bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic Solid-Phase Extraction of Drugs and Pesticides from Human Plasma Using COOH-mMWCNTs
Authors: Moon Heesung , Park Jiwon , Hwang Jinwoo , Chung Heesun
Published: April 2020

Carbon nanotubes (CNTs) are useful for extracting chemical compounds due to their properties, such as surface area and the potential for chemical modification. Especially the formation of CNTs with carboxylic acid functional group makes them disperse in water-based samples and have strong interaction forces with cationizable analytes. Based on these features, carboxylic acid functionalized multi-walled CNTs (COOH-MWCNTs) have been used as extraction sorbents. CNT can also be gathered using an external magnet by forming complex with iron oxide (Fe3O4) magnetic nanoparticles (MNPs). In this study, COOH-MWCNTs with MNPs were subjected to magnetic solid-phase extraction (mSPE) in order to extract the targeted substances such as diphenhydramine, doxylamine, tramadol, escitalopram, zolpidem, diphenamid, paclobutrazol, hexaconazole, cyproconazole and mepronil from human plasma samples. The following five factors were optimized: (i) the ratio of COOH-MWCNTs to MNPs as a sorbent from 1:1 to 1:4; (ii) sorbent amount starting from 12.5 to 75%; (iii) sample pH tested pH 2 to pH 10 with 1 N hydrochloride and 1 N sodium hydroxide; (iv) agitating time from 0 to 4 min and (v) elution solvent. Limit of detection of 10 targeted substances in human plasma were in the range of 0.1–0.4 mg/L. The recovery of targeted substances (except diphenamid) in human plasma was 73.06–110.28% for intra-day and 83.00–107.70% for inter-day and the precision (relative standard deviation, %) in human plasma was 0.3–13.3% for intra-day and 2.9–15.6% for inter-day. The method was applied to nine authentic biological samples from overdose patients in the emergency room of Chungnam National University Hospital. The performance of mSPE was compared with the liquid–liquid extraction method using ethyl acetate. The results showed that the newly developed method in this study can be used for screening analysis in forensic and clinical toxicology.
Blood Concentrations of Designer Benzodiazepines: Relation to Impairment and Findings in Forensic Cases
Authors: Heide Gunhild , Høiseth Gudrun , Middelkoop Gerrit , Øiestad Åse Marit Leere
Published: April 2020

The use of designer benzodiazepines appears to be increasing in many countries, but data concerning blood concentrations are scarce, making interpretation of concentrations difficult. The aim of this study was to report blood concentrations of clonazolam, diclazepam, etizolam, flualprazolam, flubromazepam, flubromazolam and phenazepam and to investigate the relationship between blood concentrations and impairment. The concentration data are from blood samples collected from living cases (apprehended drivers and other drug offences) and medico-legal autopsies. The blood samples were analysed for the seven designer benzodiazepines mentioned above by ultra high performance liquid chromatography–tandem mass spectrometry. Positive cases from between 1 June 2016 and 30 September 2019 were included. Blood concentrations and the conclusion from a clinical test of impairment (when available) are reported. The presented seven benzodiazepines were detected in a total of 575 cases, where 554 of these cases concerned apprehended drivers or other criminal offenders. The number of findings and the median (range) concentrations were as follows: clonazolam, n = 22, 0.0041 mg/L (0.0017–0.053 mg/L); diclazepam, n = 334, 0.0096 mg/L (0.0016–0.25 mg/L); etizolam, n = 40, 0.054 mg/L (0.015–0.30 mg/L); flualprazolam, n = 10, 0.0080 mg/L (0.0033–0.056 mg/L); flubromazepam, n = 5, 0.037 mg/L (0.0070–0.70 mg/L); flubromazolam, n = 20, 0.0056 mg/L (0.0004–0.036 mg/L); and phenazepam, n = 138, 0.022 mg/L (0.0018–0.85 mg/L). A designer benzodiazepine was the only drug detected with relevance for impairment in 25 of the 554 living cases. The physician concluded with impairment in 19 of the 25 cases. Most of the concentrations in these cases were relatively similar to or higher than the median reported concentrations. The most frequent other drugs detected were amphetamine, tetrahydrocannabinol, clonazepam and methamphetamine. The presented blood concentrations can be helpful with the interpretation of cases involving one or more of these seven benzodiazepines. The results indicate that concentrations commonly observed in forensic cases are associated with impairment.
Effects of Aerosol Insecticide Application Location on the Patterns of Residual Efficacy Against Tribolium confusum (Coleoptera: Tenebrionidae) Larvae
Authors: Scheff Deanna S , Campbell James F , Arthur Frank H , Zhu Kun Yan
Published: April 2020

Aerosol insecticides are one tool that pest management professionals can utilize as a spatial treatment inside food facilities and storage warehouses. Methods of aerosol application can vary significantly and can affect the spatial pattern of efficacy achieved. We investigated how the location from which an aerosol insecticide is applied inside a mill influenced the spatial dispersal of the insecticide. Treatments were performed using two commercial formulations, pyrethrin + pyriproxyfen (insect growth regulator [IGR]) and pyrethrin + methoprene (IGR), applied at one of three static locations or a fourth application comprising of splitting the application among all three locations. Concrete arenas were placed out at different locations within the mill during applications. At 2, 4, and 6 wk post-aerosol application, Tribolium confusum Jacquelin du Val, confused flour beetle, larvae were added to the concrete arenas and monitored for development and efficacy was evaluated based on percent adult emergence and an efficacy index that ranged from 1 (low) to 21 (high). The spatial pattern of aerosol coverage varied between insecticide formulations and the aerosol application location. Areas of the mill near walls, corners, equipment, and farthest away from the application location had larger zones of low efficacy index values among all four application locations. This study illustrated that the aerosol insecticide formulation, application location, and delivery method all significantly influenced residual efficacies of the insecticides. To increase the overall spatial coverage and IGR efficacy, targeting these areas of a mill floor with the aerosol or additional intervention techniques would increase uniform coverages and overall effectiveness.
Temozolomide and etoposide combination for the treatment of relapsed osteosarcoma
Authors: Akazawa Ryo , Umeda Katsutsugu , Saida Satoshi , Kato Itaru , Hiramatsu Hidefumi , Sakamoto Akio , Arakawa Yoshiki , Sumiyoshi Shinji , Okamoto Takeshi , Moritake Hiroshi , Adachi Souichi , Takita Junko
Published: April 2020

The prognosis of patients with relapsed osteosarcoma is extremely poor and the optimal treatment remains to be identified. Here, we retrospectively analysed the clinical outcomes of nine patients with relapsed osteosarcoma treated with temozolomide/etoposide. Of the two patients who received temozolomide/etoposide as palliative therapy for unresectable tumours, one remained alive with stable disease for >4 years. The remaining seven patients received temozolomide/etoposide as adjuvant therapy following resection of relapsed metastatic disease; of these, one was free from disease for 41 months. Potentially beneficial effects were observed in two of three O6-methylguanine-DNA methyltransferase protein-negative patients, whereas all five O6-methylguanine-DNA methyltransferase-positive patients experienced subsequent relapse. None of the patients experienced severe adverse effects requiring hospitalization. Temozolomide/etoposide is a feasible candidate as salvage therapy for relapsed osteosarcoma. Further studies are needed to verify the utility of O6-methylguanine-DNA methyltransferase protein expression as a biomarker for predicting the response to this treatment.
MS1, a direct target of MS188, regulates the expression of key sporophytic pollen coat protein genes in Arabidopsis
Authors: Lu Jie-Yang , Xiong Shuang-Xi , Yin Wenzhe , Teng Xiao-Dong , Lou Yue , Zhu Jun , Zhang Cheng , Gu Jing-Nan , Wilson Zoe A , Yang Zhong-Nan
Published: April 2020

Sporophytic pollen coat proteins (sPCPs) derived from the anther tapetum are deposited into pollen wall cavities and function in pollen–stigma interactions, pollen hydration, and environmental protection. In Arabidopsis, 13 highly abundant proteins have been identified in pollen coat, including seven major glycine-rich proteins GRP14, 16, 17, 18, 19, 20, and GRP–oleosin; two caleosin-related family proteins (AT1G23240 and AT1G23250); three lipase proteins EXL4, EXL5 and EXL6, and ATA27/BGLU20. Here, we show that GRP14, 17, 18, 19, and EXL4 and EXL6 fused with green fluorescent protein (GFP) are translated in the tapetum and then accumulate in the anther locule following tapetum degeneration. The expression of these sPCPs is dependent on two essential tapetum transcription factors, MALE STERILE188 (MS188) and MALE STERILITY 1 (MS1). The majority of sPCP genes are up-regulated within 30 h after MS1 induction and could be restored by MS1 expression driven by the MS188 promoter in ms188, indicating that MS1 is sufficient to activate their expression; however, additional MS1 downstream factors appear to be required for high-level sPCP expression. Our ChIP, in vivo transactivation assay, and EMSA data indicate that MS188 directly activates MS1. Together, these results reveal a regulatory cascade whereby outer pollen wall formation is regulated by MS188 followed by synthesis of sPCPs controlled by MS1.
Prevalence of Age-Related Lens Opacities in a Population
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Beaver Dam Eye Study was a population-based cross-sectional survey designed to estimate the prevalence and severity of lens opacities in a rural community in the United States. Prior to this survey there were no reliable estimates of the prevalence and severity of lens opacities. The survey found that lens opacities were common in adults, and the numbers were increasing as the population aged. Overall, 17.3% of the study population had nuclear sclerosis more severe than level 3 in a 5-step scale of severity; cortical opacities were found in 16.3%; and posterior subcapsular opacities occurred in 6.0% of the population. The study emphasized the importance of such data for providing for social and healthcare needs and planning for future services.
Risk Factors for Cataract
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Lens Opacities Case-Control Study was a case-control study of general ophthalmology outpatients, 40–79 years of age, designed to identify the main risk factors associated with nuclear, cortical, and posterior subcapsular lens opacities. The study identified associations between cataract and low education, a nonprofessional occupation, intake of vitamins and iron, and body mass. Diabetes was a risk factor for all cataract types except nuclear; use of oral steroids was associated with posterior subcapsular cataract, and use of gout medications with mixed cataract. The associations with nutritional intake and use of multivitamin supplements suggested a potential for modifying cataract risk. The study also suggested a role for other potentially modifiable factors, such as use of some medications and smoking.
Is Argon Laser Trabeculoplasty Equivalent to Topical Medication as an Initial Treatment for Primary Open-Angle Glaucoma?
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Glaucoma Laser Trial (GLT) was a randomized, single-blind, controlled clinical trial comparing the efficacy and safety of argon laser trabeculoplasty (ALT) to treatment with topical medication for controlling intraocular pressure (IOP) in patients with newly diagnosed, previously untreated, primary open-angle glaucoma (POAG). The study showed that initial treatment of POAG with ALT is an efficacious and safe alternative to medication therapy, particularly in patients where medical therapy is contraindicated or poor compliance is suspected. The initial use of ALT in the short term has the benefit of reducing the nuisance, inconvenience, and systemic side effects of the topical glaucoma medication alternatives.
Topical Ocular Hypotensive Medication to Delay or Prevent the Onset of Primary Open-Angle Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Ocular Hypertension Treatment Study (OHTS) was a randomized, open, placebo-controlled, clinical trial to determine whether reducing intraocular pressure (IOP) in eyes with ocular hypertension (OHTN) reduced the risk of developing primary open-angle glaucoma (POAG). The study found that topical ocular hypotensive medication was effective in delaying or preventing the development of glaucomatous optic neuropathy in eyes with OHTN. However, the authors recommended stratifying risk in patients with OHTN using variables such as baseline age, vertical and horizontal cup-to-disc ratio, visual field pattern standard deviation, IOP, and, especially, central corneal thickness.
Latanoprost for Open-Angle Glaucoma
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The United Kingdom Glaucoma Treatment Study (UKGTS) was a randomized, triple-masked, placebo-controlled trial comparing topical latanoprost, a prostaglandin analogue, with placebo in patients with newly diagnosed, previously untreated open-angle glaucoma (OAG). Compared to placebo, the latanoprost group showed a large, statistically significant reduction in the rate of glaucomatous visual field deterioration by 24 months. The UKGTS was the first placebo-controlled trial to show visual field preservation through lowering of intraocular pressure with topical drugs in patients with OAG, and the first to show the visual field–preserving effect of a topical prostaglandin analogue.
Pooled Data Analysis of the Ahmed Baerveldt Comparison Study and the Ahmed Versus Baerveldt Study
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

Data from 2 independent randomized clinical trials, the Ahmed Baerveldt Comparison (ABC) Study and the Ahmed Versus Baerveldt (AVB) Study, were pooled for analysis to determine whether the Ahmed-FP7 or the Baerveldt BG101-350 implant was more efficacious in the treatment of refractory or high-risk glaucoma. Both devices lowered intraocular pressure (IOP) and decreased the need for glaucoma medications. The Baerveldt group had a lower failure rate, lower rate of de novo glaucoma surgery, and lower mean IOP on fewer medications than the Ahmed group. However, Baerveldt implantation carried a higher risk of hypotony. The authors recommended that the selection of a device for a patient should be based on target IOP, compliance with medications, urgency for IOP lowering, surgeon familiarity with each device, and the surgeon’s personal outcomes with the individual devices.
Risk Factors for Branch and Central Retinal Vein Occlusion
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Eye Disease Case-Control Study was a clinic-based, case-control study that investigated risk factors for 5 retinal diseases—branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO), neovascular age-related macular degeneration (AMD), idiopathic macular hole, and rhegmatogenous retinal detachment—using a similar protocol and the same large pool of controls. An increased risk of BRVO was found in persons with a history of systemic hypertension, cardiovascular disease, increased body mass index at 20 years of age, a history of glaucoma, and higher serum levels of alpha 2 globulin. An increased risk of CRVO was found in persons with systemic hypertension, diabetes mellitus, and open-angle glaucoma. The authors recommended that patients with BRVO and CRVO should be evaluated for risk factors for cardiovascular disease (hypertension, hyperlipidemia, and diabetes), as well as for open-angle glaucoma.
Steroids in the Treatment of Central Retinal Vein Occlusion
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Standard Care vs. Corticosteroid for Retinal Vein Occlusion (SCORE-CRVO) Study was a randomized clinical trial comparing intravitreal triamcinolone to observation in eyes with vision loss associated with macular edema due to perfused (nonischemic) central retinal vein occlusion (CRVO). The results suggested that intravitreal triamcinolone in a 1-mg dose should be considered for up to 1 year, and possibly 2 years, in patients with vision loss associated with macular edema secondary to CRVO. The study was the first to establish an effective treatment for perfused CRVO. (Treatment with intravitreal anti–vascular endothelial growth factor [VEGF] agents has been shown to produce greater improvement in visual acuity and is now the standard of care.)
Cryotherapy for Retinopathy of Prematurity
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP) was a randomized, controlled, interventional clinical trial to determine whether cryotherapy was effective in reducing the unfavorable ocular outcomes from threshold retinopathy of prematurity (ROP). The study showed that at a 3-month assessment, cryotherapy was significantly beneficial for eyes with ROP at a defined threshold level of severity. The findings of the CRYO-ROP study led to the implementation of neonatal screening and peripheral retinal ablation for acute ROP throughout the United States and beyond. Long-term results of CRYO-ROP have also influenced the management of affected patients throughout the remainder of childhood.
Progression of Retinopathy and Vision Loss Related to Tight Blood Pressure Control in Type 2 Diabetes Mellitus
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The UK Prospective Diabetes Study (UKPDS) Hypertension in Diabetes Study was a randomized intervention trial in patients with type 2 (non-insulin-dependent) diabetes mellitus to determine whether improved blood glucose control prevented complications and reduced the associated morbidity and mortality. The Hypertension in Diabetes Study, reported in this chapter, was included in a factorial design to assess whether improved control of blood pressure would reduce the incidence of diabetic retinopathy and loss of vision. The results clearly demonstrated the importance of lowering blood pressure to reduce the progression of retinopathy, incidence of macular edema, and loss of vision in persons with relatively short duration of type 2 diabetes and moderate to severe hypertension. Treatment begun early in the course of type 2 diabetes is likely to have a long-term effect of reducing visual loss secondary to diabetic macular edema in persons with type 2 diabetes.
Does High-Dose Supplementation with Vitamins C and E, Beta Carotene, and Zinc Slow the Progression of Age-Related Macular Degeneration and Vision Loss?
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Age-Related Eye Disease Study (AREDS) was a randomized, double-masked, clinical trial with two components, an age-related macular degeneration (AMD) trial and a cataract trial. This paper reports the results of the AMD trial, which was designed to determine the effect of high-dose vitamins C and E, beta carotene, and zinc supplements on the progression of AMD and vision loss. Based on the study findings, the authors recommended that individuals fifty-five years of age and older with extensive intermediate size drusen, at least one large druse, noncentral geographic atrophy in one or both eyes, or advanced AMD or vision loss due to AMD in one eye, and without contraindications such as smoking, should consider taking a supplement of antioxidants (consisting of vitamin C and E and beta carotene) plus zinc.
Photodynamic Therapy of Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration with Verteporfin
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

In this chapter, report 1 of the Treatment of Age-Related Macular Degeneration with Photodynamic Therapy (TAP) study details the one-year results of two double-masked, placebo-controlled, randomized clinical trials to determine whether photodynamic treatment with verteporfin reduces the risk of vision loss in patients with age-related macular degeneration (AMD) due to subfoveal choroidal neovascularization (CNV) measuring 5400 µm or less in greatest linear dimension with evidence of classic CNV and best-corrected visual acuity of approximately 20/40 to 20/200. At the month-12 examination, 61% of eyes assigned to verteporfin compared with 46% of eyes assigned to placebo had lost fewer than 15 letters of visual acuity from baseline). Verteporfin therapy was found to be safe and effective in reducing the risk of vision loss, and the authors recommended verteporfin therapy for treatment of patients with predominantly classic CNV from AMD.
Ranibizumab for Neovascular Age-Related Macular Degeneration
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Minimally Classic/Occult Trial of the Anti-VEGF Antibody Ranibizumab in the Treatment of Neovascular AMD (MARINA) study was a randomized, double-blind, sham-controlled clinical trial to determine whether intravitreal administration of ranibizumab (an anti-vascular endothelial growth factor [VEGF] agent) prevents vision loss and improves mean visual acuity in patients with minimally classic or occult choroidal neovascularization related to age-related macular degeneration (AMD). Ranibizumab therapy was associated with clinically and statistically significant benefits in visual acuity and the amount of angiographic leakage from choroidal neovascularization during two years of follow-up, with low rates of serious adverse events.
Systemic Anti-Inflammatory Therapy Versus Fluocinolone Acetonide
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Multicenter Uveitis Steroid Treatment (MUST) Trial and Follow-up Study was a randomized, partially-masked, parallel treatment, comparative effectiveness trial comparing surgically placed fluocinolone acetonide intravitreous implant to systemic corticosteroids for the treatment of intermediate uveitis, posterior uveitis, and panuveitis. Systemic and implant therapies yielded similar visual outcomes through 54 months of treatment. Given the greater cost of implant therapy for bilateral disease, and the higher risk of ocular complications in the implant arm of the trial, systemic therapy may be the preferred initial therapy for most bilateral cases of active or recently active intermediate uveitis, posterior uveitis, and panuveitis. For unilateral cases, implant therapy seemed to be reasonably cost effective.
Atropine or Patching for Treatment of Moderate Amblyopia in Children
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Patching Versus Atropine Trial was a randomized clinical trial in children less than seven years of age with moderate amblyopia and a visual acuity in the amblyopic eye between 20/40 and 20/100, to determine whether treatment with atropine drops was as effective as patching. The study found that patching and atropine were equally effective in the initial treatment of moderate amblyopia. Visual acuity in the amblyopic eye improved in both groups (improvement from baseline to 6 months was 3.16 lines in the patching group and 2.84 lines in the atropine group). Improvement was initially faster in the patching group, but, after 6 months, the difference in visual acuity between treatment groups was small and clinically inconsequential (mean difference at 6 months, 0.034 logMAR units).
Contact Lens Versus Intraocular Lens Correction of Monocular Aphakia During Infancy
Authors: Penman Alan D. , Crowder Kimberly W. , Watkins William M.
Published: April 2020

The Infant Aphakia Treatment Study was a randomized, controlled clinical trial in children, between the age of 28 days and 210 days at the time of surgery, with a visually significant congenital cataract (≥3 mm central opacity) in one eye, to determine whether immediate intraocular lens (IOL) implantation was superior to contact lens for the correction of aphakia after cataract surgery. The study found that there was no statistically significant difference in grating visual acuity at 1 year of age between the IOL and contact lens groups; however, additional intraocular operations were performed more frequently in the IOL group. The authors recommended leaving the eye aphakic and correcting the aphakia with a contact lens. IOL implantation should be reserved for infants who are unable to tolerate contact lenses.
We Are So Glad She Saw the Beach
Authors: Ragsdale Lindsay B.
Published: April 2020

Goal-concordant care is the alignment of medical care with the wishes and values of the patient and family. In pediatrics, goal-concordant care can be challenging due to difficulty with prognostication, lack of robust medical evidence for interventions, parental preferences being influenced by multiple factors, complexity of decision-making, and grief related to having a child who is ill. Facilitating goals of care conversations can be challenging, emotional, and rewarding for patients and families and medical professionals. These conversations are a crucial component to ensuring goal-concordant care for patients. Delivering medical care that best aligns with family goals and values can help long term with caregiver outcomes and bereavement.
A Sad Side Effect of Cancer
Authors: Musheno Laura Rose
Published: April 2020

Depression is a common and debilitating disease in pediatric patients with life-limiting illnesses. Depression can be challenging to diagnose in patients with advanced illness because symptoms can be difficult to recognize. Evaluation for depression in this population should focus on the cognitive or psychological, rather than physical, symptoms. Treatment for depression can positively impact quality of life and should be instituted promptly. Clinicians should consider patient prognosis to help guide therapy selection because usual antidepressant medications require several weeks to take full effect, whereas psychostimulants have a much faster onset. The most effective treatment for depression should also incorporate nonpharmacologic therapies and utilize the support of the interdisciplinary palliative care team. This chapter explores the nuances of diagnosing as well as treating depression in pediatric palliative care patients.
Appendix
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The appendix is an antimesenteric cecal outpouching that forms in the fifth month of gestation. It is a hollow, blind-ending tube approximately 11 cm in length and less than 6 mm in diameter. Obstruction of the appendiceal lumen with a fecalith, or less commonly foreign bodies, worms, and lymphadenopathy, may result in swelling of the appendix. Patients present with periumbilical abdominal pain. Acute appendicitis is a clinical diagnosis. The majority of patients with signs and symptoms of acute appendicitis should receive prompt surgical intervention. Laparoscopic or open appendectomy can be associated with ileus, superficial or deep wound infections, GI leak, bleeding or hematoma, wound dehiscence, or hernia.
Duodenum
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The duodenum develops from endoderm of the caudal portion of the foregut and the cranial portion of the midgut. It is roughly 26 cm length, extending from the pylorus to the ligament of Treitz. Brunner glands secrete a bicarbonate-rich mucus that is protective to the duodenal mucosa and provides an alkaline environment for digestive enzymes to activate. Duodenal ulcers, often caused by Helicobacter pylori, can cause epigastric pain. UGI and EGD studies can show ulcers or masses in the duodenum. Severe bleeding, perforation, and obstruction caused by duodenal ulcers are managed surgically. Complications of duodenal surgery may include bleeding, anastomotic leak or stricture, bile duct injury, pancreatitis or leak, reflux esophagitis, or dumping syndrome.
Inguinal Region and Hernias
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

Failure of fusion of the processus vaginalis in childhood can predispose to indirect inguinal hernias. The inferior portion of the EO muscle runs between the ASIS and the pubic tubercle; as it folds underneath itself, it forms the inguinal ligament. A hernia is the protrusion of a hollow viscus through a musculoaponeurotic opening. Groin discomfort and a palpable bulge are common. Hernias should be diagnosed on the basis of signs and symptoms. Symptomatic hernias are repaired with open mesh or laparoscopic approaches. Early postoperative complications include urinary retention (1%-10%), hematoma (1%-2%), and superficial skin infection (about 1%).
Parathyroid Glands
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The parathyroid glands develop from the endoderm: the superior glands from the fourth pharyngeal pouch, and the inferior glands from the third pharyngeal pouch. Parathyroid glands are usually found on the posterior surface of the thyroid gland. Chief cells secrete PTH, which has a half-life of 3 to 6 minutes. Primary HPT is most often asymptomatic and serendipitously found when the serum calcium value is increased on routine testing. The parathyroid glands can be evaluated with US, CT, MRI, or sestamibi scanning. Cervical exploration for primary HPT involves resection of a solitary adenoma in approximately 85% of patients. Injury to the RLN and superior laryngeal nerve does occur.
Rectum
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The rectum develops from endoderm, emerging from the distal tip of the hindgut. The rectum measures 12 to 15 cm. Resting rectal pressure is approximately 10 mm Hg. Internal hemorrhoids cause painless bright-red bleeding. Surgeons evaluate the rectum mainly by performing a digital rectal examination, anoscopy, endorectal US, and MRI to determine the extent of disease. The choice between rubber band ligation and excisional hemorrhoidectomy depends on the location (internal vs external) and degree of internal hemorrhoids. Complications from excisional hemorrhoidectomy may include bleeding, urinary retention, and severe pain.
Spleen
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

The spleen develops from mesoderm during the fifth week of gestation. Eighty-five percent of humans have 1 spleen, and 15% have accessory spleens. The spleen cleans the blood by trapping and breaking down dysfunctional or old red blood cells. Splenic problems most commonly arise with trauma, lymphoma, benign cysts, and hematologic disorders. Surgeons evaluate the spleen using plain radiography (CXR; kidney, ureter, bladder), CT, MRI, angiography, and nuclear studies. Open splenectomy for trauma or splenomegaly is at times dangerous and difficult with the need for speed, blood transfusion, and hemodynamic support. Potential early postoperative complications include abscess, pancreatic injury, pneumonia, and wound infection.
Vascular Surgery
Authors: Abdelsattar Jad M. , El Khatib Moustafa M. , Pandian T. K. , Allen Samuel J. , Farley David R.
Published: April 2020

Blood vessels are formed from mesoderm-derived endothelial cells. Arteries, arterioles, and capillaries carry blood from the heart to tissues; venules and veins return blood to the heart. The force exerted by blood on the blood vessel wall is BP and is expressed in mm Hg. Vascular diseases present in various forms, such as bleeding, clotting, stroke, headache, and heart attack. Arteriography was the standard for evaluating arterial disease, but CT angiography and MRI are useful and ever improving. Postoperative concerns include bleeding, clotting, ischemia, stroke, and myocardial infarction.
Pyramids for Kevin
Authors: Barnes Patricia
Published: April 2020

This section demonstrates how fundraising can be the result of focusing on a goal as well as determination fueled by the love for a child, sibling, neighbor, or friend.
With Every Step There Is Help
Authors: Marrazzo Amanda
Published: April 2020

This section demonstrates how fundraising can be the result of focusing on a goal as well as determination fueled by the love for a child, sibling, neighbor, or friend.
Giving Hope
Authors: Abrahams Jim
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
Guiding Others’ Journey Through Neurosurgery
Authors: Jones Monika
Published: April 2020

The pursuit of medical careers, as well as advocating for epilepsy research, ketogenic therapies, and neuro-rehabilitation are among the efforts in this section on healthcare and research.
Hope for a Brighter Tomorrow
Authors: Gattone Phil , Gattone Jill
Published: April 2020

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.
The Light of Our Lives
Authors: Rosbeck Kari Luther
Published: April 2020

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.
Moving the Field Forward
Authors: Meskis Mary Anne
Published: April 2020

Furthering the missions of epilepsy organizations, by either volunteering for, starting, or running an organization that serves people with epilepsy have been the goals of the advocates who have dedicated their lives to organizational advocacy.
Esmé’s Journey
Authors: Savoie Hillary
Published: April 2020

In this section, people’s experiences with rare forms of epilepsy have given rise to many forms of advocacy for people with epilepsy. From forming an organization to tracking seizures, there is no act of advocacy too large or small.
Climbing My Personal Mountain
Authors: Olson Thomas
Published: April 2020

An elite athlete using her platform for epilepsy awareness, a person with epilepsy who climbed his way to a better life, and a man who ran a marathon backwards to raise funds and awareness of epilepsy are part of the journeys of the advocates in this section.
Becoming an Epilepsy Advocate
Authors: Plung Nathan
Published: April 2020

In this section, advocates use their skills in art, writing, and musical composition to positively impact the lives of many people with epilepsy.
Medicine’s Core Responsibilities
Authors: Rhodes Rosamond
Published: April 2020

Medicine’s core responsibilities cannot be derived from everyday ethics. Rather they follow from doctors’ fundamental duties to seek trust and to act for the benefit of patients and society. The additional more specific duties are justified as necessary means to achieve or maintain trust or as behavior that is required for meeting medicine’s fiduciary responsibility. Thus, the commitment to trustworthiness and the fiduciary responsibility of medicine generate the moral force behind the additional widely recognized ethical duties of physicians and inform the notion of professionalism. This chapter explains the duty of professional competence, the duty to provide care, and the duty of mindfulness and why they are important characteristics of trustworthy doctors. It also provides cases to illustrate how those duties should be understood and why those particular duties and related attitudes or virtues are critically important elements of medical ethics.
Why Trustworthy Stewardship Requires Justice
Authors: Rhodes Rosamond
Published: April 2020

Doctors make daily decisions about allocating medical resources. Society trusts doctors to make those decisions justly, and physicians typically make trustworthy and just allocations. Justice requires not only equality in the treatment of equals, but also moral discernment to identify which factors are significant and how they should be compared. This chapter reviews prominent theories of justice in medicine and argues that each of them oversimplifies by reducing unavoidable complexity into a single and often-inappropriate principle. Instead, this chapter argues that justice should be understood as the conclusion from consideration of relevant factors in particular kinds of decisions. By discussing resource allocations in four domains (nonacute care, acute care, critically scarce resources, public health), the chapter explains which principles of justice should guide allocations in each domain. The chapter includes a summary table showing which principles of justice should be categorically rejected for guiding some allocations and which should be employed.
Why Doctors Must Develop a Doctorly Character
Authors: Rhodes Rosamond
Published: April 2020

This book argues that medical ethics involves a commitment to the profession’s distinctive duties and the development of a doctorly character. To exemplify professionalism, doctors need to develop inclinations to fulfill their professional obligations, and they need to be aware that various unconscious elements influence decisions, the kinds of factors that we identify as biases, prejudices, conflicts of interest, and the like. Character development is a defense against these unwanted invisible inducements that can influence choices. The chapter discusses the importance of nurturing the virtues that comprise a doctorly character and dispose physicians to fulfill their professional responsibilities. In addition to cultivating the attitudes that incline doctors to meet their previously enumerated specific duties, this chapter discusses how professionalism involves appropriate attitudes about courage, bodily pleasures, money, honor, anger, social interaction, and caring. The chapter also explains how these concerns should be reflected in medical institutions and medical education.
Resolving Moral Dilemmas
Authors: Rhodes Rosamond
Published: April 2020

Any moral system that involves more than a single principle, rule, or duty inevitably confronts the problem of moral conflict. Moral conflicts arise when two or more cherished values are relevant considerations in a situation but point to different and incompatible actions. Doctors need guidance in thinking through these ethical quandaries that arise in clinical practice. This chapter provides a template that outlines a systematic approach for resolving clinical ethical dilemmas and provides case examples that demonstrate how the template may be employed. The model mirrors standard medical thinking. Employing the template will prompt doctors’ through the steps of moral reasoning and increase the likelihood that they will consider all relevant information and put it together in a way that leads to an ethically justified resolution. Following this structured thought process for addressing ethical dilemmas in medicine also ensures that doctors act for reasons that are consistent with the ethics of medicine and uphold their professional duties.
Professional Responsibility and Conscientious Objection
Authors: Rhodes Rosamond
Published: April 2020

Conscientious objection is a controversial topic in society and medical ethics. The central issue in medicine is whether claims of conscientious objection allow medical professionals to refuse to perform tasks that would otherwise be their duty. To inform the ongoing discussion, this chapter reviews the opposing views on conscience in the philosophic literature that describe conscience as either a moral sense or the dictate of reason. Both views hold that conscience should be obeyed, and that keeping promises is a conscience-given moral imperative. The chapter then considers exemplars of conscientious objection—Thoreau, Gandhi, and Martin Luther King Jr.—who were willing to bare the burdens of their convictions. It concludes by showing that doctors who put their own interests before their patients’ welfare violate their professional commitments and misappropriate the title “conscientious objector” because they are unwilling to bear the burdens of their choices while instead imposing burdens on patients and colleagues.
Concluding Thoughts
Authors: Rhodes Rosamond
Published: April 2020

A key claim of this book is that medical ethics should be regarded as the profession’s commitment to society. The book’s goal was therefore to explain that a good doctor is someone who identifies with the standards of medical professionalism, is committed to fulfilling the duties of the profession, and seeks the trust of patients and society in every action. After summarizing that position, this chapter addresses issues that were sidestepped along the way to avoid complicating the presentation. As a concluding thought, the impacts of structural elements of today’s medicine are discussed: clinical practice arrangements, healthcare financing arrangements, and institutional arrangements. Thoughts are also shared on why medical ethics is important, what makes for a good account of medical ethics, and why good work in medical ethics must avoid the pitfalls of being incoherent, not illuminating, inaccurate, unreasonable, inconsistent, and uninformed.
No Poop
Authors: Sperandeo Michael , Barata Isabel
Published: April 2020

Hirschsprung’s disease and Hirschsprung-associated enterocolitis are functional disorders of the enteric nervous system leading to a functional bowel obstruction. Patients will often present in the first few days of life with delayed passage of meconium, abdominal distention, and poor feeding. Hirschsprung-associated enterocolitis is associated with increased morbidity and mortality and will present with signs and symptoms consistent with bowel obstruction, frankly bloody diarrhea, lethargy, fever, and, in severe cases, septic shock. Suspected cases should receive aggressive fluid resuscitation and broad-spectrum antibiotics. The gold standard for diagnosis is rectal biopsy and definitive management is surgical. Though many patients report some degree of bowel dysfunction later in life, a great number of patients do well.
Those Baby Blues
Authors: Wagner Tracey
Published: April 2020

Background: Per American Academy of Pediatrics (AAP) guidelines, the term “brief resolved unexplained event” (BRUE) has replaced the previous term “apparent life threatening event” (ALTE). A BRUE is defined as an event occurring in infants younger than 12 months of age who were reported as having a sudden brief episode with at least one of the following symptoms: (a) cyanosis or pallor, (b) absent or irregular breathing, (c) marked change in tone, and/or (d) an altered level of responsiveness. There must be no other etiology or diagnosis that better explains the event. Management: The recommended management of a BRUE depends upon risk stratification. All low risk criteria must be present for a patient to be considered low risk. Low risk infants require limited diagnostics and do not require admission to the hospital. The AAP did not provide specific recommendations for high risk infants.
Sepsis Alert
Authors: Ramgopal Sriram
Published: April 2020

Sepsis is defined as the presence of systemic inflammatory response syndrome from a presumed infectious etiology. Septic shock is defined as the presence of sepsis with cardiovascular organ dysfunction. Approximately 20,000 to 40,000 cases of pediatric sepsis occur in the United States annually, and sepsis carries a mortality rate of 5% to 10%. Because the diagnostic criteria lack specificity and because hypotension is a late finding, sepsis can be difficult to diagnose in children. A delay in treatment is associated with an increased mortality rate. The use of electronic screening tools, history and physical exam, and prudent use of laboratory testing can facilitate detection of sepsis, though no single method is reliable. Resuscitation with antibiotics and rapid administration of fluid boluses, combined with the use of pressors in fluid refractory cases, are the mainstays of therapy, with a goal to deliver critical therapies within 1 hour of emergency department presentation.
Shaking for More than Five
Authors: Ackerman Nina
Published: April 2020

Status epilepticus (SE) has a high morbidity and mortality and is one of the most common neurologic disturbances in children. Early recognition and treatment is key to decreasing morbidity and mortality and improving clinical outcomes. When a child presents to the emergency department with SE, the priority is stabilizing the patient and aborting the seizures. First line treatment for SE is a benzodiazepine. If two rounds of benzodiazepines do not abort seizures, second- and third-line medications for refractory SE include fosphenytoin, valproic acid, levetiracetam, and phenobarbital. Obtaining a thorough history and physical as well as lab work is crucial in determining the cause of the seizure and can guide further workup and management.
He Went Wee, Wee, Wee All Night Long
Authors: Puri Ajay K. , McGuire Melissa A.
Published: April 2020

Hyperosmolar hyperglycemic syndrome is a condition occurring with increasing frequency in the pediatric population that carries a high mortality rate. Obese males of African American descent are most at risk. Diagnosis requires a high degree of suspicion as patients often present with nonspecific symptoms. A fingerstick glucose sample and laboratory testing are primary identifiers of type 2 diabetes mellitus. The hallmark of management of these patients involves aggressive fluid resuscitation and close management of their electrolytes. Patients may present with features of diabetic ketoacidosis, which presents a unique challenge to treatment. Complications such as rhabdomyolysis, malignant hyperthermia, and cerebral edema need to be identified early and managed promptly.
Is There Anything Ultrasound Isn’t Good For?
Authors: Shah Trupti , Mihailos Athena
Published: April 2020

In pediatric populations, abdominal pain is a frequent complaint in the emergency department. An accurate history and reliable physical exam can be challenging to obtain in this young age group. Multiple intra-abdominal pathologies may mimic each other. Ultrasound has been found to be a reliable tool to help diagnose certain important surgical emergencies. In the hands of a trained sonographer, appendicitis, ovarian torsion, and intussusception can all be diagnosed with accuracy on a bedside sonographic exam. All clinicians treating this age group should be familiar with this modality and its advantages and limitations.
Oxford Textbook of Headache Syndromes
Authors: Ferrari Michel , Charles Andrew , Dodick David , Sakai Fumihiko , Haan Joost
Published: April 2020

Headache syndromes rank among the most common presenting symptoms in general practice and neurology, affecting up to 15% of the adult population. The Oxford Textbook of Headache Syndromes provides clinicians with a definitive resource for diagnosing and managing patients with primary and secondary forms of headaches, either as isolated complaints or as part of a more complex syndrome.
Split into seven key sections, with 59 chapters, this comprehensive work discusses the scientific basis and practical management of headache syndromes in a logical format. Each chapter is written by international experts in neurology who share their research and extensive experience by providing a wealth of practical advice for use in clinical situations. In addition, all content is up to date and chapters incorporate discussions on the International Classification of Headache Disorders, third edition, when relevant.