bluuebunny/crossref_metadata_2025 huggingface dataset:
Damage Potential, Effect on Germination, and Development of Sitophilus oryzae (Coleoptera: Curculionidae) on Wheat Grains in Northwestern Himalayas
Authors: Mehta Vasu , Kumar Surjeet , C. S. Jayaram
Published: May 2021

The present investigation was carried out to study the biological parameters and orientation of Sitophilus oryzae (L.) toward wheat cultivar HPW-236 and mixed grains of different cultivars (HPW-155, HPW-236, HPW-249, HPW-349, HPW-360, HS-490, and VL-892). The incubation period, larval period, pupal period, and total life cycle period of S. oryzae was longer when fed on mixed grains as compared to HPW-236. Also, the weevils were more oriented toward HPW-236 and lower germination rates were observed from HPW-236 than mixed cultivars when exposed to S. oryzae. We also evaluated quantitative losses caused by S. oryzae in different cultivars of wheat recommended in the northwestern Himalayas under free-choice conditions. The weevil inflicted greater damage and weight loss in grains of HPW-236 while it was negligible in the case of HPW-360 and HPW-249. HPW-236 which is the most cultivated variety of wheat in northwestern Himalayas proved to be highly susceptible to the weevil and provided a more suitable environment for weevil’s development. Therefore, this particular cultivar can be avoided for prolong storage and the farmers should prefer cultivars such as HPW-360 and HPW-249, which proved to be least affected the weevil.
Surfing the Sweet Wave: Migrating Giant Honey Bees (Hymenoptera: Apidae:Apis dorsata) Display Spatial and Temporal Fidelity to Annual Stopover Site in Thailand
Authors: Robinson Willard S
Published: May 2021

Apis dorsata F. (Hymenoptera: Apidae), the giant honey bee of southern Asia, is an important pollinator of crops and non-cultivated angiosperms, and a producer of honey and beeswax. Its populations are in decline in many areas. Colonies migrate seasonally between highland and lowland nesting sites, taking advantage of available food sources. In 2009, a stopover site was discovered in Thailand where numerous migrating colonies bivouacked near one another. Bivouacs used the site again in 2010. I went to the site in 2016 to test the hypothesis that bees use the site regularly as part of an annual migration. I witnessed many bivouacs, spanning almost precisely the same time period and occupying the same area as in 2010. Here I describe their migratory dances in preparation for departure and their subsequent flights as well as periodic mass flight and defensive behavior. Analysis of photographs indicated that the bivouacking bees aged slowly and may thus live long enough to be capable of intergenerational transmission of migratory route knowledge. I describe attributes of the stopover site, e.g., abundant food and water availability, its location along a major river, and other possible navigational cues. Although the site is the only one of its kind so far known to researchers, such stopover sites probably exist wherever giant honey bees undertake long seasonal migrations. I recommend searching for bivouacking sites, particularly along rivers, wherever giant honey bees migrate. Stopover sites are undoubtedly essential to the life history and health of migratory bee populations, and thus warrant conservation policies.
How spatial and dietary overlap with domestic livestock affect African wild ass nutrition on the Messir Plateau (Eritrea)
Authors: Tesfai Redae T , Parrini Francesca , Owen-Smith Norman , Moehlman Patricia D
Published: May 2021

Competition with livestock over forage resources has been identified as a potential threat to the survival of the African wild ass (Equus africanus) in the Danakil ecosystem (Eritrea). The Messir Plateau is an important breeding area for the African wild ass but also hosts cattle, sheep, goats, donkeys, and camels. Locations and fecal samples of African wild ass and livestock were collected in dry and rainfall months. Stable carbon isotopes [δ 13C ‰] in fecal samples were used to assess diet composition and overlaps with domestic herbivores. Fecal samples also were used to assess the nutritional quality of African wild ass and domestic donkey diets. During the dry months, African wild ass were concentrated in the northern section of the Messir Plateau, approximately 9 km from the permanent water source, and overlapped spatially with local livestock. During the rainfall months, African wild ass dispersed throughout the Messir Plateau (124 km2) when a high number of livestock, particularly cattle from the highlands with herders, were concentrated in the northern section. During the rainfall months, the northern section had relatively better vegetation cover and access to seasonal water. The grass contribution to the diet of the African wild ass in both dry and rainfall months overlapped significantly with that of domestic donkeys and cattle. In rainfall months, the percent fecal nitrogen and phosphorus contents of African wild ass were significantly lower than those of domestic donkey samples. The lower nutrient levels in fecal samples of African wild ass during rainfall months may be due to their displacement from the northern sector by the high number of immigrant highland cattle with people. Our work provides evidence as to how the presence of domestic herbivores, particularly cattle, may negatively impact the nutrient level of wild equids and threaten the survival of the critically endangered African wild ass.
Hybrid Governance and the Attribution of Political Responsibility: Experimental Evidence from the United States
Authors: Woodhouse Eleanor Florence , Belardinelli Paolo , Bertelli Anthony Michael
Published: May 2021

How does the mode of public service delivery affect the attribution of responsibility for public goods? Through a survey experiment on a sample of more than 1,000 Americans, we provide evidence of how the allocation of public goods shapes voters’ support for incumbent politicians. We find that voters prefer a mixture of public–private financing and management when it comes to the delivery of infrastructure. However, once performance information is available, the mode of infrastructure delivery no longer influences their voting intention. The successful delivery of these infrastructure projects is what ultimately matters to voters. Moreover, this preference for a mixture of public and private involvement in public service delivery is stronger among citizens with high political knowledge, who are more likely to punish the incumbent for a failed first phase of the public service delivery. These findings deepen our understanding of how hybrid forms of public service delivery are perceived by voters and how performance information affects evaluations of the performance of public services and politicians alike.
A Very Painful Arm with an “Alien” Inside
Authors: Cuevas-Trisan Ramon , Lou Leland
Published: May 2021

Complex regional pain syndrome (CRPS) is a disabling condition that may affect the arm following certain traumatic or neurological events. It may also be seen without any precipitating event. There are two types of CRPS, and clinicians should be familiar with their diagnostic criteria. CRPS generally requires a multidisciplinary approach for successful management, including a combination of physical/occupational therapy, patient education, pharmacological management, and, in some cases, interventional procedures. Psychologic or psychiatric interventions may be needed in select cases. Management methods should be individualized and follow a stepwise approach. The main goal of management is to provide some degree of analgesia that will allow the patient to tolerate graded activity and mobilization of the affected limb. Pharmacologic management may include nonsteroidal anti-inflammatory drugs, adjuvants (specifically anticonvulsants, antidepressants, and bisphosphonates), topical analgesics, α-adrenergic antagonists, and corticosteroids. Interventional pain management procedures used to manage CRPS should always be accompanied by progressive mobilization exercises. Its prognosis is quite variable, but many patients develop long-term dysfunction in the affected limb and long-term disability.
Skateboarder Hand Blues
Authors: Sankaranarayanan Sriram , Spielman Amanda
Published: May 2021

Carpal fractures can be difficult to detect. They are often missed on initial X-rays; therefore, when there is a high degree of clinical suspicion, a computed tomography scan or magnetic resonance imaging scan can be useful to diagnose some of these occult fractures. This chapter discusses the classical findings associated with occult carpal fractures. It reviews three common carpal fractures: scaphoid fractures, triquetrum fractures, and hook of hamate fractures. It describes the anatomy, common mechanisms of injury to the region, and patient symptoms associated with each fracture. It reviews the steps to follow to reach the diagnosis, including imaging studies and classification guides. The chapter also provides information on their management and counseling advice for patients in an outpatient setting.
Can’t Open Jars Due to Crooked Fingers
Authors: Subbarao Bruno
Published: May 2021

Rheumatoid arthritis is a chronic, inflammatory, autoimmune condition that primarily affects the synovial joints. It often presents first in the hands and the feet, causing painful swelling and stiffness. If left untreated, rheumatoid arthritis can lead to considerable deformity of the hands and feet as well as disability. Prompt diagnosis with laboratory tests and imaging along with management with a multidisciplinary team can help those afflicted maintain their quality of life. Imaging can assess and qualify the extent of injury to the joints and help with prognosis. Pain is most effectively managed through a multimodal approach utilizing pharmaceuticals, physical modalities, and psychological interventions. This chapter illustrate the basic evaluation and management methods of this condition.
Coexisting Disease and the Parturient: Part One
Authors: Zouki Carole , De Ranieri Aladino
Published: May 2021

This chapter examines important organ system diseases in pregnancy seen in the cardiovascular, respiratory, renal, and gastrointestinal systems. In order to nurture the fetus, pregnant women undergo multiple physiologic and anatomic changes. There are numerous systemic changes and sometimes it can be hard to differentiate what is normal from what is not. Whether neuraxial or general anesthesia is chosen, anesthesiologists play an important role in caring for a pregnant woman. More specifically, cardiovascular or gastrointestinal disease in pregnancy can be challenging, and presentation can vary from patient to patient. In the end, the goal is to help anesthesiologists familiarize themselves with the normal and abnormal physiologic changes in pregnancy in order to develop a suitable anesthetic plan.
Parturient Pre-Anesthesia Assessment and Evaluation
Authors: McConville Patrick , Polin Carrie , Swengel Justin
Published: May 2021

Pregnancy has become attainable in women with chronic systemic disease with better management in modern day health care. It is imperative for the anesthesiologist to understand a parturient’s acute and chronic disease when she presents to the labor and delivery floor. A past medical history as well as an obstetrical history should be performed on all parturients. Optimal patient care also includes recognizing the condition of the fetus and how this will affect the plan for delivery. Frequent communication with obstetrical colleagues facilitates safe effective care.
Alternative Regional Anesthetic Techniques
Authors: Burnette Michelle S. , Roland Laura , Chu Everett , David Marianne
Published: May 2021

When neuraxial blocks are contraindicated in parturients desiring labor analgesia or requiring postoperative pain control after a cesarean delivery, alternate regional techniques can be considered. This chapter discusses the techniques available to the clinician to provide relief during the first and second stages of labor. These include paracervical block, pudendal block, and perineal infiltration. The chapter also discusses regional techniques to relieve postoperative pain after cesarean delivery. These include transversus abdominis plane (TAP) block, quadratus lumborum block (QLB), wound infiltration catheters, ilioinguinal-iliohypogastric (IIIH) block, and subcutaneous infiltration of local anesthetics. For each procedure, the technique is described, along with a discussion of the clinical indications and complications. Residents, advanced practitioners, and physicians practicing in the field of anesthesiology, family medicine, and obstetrics will benefit from this chapter.
Postpartum Complications in Obstetric Anesthesia
Authors: Li Lucy , Wang Jingping , Kaye Alan D. , Liu Henry
Published: May 2021

Pregnancy and the postpartum period are characterized by major physiological changes that can potentially lead to complications. Though the majority of pregnancies are uneventful, complications can occur with regards to anesthesia techniques including regional and general anesthesia, most patients and their newborn babies have excellent outcomes. Regional anesthesia is preferred in the obstetric patient related to a number of factors, including maintaining the ability to push the baby out and airway changes of pregnancy that can increase the risk of complications with general anesthesia. Most postpartum complications are relatively common and transient, such as postpartum back soreness and headache, while rare complications can lead to devastating outcomes. Other potential complications include headache, infection, bleeding, neurologic deficits, embolism, and other rarer events. It is imperative for the anesthesiologists to be vigilant of all these potential postpartum complications in the obstetric practice and to recognize and manage them expediently. This chapter describes some of the most common postpartum complications that the anesthesiologist will encounter and their best management.
DNA
Authors: Benarroch Eduardo E.
Published: May 2021

The DNA contains the information that determines the cell phenotype. Epigenetic regulation of DNA transcription, repair of DNA damage, and tight control of the cell cycle are fundamental cell processes that determine the cellular heterogeneity, survival, plasticity, and repair in the nervous system. Epigenetics refers to heritable changes in gene expression that are independent of the DNA sequence (genetic code). Epigenetic mechanisms include: DNA methylation, histone and chromatin modifications, and effects of noncoding RNAs. Specific mutations in genes along these pathways can be associated with both neurodevelopmental and neurodegenerative disorders. To maintain genomic stability, cells activate a DNA damage response that detects and repairs the damaged DNA cycle. The elucidation of these mechanisms has led to development of novel approaches including DNA editing for treatment.
Axonal Transport
Authors: Benarroch Eduardo E.
Published: May 2021

Axonal transport is fundamental for neuronal survival and maintenance of neuronal connectivity and synaptic function. Anterograde transport delivers membrane-bound organelles synthesized and packaged in the cell body to the axon and synaptic compartments, and also allows traffic and turnover of cytoskeletal and metabolic components to dendrites and axons. Retrograde transport is necessary for removal and degradation of materials via the endosome-lysosome and autophagy-lysosome systems and for delivery of target-derived neurotrophic signals or injury signals back to the cell body. Bidirectional transport of mitochondria is important for energy delivery and mitochondria quality control. Axonal transport requires intact microtubules, motor proteins such as kinesin for anterograde and the dynein-dynactin complex for retrograde transport, correct attachment of cargo to motors, and sufficient ATP supplied by mitochondria. Impaired axonal transport is a prominent feature of many neurodevelopmental or adult-onset neurodegenerative disorders.
Mechanisms of Cell Death and Axonal Degeneration
Authors: Benarroch Eduardo E.
Published: May 2021

Cell death in the nervous system may occur via different mechanisms that eventually lead to irreversible membrane permeabilization and cell fragmentation. The two morphological correlates are apoptosis and necrosis, which frequently coexist with each other. The main triggers of neuronal cell death are accumulation of misfolded proteins, oxidative stress, DNA damage, energy failure, excitotoxicity injury, and activation of cell death cascades by products of inflammation. Mitochondria have a central role in several mechanisms of cell death, including intrinsic apoptosis, permeability transition-driven necrosis, and parthanatos. Impaired energy metabolism and glutamate-triggered excitotoxicity may lead to oxidative stress and iron-mediated lipid peroxidation, leading to ferroptosis. Inflammation may lead to cell deaths via formation of an inflammasome and necroptosis. Axonal injury impairs delivery of protective factors and impairs axonal transport, resulting in Wallerian degeneration and formation of large axonal swelling or spheroids. Elucidation of the molecular mechanisms of cell death has profound implications in development of approaches for neuroprotection.
Sensory Processing
Authors: Benarroch Eduardo E.
Published: May 2021

Sensory information reaches the cerebral cortex via several parallel channels that involve different receptor subtypes, sensory pathways, and first-order thalamic relay nuclei, which then relay modality-specific inputs to the primary sensory cortex. From primary sensory areas, information is first processed by unimodal (modality-specific) sensory association areas organized into two parallel streams; a dorsal stream for processing of visuospatial information via the posterior parietal cortex to guide attention, motor behavior, and spatial navigation, and a ventral stream for processing of object feature information via temporal lobe for object recognition. Impairment of these pathways at subcortical level or primary sensory cortex produces modality-specific sensory loss, involvement of association areas manifest with visual spatial neglect, and several forms of agnosia.
Motor Cortex
Authors: Benarroch Eduardo E.
Published: May 2021

Voluntary movements are organized to perform a purposeful task. A motor plan constitutes the overall strategy that is organized into motor programs, which control various parts of the performance. Control of voluntary movements depends on close interactions among the frontal motor areas, posterior parietal cortex, and prefrontal cortex. These areas not only are involved in initiation and execution of movement but also participate in cognitive processes, such as spatial attention, motor learning and adaptation, recognition of intentions of others, and suppression of inappropriate actions. Developments in electrophysiological techniques and functional neuroimaging have provided new insight into the cortical mechanisms of motor control. Disturbances in these mechanisms underlie several neurologic disorders, including apraxia and dystonia.
Vascular Anatomy and Physiology
Authors: Pachuski Justin , Verbeek Thomas A. , Smith Sadie E. , McQuillan Patrick M. , Urman Richard D. , Kaye Alan D. , Liu Henry
Published: May 2021

This important chapter reviews basic vascular anatomy and physiology. The vascular system is part of the cardiovascular system, which maintains blood supply to all organs and tissues to upkeep human metabolic activities. The vascular system has three components: arteries, veins, and capillaries. These components are where oxygen, nutrients, and metabolites exchange. Vascular wall biology has been a very hot topic for the last decades because it is involved in numerous physiological and pathological processes, yet many aspects remain unknown. There are three layers in the vascular wall: tunica intima, tunica media, and tunica adventitia. Adventitia has mainly collagenous and elastic fibers, and its physiological function was mostly unknown until recently; it is believed to be involved in the pathogenesis of atherosclerosis. The vascular tone can be altered by neurohumoral and other factors. The brain, the heart, and other vital organs have the capability to regulate their blood flow via a phenomenon called autoregulation, which maintains relatively constant blood flow to vital organs over a wide range of perfusion pressures.
Preoperative Evaluation and Optimization of the Vascular Surgery Patient
Authors: Bumbarger Katharine , Lutzker Tatiana N. , Gage Parr K.
Published: May 2021

The care of the patient with vascular disease can be complicated as these patients are often high risk with multiple comorbidities. They are frequently frail and can have hypertension, diabetes, pulmonary disease, coronary artery disease, congestive heart failure, cerebral vascular disease, delirium, dementia, renal insufficiency, renal failure, peripheral vascular disease, and more. A complete preoperative evaluation and patient optimization will help ensure that the best anesthetic plan is chosen for the patient. Preoperative optimization uses the information that has been gained from the evaluation to ensure that the patient’s medical conditions are as optimized as possible in order to undergo surgery, a procedure, and anesthesia.
Perioperative Considerations for Carotid Endarterectomy
Authors: Tverdohleb Tatiana , Diaz Katherine , Chen Michelle , Lutzker Tatiana N. , Gage Parr K. , Tharian Antony R.
Published: May 2021

Carotid endarterectomy (CEA) is a common surgical technique for carotid revascularization. CEA is done in order to prevent cerebral vascular accidents (CVAs) or strokes. There is a high risk of morbidity and mortality, such as myocardial infarction and CVA, associated with this procedure. Therefore, different types of anesthetic management and various neuromonitoring techniques have been recommended by investigators. General anesthesia with inhaled anesthetics has demonstrated better neuroprotection from focal cerebral ischemia when compared with regional anesthesia. Regional anesthesia has been associated with less hemodynamic fluctuation and decreased risk of perioperative myocardial ischemia. Superficial, intermediate, and deep cervical plexus blocks (or a combination of superficial and deep cervical plexus blocks) are recognized regional anesthetic techniques utilized for CEA. In addition, neuromonitoring techniques such as somatosensory evoked potentials, motor-evoked potentials, cerebral oximetry, and patient response during regional anesthesia have been utilized to minimize cerebral ischemia intraoperatively. This chapter summarizes the perioperative considerations for patients undergoing CEA.
Endovascular Procedures of the Abdomen/Lower Extremities
Authors: Sankova Susan K. , Yoon Jeongae
Published: May 2021

This chapter continues an overview of endovascular procedures, focusing on interventions below the diaphragm. Endovascular intervention has become the major technique for management of abdominal aortic aneurysms (AAAs), both ruptured and unruptured. Advancements in endovascular techniques have shortened AAA operative and recovery times and permitted intervention on patients previously felt too tenuous for an open surgical approach. Peripheral artery disease (PAD) can also be treated with a variety of endovascular techniques, including angioplasty, atherectomy, and stenting. Endovascular interventions in PAD have similarly reduced the recovery burden for patients and provide similar outcomes to open procedures. The minimally invasive nature of the endovascular approach often allows greater flexibility in anesthetic technique compared to open procedures. In conjunction with the procedural approach, the patient’s health status, preferences, and anesthesiologist preferences permit a choice of anesthesia care that may lie along a spectrum ranging from local anesthesia with minimal sedation to full general endotracheal anesthesia. The endovascular approach does, however, present specific anesthesia management concerns in both the intra- and postoperative period, which are reviewed in this chapter.
Surgery for Vascular Access in Renal Dialysis
Authors: Hoffman Christopher Ryan , Xia Zhongyuan , Liu Henry
Published: May 2021

End-stage renal disease is a widely prevalent condition worldwide. Its impact on morbidity and mortality necessitates surgical intervention to establish renal replacement therapy. Insufficient supply and demand render renal transplantation an option for a minority of patients requiring treatment. Multiple procedures have been put into practice to establish dialysis access. Selecting the appropriate procedure can depend on the urgency of intervention, patient clinical status, anatomic limitations, and patient/provider preference. Complications can vary, but most commonly include infection, primary patency failure, stenosis, thromboembolic phenomena, device failure, and surgical complication. The anesthesia modality is most commonly a general anesthetic. However, some procedures can be achieved under regional anesthesia or local anesthetic infiltration. Thorough preoperative assessment and optimization is required to improve outcomes in a patient population commonly experiencing multiple organ system comorbidities. This typically requires a multidisciplinary care team, including cardiology, nephrology, surgery, and anesthesiology and potentially other specialties on an individual basis to reduce perioperative morbidity and mortality and improve outcomes.
Preoperative Evaluation and Optimization
Authors: Belfar Alexandra L. , Duong Kevin , Deng Yi , Nikolaidis Melissa
Published: May 2021

This chapter focuses on the pre-operative evaluation and optimization of patients prior to thoracic surgery. Of primary importance is a thorough assessment of pulmonary mechanics, lung parenchymal function, and cardiopulmonary reserve. Within these categories, specific parameters to consider include forced expiratory volume, carbon monoxide diffusing capacity, and the maximum rate of oxygen consumption. The Thoracic Revised Cardiac Risk Index can be utilized for cardiac risk stratification and to assess the need for referral to a cardiologist for additional presurgical optimization. Pre-operative interventions such as smoking cessation, adequate nutrition, exercise, and pulmonary rehabilitation can decrease the incidence of respiratory complications.
Pneumonectomy
Authors: Wood Lacey , Tharian Antony
Published: May 2021

Pneumonectomy is a complex surgical procedure requiring a multidisciplinary approach and multifaceted anesthetic management. In this chapter, the authors begin with the history of pneumonectomy and indications and contraindications to the procedure. There is an overview of lung cancer, staging, and appropriate treatment for the different stages of lung cancer. The preoperative evaluation is briefly summarized with an algorithm to follow and is then covered in depth through breaking it down into cardiovascular risk assessment and evaluation, cardiac risk calculators, respiratory mechanics, lung parenchymal function, and finally evaluation of the cardiopulmonary interaction. The surgical procedure and types of pneumonectomy are explained for a thorough understanding before diving into anesthetic management. Preoperative planning and appropriate review prior to taking the patient to the operating room are covered, followed by a discussion of lines and monitors, lung isolation, one-lung ventilation recommendations, hemodynamic management and clamping of the pulmonary artery, supplemental studies, intraoperative fluid management, special considerations for extrapleural pneumonectomy and tracheal sleeve pneumonectomy, guidelines for extubation, and pain management. Lastly, postoperative monitoring and complications including cardiac arrhythmias, stroke, perioperative pulmonary complications and postneumonectomy pulmonary edema, bronchopleural fistula, and cardiac herniation are described.
Esophagectomy
Authors: Perry Tiffany D. , Desvarieux Tricia , Sidoran Kevin
Published: May 2021

Esophagectomy is a challenging procedure from a surgical and anesthetic perspective with high morbidity and mortality. Thorough preoperative evaluation is important for anesthetic planning and management. Minimizing aspiration risk is of critical importance during induction of anesthesia. There are multiple surgical approaches with minimally invasive approaches gaining traction. Most approaches require one-lung ventilation (OLV), and protective ventilatory strategies should be employed. Hypotension and arrhythmias are common intraoperative complications due to manipulation of the heart and large vessels during dissection. Postoperatively, pulmonary complications are common and a large source of mortality. Adequate pain control via thoracic epidural or potentially paravertebral blocks play an important role in reducing pulmonary complications and promoting early recovery. Enhanced recovery after surgery programs are increasingly prevalent for esophagectomy and provide a multidisciplinary perioperative treatment protocol with the goal of reducing complications, promoting recovery and improving treatment outcomes.
Visit 4
Authors: Ferguson Robert J. , Gillock Karen Lee
Published: May 2021

In Visit 4, clinicians focus on four primary goals. First, they conduct a review of the verbal rehearsal strategies taught in the last session, asking about what verbal rehearsal strategies were used, for what, when, where, and modified as needed. Second, clinicians and survivors work together to review the cognitive restructuring skills of realistic probabilities and decatastrophizing, primarily by inquiring how helpful these methods are in rethinking memory problems or barriers and which method appeared to aid coping and how. Next, the external strategies of keeping a schedule and memory routines are taught, including the rationale for keeping a schedule and day planner; the importance of keeping one schedule organizer and consulting the schedule daily; and the rationale for keeping memory routines and the importance of keeping it simple. Finally, homework involves applying the chosen compensatory strategies. The clinician should seek specifics about when and where the strategies will be used.
Inhaled anaesthetics and morbid obesity
Authors: De Baerdemaeker Luc , Hendrickx Jan , De Wolf Andre M.
Published: May 2021

Even though morbid obesity affects many factors governing uptake, distribution, and elimination (i.e. pharmacokinetics) of inhaled anaesthetics, its overall effects are modest. Obesity-induced pharmacodynamic changes are also small or non-existent: the minimum alveolar concentration (MAC) and MACawake of modern anaesthetics does not differ between lean and morbidly obese patients.
Obstructive sleep apnoea
Authors: Raveendran Raviraj , Chung Frances
Published: May 2021

Recent understanding of sleep physiology, pathogenesis of obstructive sleep apnoea (OSA), and anaesthetic effects on OSA has resulted in significant changes in the perioperative management of OSA patients. The incidence of OSA is increasing in proportion to the increase in obesity incidence. A significant number of OSA patients are not diagnosed when they present for elective surgery. Recent outcome studies on surgical populations have shown that OSA patients have increased morbidity. At the same time, algorithm-based management and the use of continuous positive airway pressure show promising results in perioperative outcomes. Anaesthesiologists have a vital role in managing OSA patients by identifying OSA and associated comorbid conditions. This chapter reviews the epidemiology, pathophysiology, and management of OSA in morbidly obese patients.
Cardiopulmonary resuscitation in the obese patient
Authors: Stander Eric
Published: May 2021

Cardiopulmonary resuscitation (CPR) in obese patients carries several challenges not seen in other populations and understanding of the differences in anatomy, physiology, pharmacology, and outcomes will assist the physician in better performance during this critical moment with improved outcomes. The probability of needing to perform cardiac resuscitation in obese patients is increasing, simply in that the number of patients who are obese is increasing, and obesity carries higher risks of morbidity. According to the Centers for Disease Control and Prevention, in 2013, 28.3% of the population in the United States were obese (28.0–28.6 at 95% confidence interval), and this number has been increasing yearly since 2011. This chapter reviews considerations in the management of the airway, optimal ventilations during CPR, best options for circulation, and medications used during CPR in obese patients. Objective data are limited, in respect to CPR in obese patients, and continued research is necessary in all phases of this therapy. An especially acute problem, not discussed enough, might just be availability of reasonable intravenous access.
Day care surgery
Authors: Sultana Adrian
Published: May 2021

Anaesthetists encounter morbidly obese patients in every aspect of their daily practice and especially as ambulatory (day) surgery candidates. Restrictions on body mass index for day surgery appear to have become obsolete and obese patients who are medically fit do well after day case surgery. The less invasive group of bariatric surgical operations including endoluminal procedures may be accepted as outpatients. Comprehensive preoperative assessment focusing on airway, respiratory, and cardiovascular issues is recommended. The full gamut of sophisticated airway equipment and all-round airway skills must be available in the day surgery environment to adequately deal with these patients. An ideal anaesthetic technique is discussed in the chapter.
Epidemiology and genetics of Sjögren’s syndrome
Authors: Bowman Simon J.
Published: May 2021

Sjögren’s syndrome (SS) is a chronic, immune-mediated condition of unknown aetiology, characterized by focal lymphocytic infiltration of exocrine glands associated with dry mouth and dry eyes. It occurs either as a primary disorder (primary SS (pSS)), or as a secondary condition in which the glandular features occur, typically as a late feature of other rheumatic diseases, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma (secondary SS). There is a strong female bias. Typically pSS affects women in middle age, with an estimated prevalence of 0.04%–0.4%. Of patients with pSS, 75% have anti-Ro and/or anti-La antibodies, often with raised immunoglobulin levels (hypergammaglobulinaemia). There is a 44-times increased risk of mucosa-associated lymphoid tissue (MALT) B-cell lymphoma in pSS, typically affecting the salivary glands. Anti-Ro/La antibodies are typically associated with the HLA-DR3-DQ2 haplotype. Genome-wide screening has identified interferon-related and B-cell-related genes linked to pSS.
Salivary gland biopsy—procedure and histopathology
Authors: Fisher Benjamin
Published: May 2021

The most commonly biopsied glands for the diagnosis of Sjögren’s syndrome (SS) are the labial minor salivary glands. Techniques employed include wedge biopsies, the Daniels technique, punch biopsies, and ‘minimally invasive’ procedures. The Daniels technique is described together with its possible complications and its potential advantages over other approaches. The typical histological change associated with SS is a focal lymphocytic sialadenitis (FLS), which needs to be distinguished from a nonspecific chronic sialadenitis. Once the presence of FLS is established, the number of lymphocytic foci with ≥ 50 mononuclear cells are counted, divided by the glandular surface area in mm2, then multiplied by 4 to give the number of foci per 4 mm2. FLS with a focus score ≥ 1 is currently established as the threshold for a biopsy to be considered supportive of a diagnosis of SS. Other features that should be reported include the presence of germinal centre-like lesions and lymphoepithelial lesions.
Haematological manifestations of Sjögren’s syndrome
Authors: Yeoh Su-Ann , Ciurtin Coziana
Published: May 2021

Haematological abnormalities in primary Sjögren’s syndrome (pSS) may present in various ways—anaemia (the most frequently occurring cytopoenia), leucopoenia (lymphopoenia or neutropoenia), thrombocytopoenia, hypergammaglobulinaemia, or hypocomplementaemia—all of which can occur either in isolation or in combination. They occur more commonly in patients with positive anti-Ro/SSA status and can occur even before sicca symptoms appear. Patients with pSS have an increased risk of developing non-Hodgkin’s lymphoma, with mucosa-associated lymphoid tissue non-Hodgkin’s lymphoma of the salivary glands being the most common. Adverse haematological prognostic factors include hypocomplementaemia, hypergammaglobulinaemia, and cryoglobulinaemia. In this review, we also discuss therapeutics used in pSS treatment and their effect on haematological abnormalities.
Nonpharmacological interventions for the management of fatigue and constitutional symptoms in Sjögren’s syndrome
Authors: Hackett Katie L. , Cartner Helen
Published: May 2021

Current treatments for Sjögren’s syndrome (SS) are limited. Pharmacological treatments tend to focus on topical treatments for dryness or oral muscarinic agonists which increase tear production and salivary flow. National treatment guidelines for primary SS incorporating available published evidence and expert opinion include recommendations for specific pharmacological topical and systemic treatments. However, despite the availability of such treatments, SS patients still experience symptoms, difficulties performing their daily activities, and reduced quality of life. This chapter explores specific ways nonpharmacological support for patients with primary SS might be delivered. These include the provision of information and patient education, as well as specific symptom management support for anxiety, sleep disturbances, pain, discomfort, low mood, and anxiety. Possible modes of delivering interventions and consideration of the differing levels of support which are required for different patients are also discussed.
Juvenile- and young adult–onset Sjögren’s syndrome
Authors: Renton William D. , Price Elizabeth J. , Ramanan A.V.
Published: May 2021

Sjögren’s syndrome (SS) is very rare in teenagers and there are only anecdotal reports world-wide of its occurrence in prepubertal children. Paediatric cohort studies have demonstrated that approximately half of patients with Sjögren’s syndrome (SS) have primary disease. As with adults, secondary SS is most commonly associated with systemic lupus erythematosus, although cases have also been reported in patients with juvenile idiopathic arthritis, mixed connective tissue disease, and other autoimmune conditions. The condition is almost certainly underdiagnosed. Children and young adults rarely complain of dryness and usually present with parotid gland swelling and systemic disease. Clinical manifestations, diagnosis, and management are all discussed in this chapter.
Mimics of Sjögren’s syndrome
Authors: Sutcliffe Nurhan
Published: May 2021

Systemic diseases, which affect salivary and lacrimal glands, can cause dry eyes and mouth and swelling of the affected glands and may present in a similar way to SS. There may also be overlapping extra-glandular, laboratory, and imaging features, which can pose a diagnostic challenge. Certain diseases affecting salivary and lacrimal glands such as sarcoidosis, IgG4-related disease, chronic hepatitis C virus, HIV infections, and graft-versus-host disease can mimic Sjögren’s syndrome, usually via a process of similar inflammation of affected glands. This chapter will focus on these diseases. When evaluating a patient with suspected primary Sjögren’s syndrome it is important to rule out its differential diagnoses. Biopsy of the major or minor salivary gland or of the lacrimal glands may sometimes be needed to reach a final diagnosis.
Diffuse alveolar haemorrhage
Authors: Robinson Chapman
Published: May 2021

One of three underlying histopathological abnormalities is seen on lung biopsy samples; pulmonary capillaritis as is seen in systemic vasculitis and anti-GBM disease, diffuse alveolar damage in ARDS, and alveolar haemorrhage in the absence of alveolar damage as is seen in coagulopathies and elevated left-sided cardiac pressures. Bleeding into the alveoli is often a feature of a small-vessel vasculitis of the lungs. Most of this blood tends to remain in the lungs and is not expectorated. Patients with diffuse alveolar haemorrhage may have a background history of vasculitis over the preceding weeks to months. They can present with slowly progressive dyspnoea with haemoptysis or be acutely unwell with hypoxia. They may require ventilatory support.
Pulmonary disease in the immunocompromised—non-HIV
Authors: Robinson Chapman
Published: May 2021

Pulmonary disease is a significant cause of morbidity and mortality in the immunocompromised, and its diagnosis and management are challenging. In the UK, this is encountered most commonly in the setting of immunocompromise secondary to cytotoxic chemotherapy, haematological malignancy, immunosuppression post-transplant (particularly renal and haematopoietic stem cell transplant (HSCT), including bone marrow, cord blood, and growth factor-stimulated peripheral blood transplantation), prolonged corticosteroid use, and HIV.
Unexplained respiratory failure
Authors: Robinson Chapman
Published: May 2021

Respiratory failure is conventionally divided into type I (hypoxia only) and type II (hypoxia and hypercapnia). Type I is an increased A–a O2 gradient, with adequately increased alveolar ventilation maintaining a normal PaCO2. The causes are numerous, including most of respiratory medicine, and require the usual history, examination, and investigations.
Asbestos and the lung
Authors: Robinson Chapman
Published: May 2021

Asbestos consists of a family of naturally occurring hydrated silicate fibres that may be subdivided into two groups: curly serpentine fibres, of which chrysotile (white) is the only fibre currently in commercial use, and straight, needle-like amphiboles, which comprise crocidolite (blue), amosite (brown), anthophyllite, tremolite, and actinolite. Fibres have a predisposition to localize to the pleura. They differ in their lung clearance kinetics and pathogenic potential; amphibole fibres clear more slowly from the lung and are more carcinogenic than chrysotile. While asbestos usage in developed countries is restricted, the use of chrysotile asbestos in developing economies continues to rise.
Dysfunctional breathing
Authors: Robinson Chapman
Published: May 2021

Dysfunctional breathing encompasses a range of breathing pattern abnormalities with breathlessness and overbreathing in the absence of or in excess of any physiological abnormality. Hyperventilation syndrome is a form of dysfunctional breathing and the terms are often used interchangeably. Dysfunctional breathing may occur as part of a spectrum of physical symptoms (e.g. chest pain, palpitations/tachycardia, fatigue, dizziness, paraesthesiae, headache, diarrhoea, inappropriate sweating, etc.) from anxiety or panic disorder.
Pleural effusion
Authors: Robinson Chapman
Published: May 2021

A pleural effusion results from the accumulation of abnormal volumes (>10–20 mL) of fluid in the pleural space. Pleural effusions are common and are associated with many different diseases, differential diagnosis of effusions, and details of pleural fluid analysis.
Pulmonary thromboembolic disease
Authors: Robinson Chapman
Published: May 2021

A pulmonary embolism (PE) is an obstruction of part of, or the entire, pulmonary vascular tree, usually caused by thrombus from a distant site.
Respiratory infection—mycobacterial
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

Includes: Tuberculosis: epidemiology and pathophysiology, first-line anti-TB drugs, TB chemotherapy with comorbid disease, multidrug-resistant TB (MDR-TB), latent TB infection, TB and anti-TNF-α‎ treatment, disseminated BCG infection (BCGosis), future developments in TB, non-tuberculous mycobacteria (NTM), NTM species and lung disease.
Pneumothorax aspiration
Authors: Chapman Stephen J. , Robinson Grace V. , Shrimanker Rahul , Turnbull Chris D. , Wrightson John M.
Published: May 2021

This chapter considers pneumothorax aspiration. 1° pneumothorax: Consider aspiration if patient breathless, hypoxic, and pneumothorax large. 2° pneumothorax: Consider aspiration if evidence of underlying lung disease (or patient with significant smoking history, aged >50 years), with small pneumothorax and breathlessness.
Double common envelope jets supernovae (CEJSNe) by triple-star systems
Authors: Soker Noam
Published: May 2021

I propose a new type of common envelope jets supernova (CEJSN) events where instead of a single neutron star (NS; or a black hole; BH) a tight binary system of an NS and a main-sequence star enters a common envelope evolution (CEE) with a red supergiant. The NS and the main-sequence star of the tight binary system merge inside the red supergiant envelope and enter a CEE of their own. The NS accretes some mass through an accretion disc and launches jets that explodes the main-sequence star. I estimate that the two jets that the NS launches at this phase carry an energy of $\approx 10^{52} {~\rm erg}$, about the same order of magnitude as the energy that the jets will carry when the NS or its BH remnant will enter the core in a later phase. For that, I term the entire event a double CEJSN. The outcome of the double CEJSN is a very long, months to years, and very energetic event, a total energy of $\approx 10^{52} \!-\! 10^{53} {~\rm erg}$, that will be observationally classified as a peculiar superenergetic event. I crudely estimate that new transient surveys should detect about one CEJSN event from a triple-star system per year.
Submillimetre observations of the two-component magnetic field in M82
Authors: Pattle Kate , Gear Walter , Redman Matt , Smith Matthew W L , Greaves Jane
Published: May 2021

We observed the starburst galaxy M82 in 850 µm polarized light with the POL-2 polarimeter on the James Clerk Maxwell Telescope (JCMT). We interpret our observed polarization geometry as tracing a two-component magnetic field: a poloidal component aligned with the galactic ‘superwind’, extending to a height ∼350 pc above and below the central bar; and a spiral-arm-aligned, or possibly toroidal, component in the plane of the galaxy, which dominates the 850 µm polarized light distribution at galactocentric radii ≳2 kpc. Comparison of our results with recent High-resolution Airborne Wideband Camera Plus (HAWC+) measurements of the field in the dust entrained by the M82 superwind suggests that the superwind breaks out from the central starburst at ∼350 pc above the plane of the galaxy.