bluuebunny/crossref_metadata_2025 huggingface dataset:
Ion Channels and Channelopathies
Authors: Benarroch Eduardo E.
Published: May 2021

Ion channels are the basic elements regulating activity and communication in the nervous system. They consist of several subunits forming a central pore and are subdivided on the basis of their ion selectivity, gating mechanisms, and kinetics of activation and inactivation. Ion channels form part of macromolecular complexes restricted to specific membrane domains via interactions with scaffold proteins, lipid rafts, and actin cytoskeleton. The selective expression and distribution of ion channels define the electrophysiological properties of the neurons, their axons, and muscle cells. The interactions among different types of sodium, calcium, and potassium channels determine cell excitability, firing pattern and conduction of the action potential, and probability of neurotransmitter release at presynaptic terminals. Central nervous system channelopathies manifest with epilepsy, episodic ataxia, paroxysmal movement disorders, or hemiplegic migraine, frequently in several combinations. Peripheral channelopathies produce myotonia, periodic paralysis, myasthenic syndrome, paroxysmal pain disorders, or congenital insensitivity to pain.
Microenvironment in the Central Nervous System
Authors: Benarroch Eduardo E.
Published: May 2021

The regulation of the microenvironment in the CNS is critical for neuronal and glial survival, function, and response to injury. This regulation occurs via components of a neurovascular unit that control the functional coupling between neuronal activity and local cerebral blood flow and maintain the blood-brain barrier. Cerebrospinal fluid production, circulation, and interchange with the interstitial fluid are also major factors maintaining the cerebral microenvironment and have an important role in removal of toxic products from the CNS. Impaired regulation of the local blood flow, disruption of the blood-brain barrier, and altered cerebrospinal fluid dynamics are common pathophysiological consequences of traumatic, vascular, inflammatory disorders and have an important role in epilepsy and neurodegeneration.
Brainstem Mechanisms of Motor Control
Authors: Benarroch Eduardo E.
Published: May 2021

Brainstem function is affected in many neurologic disorders and has a major impact in quality of life and survival. The brainstem harbors gaze-control mechanisms that maintain optimal visual acuity during binocular vision by ensuring that the images of objects remain steady and stimulate corresponding areas of the retina. The control of ocular motor neurons depends primarily on feedforward commands in response to head movement, object motion, or behavioral relevant stimuli. Vocalization, speech, swallowing, and control of the upper airway during respiration require coordinated motor plans via central pattern generator networks in the pons and medulla. Knowledge of brainstem circuits involved in these function is not only helpful to localize lesions in the CNS but also provide insight about potential targets of treatment.
Basal Ganglia Circuits
Authors: Benarroch Eduardo E.
Published: May 2021

The basal ganglia circuits have a central role in reward-based action learning, goal-directed behaviors; and habit formation. These processes largely depend on dopamine signals in the striatum, which controls the activity of the other components of the basal ganglia circuits, including the globus pallidus, substantia nigra, and subthalamic nucleus. Reward signals trigger a dopamine peak in the striatum, which promotes selection of a rewarding action and prevents initiation of competing actions. Dopamine also prevents abnormal synchronized oscillatory activity in the basal ganglia circuits. Loss of dopaminergic signaling triggers changes that underlie the motor manifestations of Parkinson disease (PD), including akinesia and levodopa-induced dyskinesia. Imbalance between dopaminergic and cholinergic signaling in the striatum underlies hyperkinetic movement disorders.
Peripheral and Spinal Mechanisms of Nociception
Authors: Benarroch Eduardo E.
Published: May 2021

Pain is a conscious subjective experience driven by activity of nociceptors. Pain includes not only nociception but also abnormal transmission and processing of painful stimuli. Nociception involves unmyelinated and small myelinated fibers from small dorsal root ganglion neurons that respond to noxious heat, mechanical, or chemically stimuli. These neurons are functional and biochemically heterogeneous in terms of their sensitivity to stimuli, type of afferent axons, neurochemical composition, and targets in the dorsal horn. They activate both second-order projection neurons and different subsets of excitatory and inhibitory interneurons that have a major role in processing of sensory information. Mutations affecting ion channels in nociceptors, inflammatory mediators, or peripheral nerve injury trigger changes and expression of ion channels and receptors. This results in increased excitability of nociceptors, known as peripheral sensitization. Abnormal activity in nociceptors triggers plastic channels in the dorsal horn resulting in altered balance between excitation and inhibition, resulting in central sensitization. Local activation of microglia and astrocytes plays a major role in this process. Elucidation of mechanisms of peripheral and central sensitization provide insight into the pathophysiology of neuropathic pain and potential therapeutic targets for its treatment.
Central Processing and Modulation of Pain
Authors: Benarroch Eduardo E.
Published: May 2021

Pain is a complex sensation that has sensory-discriminative, cognitive, and affective-emotional dimensions. The different aspects of the pain experience engage a complex network of cortical areas activated by ascending pathways that relay on several nuclei of the thalamus. These cortical areas, frequently referred to as the pain matrix, include the primary and secondary somatosensory cortex, insula, anterior and midcingulate cortex, and prefrontal cortex. The areas interact with subcortical regions involved in pain modulation, such as the periaqueductal gray, rostral ventromedial medulla, and brainstem monoaminergic groups. The experience of pain is strongly affected by attention and emotion. The pain modulatory system closely interacts with the reward and motivation system. Abnormal functional connectivity and aberrant plasticity in these areas have a major role in the pathophysiology of chronic pain.
Language
Authors: Benarroch Eduardo E.
Published: May 2021

Language, speech, and semantic knowledge are fundamental cognitive functions critical for human communication and knowledge of the world. Language comprehension and production involve core areas in the left temporoparietal cortex and inferior frontal gyrus that participate in separate but interacting networks for semantic and syntactic processing. Voice and speech production are controlled by separate corticobulbar systems that are hierarchically organized. Semantic knowledge about world objects and their action primarily involves ventrolateral portions of the anterior temporal lobe. Disturbances of these processes manifest with different forms of primary progressive aphasia, apraxia of speech, or semantic variant primary progressive aphasia.
Bronchoscopy and Mediastinoscopy Procedures
Authors: Wilson Justin W.
Published: May 2021

Thoracic and diagnostic procedures such as bronchoscopy and mediastinoscopy are fairly common especially for patients with thoracic cancer. The typical surgical progression for thoracic cancer patients is performance of bronchoscopy to demonstrate airway anatomy and check tumor burden throughout the airway and then proceed with mediastinoscopy to sample mediastinal lymph nodes and send to pathology, if the nodes are negative for cancer then subsequent tumor resection is warranted. Standard preoperative workup includes the usual preoperative labs (hematology and chemistry), electrocardiogram, chest X-ray, and computed tomography scan to determine location of tumor especially to adjoining structures. The authors will discuss bronchoscopy and mediastinoscopy in detail and the difficulties and challenges these patients can present from the anesthetic perspective, including preoperative and intraoperative management.
Bronchopleural Fistula
Authors: Humanez Jose C. , Shah Saurin , Graham Thimothy , Patel Kishan , Mongan Paul
Published: May 2021

Bronchopleural fistula (BPF) is a pathological communication between bronchial tree and pleural space. BPF has multiple etiologies but postsurgical ones carry the highest incidence and the worst prognosis. Diagnosis is based on the clinical presentation and confirmation with radiological imaging (chest X-ray, computed tomography scan) or bronchoscopy. Management of BPF involves a combination of surgical procedures, medical therapy and diagnostic and therapeutic bronchoscopy. Anesthetic considerations and management focus in perioperative optimization of intravascular volume status, proper and careful isolation of the affected lung to avoid spillage of contaminated material into the unaffected lung, and assurance of proper ventilation (either by conventional or special ventilatory techniques) during and after the operation.
Visit 5
Authors: Ferguson Robert J. , Gillock Karen Lee
Published: May 2021

In this visit, of Memory and Attention Adaptation Training (MAAT), the clinician will first review the survivor’s homework, asking about what strategies the survivor has used since the prior visit and how successful they have been. Specifically, both will review how keeping a schedule is improving daily task performance and follow through and review of memory routines. The clinician will then introduce the external strategies of external cueing and distraction reduction (auditory and visual distractions) and will advise the survivor to limit multitasking, which adversely affects the learning of new information, and reduce use of electronic devices and social media, especially passive scrolling through social media pages. The rationale for and concepts involved in activity scheduling and pacing are explained to the survivor. The survivor is asked to apply the chosen compensatory strategy and practice it, and homework is assigned.
Visit 7
Authors: Ferguson Robert J. , Gillock Karen Lee
Published: May 2021

The first goal of the penultimate visit is to review active listening and verbal rehearsal skills for socializing by asking about what strategies were used, for what, when, and where and modifying as needed. The second goal is to review fatigue management and sleep quality improvement by asking what strategies were used, for what, when, and where and modifying as needed. The third goal is to introduce the internal strategy of visualization, including the rationale and reviewing visual–auditory associations, as well as reviewing visualization strategies and emphasizing novelty and humor to evoke emotion and deepen memory. The strategies taught are simple visualization, name–face mnemonic, and the method of loci. The final goal, as customary, is to assign homework, including identifying, practicing, and applying relevant visualization strategies. The clinician asks the survivor how they might use the strategy or strategies and how they may practice in the “real world.”
Pharmacokinetics and pharmacodynamics in obesity
Authors: Moon Tiffany Sun , Ogunnaike Babatunde O.
Published: May 2021

Drug dosing in obese patients has been a challenge because the change in weight can be a source of errors, both of underdosing and overdosing the patient, with serious ramifications. Different scalars are used to calculate drug dosing—total body weight, lean body weight, ideal body weight, and so on. Some drugs should be dosed on total body weight and others on ideal body weight. This chapter elaborates on dosing in common classes of drugs used in anaesthesia as well as the pharmacological principles applied to achieve therapeutic aims of administration.
Continuous positive airway pressure
Authors: Lenhardt Rainer , Businger Jerrad R.
Published: May 2021

Given the increased risk prevalence of coronary artery disease, inflammatory disease, and cancer, morbidly obese patients are frequently scheduled for various types of surgery. In addition, the number of bariatric surgeries has risen almost exponentially. Therefore, the anaesthesiologist is more frequently challenged with providing general anaesthesia for this patient population. General anaesthesia comes with increased risks of events such as perioperative morbid cardiac events and postoperative respiratory failure. Postoperative respiratory failure is particularly common after cardiac, thoracic, and major abdominal surgery. Anaesthesiologists have a range of support mechanisms at their disposal to reduce postoperative respiratory failure including emergent reintubation. Apart from simple oxygen delivery via nasal cannulas or face masks, Venturi masks, and Mapleson circuits, there are various positive pressure systems available. These systems are commonly referred to as non-invasive ventilation (NIV) systems. NIV can be non-invasive continuous positive airway pressure or non-invasive intermittent positive pressure ventilation. Both types of NIV have been shown to improve oxygenation and hypercapnia in morbidly obese patients in the perioperative environment. This chapter presents the physiology and pathophysiology of the respiratory system in the morbidly obese patient. In addition, it illustrates the impact and implications of NIV systems on this patient population in the perioperative setting.
Perioperative paediatric obesity
Authors: Doll Alissa , Ambardekar Aditee P.
Published: May 2021

Paediatric obesity is a worldwide epidemic with estimations of the prevalence of overweight and obese as high as 23.8% and 22.6% in paediatric and adolescent males and females, respectively. In the United States, significant increases in the prevalence of obesity in children were noted in the 1980s and 1990s but have since levelled off in 2010 at 16.9% overall. Moreover, about 12% of infants 6–23 months of age in the United States are considered overweight. The World Health Organization and the United States Centers for Disease Control have slightly different definitions of paediatric obesity based on body mass index, which leads to somewhat varied estimations of prevalence. Despite this, recent trends suggest the number of overweight and obese children presenting for elective and emergent procedures is increasing. A serious public health concern, paediatric obesity can accompany congenital or genetic comorbidities or be the cause of accelerated comorbidities such as cardiovascular disease, diabetes, and cancers that are typically associated with adult morbidity and mortality. This chapter describes the comorbidities that are typically associated with paediatric obesity as they become relevant in the perioperative period, summarizes surgical procedures in which paediatric obesity is common, and discusses peri-anaesthetic implications of the obese child or adolescent.
Obesity in pregnancy
Authors: Onuoha Onyi C.
Published: May 2021

In both affluent and developing countries, obesity continues to approach epidemic proportions and has become a major contributor to the global burden of chronic disease and disability. Although recent data may indicate the exponential increase in obesity in the United States may be levelling off, the prevalence of obesity remains high. The National Health and Nutrition Examination Survey in 2010 estimated the incidence of obesity in adult women as 35.8%. Unfortunately, women of reproductive age are not spared by this epidemic. Particularly in pregnancy, obesity is a public health issue of concern. Maternal obesity is defined as a body mass index of greater than 30 kg/m2 at the first antenatal consultation. According to one study, 50% of pregnant women are overweight or obese and as many as 8% of women in their reproductive childbearing age are morbidly obese with a body mass index of over 40 kg/m2. Indisputably, obesity has been associated with significant obstetric and anaesthetic risk including being identified as an independent risk factor for maternal mortality by the CEMACH Maternal Death Enquiry. A basic understanding of the general impact of obesity on pregnancy is therefore critical. The goal of this chapter is to (1) discuss the physiological changes that occur in the obese parturient, (2) highlight the resulting implications or challenges encountered, and finally (3) review the potential strategies to ensure the delivery of safe anaesthetic care in this patient population.
Obesity and non-operating room anaesthesia
Authors: Gargya Akshat , Troum Matthew , Goldberg Marc
Published: May 2021

Obesity, the modern-day epidemic, comes with many physiological consequences that make the job of an anaesthesiologist challenging. When an obese patient presents to the operating room, the anaesthesiologist needs to take many different variables into account. These variables include, but are not limited to, airway management, comorbid conditions, safest anaesthetic technique, physiological and mechanical changes that occur in the obese patient, positioning, and postoperative care. When a similar patient presents for anaesthetic care outside the operating room, sometimes called ‘out-of-operating room anaesthesia’ or ‘non-operating room anaesthesia’, these factors are compounded for multiple reasons. These include distance from the ‘mother ship’ (the main operating room), colleagues who can provide back-up, and availability of all emergency equipment, among others.
Intensive care
Authors: Tsai Andrea L. , Schumann Roman
Published: May 2021

The evidence for best practices and outcomes for the intensive care unit (ICU) patient with obesity is slowly emerging but is often still expert consensus derived. A critical care environment with appropriate equipment and personnel is essential to maintain caregiver and patient safety as well as to allow for early mobilization. Sedation strategies may favour dexmedetomidine for its relative absence of respiratory depression, and for most sedation agents, a titration-to-effect dosing strategy applies, rather than weight-based dosing. Vascular access is best facilitated with ultrasound guidance and should avoid the femoral site when possible. Despite obesity, techniques such as prone positioning and venovenous extracorporeal membrane oxygenation should be an option for those who would benefit. Best practice recommendations or guidelines are available for nutritional support and venous thromboembolism prophylaxis in the ICU patient with obesity. Antimicrobial dosing remains a challenge, is drug specific, and guided by drug level monitoring where available. Despite increased complications in ICU patients with obesity, the relationship of the latter to mortality is not clear. Possibly an obesity classification other than body mass index, integrating adipose tissue distribution, would help to answer this question in future research.
Obesity and trauma
Authors: McCunn Maureen , Richards Justin , Greco Karla
Published: May 2021

As the number of patients who are obese continues to grow, the number of these patients who will experience a traumatic injury will also continue to increase. Caring for this population has predictable challenges that must be anticipated prior to arrival at the operating room. Obese patients can have coexisting comorbidities that can be difficult to appreciate in the setting of a trauma. In addition, intubation, intravenous access, positioning, anaesthetic management, and postoperative plans will all have unique challenges that must be predicted and thought out in advance. As of yet, there are no formal guidelines or protocols that standardize care of the obese trauma patient. Familiarity with pathophysiology in the obese patient, utilizing resources, and optimizing conditions are essential in order to care for this specific population.
Oral manifestations and management
Authors: Tappuni Anwar R.
Published: May 2021

Low salivary flow rate is a significant problem in Sjögren’s syndrome (SS), which can affect patients’ general and oral health and well-being. Successful management of the long-term effects on oral health requires a systematic approach in assessing the severity of the oral dryness and the signs and symptoms of salivary gland dysfunction to enable clinicians to implement protective and palliative measures to SS patients to achieve oral comfort and adequate oral function. The use of topical fluoride for preventing dental caries and topical oral products or a cholinergic agonist medication for the relief of the dryness symptoms is recommended in the National Institute for Health and Care Excellence–approved guidelines for the management of SS.
A therapeutic strategy for Sjögren’s syndrome dry eye
Authors: Rolando Maurizio , Roper Nicola , Figueiredo Francisco C , Aragona Pasquale
Published: May 2021

Sjögren’s syndrome dry eye is a complex disease. Three pathogenic factors are usually present at different levels of severity. These factors are tear instability, epithelial malfunction, and inflammation. Two additional factors, meibomian gland dysfunction and nerve dysfunction, may play a significant role. A successful therapeutic approach must correct each of these individual components, promoting the restoration of normal ocular surface homeostasis. This may involve the simultaneous use of different tools according to the clinical presentation, such as tear substitutes, anti-inflammatory drugs (steroids, cyclosporine A, Omega-3 fatty acids, etc.), epithelium protectants, and growth factor rich blood derivatives, bandage contact lenses, punctal plugs, and secretagogues.
Chronic cough
Authors: Robinson Chapman
Published: May 2021

This chapter discusses chronic cough and includes information on aetiology and clinical assessment, treatment, causes of cough; chronic cough: asthma, GORD, rhinitis, post-infectious, ACE inhibitors, idiopathic.
Critically ill patient with respiratory disease
Authors: Robinson Chapman
Published: May 2021

This may be due to a deterioration or exacerbation of an existing condition, a first presentation of a previously undiagnosed disease, or with respiratory involvement of a systemic disease. As with any critically ill patient, standard management is required initially to stabilize, with the focus then moving to diagnosis and treatment. Depending on the presence of any pre-existing respiratory disease and the nature and severity of this, it may be important to determine disease-specific treatment and/or treatment limitations (‘ceilings of care’).
Haemoptysis
Authors: Robinson Chapman
Published: May 2021

Haemoptysis is a common and non-specific symptom and can be a sign of significant underlying lung disease. Small-volume haemoptysis is a commonly encountered problem in the outpatient department. It can be safely and efficiently investigated as an outpatient. Massive haemoptysis is usually encountered in the accident and emergency department or in a patient already on the ward with known underlying lung disease. The approaches to small-volume and massive haemoptysis are different.
Pulmonary disease in the immunocompromised—HIV
Authors: Robinson Chapman
Published: May 2021

HIV is associated with a reduction in cell mediated immunity, reflected in low CD4 counts. Widespread use of antiretroviral therapy (ART) and antimicrobial prophylaxis means life expectancy is now near normal. Respiratory disease remains common in the setting of HIV, and patients should be managed in consultation with an HIV specialist.
Asthma
Authors: Robinson Chapman
Published: May 2021

Asthma is a chronic inflammatory disorder of the airway characterized by bronchial hyperreactivity to a variety of stimuli, leading to a variable degree of airway obstruction, some of which may become irreversible over many years.
Bronchiectasis
Authors: Robinson Chapman
Published: May 2021

Bronchiectasis is irreversible abnormal dilatation of one or more bronchi, with chronic airway inflammation. It is associated with chronic sputum production, recurrent chest infections, and airflow obstruction.
Eosinophilic lung disease
Authors: Robinson Chapman
Published: May 2021

Pulmonary eosinophilias are disorders classically associated with CXR infiltrates and a raised blood eosinophil count, although eosinophilic infiltration of the lung can occur without blood eosinophilia. Eosinophilia is found on lung biopsy or BAL.
Extreme environments—flying, altitude, diving
Authors: Robinson Chapman
Published: May 2021

Flying presents potential physiological challenges: modest hypoxia, gas expansion/ contraction with ascent/ descent, recirculation of air with increased risk of air-borne infection. Hypoxia of high altitude may lead to high altitude illness, comprising acute mountain sickness, which is generally minor and self-limiting, and high altitude pulmonary or cerebral oedema, which are serious and even life threatening. Increased recreational diving has raised the awareness of respiratory problems at depth. These can essentially be divided into five: barotrauma, e.g. ruptured bullae and pneumothorax, worsening of pre-existing disorder whilst at depth, e.g. asthma, nitrogen gas evolved from solution in body fluids (the ‘bends’), breath-hold diving and ascent hypoxia, pulmonary oedema.
Idiopathic interstitial pneumonias
Authors: Robinson Chapman
Published: May 2021

The idiopathic interstitial pneumonias (IIPs) comprise a group of diffuse lung diseases of unknown aetiology that primarily involve the pulmonary interstitium—the area between the alveolar epithelium and capillary endothelium, as well as the septal and bronchovascular tissues that make up the fibrous framework of the lung. These primarily interstitial processes, however, frequently also involve the airways, vasculature, and alveolar airspaces. The underlying pathological process is one of varying degrees of inflammation and fibrosis.
Pneumoconioses
Authors: Robinson Chapman
Published: May 2021

Pneumoconioses are non-neoplastic pulmonary diseases caused by the reaction of the lung to the inhalation of mainly mineral, but also organic dusts. Inhaled particles of dust size <5 microns reach the terminal airways and alveoli and settle on the epithelial lining. From here, they are slowly cleared by macrophages or alveolar cells. They may pass into the lymphatic system, be cleared via the airway, or remain in the alveolus. The dust particles can lead to an inflammatory reaction within the lung, depending on their physical and chemical properties. The inflammation causes characteristic alterations in pulmonary structure and radiological abnormalities.
Pneumothorax
Authors: Robinson Chapman
Published: May 2021

A pneumothorax is air in the pleural space. May occur with apparently normal lungs (1° pneumothorax) or in the presence of underlying lung disease (2° pneumothorax).
Respiratory infection—fungal
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

Includes: Aspergillus lung disease, severe asthma with fungal sensitisation, allergic bronchopulmonary aspergillosis, invasive aspergillosis, chronic pulmonary aspergillosis, summary of Aspergillus lung disease, pneumocystis pneumonia (PCP): diagnosis and treatment, cryptococcosis, candidal pneumonia, endemic mycoses, histoplasmosis, blastomycosis, endemic mycoses: coccidioidomycosis, paracoccidioidomycosis
Sleep apnoea and hypoventilation
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

OSA, or obstructive sleep apnoea/hypopnoea (OSAH) are currently the preferred terms for the problem of dynamic upper airway obstruction during sleep. OSA is part of a spectrum, with trivial snoring at one end and repetitive complete obstruction throughout the night (such that the patient cannot sleep and breathe at the same time). Along this spectrum is a point at which the degree of obstruction and the attendant arousal fragments sleep sufficiently to cause daytime symptoms. Distinction should be made between just the findings on sleep study of OSA episodes (OSA) and an abnormal sleep study plus the presence of symptoms (i.e. obstructive sleep apnoea syndrome, OSAS). Asymptomatic OSA is much more common than symptomatic (OSAS).
Ethical considerations
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

Respiratory physicians are often involved in making difficult decisions about the appropriateness of treatment and the prolongation of life in patients with chronic underlying lung disease. Sometimes, artificial ventilation may prolong the dying process; life has a natural end, and the potential to prolong life in the ICU can cause dilemmas. In other cases, these interventions are valuable at prolonging life with a reversible complication.
Inhalers and nebulizers
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

There are many different inhaler devices that deliver drugs directly to the airways, but essentially two basic types MDIs and dry powder inhalers (DPIs). New devices are being introduced all the time, with one, two, or three drugs delivered simultaneously.
Intensive care unit (ICU) referral
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

Ideally, communicate with ICU early, as it is much better that they know about a potentially sick patient who may need ICU input than to find your patient (and you!) in difficulty later on, with no ICU bed. Previously, multiple different scoring systems for the early recognition of sick patients were in use in hospitals, enabling doctors and nursing staff to readily identify and assess a deteriorating patient, including response to treatment.
Thoracentesis
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

Thoracentesis (‘pleural tap’ or pleural fluid aspiration) may be diagnostic or therapeutic. Site selection using US guidance gives a higher success rate and a better adverse event profile and should be used routinely. Use a dedicated procedure room when possible.
Tracheostomy
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

This is usually performed as an adjunct to assisted ventilation. Such patients are now often returned to respiratory wards for ‘decannulation’ with the potential for complications to occur there.
Correlated time variability of multicomponent high-velocity outflows in J162122.54+075808.4
Authors: Aromal P , Srianand R , Petitjean P
Published: May 2021

We present a detailed analysis of time variability of two distinct C iv broad absorption line (BAL) components seen in the spectrum of J162122.54+075808.4 (zem = 2.1394) using observations from SDSS, NTT, and SALT taken at seven different epochs spanning about 15 yr. The blue-BAL component (with an ejection velocity, $v_{\rm e}\sim 37\, 500$ km s−1) is an emerging absorption that shows equivalent width variations and kinematic shifts consistent with acceleration. The red-BAL component ($v_{\rm e} \sim 15\, 400$ km s−1) is a three-component absorption. One of the components is emerging and subsequently disappearing. The two other components show kinematic shifts consistent with acceleration coupled with equivalent width variability. Interestingly, we find the kinematic shifts and equivalent width variability of the blue- and red-BAL components to be correlated. While the C iv emission-line flux varies by more than 17 per cent during our monitoring period, the available light curves (covering rest frame 1300–2300 Å) do not show more than a 0.1 mag variability in the continuum. This suggests that the variations in the ionizing flux are larger than that of the near-ultraviolet flux. However, the correlated variability seen between different BAL components cannot be explained solely by photoionization models without structural changes. In the framework of disc wind models, any changes in the radial profiles of density and/or velocity triggered either by disc instabilities or by changes in the ionizing radiation can explain our observations. High-resolution spectroscopic monitoring of J1621+0758 is important to understand the physical conditions of the absorbing gas and thereby to constrain the parameters of disc wind models.
Network pharmacology-based identification of the key mechanism of quercetin acting on hemochromatosis
Authors: Ding Haoxuan , Chen Lingjun , Hong Zuopeng , Yu Xiaonan , Wang Zhonghang , Feng Jie
Published: May 2021

Hemochromatosis is an iron overload disease, which lacks nutritional intervention strategies. This study explored the protective effect of quercetin on hemochromatosis and its possible mechanism through network pharmacology. We used Online Mendelian Inheritance in Man to screen the disease targets of hemochromatosis, and further constructed a potential protein interaction network through STITCH. The above-mentioned targets revealed by Gene enrichment analysis have played a significant role in ferroptosis, mineral absorption, basal cell carcinoma, and related signal pathways. Besides, the drug likeness of quercetin obtained by Comparative Toxicogenomics Database was evaluated by Traditional Chinese Medicine Systems Pharmacology, and potential drug targets identified by PharmMapper and similar compounds identified by PubChem were selected for further research. Moreover, gene ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis revealed the relationship between quercetin and glycosylation. Furthermore, we performed experiments to verify that the protective effect of quercetin on iron overload cells is to inhibit the production of reactive oxygen species, limit intracellular iron, and degrade glycosaminoglycans. Finally, iron-induced intracellular iron overload caused ferroptosis, and quercetin and fisetin were potential ferroptosis inhibitors. In conclusion, our study revealed the correlation between hemochromatosis and ferroptosis, provided the relationship between the target of quercetin and glycosylation, and verified that quercetin and its similar compounds interfere with iron overload related disease. Our research may provide novel insights for quercetin and its structurally similar compounds as a potential nutritional supplement for iron overload related diseases.
Transcriptomic insights into the zinc homeostasis of MCF-7 breast cancer cells via next-generation RNA sequencing
Authors: Zaman Mohammad S , Barman Shital K , Corley Susan M , Wilkins Marc R , Malladi Chandra S , Wu Ming J
Published: May 2021

A significant gap in the knowledge of zinc homeostasis exists for breast cancer cells. In this study, we investigated the transcriptomic response of the luminal breast cancer cells (MCF-7) to the exposure of extracellular zinc using next-generation RNA sequencing. The dataset was collected for three time points (T0, T30, and T120) in the time course of zinc treatment, which revealed the dramatic increase, up to 869-fold, of the gene expression for metallothioneins (MT1B, MT1F, MT1X, and MT2A) and the zinc exporter ZnT1 (SLC30A1) at T30, continuingly through to T120. The similar dynamic expression pattern was found for the autophagy-related gene (VMP1) and numerous genes for zinc finger proteins (e.g. RNF165, ZNF365, ZBTB2, SNAI1, ZNF442, ZNF547, ZNF563, and ZNF296). These findings point to the all-hands-on-deck strategy adopted by the cancer cells for maintaining zinc homeostasis. The stress responsive genes encoding heat shock proteins (HSPA1A, HSPA1B, HSPA1L, HSPA4L, HSPA6, HSPA8, HSPH1, HSP90AA1, and HSP90AB1) and the MTF-1 biomarker genes (AKR1C2, CLU, ATF3, GDF15, HMOX1, MAP1A, MAFG, SESN2, and UBC) were also differentially up-regulated at T120, suggesting a role of heat shock proteins and the MTF-1 related stress proteins in dealing with zinc exposure. It is for the first time that the gene encoding Polo-like kinase 2 (PLK2) was found to be involved in zinc-related response. The top differentially expressed genes were validated by qRT-PCR and further extended to the basal type breast cancer cells (MDA-MB-231). It was found that the expression level of SLC30A1 in MDA-MB-231 was higher than MCF-7 in response to zinc exposure. Taken together, the findings contribute to our knowledge and understanding of zinc homeostasis in breast cancer cells.
Vernacular Discourses Of Gender Equality In The Post-War British Working Class
Authors: Sutcliffe-Braithwaite Florence , Thomlinson Natalie
Published: May 2021

Why did women’s roles change so dramatically in the West in the period after 1945? These years saw major changes in those roles, and in dominant understandings of female selfhood, from a model based on self-abnegation to one based on self-fulfilment. The roots of this shift have often been located in the post-1968 feminist movement and in economic change. Examining this question through the lens of Great Britain, this article, however, centres working-class women as drivers of these changes, drawing on oral history interviews with over 100 women from coalfield communities. In the decades after 1950, these women constructed a new vernacular discourse of gender equality which had profound implications for the position of women in society. This vernacular discourse shared some similarities with post-1968 feminism, but rather than focusing on the division of domestic and paid labour, or sexual violence, it emphasized women’s autonomy, individuality and voice. In constructing it, working-class women drew on pervasive post-war ideas about equality and democracy, discourses of individualism and individual fulfilment, and discourses of ‘companionate’ marriage and ‘child-centred’ parenting in order to make claims for women’s rights. Through doing so, they constructed women not only as wives and mothers, but also as free and equal individuals.
Relationship between behavioral inhibition and approach motivation systems (BIS/BAS) and intrinsic brain network connectivity in adult cannabis users
Authors: Taylor Mackenzie B , Hammonds Ryan , Filbey Francesca M
Published: May 2021

Dampened behavioral inhibition and overactive behavioral approach motivation systems (i.e. BIS/BAS) are associated with cannabis use disorder (CUD), although the underlying neural mechanisms of these alterations have not yet been examined. The brain’s executive control network (ECN) plays a role in decision-making and is associated with BIS/BAS. In this study, we tested the hypothesis that altered ECN resting-state functional connectivity (rsFC) underlies dysfunctional behavioral inhibition and approach motivation in cannabis users. To that end, we collected resting-state functional magnetic resonance imaging scans in 86 cannabis using adults and 59 non-using adults to examine group differences in the relationship between ECN rsFC and BIS/BAS. Our results showed that BIS was positively correlated with left ECN rsFC in cannabis users, while it was positively correlated with right ECN rsFC in non-users. There was a trend-level moderation effect of group on the association between BIS/BAS and ECN rsFC, showing a weaker association in BIS/BAS and ECN rsFC in cannabis users compared to non-users. An exploratory mediation analysis found that the severity of CUD mediated the relationship between users’ BIS scores and left ECN rsFC. These findings suggest that cannabis use may lead to dysregulation in typical ECN functional organization related to BIS/BAS.
Unimpaired social cognition in adult patients with ADHD: brain volumetric and behavioral results
Authors: Mehren Aylin , Thiel Christiane Margarete , Bruns Swantje , Philipsen Alexandra , Özyurt Jale
Published: May 2021

The present study aimed to investigate whether adult patients with attention deficit hyperactivity disorder (ADHD) show deficits in social cognition and to identify the structural neural correlates of social cognitive skills in ADHD. Twenty-six adult patients with ADHD and 26 matched healthy control participants performed the Movie for the Assessment of Social Cognition and underwent a structural magnetic resonance imaging scan. We compared theory of mind (ToM) performance between ADHD patients and healthy controls. Using voxel-based morphometry, we further compared gray matter volumes in regions that are critical for social cognition between the two groups and examined whether ToM performance was correlated with brain morphometry measures. We did not observe any between-group differences in ToM abilities or regional gray matter volumes. Across both groups, performance on affective aspects of ToM correlated positively with gray matter volumes in the medial part of the superior frontal gyri, which is typically involved in social cognition. This study is the first to relate brain structure to social cognitive abilities in adult patients with ADHD. Although our sample was small and heterogeneous, with half of the patients showing mild-to-moderate psychiatric comorbidities, our results may encourage longitudinal studies that relate social cognitive development in childhood and adolescence to brain maturation of ADHD patients.
The relationship between sleep and physical activity: the moderating role of daily alcohol consumption
Authors: Tracy Eunjin Lee , Reid Kathryn Jean , Baron Kelly Glazer
Published: May 2021

Study Objectives

Studies have demonstrated a daily, bidirectional relationship between sleep and physical activity. However, little is known about how other health behaviors, such as alcohol consumption affect this relationship. This study examined how daily and average alcohol consumption affects the relationships between sleep and physical activity.

Methods

Participants included 70 men and women, ages 18–50 with sleep duration >6.5 hours. Participants wore an actigraph, physical activity monitor and recorded number of alcoholic drinks by daily food logs for 7 days. Results were analyzed using multi-level models to evaluate the 7-day average (i.e. between-person effects) and daily effects (i.e. within-person effects) simultaneously.

Results

Those with more average (7 day) minutes of vigorous physical activity had less wake after sleep onset (WASO). Furthermore, a higher number of alcoholic drinks was associated with longer sleep duration and higher WASO over 7 days. Days with a higher number of alcoholic drinks were associated with higher WASO and sleep fragmentation that night. Alcohol intake moderated the average (7 days) and daily relationships between sleep and physical activity such that high average (7 days) WASO was associated with shorter average total physical activity duration, but only for those with higher alcohol intake. In addition, longer physical activity duration during the day was associated with lower sleep fragmentation that night, but only for those with lower alcohol intake.

Conclusions

These data demonstrate that in a naturalistic setting, alcohol intake negatively impacts sleep and diminishes the benefits of physical activity on sleep.
Congenital Rubella: A Salient Cause of Congenital Heart Defects in Infants
Authors: Gupta Saniya , Verma Sanjay , Dash Nabaneeta , Goel Malika , Rawat Amit , Singh Mini P , Rohit Manoj Kumar , Kumar Praveen
Published: May 2021

Background

Structural congenital heart defects (CHD) take a huge toll of congenital defects in children in India. Limited information is available regarding modifiable risk factors for its causation. This study was planned with an aim to determine the prevalence of congenital rubella infection in Indian infants with structural CHD’s.

Methodology

This cross-sectional, observational study was conducted at a tertiary care hospital in Northern India over 1 year period (1 July 2016 to 30 June 2017). Infants <6 months with structural CHD were enrolled after taking informed consent from their mothers. Blood samples were collected from mother–child binomials and tested for rubella IgM and IgG antibodies.

Results

A total of 80 infants (M : F = 56 : 24), having mean age 69.4 (±56.5) days; were enrolled. In these infants, prevalence of congenital rubella infection (either infant’s IgM rubella positive or infant’s IgG rubella titers higher than mother’s) was 8.75% (7/80). A total of 12.5% of studied mothers were seronegative for rubella IgG antibodies. Statistically significant association was found between the occurrence of congenital rubella and cataract (p = 0.0039), splenomegaly (p = 0.007) and microcephaly (p = 0.0084) in infants having structural CHD.

Conclusions

Congenital rubella syndrome still remains an important modifiable cause for structural CHD in India. Sincere efforts for rubella elimination via further strengthening current vaccination strategy would help in decreasing burden of structural CHD in India.
Trauma Response for Elderly Anticoagulated Patients: An Initiative to Reduce Trauma Resource Utilization in the Emergency Department
Authors: Pelaez Carlos A. , Spilman Sarah K. , Fuchsen Elizabeth A. , Semmens Ashlea D. , Sidwell Richard A.
Published: May 2021

Background:

Trauma centers are challenged to have appropriate criteria to identify injured patients needing a trauma activation; one population that is difficult to triage is injured elderly patients taking anticoagulation or antiplatelet (ACAP) medications with suspected head injury.

Objective:

The study purpose was to evaluate a hospital initiative to improve the trauma triage response for this population.

Methods:

A retrospective study at a Level I trauma center evaluated revised trauma response criteria. In Phase 1 (June 2017 to April 2018; n = 91), a limited activation occurred in the trauma bay for injured patients 55 years and older, taking ACAP medications with evidence of head injury. In Phase 2 (June 2018 to April 2019; n = 142), patients taking ACAP medications with evidence of head injury received a rapid emergency department (ED) response. Primary outcomes were timeliness of ED interventions and hospital admission rates. Differences between phases were assessed with Kruskal–Wallis tests.

Results:

An ED rapid response significantly reduced trauma team involvement (100%–13%, p < .001). Compared with Phase 1, patients in Phase 2 were more frequently discharged from the ED (48% vs. 68%, p = .003), and ED disposition decision was made more quickly (147 vs. 120 min, p = .01). In Phase 2, time to ED disposition decision was longer for patients who required hospital admission (108 vs. 179 min, p < .001); however, there were no significant differences between phases in reversal intervention (6% vs. 11%, p = .39) or timeliness of reversal intervention (49 vs. 118 min, p = .51).

Conclusion:

The ED rapid response delivered safe, timely evaluation to injured elderly patients without overutilizing trauma team activations.