bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of Adjuvant or Neoadjuvant Chemotherapy in Extremity and Truncal Sarcoma
Authors: Canter Robert J
Published: January 2021

Although neoadjuvant chemotherapy has been an established component of multimodality cancer care for patients with pediatric sarcomas for the past 25 years, the role of adjuvant or neoadjuvant chemotherapy in the management of adult patients with soft tissue sarcoma (STS) amenable to treatment with curative intent remains controversial. Overall, meta-analyses have revealed modest improvements in survival outcomes with the use of adjuvant or neoadjuvant chemotherapy, but individual trials have demonstrated inconsistent results leading some to question the robustness and external validity of the results. A recent randomized trial using anthracycline- and ifosfamide-based chemotherapy has provided further positive evidence in support of neoadjuvant chemotherapy for adult STS patients, but concerns persist regarding the risks of chemotherapy-related toxicities and the generalizability of the findings. Given the substantial risk of distant recurrence and disease-specific death for adult STS patients with tumors greater than 10 cm, especially those with synovial sarcoma and myxoid or round liposarcoma histologies, these patients should be strongly considered for neoadjuvant chemotherapy as part of a combined modality approach. The impact of recent level I data on the broader implementation of adjuvant or neoadjuvant chemotherapy in adult STS remains to be seen.
 This review contains 5 figures and 34 references
Key Words: chemotherapy, limb salvage, myxoid/round cell liposarcoma, multimodality therapy, soft tissue sarcoma, surgery, survival, synovial sarcoma, undifferentiated pleomorphic sarcoma
Rare Fibroblastic and Myofibroblastic Tumors
Authors: Zheleva Vasilena , Liang Yu , Melstrom Laleh
Published: January 2021

This review discusses the clinical presentation, histopathologic characteristics, and diagnostic and treatment algorithms for several distinct fibroblastic and myofibroblastic tumor subtypes. Low-grade fibromyxoid sarcomas typically arise in the deep soft tissues of the proximal extremities or trunk in young adults. They tend to have a high local recurrence rate, although some may have distant metastases. Histologically, they consist of bland fibroblasts with a whorled or linear arrangement alternating with hypocellular myxoid stroma. Sclerosing epithelioid fibrosarcomas typically arise in the deep soft tissues of the lower extremities of middle-aged adults. They tend to be slow growing but clinically aggressive, with a high propensity for local recurrence and distant metastases. Classic histologic features include the presence of small, uniform, ovoid epithelioid cells with sparse cytoplasm, arranged in cords within a sclerotic fibrous stroma. Myxoinflammatory fibroblastic sarcomas mainly affect the hands and feet. They are prone to local recurrence, with a very low likelihood of distant metastasis. Histologically, they have nodular architecture and highly cellular areas with an abundance of inflammatory cells, among which characteristic large Reed-Sternberg–like and lipoblast-like cells and hypocellular areas rich in myxoid stroma can be seen. Inflammatory myofibroblastic tumors typically occur in children and young adults, with common anatomic locations being the omentum, mesentery, retroperitoneum, and lung. Histologically, they are composed of myofibroblastic spindle cells accompanied by a lymphoplasmacytic inflammatory infiltrate. Surgical resection is the mainstay of treatment for all of the above tumor types. Radiation therapy may be used as adjuvant therapy for tumors with a high risk of local recurrence, in the setting of positive margins, or for unresectable primary or metastatic disease. There is no definite role for standard chemotherapy, but in certain cases, targeted therapy may be of use, such as ALK inhibitors in ALK-positive inflammatory myofibroblastic tumors. 

This review contains 16 figures, 1 table and 30 references
Key words: inflammatory myofibroblastic sarcoma, low-grade fibromyxoid sarcoma, myxoinflammatory fibroblastic sarcoma, sclerosing epithelioid fibrosarcoma
Clinical Trial Design and Statistics
Authors: Sosa Julie Ann
Published: January 2021

A clinical trial is a planned experiment designed to prospectively measure the efficacy or effectiveness of an intervention by comparing outcomes in a group of subjects treated with the test intervention with those observed in one or more comparable group(s) of subjects receiving another intervention.  Historically, the gold standard for a clinical trial has been a prospective, randomized, double-blind study, but it is sometimes impractical or unethical to conduct such in clinical medicine and surgery. Conventional outcomes have traditionally been clinical end points; with the rise of new technologies, however, they are increasingly being supplemented and/or replaced by surrogate end points, such as serum biomarkers. Because patients are involved, safety considerations and ethical principles must be incorporated into all phases of clinical trial design, conduct, data analysis, and presentation. This review covers the history of clinical trials, clinical trial phases, ethical issues, implementing the study, basic biostatistics for data analysis, and other resources. Figures show drug development and clinical trial process, and type I and II error. Tables list Food and Drug Administration new drug application types, and types of missing data in clinical trials.
This review contains 2 highly rendered figures, 2 tables, and 38 references
Ethical And Social Issues In Medicine
Authors: Loewy Roberta Springer , Loewy Erich H. , Fitzgerald Faith T.
Published: January 2021

So rapidly has the field of health care ethics continued to grow that, when recently “googled,” the term produced 28.2 million hits. The challenge is to address the ethical and social issues in medicine in this very limited article space. It remains an impossible task to present more than a superficial discussion of these complex issues and the complicated cases in which they are to be found. Like good medicine, good ethics cannot be practiced by algorithm. The authors have opted to provide an operational guide to help clinicians sort through the ethical and social quandaries they must face on a daily basis. To that end, the authors have chosen to divide this chapter into the following sections: 1. A brief description of the biopsychosocial nature of ethics and how it differs from personal morality 2. A method for identifying and dealing with ethical issues 3. A discussion of the role of bioethicists and ethics committees 4. The professional fiduciary role of clinicians 5. Listings of some of the common key bioethical and legal terms (online access only) 6. A very brief discussion of the terms cited in the above listings (online access only)
This reviews contains 4 tables, 8 references, 1 appendix, and 20 additional readings.
Keywords: Ethical, social, right, wrong, good, bad, obligation, moral authority, critically reflective, and multiperspectival activity, Curiosity, Honesty, Patience, Open-mindedness
Approach to the Patient with Abdominal Pain
Authors: Sajed Dana
Published: January 2021

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations.
This review contains 5 figures, 8 tables, and 92 references
Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography
Review of Inflammatory Bowel Disease
Authors: Guttman Joshua , Davis Frederick
Published: January 2021

Inflammatory bowel disease (IBD) is an inflammatory condition of the gastrointestinal (GI) tract made up of ulcerative colitis (UC) and Crohn disease (CD). These diseases are differentiated based on the location in the GI tract and findings on colonoscopy and biopsy. Management in the emergency department is similar for these two conditions. Patients presenting with exacerbations of known IBD should be classified according to severity and managed accordingly. Mild to moderate disease will require only a limited workup consisting of testing for anemia and electrolyte abnormalities. These patients may be discharged with a 5-aminosalicylic acid (5-ASA) agent, or if the condition is refractory to 5-ASA, then with oral budesonide. Severe or fulminant disease will need intravenous hydration, intravenous corticosteroids, computed tomography (CT) to assess for intestinal complications, and admission to the hospital. Patients with abscesses, colitis, or ileitis on CT will need antibiotics. Additionally, patients should be evaluated for both intestinal complications, such as strictures and fistulas, and extraintestinal manifestations, the majority of which are dermatologic and ophthalmologic. Patients with fulminant complications, toxic megacolon and intestinal perforation, should receive intravenous antibiotics, hydration, and immediate surgical consultation. Patients presenting with signs and symptoms of IBD but without a known diagnosis should receive supportive therapy. If discharged, they should be referred to a gastroenterologist for colonoscopy to make an appropriate diagnosis and to initiate therapy.
 
Key words: Inflammatory bowel disease (IBD), gastrointestinal (GI) tract, ulcerative colitis (UC), Crohn disease (CD), colonoscopy, fulminant complications
 
This review contains highly rendered 5 figures, 5 tables, and 30 references.
Drugs of Abuse
Authors: Zuckerman Matthew D , Babu Kavita
Published: January 2021

The term “drugs of abuse” lacks a formal medical definition. Historically, discussions of drugs of abuse focused on “street drugs”; however, the adverse effects of the nonmedical use of prescription medications, such as opiates, benzodiazepines, and therapeutic amphetamines, are increasingly seen. The purpose of this review is to aid the clinician in identifying and treating a broad representation of drugs of abuse, which may include those illicitly produced in laboratories (e.g., methamphetamine), diverted pharmaceuticals (oxycodone), and herbal products (marijuana). This review covers stimulants, hallucinogens, cannabinoids, and sedative-hypnotics. Figures show substances ranked according to weighted harm score on a normalized scale from 0 being no harm to 100 being extreme harm to self and others, a treatment algorithm for sympathomimetic toxicity, a treatment algorithm for sedative-hypnotic overdose, and a treatment algorithm for opioid overdose. Tables list commonly abused sympathomimetic agents, modern novel drugs of abuse, commonly abused sedative-hypnotic agents, commonly abused opiates, and pitfalls of the drug screen.
This review contains 4 highly rendered figures, 6 tables, and 90 references.
Key Words: street drugs, prescription medications, opiates, benzodiazepines, amphetamines, stimulants, hallucinogens, oxycodone, marijuana, overdose
High Altitude Illness
Authors: Harris N. Stuart
Published: January 2021

High-altitude illnesses include acute mountain sickness (AMS), high-altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). Gradual ascent provides the optimal means of avoiding high-altitude illness; thus, public education regarding gradual ascent plays an important role in reducing the morbidity and mortality of serious altitude illness. This review summarizes the primary types of acute altitude sickness, acclimatization to high altitude, assessment and stabilization, diagnosis, treatment and disposition, prophylaxis, and outcomes for patients with high-altitude illness. Figures show physiologic changes leading to acclimatization to high altitude, HAPE physiology, the ‘bar-code sign’ indicating the presence of pneumothorax, the ‘waves on a beach’ sign indicating the absence of pneumothorax, images of lungs with and without edema on ultrasonography, a chest x-ray of HAPE, and a photograph of a portable hyperbaric treatment bag. Tables list rules to avoid serious altitude illness; initial assessment of the new patient with potential high-altitude illness; differential diagnosis, diagnostic criteria, and treatments for AMS, HACE, and HAPE; the Lake Louise score for establishing AMS severity; and prophylaxis for cerebral forms of altitude illness. Videos show the use of a high-frequency linear array probe to assess pneumothorax.
This review contains 8 highly rendered figures, 14 tables, 3 videos, and 68 references.
Pediatric Seizures and Status Epilepticus
Authors: Retterath Lindsey , Woolridge Dale
Published: January 2021

Seizures represent a common neurologic complaint among pediatric patients in the emergency department (ED). They can be classified as generalized or focal. In terms of etiology, seizures are most basically broken down into “acute symptomatic” seizures, which are due to another primary medical cause, and unprovoked seizures which occur as a primary pathology. Febrile seizures are the most common types of seizures in children, which themselves can be simple or complex. The most concerning seizures are those which associate with meningismus, encephalitis, metabolic derangements, intracranial mass, and, of course those which progress to status epilepticus. Significantly, it is appropriate and even critical to assume status epilepticus and intervene accordingly whenever a child arrives to the ED seizing for an unspecified period of time. This review covers the initial evaluation, resuscitation, management, work-up, and disposition of pediatric patients who present to the emergency room with seizures. Figures in this chapter illustrate stepwise and algorithmic approaches to initial management, expanded differential, systematic diagnostic approach, and disposition for pediatric patients presenting with seizures and status epilepticus. Tables list important physical exam components for evaluating children with seizures, classifications of seizures, common seizure look-alikes in children, features of febrile seizures, etiologies of pediatric seizures.
This review contains 5 figures, 11 tables, and 22 references.
Key Words: pediatric seizures, febrile seizures, pediatric neurologic emergencies, pediatric emergency medicine, status epilepticus
Dental Emergencies
Authors: Bollman E Brennan , De Wulf Annelies L
Published: January 2021

Patients with dental complaints commonly present to the emergency department for initial management. Immediate airway assessment and stabilization as needed are imperative. Based on clinical signs and symptoms, providers may assess the degree of dental decay and make an appropriate referral. Nonsteroidal antiinflammatory drugs are effective for most dental pain, and antibiotics are not indicated in the absence of overt infection. Emergency providers may drain simple odontogenic abscesses, but referral for definitive endodontic therapy is still required. Abscesses may extend into the deep fascial spaces of the face and neck. When “red flag” findings are seen, it is critical to protect the airway and obtain early consultation with specialists, along with advanced imaging and likely admission for drainage and intravenous antibiotics. Complications such as Ludwig angina, vascular erosion, and necrotizing fasciitis may lead to significant morbidity and mortality in otherwise healthy patients. Gingivitis and periodontitis are typically chronic, slowly progressing diseases but also have acute necrotizing variants that require antibiotics and prompt dental follow-up. Dentoalveolar fractures may be temporized by an emergency provider with commercial splints and coverings. Tooth avulsion is a dental emergency that requires proper handling and prompt replantation within 60 minutes. Mandibular fractures should be suspected with malocclusion and a positive tongue blade test. After diagnosis, however, these may be managed on an outpatient, nonemergent basis. Given the significant force required to produce a mandible fracture, patients should be assessed for other acute traumatic injuries.
This review contains 11 figures, 5 tables, and 45 references.
Key words: antibiotic, dental infection, dentoalveolar trauma, gingivitis, mandible fracture, odontogenic abscess
Epidemiology of Inflammatory Bowel Disease
Authors: Barnes Edward L. , Burakoff Robert
Published: January 2021

Inflammatory bowel disease (IBD) comprises chronic disorders characterized by inflammation of the gastrointestinal tract. The two major identified subtypes of IBD are ulcerative colitis (UC) and Crohn disease (CD), and over many years, each can demonstrate periods of recurrence and remission. Although the presentation and clinical patterns of UC and CD have been well studied, many questions remain regarding the underlying disease pathogenesis. On an individual level, the development of clinically active IBD appears to occur on account of a complex set of interactions of distinct risk factors, including genetic predisposition, environmental exposures, and geographic location. On a global scale, the highest rates of IBD are found in Europe and North America, with worldwide prevalence of UC and CD increasing. Figures show the prevalence of UC and CD in the United States, stratified by region. Tables show the prevalence of IBD in North America as identified by various studies and environmental risk factors for inflammatory bowel disease.
This review contains 2 highly rendered figures, 2 tables, and 134 references.
Gastroesophageal Reflux Disease
Authors: III R. Thomas Finn , Chan Walter W
Published: January 2021

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis made in outpatient clinics, responsible for over 5 million annual outpatient visits and likely hundreds of thousands of inpatient stays for noncardiac chest pain. GERD’s current definition, based on international consensus, is a “condition which develops when the reflux of stomach contents causes troublesome symptoms (i.e., at least two heartburn episodes per week) and/or complications.” Also defining GERD is the presence of erosive esophagitis on upper endoscopy (esophagogastroduodenoscopy [EGD]) with or without the presence of troublesome symptoms or the presence of troublesome symptoms without endoscopic evidence of erosive esophagitis (also known as nonerosive reflux disease). This review looks at GERD in detail, including its epidemiology and risk factors, genetics, pathogenesis and etiologic factors, clinical presentation and symptoms, differentials, diagnosis, and complications. Figures presented are an EGD image showing signs of erosive esophagitis, Barrett esophagus, and hiatal hernia and sample recordings from a 24-hour combined multichannel intraluminal impedance and pH testing. Tables list differential diagnoses for GERD, indications for performing EGD in patients with GERD symptoms, and a summary of GERD therapies.
This review contains ­2 figures, 4 tables, and 74 references.
Barrett Esophagus
Authors: Jajoo Kunal , Gavini Sravanya
Published: January 2021

Barrett esophagus is the condition in which normal stratified squamous epithelium of the esophagus is replaced by metaplastic columnar epithelium, which may predispose to development of malignancy. This metaplasia is thought to be a reparative mechanism to cope with reflex esophagitis induced by chronic gastroesophageal reflux disease. Barrett esophagus is associated with an increased risk of esophageal adenocarcinoma (EAC), although the more recent studies have shown that the risk of progression to malignancy is lower than was initially postulated. Endoscopic screening and surveillance are still warranted for early detection of dysplasia and neoplasia and prevention of EAC. This review looks at Barrett esophagus in detail, including its epidemiology and risk factors, etiology and pathogenesis, clinical presentation and symptoms, diagnosis, differential diagnosis, treatment, complications, and prognosis. Figures show images of Barret esophagus, endoscopic mucosal resection of nodule associated with Barrett esophagus, and focal radiofrequency ablation; a schematic of using Prague circumferential (C) and maximal extent (M) criteria to classify and report Barrett esophagus; and a proposed management algorithm for patients with Barrett esophagus. Tables list risk factors associated with Barrett esophagus and neoplastic progression to EAC, guidelines for screening and surveillance, and endoscopic eradication therapies. A list of useful Web sites relating to Barrett esophagus is also presented.
This review contains ­5 highly rendered figures, 3 tables, and 33 references.
Peptic Ulcer Diseases
Authors: Lew Edward A
Published: January 2021

The etiology of peptic ulcers is generally related to impaired mucosal defenses in the presence of aggressive factors (e.g., gastric acid and pepsin). Major risk factors include infection with Helicobacter pylori and the use of nonsteroidal antiinflammatory drugs; high rates of acid secretion can also predispose to ulcer formation. The prevalence of peptic ulcers in Western countries has declined since the 1950s, a phenomenon that is likely due to a corresponding decrease in H. pylori infections among the general population. This review summarizes the epidemiology, etiology, diagnosis, and treatment of peptic ulcers. Figures show the etiopathogenesis of peptic ulcers, the approach to a patient who has new and undiagnosed ulcerlike symptoms, and images of a gastrointestinal series in which double contrast (barium and air) was used, as well as an upright chest x-ray of a patient with an acute abdomen caused by a perforated duodenal ulcer. Tables list the differential diagnosis of peptic ulcer disease and commonly used regimens to eradicate H. pylori.
This review contains 3 highly rendered figures, 2 tables, and 35 references.
Autoimmune Pancreatitis
Authors: Yang Allison L , McNabb-Baltar Julia
Published: January 2021

Autoimmune pancreatitis (AIP) is a subcategory of chronic pancreatitis that is highly responsive to steroids. The term was first proposed in 1995 by Yoshida and colleagues, and since its discovery, the diagnosis of AIP has dramatically increased. AIP is a chronic fibroinflammatory disease characterized by lymphoplasmacytic infiltrates and fibrosis on histology. There are two distinct subtypes: type 1 AIP is the pancreatic manifestation of a systemic serum immunoglobulin G subtype 4–related disease (IgG4-RD) and type 2 AIP is described clinically as idiopathic duct-centric pancreatitis and has no association with IgG4. Clinically, AIP presents most commonly as obstructive jaundice in type 1 AIP and can present as acute pancreatitis in type 2 AIP. The diagnostic criteria include histology, imaging findings, and responsiveness to steroids as well as laboratory findings and other organ involvement. The mainstay of treatment is steroid therapy, with immunomodulators such as rituximab used for maintenance or relapsing disease. Long-term complications of AIP include pancreatic insufficiency and are often associated with relapsing disease.
This review contains 45 references, 1 figure, and 2 tables.
Key Words: autoimmune pancreatitis, chronic pancreatitis, EUS-guided biopsy, IgG4, immunomodulatory, obstructive jaundice, pancreas mass, steroid
Management of Gastrointestinal Stromal Tumors
Authors: Serrano César , George Suzanne
Published: January 2021

Gastrointestinal stromal tumors (GISTs) are the most common tumors of mesenchymal origin in the gastrointestinal tract. These tumors are believed to arise from the interstitial cells of Cajal. The oncogenic activation of KIT or platelet-derived growth factor receptor–α is common to these tumors, and GISTS are considered to be a successful model for rational development of personalized treatments against oncogenic driver mutations in cancer. This review covers the epidemiology, etiology and genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of GISTs. Figures show KIT primary and secondary mutations, the clinical and molecular progression of GISTs, a contrast-enhanced computed tomographic scan showing a gastric GIST presenting as a huge abdominal mass, a magnetic resonance image showing a rectal GIST at baseline and responding to neoadjuvant imatinib after 8 months of treatment, and hematoxylin-eosin stain of a fusocellular and an epithelioid GIST. Tables list demographics and clinical characteristics, associated genetic syndromes, relevant differential diagnosis, risk stratification systems used in GIST, and the comparative activity of approved regimens for GIST.
This review contains 5 highly rendered figures, 5 tables, and 74 references.
General Principles of Antibiotic Therapy
Authors: Letourneau Alyssa R. , Calderwood Michael S.
Published: January 2021

The essential feature of effective antibiotic agents is the ability to inhibit the growth of microorganisms at concentrations tolerated by the host. Antibiotic agents generally target anatomic structures or biosynthetic pathways unique to bacteria. The appropriate choice of an antibiotic for an infection depends on the following: clinician’s level of suspicion; the infecting organism and its antibiotic susceptibilities; the type of infection; factors associated with specific antibiotic agents; host factors; and public health considerations. This review provides an overview of antibiotic therapy and covers identifying the cause of an infection, determination of bacterial susceptibility to specific drugs, site of infection and ancillary therapy, antibiotic drug targets, pharmacodynamic parameters, factors affecting dosage and route of administration, host factors, complications of antibiotic therapy, Clostridium difficile infection, and antimicrobial resistance. 
This review contains 2 figures, 7 tables, and 45 references.
Key words: Antimicrobial therapy, antibiotic, infection, microorganism, renal dosing, hepatic dosing, Clostridium difficile
Viral Hepatitis Other than A, B, or C
Authors: Anwar Nadeem , Sherman Kenneth E.
Published: January 2021

Viral hepatitis is a global, although variably distributed, health problem associated with significant morbidity and mortality. Infection with a hepatitis virus leads to acute inflammation and liver cell damage (hepatocyte injury). Such infection may be symptomatic or subclinical and may result in disease resolution, death from fulminant hepatic failure, or development of  a chronic disease state. Whereas the chronic infection with hepatitis B and C accounts for a global burden of more than 500,000,000 cases, the global death rate from all types of hepatitis is approximately 1 million people annually. This review focuses on the virology, epidemiology, clinical features, diagnosis, treatment, and prevention of hepatitis D and hepatitis E, as well as other viruses associated with hepatitis. Figures show the global distribution of hepatitis D infection, elevation of anti–hepatitis D virus antibodies in hepatitis B/hepatitis D virus coinfection, geographic distribution of hepatitis E virus by genotype, factors significant in the pathogenesis of hepatitis E, and pattern of antibody elevation in hepatitis E. The table lists proposed diagnostic criteria for hepatitis E virus.
This review contains 5 highly rendered figures, 1 table, and 42 references.
Key words: hepatitis D, hepatitis D virus, hepatitis E, hepatitis E virus, non-A hepatitis, non-B hepatitis, non-C hepatitis, viral hepatitis
Nutrition For Healthy Infants And Toddlers
Authors: Collier Sharon , Kinne Jenny
Published: January 2021

Feeding and eating are essential to life. As the infant grows into a toddler, the child goes through transitions with feeding, starting with breast milk or formula, transitioning to complementary feeding between the ages of 4 and 6 months, and then advancing to table foods. It is important to provide adequate nutrition to meet the growing needs of the child from a macronutrient and micronutrient standpoint through infancy to childhood. Throughout this time, anthropometric measurements are obtained to assess proper growth. Feeding is a dynamic part of a child’s life that varies at each stage of childhood, which comes with challenges such as avoiding choking hazards, preventing potential food allergies, providing a varied diet to meet macronutrient and micronutrient needs, and supporting advancement in textures for appropriate development of feeding skills and avoiding issues with picky eating. Providing proper nutrition from quality, quantity, and texture standpoints at each stage of childhood is essential to ensure adequate nutrition to promote healthy and expected growth and development.  
This review contains 4 figures, 10 tables and 43 references
Key words: breast milk, complementary feeding, food, food safety, formula, growth, infant, micronutrients, neophobia, nutrition, oral health, physical activity, toddler
Definitions, Classification, and Screening of Acute Kidney Injury
Authors: Davenport Andrew
Published: January 2021

Acute kidney injury (AKI; previously acute renal failure) is defined as an acute and sustained deterioration in kidney function. As AKI is a descriptive term, an attempt should be made to establish a diagnosis in patients with AKI. There are numerous causes of AKI, and all or part of the kidney may be affected. This review discusses the definitions of AKI, measurement of renal function, incidence of AKI, baseline serum creatinine, grading and severity of AKI, and screening for AKI. Figures show renal reserve and renal tubule. Tables list consensus definitions of AKI, effect of patient demographics on serum creatinine concentration, endogenous compounds that can interfere with colorimetric modified Jaffe-based reactions for determining serum creatinine concentration, risk factors for developing AKI in adult patients proposed by the Renal Angina Index, and risk factors for developing acute contrast-induced kidney injury in adult patients.
Key Words: Acute kidney injury; Acute renal failure; Glomerular filtration rate; Serum creatinine; Kidney function; Estimated glomerular filtration rate; Biomarkers of AKI
Pathophysiology of Acute Kidney Injury
Authors: Bumb Shalini , Malone Andrew , Sparks Matthew A.
Published: January 2021

Acute kidney injury (AKI) is defined as the abrupt loss of kidney excretory function with the accumulation of nitrogenous waste products and fluid overload. The etiologies of AKI are numerous and can largely be classified as prerenal, intrinsic, or postrenal. Complex pathways involving inflammatory mediators, vascular compromise, and direct cellular injury are triggered, and equally as complex pathways, including autophagy and fibrosis, are involved in the recovery. Prerenal azotemia is caused by a reduction in tissue perfusion with resulting AKI. Although acute tubular necrosis is the most common intrinsic etiology, other nephrotoxins and exposures can result in intrinsic injury as well. Postrenal AKI is due to obstruction of urinary flow. Herein, in further detail, the mechanisms, pathophysiology, and manifestations of these causes of AKI are discussed. Research into the mechanisms and development of markers and techniques to advance clinical practice is ongoing.
Intracerebral Hemorrhage
Authors: Kreitzer Natalie P. , Adeoye Opeolu
Published: January 2021

Intracerebral hemorrhage can be classified as either secondary (due to trauma, vascular malformations, aneurysms, tumors, or hemorrhagic transformation of ischemic stroke) or primary (without a clear secondary cause). Intracerebral hemorrhage is a neurologic emergency, and leads to significant death and disability each year; care should be expedited and emergency departments should be equipped to appropriately care for and manage these patients. This review covers the risk factors, natural history, pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes for patients with intracerebral hemorrhage. Figures show head computed tomographic scans demonstrating a left basal ganglia intracerebral hemorrhage, and an algorithm of management of intracerebral hemorrhage in the emergency department. Tables list some common causes of intracerebral hemorrhage, Boston criteria for diagnosis of cerebral amyloid angiopathy, mechanism of action of common anticoagulants, and suggested reversal agents.
This review contains 2 highly rendered figures, 4 tables, and 79 references.
Hepatic Encephalopathy, Chronic Hepatic Encephalopathy (Portosystemic Encephalopathy), and Acute Liver Failure
Authors: Greenberger Norton , Qamar Amir A.
Published: January 2021

Hepatic encephalopathy, also referred to as portosystemic encephalopathy (PSE), is a complex neuropsychiatric disorder resulting from chronic parenchymal liver disease or liver failure, often in conjunction with portosystemic shunts, either naturally occurring or surgically created. PSE is characterized by changes in personality, level of consciousness, motor function, and cognition. This chapter discusses the pathophysiology, pathogenesis, diagnosis, and treatment of hepatic encephalopathy as well as general considerations, clinical findings, complications, treatment, specific causes, and prognosis regarding acute liver failure (ALF). Tables describe the causes of cirrhosis of the liver, grades of hepatic encephalopathy, diagnostic criteria and precipitating factors for PSE, a comparison of PSE patients with spontaneous shunts and cirrhotic controls, factors that may result in overt PSE in patients with well-preserved liver function, considerations in the management of PSE, and causes of ALF. Figures illustrate the A-deletion and square, spiral, star, and signature tests; triphasic waves; and magnetic resonance images of a patient with PSE. Graphs show the relationship between rifaximin and risk of an episode of hepatic encephalopathy, causes of ALF, and incidence of acetaminophen-related ALF.
This chapter contains 6 highly rendered figures, 8 tables, and 14 references.
Intrapartum Care
Authors: Hart Jessica M. , Young Brett C.
Published: January 2021

Intrapartum care encompasses the treatment of pregnancy during labor and delivery. Knowledge of the normal labor process is essential to effectively recognize and treat abnormalities, and thus optimize maternal and fetal health. This review aims to outline the physiology of labor and discuss contemporary features of spontaneous labor, prolonged labor, and arrest of labor. It addresses management of group B streptoccocous colonization and electronic fetal monitoring practices. Additionally, issues associated with term labor such as prelabor rupture of membranes, abruption, intrapartum intraamniotic infection, and persistent occiput posterior position are discussed. The review concludes with a brief overview of delivery methods. 
This review contains 7 figures, 14 tables, and 49 references.
Keywords: term labor, intrapartum monitoring, induction of labor, Group B Streptococcous prophylaxis, prelabor rupture of membranes, intraamniotic infection, mode of delivery
Abnormalities of the Fetal Head and Neck
Authors: McHugh Ann , Malone Fergal D.
Published: January 2021

Fetal head and neck abnormalities can be reliably assessed using a combination of 2D and 3D ultrasound. The accuracy of imaging depends to a large extent on gestational age. Magnetic resonance imaging (MRI) has evolved as a useful adjunct to ultrasound particularly for prenatal diagnosis of fetal head and neck anomalies. Intrauterine MRI improves diagnostic accuracy for fetal brain abnormalities and often leads to changes in management. MRI can be used to refine diagnoses in complex cases where ultrasound imaging is unclear or cannot determine the precise diagnosis. Some fetal neck masses can result in neonatal respiratory compromise. An ex utero intrapartum treatment (EXIT) procedure may be required if a neck mass is causing tracheal occlusion. Polyhydramnios can occur if there is oesophageal compression. When a fetal head and neck abnormality is detected, appropriate counselling regarding diagnosis, prognosis, and treatment options is crucial in allowing the patient to make an informed and timely decision in relation to pregnancy management.
This review contains 14 figures, 3 tables, and 68 references.
Key words: Intracranial abnormality, anencephaly, encephalocele, cystic hygroma, fetal neck mass, ventriculomegaly, fetal goiter, Craniosynostosis, Agenesis of the corpus callosum, Holoprosencephaly, EXIT
Gestational Trophoblastic Disease
Authors: Roque Dario R , Urh Anze , Kalife Elizabeth T
Published: January 2021

Gestational trophoblastic disease (GTD) represents a group of disorders that derive from placental trophoblastic tissue, including hydatidiform moles, postmolar gestational trophoblastic neoplasia (GTN), and gestational choriocarcinoma. GTN is the most curable gynecologic malignancy and tends to be more common after a complete molar pregnancy than a partial mole. Human chorionic gonadotropin (β-hCG) represents a marker for GTD and should be followed for 6 months after molar pregnancy evacuation to rule out the development of postmolar GTN. GTN is defined by a plateaued, rising, or prolonged elevated β-hCG value after molar evacuation; histologic diagnosis of choriocarcinoma, invasive mole, placental site trophoblastic tumor, or epithelioid trophoblastic tumor; or identification of metastasis after molar pregnancy evacuation. Classification for GTN as low (score ≤ 6) or high risk (score > 7) is based on the World Health Organization prognostic score. This scoring system helps select treatment, which usually entails actinomycin D or methotrexate for low-risk disease and EMA/CO (etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) for high-risk disease. These regimens can achieve cure rates approaching 100% and over 90% for low- and high-risk disease, respectively.
 This review contains 5 figures, 8 tables and 49 references
Key words: choriocarcinoma, gestational trophoblastic disease, gestational trophoblastic neoplasia, human chorionic gonadotropin, hydatidiform mole, invasive mole
Viral Infections in Pregnancy – Part 2: Viral Influenza, Mononucleosis, Mumps, Parvovirus, Rubella, Rubeola, Varicella-Zoster Virus, and Zika Virus
Authors: Duff Patrick
Published: January 2021

A number of viral infections contribute to morbidity and mortality in pregnancy and the postpartum period [see Table 1]. Here we discuss some of the major viral infections that occur in pregnancy. This particular review focuses on viral influenza, mononucleosis, mumps, parvovirus, rubella, rubeola, varicella-zoster virus, and Zika virus; other viral etiologies are discussed separately. It is imperative to understand the risk factors, clinical course, diagnostic methodology, and management of these illnesses in order to optimize perinatal outcome.
 
This review contains 4 figures, 12 tables, and 76 references.
Keywords: viral infection, pregnancy, prenatal, perinatal, influenza, mumps, parvovirus, rubella, rubeola, measles, varicella-zoster virus, Zika virus, management
Opioid-Induced Constipation: A Comprehensive Overview
Authors: Patel Trisha , Chen Hamilton , Michels John , Hata Justin
Published: January 2021

In the United States, 4.3 million adults are regularly taking opioid medications. Opioid-induced constipation (OIC) is underdiagnosed considering the prevalence of opioid use among Americans. This review is intended to clarify issues related to OIC. OIC is caused by opioids binding to specific receptors in the gastrointestinal system, resulting in various anatomic effects, including decreased gastric motility, increased sphincter tone, reduced intestinal secretions, and increased water absorption in the bowel. Various treatments include water and fiber consumption, laxatives, enemas, cessation of opioids, and central and peripheral opioid antagonists. OIC is treatable, but timely diagnosis and patient education are paramount for successful resolution.
Key words: chronic pain; constipation; mu, delta, and kappa receptors; myenteric plexus; opioid; opioid-induced constipation; opioid receptor antagonists; submucosal plexus
Antiepileptic and Antidepressant Drugs Used in the Treatment of Pain
Authors: Voiculescu Lucia Daiana
Published: January 2021

Antiepileptics and antidepressants are two categories of drugs frequently used as adjuvant analgesics. They interfere with the pain pathways at different levels through complex and not always well-defined molecular mechanisms. Although only a few have been licensed for use in the treatment of certain types of pain, anticonvulsants and antidepressants are widely prescribed off-label for pain associated with a variety of conditions. Most solid data come from experience with their use for postherpetic neuralgia, pain associated with diabetic neuropathy, and fibromyalgia. Anticonvulsants and antidepressant drugs are frequently used as first-line therapy in the treatment of pain, especially neuropathic type.

Key words: antidepressant drugs, antiepileptic drugs, carbamazepine, gabapentinoids, neuropathic pain, off-label use, serotonin-norepinephrine reuptake inhibitors, serotonin syndrome, tricyclic antidepressants, use in specific populations
Reconstruction of the Thumb after Traumatic Tissue Loss
Authors: Clune James E , Jones Neil F
Published: January 2021

The distinctive prehensile functions of the human hand are orchestrated by the thumb. Without a thumb, the hand lacks critical movements allowing for pinch, grasp, and fine manipulation. Based on the patient’s individual needs, occupation, and desires, thumb reconstruction should be offered to every patient with a traumatic amputation. Position, stability, mobility, and sensation command attention when reconstructing the absent thumb. We present the spectrum of various techniques available for reconstructing a useful thumb.

This review contains 9 figures, 3 tables and 51 references. 
Key words: Thumb; reconstruction, amputation, pollicization, toe transfer, metacarpal lengthening, webspace deepening
Lower Blepharoplasty
Authors: Bojovic Branko , Buta Martin
Published: January 2021

This review provides an overview of lower eyelid blepharoplasty, with discussion focused on relevant anatomy, the effects of aging on the lower eyelid and lid/cheek junction, patient evaluation, the most common surgical techniques, complications from surgery, and outcomes assessment. Emphasis is placed on tailoring surgical approaches to the specific aesthetic and functional concerns for each patient. 
Keywords: blepharoplasty, lower lid surgery, transconjunctival blepharoplasty, transcutaneous blepharoplasty, pseudoherniation, cosmetic surgery, surgery techniques, aesthetic surgery, tear trough deformity, orbital fat, eyelid laxity, canthoplasty
This review contains 6 figures, 2 tables, and 50 references.
Antisocial Personality Disorder and Its Clinical Management
Authors: Black Donald W.
Published: January 2021

Antisocial personality disorder (ASPD) is characterized by irresponsibility, aggression, criminality, and, in some, a lack of conscience. Recognized for over 200 years, ASPD is associated with domestic violence, psychiatric comorbidity, substance abuse, and excess health care use. ASPD is highly prevalent, and most affected individuals are men. ASPD has its onset in childhood or adolescence, when it may be diagnosed as a disruptive behavior disorder or conduct disorder. Not diagnosed until age 18, ASPD peaks in severity in the late teens or early 20s. It is lifelong for most persons, although the trend is toward improvement in those individuals with an adolescent onset and a prominent antisocial lifestyle. Those who do best have milder syndromes, are married/partnered, have stable jobs, and are older. ASPD is thought to result from a combination of genetic and environmental factors. Some antisocial persons have shown functional abnormalities in limbic structures and the frontotemporal cortex, portions of the brain that control judgment and regulate impulses. There are no effective pharmacologic treatments, but some antisocial persons receive off-label medication to dampen aggressive tendencies and curb impulsivity. Psychotropic medication is also used to treat comorbid syndromes (e.g., major depression). Cognitive-behavioral therapy may be helpful in mild cases. Family and couples therapies may be important for antisocial persons who are partnered or have offspring.
This review contains 1 figure, 2 tables, and 99 references.
Key words: aggression, antisocial personality disorder, conduct disorder, impulsivity, juvenile delinquency, lack of remorse, psychopathy, sociopathy
Supportive Psychotherapy
Authors: Crocker Erin
Published: January 2021

Supportive psychotherapy (SPT) is a form of psychological treatment in which a care provider collaborates with a patient to help maximize his or her level of psychosocial functioning and adaptation to his or her current situation. Unfortunately, SPT is often limited to use by psychiatrists within psychiatric settings, even though patients with medical illness also benefit significantly from these interventions. There is arguably a need to incorporate training in brief SPT techniques into general medical education as learning to provide support to patients and help them function to the best of their ability during difficult times is an important part of the role that all physicians should be prepared to provide for their patients.
This review contains 4 figures, 3 tables, and 45 references.
Key words: alliance, boundaries, coping, empathy, frame, psychotherapy, relationships, supportive
Overview of Ethics in Psychiatry
Authors: Erwin Cheryl , Tansey Janeta
Published: January 2021

This review of psychiatry ethics is intended for residents, fellows, and practicing psychiatrists. We provide an overview of the historical sources of ethical reasoning and give practitioners a structured method for analysis of ethical dilemmas typically encountered in the practice of medicine. Through the use of case examples, we explain how difficult situations often challenge received knowledge and superficial opinion about the ethical options present and justifiable in real-life situations. This review will appeal to the higher callings and traditions of medicine and encourage the physician who is faced with ethical decisions about which reasonable practitioners may disagree. Tools of ethical reasoning provide a means for making ethical decisions that are grounded in history and tradition.
This review contains 1 figure, 6 tables, and 30 references.
Key words: confidentiality, decision making, doctor-patient relationship, ethics, informed consent, narrative, principles, professionalism, respect, virtue