of dacryorrhea and hyperemia was not significantly different in the second to seventh days in the control and test eyes (P < 0.05). The frequency of xerophthalmia was not significantly different between the control and the test eyes on the second to third days (P < 0.05), but there was a significant difference on the fourth, fifth, sixth, and seventh days (P = 0.0001). Also, the frequency of corneal opacity was not significantly different in the second and third days (P < 0.05), but in the fourth (P < 0.05), fifth, sixth, and seventh days, this difference was significant (P = 0.0001).

Conclusions
Based on the results, although the implementation of eye care protocol has been able to have a significant effect on reducing ocular complications and problems, routine eye care in the intensive care unit also has clinical effectiveness. Therefore, in order to prevent and completely eliminate eye disorders in the intensive care unit, more evidence and research are needed.

Trial registration
The trial was retrospectively registered on https://en.irct.ir/trial/43493 on 13 November 2019 (13.11.2019) with registration number [IRCT20140307016870N5].
Parents’ and carers’ impression of “quality” within a Paediatric Emergency Department
Authors: Lacey Brendan , West Adam , Craig Simon 
Published: July 2021

Abstract
Background
Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback.

Methods
A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”.

Results
One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%).

Conclusion
We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED.
Longitudinal trajectories of pneumonia lesions and lymphocyte counts associated with disease severity among convalescent COVID-19 patients: a group-based multi-trajectory analysis
Authors: Shi Nannan , Huang Chao , Zhang Qi , Shi Chunzi , Liu Fengjun , Song Fengxiang , Hou Qinguo , Shen Jie , Shan Fei , Su Xiaoming , Liu Cheng , Zhang Zhiyong , Shi Lei , Shi Yuxin 
Published: July 2021

Abstract
Background
To explore the long-term trajectories considering pneumonia volumes and lymphocyte counts with individual data in COVID-19.

Methods
A cohort of 257 convalescent COVID-19 patients (131 male and 126 females) were included. Group-based multi-trajectory modelling was applied to identify different trajectories in terms of pneumonia lesion percentage and lymphocyte counts covering the time from onset to post-discharge follow-ups. We studied the basic characteristics and disease severity associated with the trajectories.

Results
We characterised four distinct trajectory subgroups. (1) Group 1 (13.9%), pneumonia increased until a peak lesion percentage of 1.9% (IQR 0.7–4.4) before absorption. The slightly decreased lymphocyte rapidly recovered to the top half of the normal range. (2) Group 2 (44.7%), the peak lesion percentage was 7.2% (IQR 3.2–12.7). The abnormal lymphocyte count restored to normal soon. (3) Group 3 (26.0%), the peak lesion percentage reached 14.2% (IQR 8.5–19.8). The lymphocytes continuously dropped to 0.75 × 109/L after one day post-onset before slowly recovering. (4) Group 4 (15.4%), the peak lesion percentage reached 41.4% (IQR 34.8–47.9), much higher than other groups. Lymphopenia was aggravated until the lymphocytes declined to 0.80 × 109/L on the fourth day and slowly recovered later. Patients in the higher order groups were older and more likely to have hypertension and diabetes (all P values < 0.05), and have more severe disease.

Conclusions
Our findings provide new insights to understand the heterogeneous natural courses of COVID-19 patients and the associations of distinct trajectories with disease severity, which is essential to improve the early risk assessment, patient monitoring, and follow-up schedule.
Massive haemorrhagic complications of ruptured pulmonary arteriovenous malformations: outcomes from a 12 years’ retrospective study
Authors: Ma Xu , Jie Bing , Yu Dong , Li Ling-Ling , Jiang Sen 
Published: July 2021

Abstract
Background
The life-threatening haemorrhagic complications of pulmonary arteriovenous malformations (PAVMs) are extremely rare, and only described in isolated cases. This study was designed to comprehensively investigate management of ruptured PAVMs.

Methods
We retrospectively assessed clinical and imaging data of ruptured PAVMs to summarize incidence, clinical characteristics, and outcomes following embolisation between January 2008 and January 2021.

Results
Eighteen of 406 (4.4%) patients with PAVMs developed haemorrhagic complications. Twelve of 18 patients were clinically diagnosed with hereditary haemorrhagic telangiectasia (HHT). Haemorrhagic complications occurred with no clear trigger in all cases. Eight of 18 patients (44.4%) were initially misdiagnosed or had undergone early ineffective treatment. 28 lesions were detected, with 89.3% of them located in peripheral lung. Computed tomography angiography (CTA) showed indirect signs to indicate ruptured PAVMs in all cases. Lower haemoglobin concentrations were associated with the diameter of afferent arteries in the ruptured lesions. Successful embolotherapy was achieved in all cases. After embolotherapy, arterial oxygen saturation improved and bleeding was controlled (P < 0.05). The mean follow-up time was 3.2 ± 2.5 years (range, 7 months to 10 years).

Conclusions
Life threatening haemorrhagic complications of PAVMs are rare, they usually occur without a trigger and can be easily misdiagnosed. HHT and larger size of afferent arteries are major risk factors of these complications. CTA is a useful tool for diagnosis and therapeutic guidance for ruptured PAVMs. Embolotherapy is an effective therapy for this life-threatening complication.
Understanding junior doctors’ experiences of teaching on the acute take: a qualitative study
Authors: Hayden Charlotte , Raidan Jedd , Rees Jonathan , Oswal Abhishek 
Published: July 2021

Abstract
Background
New medical graduates are significantly unprepared to manage acutely unwell patients due to limited first-hand clinical exposure in the undergraduate curriculum. Supporting undergraduate learning in the acute setting can be challenging for junior doctors when balancing teaching and clinical responsibilities. Our aim was to explore junior doctors’ first-hand experiences of supporting undergraduate education in the acute admissions environment(take).

Methods
Fourteen junior doctors in one teaching hospital in South West England took part in semi-structured focus groups (4–6 participants in each) which were audio-recorded, transcribed, and thematically analysed.

Results
Junior doctors described their educational role as comprising: teaching, demonstrating, coaching, and supervising. They perceived the acute take as a highly variable, unpredictable setting that offered a broad scope for learning. Tensions between doctors’ clinical and educational roles were described, influenced by internal and external factors. Clinical work was prioritised over teaching and participants lacked confidence in supervisory and clinical skills. Doctors felt pressured to meet students’ expectations and lacked understanding of their educational needs. Senior colleagues were highly influential in establishing an educational culture and were often a source of pressure to deliver timely clinical care. Organisations were perceived not to value teaching due to the lack of provision of dedicated teaching time and prioritisation of limited resources towards patient care. Participants managed tensions by attempting to formally separate roles, demoting students to passive observers, and they sought greater continuity in placements to better understand students’ abilities and expectations.

Conclusions
Educational opportunities for undergraduate students on the acute take are varied and highly valuable. This study provides insight into the provision of workplace education and its challenges from junior doctors’ perspectives. We highlight areas for improvement of relevance to educational providers.
Dispensing antiretrovirals during Covid-19 lockdown: re-discovering community-based ART delivery models in Uganda
Authors: Zakumumpa Henry , Tumwine Christopher , Milliam Kiconco , Spicer Neil 
Published: July 2021

Abstract
Background
The notion of health-system resilience has received little empirical attention in the current literature on the Covid-19 response. We set out to explore health-system resilience at the sub-national level in Uganda with regard to strategies for dispensing antiretrovirals during Covid-19 lockdown.

Methods
We conducted a qualitative case-study of eight districts purposively selected from Eastern and Western Uganda. Between June and September 2020, we conducted qualitative interviews with district health team leaders (n = 9), ART clinic managers (n = 36), representatives of PEPFAR implementing organizations (n = 6).In addition, six focus group discussions were held with recipients of HIV care (48 participants). Qualitative data were analyzed using thematic approach.

Results
Five broad strategies for distributing antiretrovirals during ‘lockdown’ emerged in our analysis: accelerating home-based delivery of antiretrovirals,; extending multi-month dispensing from three to six months for stable patients; leveraging the Community Drug Distribution Points (CDDPs) model for ART refill pick-ups at outreach sites in the community; increasing reliance on health information systems, including geospatial technologies, to support ART refill distribution in unmapped rural settings. District health teams reported leveraging Covid-19 outbreak response funding to deliver ART refills to homesteads in rural communities.

Conclusion
While Covid-19 ‘lockdown’ restrictions undoubtedly impeded access to facility-based HIV services, they revived interest by providers and demand by patients for community-based ART delivery models in case-study districts in Uganda.
Application of comprehensive unit-based safety program model in the inter-hospital transfer of patients with critical diseases: a retrospective controlled study
Authors: Gu Yimei , Liang Lina , Ge Liuna , Jiang Ling , Hu Xiaole , Xu Jing , Cao Yu , Feng Xiaoting 
Published: July 2021

Abstract
Background
To explore the effect of applying a comprehensive unit-based safety program (CUSP) in the intrahospital transfer of patients with critical diseases.

Methods
A total of 426 critically ill patients in the first affiliated Hospital of Anhui Medical University from August 2018 to February 2019 were divided into two groups according to the time of admission. Overall, 202 patients in the control group were treated with the routine transfer method, and 224 patients in the observational group were treated with the transfer method based on the CUSP model. The safety culture assessment data of medical staff, the occurrence rate of adverse events and related causes, the time of transfer, and the satisfaction of patients’ relatives to the transfer process were compared before and after implementation of the transfer model between the two groups.

Results
Before and after the implementation of the CUSP mode transfer program, there were significant differences in the scores of all dimensions of the safety culture assessment of medical staff (P < 0.05), and the occurrence rate of adverse events and the causes in the observational group were significantly lower than those in the control group (disease-related, staff-related, equipment-related, environment-related) (P < 0.05). The transfer time for Computed Tomography (CT), Magnetic Resonance Imaging (MRI), operating room, and the interventional room was significantly shorter in the observational group than that in the control group (P < 0.05), while the satisfaction of relatives to the transfer process was significantly higher than those in the control group (P < 0.05).

Conclusion
The implementation of CUSP model for the intrahospital transfer of critically ill patients can significantly shorten the in-hospital transfer time, improve the attitude of medical staff towards safety, reduce the occurrence rate of adverse events, and improve the satisfaction of patients’ relatives to the transfer process.
Actinomycosis in a gray four-eyed opossum (Philander opossum) caused by a novel species of Schaalia
Authors: Knoepfler Stefanie , Schauer Alexandria , Thomann Andreas , Feyer Simon , Rüegg-van den Broek Peggy , Glardon Olivier Jean , Kittl Sonja 
Published: July 2021

Abstract
Background
Infective lesions of the jaws and adjacent tissues (lumpy jaw disease, LJD) have been recognized as one major cause of death of captive macropods. Fusobacterium necrophorum and Actinomyces species serve as the main source of LJD in kangaroos and wallabies. Currently, little is reported about LJD or similar diseases in opossums.

Case presentation
Here we report a case of actinomycosis resembling the entity lumpy jaw disease in a gray four-eyed opossum, caused by a novel species of Schaalia. A 2.8 year old male Philander opossum was presented with unilateral swelling of the right mandible. After an initial treatment with marbofloxacin, the opossum was found dead the following day and the carcass was submitted for necropsy. Postmortem examination revealed severe mandibular skin and underlying soft tissue infection with subsequent septicemia as the cause of death. Histological examination demonstrated Splendore-Hoeppli phenomenon, typically seen in classical cases of actinomycosis. Bacteriology of liver and mandibular mass yielded a previously undescribed species of Schaalia, whose 16 S rRNA gene sequence was 97.0 % identical to Schaalia canis. Whole genome sequencing of the opossum isolate and calculation of average nucleotide identity confirmed a novel species of Schaalia, for which no whole genome sequence is yet available.

Conclusions
The herewith reported Schaalia infection in the gray four-eyed opossum resembling classical actinomycosis gives a novel insight into new exotic animal bacterial diseases. Schaalia species may belong to the normal oral microbiome, as in macropods, and may serve as a contributor to opportunistic infections. Due to the lack of current literature, more insights and improved knowledge about Schaalia spp. and their pathogenicity will be useful to choose appropriate therapy regimens and improve the treatment success rate and outcome in exotic and endangered species.