bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on Hebei Province’s Iron and Steel Industry Transformation from the Perspective of Low-Carbon Economy
Authors: Han Yichang , Huo Qiuyue
Published: June 2021

With the gradual rise of a low-carbon economy, the continuous expansion of Hebei’s steel industry and the extensive development of enterprises have brought about a series of serious environmental problems. In this context, the transformation of Hebei’s steel industry is imperative. This article takes the perspective of low-carbon economy as an entry point to study the development of the iron and steel industry in Hebei Province. Based on the theory of low-carbon economy, by drawing on the research results of predecessors and searching for relevant industry data, it restores the development of the iron and steel industry in Hebei Province. The author builds an econometric model to analyze the reasons for the high energy consumption, high pollution, high emission and low benefit development characteristics of Hebei iron and steel industry, finds out the problems that hinder Hebei iron and steel industry from low-carbon transformation, and puts forward scientific suggestions for the development of Hebei iron and steel industry.
Study on wind damage grade model for eucalyptus plantation in Guangxi, China
Authors: Ni Ruiqiang , Wang Tingran , Qin Xiaorui , Zhao Xiyue , Hao Ming , Lu Fadian
Published: June 2021

Wind damage is one of the dominant natural disasters that have the greatest impact on the growth of plantations. However, little attention has been paid to the wind damage grade model. Based on eucalyptus plantations from national forest inventory data and field investigations in Guangxi, ten significant factors that are susceptible to wind damage were selected to perform multiple linear regression analysis on wind damage grade model. Through assessing the level of wind damage based on forest characteristic and site conditions, we aimed to reduce the loss of economic benefits caused by wind damage. The results showed that the age group of eucalyptus trees, slope, soil thickness, management grade, and total vegetation coverage had significant effects on the wind damage of eucalyptus trees in this area. Therefore, it is necessary to protect the vegetation coverage of forest land and to strengthen the management of forest land to improve the wind resistance of eucalyptus forests in the future.
Influence of different air supply parameters on indoor thermal comfort of upper air supply room
Authors: Xiang Pei , Dong Min , Huo Nengmeng , Xu Chuanliang , Yang Fengluan
Published: June 2021

The temperature field, velocity field and PMV evaluation indexes under different air supply parameters are calculated by using Airpack software to divide grids and carry out numerical simulation. The cloud maps of evaluation indexes for different air supply parameters are compared and analyzed. The result determines the optimal air supply parameters.
Study on Volatile Organic Compounds of Tree Species and the Influence on Ozone and Secondary Organic Aerosol
Authors: Xiao Yan , Meng-xuan He , Yi Guo , Yun Wang , Jing-jing Han , Quan-zhou Li
Published: June 2021

Biogenic volatile organic compounds (BVOCs) which offer high reactivity are important precursors for the formation of ozone (O3) and secondary organic aerosols (SOA), then leading to air pollution. In order to explore the potential correlation between BVOCs and O3 and SOA, and to screen out better tree species for urban greening, in this paper, 32 tree species were selected to carry out related experiments. The results showed that: hydrocarbons, alcohols, and aldehydes were significantly correlated with SOA generation, and ketone, ester, hydrocarbons and alcohols also showed significant relationship with O3. Analyzed by UPGMA cluster, Ailanthus altissima, Acer truncatum, Rhus typhina, Prunus cerasifera f. atropurpurea, Prunus persica f. Duplex and Cerasus serrulata var. lannesiana were found weak correlation with O3 and SOA generation, while Salix matsudana, Populus tomentosa and Salix matsudana f pendula were strongly related.
Research on “PPP+ABS” Management Model of Infrastructure Project Based on AHP and Entropy Method
Authors: Huo Qiuyue , Li Yuxuan
Published: June 2021

Infrastructure construction projects as an important part of social development, have effectively ensured the healthy development of society and promoted the improvement of the national economic level. In the context of the continuous innovation of the government’s investment and financing system, in order to optimize the construction of infrastructure projects, this paper creates a risk management evaluation model for infrastructure construction projects based on the “PPP+ABS” model, which is of great significance for promoting our country’s infrastructure construction projects to find financing methods that suit their own development.
Analysis on the treatment of VOC pollution hazards
Authors: Liu Chunhui
Published: June 2021

This paper introduces the harm of VOCs, makes a more detailed demonstration and understanding on the governance of VOCs, and introduces the emission characteristics and governance technology of key industries in detail, so as to learn from the governance methods of volatile organic compounds (VOCs), briefly discusses the governance and comprehensive utilization, and truly governs VOCs from the source.
The Mechanism of Plant Resistance to Cadmium in Soil
Authors: Zheng Yingyi , Yang Huan , Han Mengxuan , You Shaohong , Jiang Pingping
Published: June 2021

In recent years, soil heavy metal pollution has caused serious harm to human beings and the environment. Phytoremediation has become the main means of soil remediation because of its advantages such as low cost, obvious effect and low secondary pollution. In this paper, the status quo and harm of soil cadmium pollution in China and the mechanism of phytoremediation of cadmium were summarized.
Optimization of extraction of polyphenols from chestnut shell by response surface methodology
Authors: Li You , Fang Shuangjie , Hu Fuxia , Wang Fengqin , Zhou Changxin , Wang Zhaosheng
Published: June 2021

Chestnut shell is one of the main by-products in the chestnut processing, which contains abundant polyphenols, so it can be used as a source of polyphenols. In this study, using ethanol as the extraction solvent, the optimum extraction conditions of polyphenols from chestnut shell were determined by single factor experiment and response surface experiment: liquid-solid ratio of 39:1, extraction temperature of 74°C, extraction time of 91 min, ethanol concentration of 65%. Under these conditions, the extraction rate (ER) of polyphenols from chestnut shell was 6.09%. The results can assist in better exploitation of chestnut shell, which can not only reduce resource waste and environmental pollution, but also obtain economic benefits.
Endothelin-1 and Parameters of Systolic Blood Pressure in Hemodialysis
Authors: Singh Anika T , Mothi Suraj Sarvode , Li Ping , Sabbisetti Venkata , Waikar Sushrut S , Mc Causland Finnian R
Published: June 2021

BACKGROUND

Hypertension is common in hemodialysis (HD) patients. Increased blood pressure (BP) variability, particularly higher and lower extremes, is associated with adverse outcomes. We explored the association of endothelin-1 (ET-1), a potent vasoconstrictor, with different BP parameters (pre-HD, intra-HD, and post-HD) during HD in a contemporary patient cohort.

METHODS

This study uses the DaVita Biorepository, a longitudinal prospective cohort study with quarterly collection of clinical data and biospecimens. Unadjusted and adjusted linear mixed effects regression models were fit to determine association of pre-HD ET-1 (log-transformed and quartiles) with HD-related systolic BP (SBP) parameters (pre-HD, nadir intra-HD, and post-HD). As ET-1 was measured at baseline, analyses were restricted to 1 year of follow-up.

RESULTS

Among 769 participants, mean age was 52 years, 42% were females, and 41% were Black. Mean pre-HD SBP was 152 (±28) mm Hg and mean ET-1 concentration was 2.3 (±1.2) ng/ml. In fully adjusted models, each unit increase in SD of log-transformed ET-1 was associated with a 2.7 (95% confidence interval [CI] 1.5, 4.0) mm Hg higher pre-SBP; 1.6 (95% CI 0.9, 2.3) mm Hg higher nadir SBP; and 2.0 (95% CI 1.1, 2.9) mm Hg higher post-SBP. Each SD increase in log-transformed ET-1 was associated with 21% higher odds of experiencing intradialytic hypertension (odds ratio 1.21; 95% CI 1.10–1.34).

CONCLUSIONS

Higher baseline ET-1 levels are independently associated with higher SBP and higher odds of intradialytic hypertension. These results highlight a potential role for ET-1 in BP control in HD patients and raise the possibility of ET-1 antagonism as a therapeutic target.
Evaluating a Topical Adjunctive Post Submental ATX-101 (Deoxycholic Acid) Injection for Improved Recovery: A Single-Center, Double-Blind, Randomized Controlled Pilot Study
Authors: Shridharani Sachin M
Published: June 2021

Background

Optimizing postprocedural recovery and outcomes for patients is the aim for all physicians. TransFORM Body Treatment with TriHex Technology (TFB) is a topical product that aids in the elimination of fat particles created during procedures and the reduction of associated inflammation, thus speeding up postprocedure recovery time.

Objectives

Evaluation of postprocedural symptoms, signs, and healing following submental deoxycholic acid (DCA) injections in combination with TFB.

Methods

Participants received 2 treatments of submental DCA injections. Posttreatment 1, every participant received TFB to apply twice daily to the submental area. Follow-up visits included weeks 1, 2, and 4. After week 4, participants discontinued TFB for 30 days before the second treatment. At the second treatment visit, participants were randomized to receive either TFB or a bland moisturizer to apply twice daily with the same follow-up visits as posttreatment 1. Induration measurements, submental fullness grading, and standardized photography were captured at every visit. At all follow-up visits and before treatment 2, investigator assessments and participant assessments were completed.

Results

Posttreatment 2, investigator assessments of edema and induration decreased in participants using TFB at weeks 1 and 2 compared with the bland moisturizer. Induration measurements objectively showed a statistically significant reduction at week 2 (posttreatment 2) in participants using TFB compared with the bland moisturizer. Furthermore, participants reported less tenderness and soreness in the TFB group over the bland moisturizer.

Conclusions

Investigator assessments, participant query, and objective induration analyses have demonstrated that the use of TFB post DCA injections may reduce induration, edema, and discomfort associated with this procedure.

Level of Evidence: 2
A heterogeneous network embedding framework for predicting similarity-based drug-target interactions
Authors: An Qi , Yu Liang
Published: June 2021

Accurate prediction of drug-target interactions (DTIs) through biological data can reduce the time and economic cost of drug development. The prediction method of DTIs based on a similarity network is attracting increasing attention. Currently, many studies have focused on predicting DTIs. However, such approaches do not consider the features of drugs and targets in multiple networks or how to extract and merge them. In this study, we proposed a Network EmbeDding framework in mulTiPlex networks (NEDTP) to predict DTIs. NEDTP builds a similarity network of nodes based on 15 heterogeneous information networks. Next, we applied a random walk to extract the topology information of each node in the network and learn it as a low-dimensional vector. Finally, the Gradient Boosting Decision Tree model was constructed to complete the classification task. NEDTP achieved accurate results in DTI prediction, showing clear advantages over several state-of-the-art algorithms. The prediction of new DTIs was also verified from multiple perspectives. In addition, this study also proposes a reasonable model for the widespread negative sampling problem of DTI prediction, contributing new ideas to future research. Code and data are available at https://github.com/LiangYu-Xidian/NEDTP.
Pain and depression comorbidity causes asymmetric plasticity in the locus coeruleus neurons
Authors: Llorca-Torralba Meritxell , Camarena-Delgado Carmen , Suárez-Pereira Irene , Bravo Lidia , Mariscal Patricia , Garcia-Partida Jose Antonio , López-Martín Carolina , Wei Hong , Pertovaara Antti , Mico Juan Antonio , Berrocoso Esther
Published: June 2021

There is strong comorbidity between chronic pain and depression, although the neural circuits and mechanisms underlying this association remain unclear.

By combining immunohistochemistry, tracing studies and western blotting, with the use of different DREADDS (designer receptor exclusively activated by designer drugs) and behavioural approaches in a rat model of neuropathic pain (chronic constriction injury), we explore how this comorbidity arises. To this end, we evaluated the time-dependent plasticity of noradrenergic locus coeruleus neurons relative to the site of injury: ipsilateral (LCipsi) or contralateral (LCcontra) locus coeruleus at three different time points: short (2 days), mid (7 days) and long term (30–35 days from nerve injury).

Nerve injury led to sensorial hypersensitivity from the onset of injury, whereas depressive-like behaviour was only evident following long-term pain. Global chemogenetic blockade of the LCipsi system alone increased short-term pain sensitivity while the blockade of the LCipsi or LCcontra relieved pain-induced depression. The asymmetric contribution of locus coeruleus modules was also evident as neuropathy develops. Hence, chemogenetic blockade of the LCipsi→spinal cord projection, increased pain-related behaviours in the short term. However, this lateralized circuit is not universal as the bilateral chemogenetic inactivation of the locus coeruleus-rostral anterior cingulate cortex pathway or the intra-rostral anterior cingulate cortex antagonism of alpha1- and alpha2-adrenoreceptors reversed long-term pain-induced depression. Furthermore, chemogenetic locus coeruleus to spinal cord activation, mainly through LCipsi, reduced sensorial hypersensitivity irrespective of the time post-injury.

Our results indicate that asymmetric activation of specific locus coeruleus modules promotes early restorative analgesia, as well as late depressive-like behaviour in chronic pain and depression comorbidity.
Electrophysiological Signatures of Hierarchical Learning
Authors: Liu Meng , Dong Wenshan , Qin Shaozheng , Verguts Tom , Chen Qi
Published: June 2021

Human perception and learning is thought to rely on a hierarchical generative model that is continuously updated via precision-weighted prediction errors (pwPEs). However, the neural basis of such cognitive process and how it unfolds during decision-making remain poorly understood. To investigate this question, we combined a hierarchical Bayesian model (i.e., Hierarchical Gaussian Filter [HGF]) with electroencephalography (EEG), while participants performed a probabilistic reversal learning task in alternatingly stable and volatile environments. Behaviorally, the HGF fitted significantly better than two control, nonhierarchical, models. Neurally, low-level and high-level pwPEs were independently encoded by the P300 component. Low-level pwPEs were reflected in the theta (4–8 Hz) frequency band, but high-level pwPEs were not. Furthermore, the expressions of high-level pwPEs were stronger for participants with better HGF fit. These results indicate that the brain employs hierarchical learning and encodes both low- and high-level learning signals separately and adaptively.
Post-stenting fractional flow reserve vs coronary angiography for optimization of percutaneous coronary intervention (TARGET-FFR)
Authors: Collison Damien , Didagelos Matthaios , Aetesam-ur-Rahman Muhammad , Copt Samuel , McDade Robert , McCartney Peter , Ford Thomas J , McClure John , Lindsay Mitchell , Shaukat Aadil , Rocchiccioli Paul , Brogan Richard , Watkins Stuart , McEntegart Margaret , Good Richard , Robertson Keith , O’Boyle Patrick , Davie Andrew , Khan Adnan , Hood Stuart , Eteiba Hany , Berry Colin , Oldroyd Keith G
Published: June 2021

Aims 

A fractional flow reserve (FFR) value ≥0.90 after percutaneous coronary intervention (PCI) is associated with a reduced risk of adverse cardiovascular events. TARGET-FFR is an investigator-initiated, single-centre, randomized controlled trial to determine the feasibility and efficacy of a post-PCI FFR-guided optimization strategy vs. standard coronary angiography in achieving final post-PCI FFR values ≥0.90.

Methods and results 

After angiographically guided PCI, patients were randomized 1:1 to receive a physiology-guided incremental optimization strategy (PIOS) or a blinded coronary physiology assessment (control group). The primary outcome was the proportion of patients with a final post-PCI FFR ≥0.90. Final FFR ≤0.80 was a prioritized secondary outcome. A total of 260 patients were randomized (131 to PIOS, 129 to control) and 68.1% of patients had an initial post-PCI FFR <0.90. In the PIOS group, 30.5% underwent further intervention (stent post-dilation and/or additional stenting). There was no significant difference in the primary endpoint of the proportion of patients with final post-PCI FFR ≥0.90 between groups (PIOS minus control 10%, 95% confidence interval −1.84 to 21.91, P = 0.099). The proportion of patients with a final FFR ≤0.80 was significantly reduced when compared with the angiography-guided control group (−11.2%, 95% confidence interval −21.87 to −0.35], P = 0.045).

Conclusion 

Over two-thirds of patients had a physiologically suboptimal result after angiography-guided PCI. An FFR-guided optimization strategy did not significantly increase the proportion of patients with a final FFR ≥0.90, but did reduce the proportion of patients with a final FFR ≤0.80.
Association between sodium–glucose cotransporter-2 inhibitors and risk of sudden cardiac death or ventricular arrhythmias: a meta-analysis of randomized controlled trials
Authors: Sfairopoulos Dimitrios , Zhang Nan , Wang Yueying , Chen Ziliang , Letsas Konstantinos P , Tse Gary , Li Guangping , Lip Gregory Y H , Liu Tong , Korantzopoulos Panagiotis
Published: June 2021

Aims 

Sudden cardiac death (SCD) and ventricular arrhythmias (VAs) are important causes of mortality in patients with type 2 diabetes mellitus (T2DM), heart failure (HF), or chronic kidney disease (CKD). We evaluated the effect of sodium–glucose cotransporter-2 (SGLT2) inhibitors on SCD and VAs in these patients.

Methods and results 

We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that enrolled patients with T2DM and/or HF and/or CKD comparing SGLT2i and placebo or active control. PubMed and ClinicalTrials.gov were systematically searched until November 2020. A total of 19 RCTs with 55 ,590 participants were included. Sudden cardiac death events were reported in 9 RCTs (48 patients receiving SGLT2i and 57 placebo subjects). There was no significant association between SGLT2i therapy and SCD [risk ratio (RR) 0.74, 95% confidence interval (CI) 0.50–1.08; P = 0.12]. Ventricular arrhythmias were reported in 17 RCTs (126 patients receiving SGLT2i and 134 controls). SGLT2i therapy was not associated with a lower risk of VAs (RR 0.84, 95% CI 0.66–1.06; P = 0.14). Besides the subgroup of low-dosage SGLT2i therapy that demonstrated decreased VAs compared to control (RR 0.45, 95% CI 0.25–0.82; P = 0.009), or to placebo (RR 0.46, 95% CI 0.25–0.85; P = 0.01), further subgroup analysis did not demonstrate any significant differences.

Conclusion 

SGLT2i therapy was not associated with an overall lower risk of SCD or VAs in patients with T2DM and/or HF and/or CKD. However, further research is needed since the number of SCD and VA events were relatively few leading to wide confidence intervals, and the point estimates suggested potential benefits.
Reconstructing the History of Variation in Effective Population Size along Phylogenies
Authors: Brevet Mathieu , Lartillot Nicolas
Published: June 2021

The nearly neutral theory predicts specific relations between effective population size (Ne) and patterns of divergence and polymorphism, which depend on the shape of the distribution of fitness effects (DFE) of new mutations. However, testing these relations is not straightforward, owing to the difficulty in estimating Ne. Here, we introduce an integrative framework allowing for an explicit reconstruction of the phylogenetic history of Ne, thus leading to a quantitative test of the nearly neutral theory and an estimation of the allometric scaling of the ratios of nonsynonymous over synonymous polymorphism (πN/πS) and divergence (dN/dS) with respect to Ne. As an illustration, we applied our method to primates, for which the nearly neutral predictions were mostly verified. Under a purely nearly neutral model with a constant DFE across species, we find that the variation in πN/πS and dN/dS as a function of Ne is too large to be compatible with current estimates of the DFE based on site frequency spectra. The reconstructed history of Ne shows a 10-fold variation across primates. The mutation rate per generation u, also reconstructed over the tree by the method, varies over a 3-fold range and is negatively correlated with Ne. As a result of these opposing trends for Ne and u, variation in πS is intermediate, primarily driven by Ne but substantially influenced by u. Altogether, our integrative framework provides a quantitative assessment of the role of Ne and u in modulating patterns of genetic variation, while giving a synthetic picture of their history over the clade.
Impasse or mutation? Austerity and (de)financialisation of local governments in Britain
Authors: Dagdeviren Hulya , Karwowski Ewa
Published: June 2021

Post crisis, local governments’ (LGs) budgets have been drastically cut in Britain. Similar budgetary strains had serious consequences in the past, leading to major restructuring in LGs’ functions. This paper interrogates the spatial dynamics of short-term municipal finances by putting into dialogue the political economy perspectives on financialisation with the economic geography literature on urban governance. Using data for over 400 municipal authorities in Britain, we examine locational underpinnings of changing financial practices with respect to spending cuts. We find that austerity increased risk and uncertainty for LGs. To preserve key services in such an environment, they resorted to short-term borrowing in breach of regulatory guidance. Effectively, an internal market for inter-council lending and borrowing has been created based on market principles in which LGs with surplus cash and reserves have extended credit to those with liquidity problems. On the asset side, the austerity programme forced them to embrace financial logics through a spectacular shift from cash and deposit holdings to investment in money market funds and credit extension as they have strived to generate as much income as possible to fund services at risk.
Directed evolution of alditol oxidase for the production of optically pure D-glycerate from glycerol in the engineeredEscherichia coli
Authors: Zhang Chao , Chen Qian , Fan Feiyu , Tang Jinlei , Zhan Tao , Wang Honglei , Zhang Xueli
Published: June 2021

D-glycerate is an attractive chemical for a wide variety of pharmaceutical, cosmetic, biodegradable polymers, and other applications. Now several studies have been reported about the synthesis of glycerate by different biotechnological and chemical routes from glycerol or other feedstock. Here, we present the construction of an Escherichia coli engineered strain to produce optically pure D-glycerate by oxidizing glycerol with an evolved variant of alditol oxidase (AldO) from Streptomyces coelicolor. This is achieved by starting from a previously reported variant mAldO and employing three rounds of directed evolution, as well as the combination of growth-coupled high throughput selection with colorimetric screening. The variant eAldO3-24 displays a higher substrate affinity toward glycerol with 5.23-fold than the wild-type AldO, and a 1.85-fold increase of catalytic efficiency (kcat/KM). Then we introduced an isopropyl-β-D-thiogalactopyranoside (IPTG)-inducible T7 expression system in E. coli to overexpress the variant eAldO3-24, and deleted glucosylglycerate phosphorylase encoding gene ycjM to block the consumption of D-glycerate. Finally, the resulting strain TZ-170 produced 30.1 g/l D-glycerate at 70 h with a yield of 0.376 mol/mol in 5-l fed-batch fermentation.
Crisis-Induced Innovation: Quality Upgrading in Chinese Industrial Clusters
Authors: Hu Xiangting , Ruan Jianqing , Zhang Xiaobo
Published: June 2021

Supporting institutions and policies play a key role in facilitating upgrades to product quality among manufacturing firms. However, the emergence of quality-supporting institutions has not been well studied. Based on qualitative and quantitative evidence in Chinese clusters, this paper shows that quality-enhancing institutions and policies often emerge in response to crises, such as consumer boycotts and impositions of export barriers, which can catalyze collective action from entrepreneurs and local governments to improve product quality. (JEL codes: L15; L22; L51; L60).
Improving the diagnosis and management of acute schistosomiasis with antibody, antigen and molecular techniques: lessons from a cluster of six travellers
Authors: Camprubí-Ferrer Daniel , Romero Lucía , Van Esbroeck Marjan , Wammes Linda J , Almuedo-Riera Alex , Rodriguez-Valero Natalia , Balerdi-Sarasola Leire , Hoekstra Pytsje T , Subirà Carme , Valls Maria Eugenia , Micalessi Isabel , Corstjens Paul , Cortes-Serra Nuria , Huyse Tine , Benegas Mariana , Álvarez-Martínez Miriam J , Muñoz Jose , van Lieshout Lisette
Published: June 2021

Different diagnostic tests were evaluated in a cluster of six European travellers with acute schistosomiasis (AS) acquired in Mozambique. Adult worm and soluble egg antibodies, circulating anodic antigen (CAA) and DNA detection allowed early confirmation of AS. CAA permitted monitoring treatment response and Sm1-7 polymerase chain reaction allowed identification of Schistosoma mansoni complex.
Pediatric Airway and Mediastinum Radiology
Authors: Finkle Joshua H.
Published: June 2021

Chapter 10 examines radiologic images for common and uncommon pediatric airway and mediastinal disorders. These include pediatric airway disorders such as epiglottitis, croup, exudative tracheitis, congenital tracheomalacia, obstructive sleep apnea, retropharyngeal abscess, esophageal atresia, and tracheoesophageal fistula. The chapter goes on to look at vascular impressions on the trachea and esophagus, including double aortic arch, aberrant right subclavian artery, right aortic arch with aberrant left subclavian artery, pulmonary sling, esophageal and tracheal foreign bodies, and bronchial foreign body. Mediastinal abnormalities examined include normal thymus and mediastinal masses. The chapter covers the clinical features and anatomy associated with these disorders as well as their diagnosis based on the radiologic imaging.
Pediatric Gastrointestinal Radiology
Authors: Raza Syed Ali , Clebone Anna
Published: June 2021

Chapter 12 examines radiologic images for common and uncommon pediatric gastrointestinal disorders. These include neonatal high bowel obstructions such as midgut malrotation and volvulus, duodenal atresia, duodenal web, annular pancreas, and pyloric stenosis. The chapter goes on to look at neonatal low bowel obstruction, including ileal disease such as ileal atresia and meconium ileus and colonic disease such as Hirschsprung disease and meconium plug. We then look at causes of pediatric bowel obstruction in older patients, such as intussusception, appendicitis, enteric duplication cysts, and inguinal hernia. Additional neonatal disorders discussed include necrotizing enterocolitis, and meconium peritonitis. Diseases of the pancreas examined include cystic fibrosis and pancreatitis. Liver tumors reviewed are infantile hepatic hemangioma and hepatoblastoma. Diseases of the biliary system looked at include choledochal cysts and biliary cysts, and biliary atresia. Splenic abnormalities examined include polysplenia and asplenia, heterotaxy syndromes, and sickle cell disease.
Pediatric Genitourinary Radiology
Authors: Khadir Mohammed Mohsin
Published: June 2021

Chapter 13 examines radiologic images for common and uncommon pediatric genitourinary disorders. These include pediatric congenital disorders such as renal agenesis, autosomal recessive polycystic kidney disease, multicystic dysplastic kidney, horseshoe kidney/cross-fused ectopia, prune belly syndrome, congenital uteropelvic junction obstruction, vesicoureteral reflux, duplicated collecting system, ureterocele, urachal anomalies, bladder exstrophy, and posterior urethral valves. The chapter goes on to look at neuroblastoma and Wilms tumor. Reproductive disorders are also examined, such as ovarian torsion, testicular torsion, epididymo-orchitis, hydrocele, varicocele, testicular tumors, and sacrococcygeal teratoma. This chapter covers the clinical features and anatomy associated with these disorders as well as their diagnosis based on radiologic imaging.
The Treatment Framework of TFPP and Initial Interventions
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

This chapter outlines core symptoms and mental states common to many patients with PTSD. The symptoms and their meaning, which necessarily will have individual variations, are presented and described through a psychodynamic lens. Fundamental elements of TFPP are described, Common approaches and pitfalls are presented all with clinical descriptions. Central difficulties that patients with PTSD commonly have in engaging in psychotherapy are outlined, including disruptions in narrative coherence, core problems of trust, and feelings of shame, guilt and alienation, that necessarily affect the way therapy can proceed. Approaches to these problems are highlighted, including ways to help build a safe therapeutic environment.
Phase 1
Authors: Busch Fredric N. , Milrod Barbara L. , Chen Cory K. , Singer Meriamne B.
Published: June 2021

This chapter examines the initial approach to PTSD symptoms using TFPP. Symptoms serve as a lens through which to explore and address contributory emotions, conflicts, and defenses. Symptoms may express or function to ward off intolerably painful emotions generated by the trauma. The therapist works to link the symptoms to relevant traumatic events, which patients have often avoided via dissociation or other defenses. The therapist is empathic with patients’ distress in describing trauma and also works with patients’ reactions to better understand the impact of trauma. Exploration of the context, emotions, and meanings of symptoms helps patients to gain a clearer understanding of past and present precipitants and the reasons that symptoms continue. The therapist additionally explores how developmental experiences, including early traumatic events, affect patients’ reactions to subsequent trauma.
Limited speech outside the home in a young girl who speaks normally at home
Authors: Sharma Sumita
Published: June 2021

Selective mutism (SM) is a childhood anxiety disorder characterized by failure to speak in at least one specific social setting such as school, despite the ability to speak in other, more familiar settings. The symptoms must persist for at least one month. Many children with SM also have excessive shyness, poor eye contact, and fear of embarrassment. Despite the failure to speak, the child’s nonverbal communication ability is typically age appropriate and prosocial nonverbal communication such as nodding or giggling is often observed. Since SM frequently co-occurs with other communication disorders, the assessment should include a hearing and speech and language evaluation. Behavioral therapy and cognitive behavioral therapy (CBT) are the primary treatments for SM. Medications are most effective when combined with behavioral treatments and may include the use of selective serotonin reuptake inhibitors (SSRIs).
Worries about being embarrassed in front of classmates
Authors: Grossman Mila N.
Published: June 2021

Social anxiety disorder is characterized by excessive anxiety about social situations and fear of being scrutinized by others. The child worries that they will act in a way that will be negatively evaluated or lead to feelings of humiliation, embarrassment, or social rejection. These feelings must occur in the presence of peers. This disorder can affect academic performance and a child’s ability to develop healthy relationships with peers. Social anxiety disorder can be distinguished from normative shyness based on the degree of impairment. Cognitive behavioral therapy (CBT) including gradual exposure to social situations and social effectiveness therapy are the main psychotherapeutic treatment approaches. Medication classes used to treat social anxiety disorder include selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs).
An adolescent requesting to pause puberty
Authors: Ross Cordelia Y. , Keuroghlian Alex S.
Published: June 2021

Gender dysphoria occurs when a patient has distress associated with incongruence between a person’s experienced gender and the gender traditionally associated with their sex assigned at birth. This must occur for at least six months. The psychiatric assessment of a patient with gender dysphoria should include exploration of the child’s developmental history of gender-expansive identification and expression; sources of distress relating to familial, community, and social stigma; and ways to help families adopt an accepting and nurturing response. Gender affirmation can include psychological, social, legal, and biological interventions. The goal of psychotherapy is to help a person explore, discover, and affirm their gender identity. Social affirmation may include changing names, pronouns, and gender expression. Legal gender affirmation may take place through a name or gender marker change on official documents. Biological affirmation may include pubertal suppression for younger adolescents, gender-affirming hormone therapy, and/or gender-affirming surgery.
Long-term effects of early pain and injury
Authors: Moriarty Orla , Walker Suellen M.
Published: June 2021

Nociceptive pathways are functional following birth, and acute responses to noxious stimuli have been documented from early in development in clinical and laboratory studies. The ability of noxious afferent input to alter the level of sensitivity of nociceptive pathways in the adult nervous system, with, for example, the development of central sensitization, is well established. However, the developing nervous system has additional susceptibilities to alterations in neural activity, and pain in early life may produce effects not seen following the same input at older ages. As a result, early tissue injury may lead to persistent changes in somatosensory processing and altered sensitivity to future noxious stimuli. Furthermore, there is increasing evidence that neonatal pain can result in long-term changes in cognitive and affective behavior. Effects of pain in early life are superimposed on a highly plastic developing system, and long-term outcomes vary depending on the type and severity of the injury, and on the evaluation methods used. Laboratory studies allow evaluation of different injuries, potential confounding factors, underlying mechanisms, and potential analgesic modulation.
Long-term effects of pain in infants
Authors: Grunau Ruth E. , Vinall Miller Jillian , Chau Cecil M. Y.
Published: June 2021

The long-term effects of infant pain are complex, and vary depending on how early in life the exposure occurs, due to differences in developmental maturity of specific systems underway. Changes to later pain sensitivity reflect multiple factors such as age at pain stimulation, extent of tissue damage, type of noxious insult, intensity, and duration. In both full-term and preterm infants exposed to hospitalization, sequelae of early pain are confounded by parental separation and quality of pain treatment. Neonates born very preterm are outside the protective uterine environment, with repeated exposure to pain occurring during fetal life. Especially for infants born in the late second trimester, the cascade of autonomic, hormonal, and inflammatory responses to procedures may induce excitotoxicity with widespread effects on the brain. Quantitative advanced imaging techniques have revealed that neonatal pain in very preterm infants is associated with altered brain development during the neonatal period and beyond. Recent studies now provide evidence of pathways reflecting mechanisms that may underlie the emerging association between cumulative procedural pain exposure and neurodevelopment and behavior in children born very preterm. Owing to immaturity of the central nervous system, repetitive pain in very preterm neonates contributes to alterations in multiple aspects of development. Importantly, there is strong evidence that parental caregiving to reduce pain and stress in preterm infants in the Neonatal Intensive Care Unit (NICU) may prevent adverse effects, and sensitive parenting after NICU discharge may help ameliorate potential long-term effects.
Genetics and pain in childhood
Authors: Mogil Jeffrey S.
Published: June 2021

Genomic and other “omic” approaches are now routinely applied to the study of pain. Some of these investigations have utilized pediatric populations. This review describes what is currently known about the heritability of pain in children (from twin studies), genes relevant to pain in children (from single-gene mutations, candidate gene, and genome-wide association studies), and the application of newer techniques, such as epigenomics, to pediatric pain.
Pain in children with intellectual or developmental disabilities
Authors: MacDonald Andrina , Bennett Kristi , Stansbury Jean C.K. , Barney Chantel C. , Belew John , Schwantes Scott , Valkenburg Abraham J. , Symons Frank J.
Published: June 2021

Children with intellectual and developmental disabilities (I/DD) are estimated to have more than twice the incidence of chronic pain than their typically developing peers. Pain assessment is particularly challenging given the array of individual cognitive and communication abilities found in children with I/DD. Early recognition and accurate assessment of pain is essential for effective management and ultimately preventing the development of pain syndromes resulting from untreated nociceptive pain. Pain assessment instruments are available to support better pain management; however, more widespread use of these assessments within clinical practice and research studies is a necessary next step.
Procedural sedation
Authors: Tsze Daniel S. , Cravero Joseph P.
Published: June 2021

Pediatric patients undergoing procedures often require sedation to provide the appropriate combination of anxiolysis, analgesia, and motionlessness. Owing to the behavioral and developmental issues involved with this population, children require sedation to accomplish procedures much more often than adults. Pediatric procedural sedation is a dynamic area of practice. This chapter reviews the basic concepts involved in sedation delivery and addresses the various considerations involved in sedation cases, including patient factors, procedure factors, and provider factors. Various drugs available for sedation (and the various routes of delivery) are also reviewed, with comments on appropriate strategies for a variety of common diagnostic and therapeutic procedures.
Inflammatory arthritis and arthropathy
Authors: Chira Peter , Schanberg Laura E.
Published: June 2021

Musculoskeletal pain from childhood-onset rheumatologic conditions such as juvenile idiopathic arthritis is variable in severity and impact. Advancements in understanding the mechanisms of inflammation causing arthritis and its associated pain have led to new treatments and guidelines for improved control of arthritis disease activity when implemented in a timely manner. In spite of these new treatments, pain often persists in childhood arthritis, even when little-to-no active inflammation is detected, highlighting the need to use a biopsychosocial model to address all factors contributing to pain symptoms. Using this holistic approach, we can better manage the pain of children with rheumatologic diseases in routine clinical practice, as well as in settings such as clinical trials and other treatment interventions.
Pain treatment and prevention in pediatric palliative care
Authors: Friedrichsdorf Stefan J.
Published: June 2021

Annually, at least 21 million children could benefit from pediatric palliative care (PPC) and 8 million would need specialized PPC services. In the USA alone, more than 40,000 children aged 0–19 years die annually; 55% of them are infants younger than 1 year of age. Pain is common, under-recognized, and under-treated, especially in children with progressive neurodegenerative and chromosomal conditions with central nervous system impairment. Unrelieved pain is also common in children with advanced serious illness during the end-of-life period, and, when treated, the therapy is commonly ineffective. Treating pain in children with serious illness is not profoundly different than advanced pain management for children with complex acute conditions or diseases such as major trauma, burns, cancer, or those with sickle cell disease in vaso-occlusive crisis. It is important to appreciate that children with serious illness are more likely to simultaneously suffer from acute pain, neuropathic pain, visceral pain, total pain, and chronic pain. As such, multimodal analgesic (i.e., multiple agents, interventions, rehabilitation, psychological modalities, and integrative (“nonpharmacologic,” e.g., behavioral, physiological, and psychological) therapies that act synergistically for more effective pediatric pain and symptom control with fewer side effects than a single analgesic or modality must be employed. Opioids, such as morphine, fentanyl, hydromorphone, oxycodone, and methadone, remain the mainstay medications to effectively treat pain in children with serious illness. However, medications alone are often insufficient for optimal pain control. In fact, the paradigm shift away from “medications only” toward offering “multimodal analgesia” to children with serious illness experiencing pain, including addressing chronic pain/primary pain disorders and total pain has become a “game changer” in advancing PPC to ensure that patients can live as long as possible, as well as possible.
Recurrent abdominal pain
Authors: Verrill Schurman Jennifer , Drews Deacy Amanda , Friesen Craig A.
Published: June 2021

Recurrent abdominal pain is a common complaint in children and adolescents; however, it has been historically understudied and not well understood. Development of a discrete symptom-based diagnostic classification system to guide research and treatment has resulted in new research information being generated at an increasing rate. Although significant gaps in our knowledge remain, we are gradually coming to understand the complex etiology of recurrent abdominal pain in children and are making strides in clinical treatment. However, specific clinical practice guidelines do not yet exist and evidence remains limited for most, if not all, of the common treatments employed. This chapter highlights current theory and evidence available to guide office-based assessment and intervention efforts, as well as promising directions for future research.
Brain responses in infants
Authors: Hartley Caroline , Slater Rebeccah
Published: June 2021

We cannot know whether another person is experiencing pain unless they tell us, making reliable pain assessment difficult in nonverbal infants. Consequently, the treatment of infant pain is reliant on inferences based on observations. Understanding how infants respond to noxious stimulation, and how their responses change with factors such as age, pathology, and sex, is essential to improve pain treatment and to evaluate the efficacy of pharmacological and nonpharmacological interventions. Even in the most immature infants, noxious stimulation evokes activity across all levels of the nervous system, eliciting changes in heart rate, respiratory rate, reflex withdrawal, hormonal responses, facial expression, and brain activity. This chapter focuses on measures of noxious-evoked brain activity in infants, including methods of assessment, use in clinical trials, and the current limitations of these techniques.
Principles of clinical pharmacology applied to analgesics in children
Authors: Allegaert Karel , Simons Sinno H.P. , Tibboel Dick
Published: June 2021

Analgesic dosing regimens should take into account the severity and type of pain, the therapeutic window of the drug, and also the age or developmental state of the child. Translation of these concepts to safe and effective pharmacological management of pain in neonates, infants, and children necessitates a thorough understanding of the principles of clinical pharmacology of analgesics in children. Growth, weight or size, and maturation or age evolve in children and profoundly affect the pharmacokinetics (concentration–time profile, absorption, distribution, metabolism, and excretion) and pharmacodynamics (concentration–effect profile, objective assessment) of drugs, and this is also the case for analgesics. This will result in extensive variability in dosing and effects throughout childhood, and this variability is most prominent in infancy. In addition to maturational changes, there are also nonmaturational aspects (preterm neonates and critical illness, obesity, pharmacogenetics) that should be considered to further improve dosing in every individual child.
The nonsteroidal anti-inflammatory drugs and acetaminophen
Authors: Anderson Brian J.
Published: June 2021

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (N-acetyl-p-aminophenol (APAP; paracetamol)) are the commonest analgesic drugs used in childhood. Though both drugs act through inhibition of prostaglandin H2 synthetase, acetaminophen lacks the anti-inflammatory effects of the NSAIDs. Neonatal acetaminophen hepatic clearance is reduced in premature neonates (5–10% adult rates) and increases to 30% adult rates in neonates born at term; adult rates (approximately 16–20 l/h/70 kg) are reached within the first year of life. NSAID clearance maturation, mostly through cytochrome P450 mixed oxidases, is more rapid. Concentration–response relationships suggest a maximum pain reduction of 5 or 6 on a 10-point scale for both drugs. Combination therapy does not increase this maximum effect but does prolong duration of analgesia. Whilst both drugs have good safety profiles, dosing of both drug groups is tempered by concerns about toxicity. Acetaminophen hepatotoxicity is associated with single doses (>250 mg/kg in preschool children, >150 mg/kg in adults) and therapy duration longer than 3–5 days (>90 mg/kg/day).The most common minor adverse events in NSAID recipients are nausea, dizziness, and headache. More concerning is the potential of NSAIDs to cause gastrointestinal irritation, blood clotting disorders, renal impairment, neutrophil dysfunction, and bronchoconstriction. These adverse effects are uncommon provided care is taken with drug dose, duration of therapy, and recognition of contraindications.