bluuebunny/crossref_metadata_2025 huggingface dataset:
Understandability, actionability, and readability of online patient education materials about diabetes mellitus
Authors: Lipari Melissa , Berlie Helen , Saleh Yasmin , Hang Pang , Moser Lynette
Published: January 2019

Purpose

The purpose of this study was to assess the understandability, actionability, and readability of online diabetes education materials.

This was a descriptive study that identified printable diabetes education materials through an online search. Materials were included from the following sources: national organizations with materials approved by expert panels, corporations with materials subject to FDA approval, and not-for-profit organizations with inter-professional advisory boards to approve materials. Topics included were basic knowledge of diabetes, hypoglycemia, insulin, and blood sugar goals. Materials were excluded if they were non-printable, contained active links, had a publication date prior to January 2011, were greater than 2 pages in length, or were pediatric focused. Understandability and actionability of the patient education materials were evaluated using the Patient Education Materials Assessment Tool (PEMAT). Descriptive statistics and inter-rater reliability analysis using the kappa statistic were utilized. Readability was assessed using the Flesch-Kincaid Grade Level and Simple Measure of Gobbledygook (SMOG) formula. Pearson correlation coefficient was calculated to assess the relationship between reading grade level and PEMAT scores. In total, 25 websites were identified, 5 of which met the inclusion criteria; 13 patient education materials were included, PEMAT scoring revealed that 4 of these met the criteria for understandability and only 1 met the criteria for actionability. There was no correlation found between PEMAT scores and reading grade levels (Pearson correlation coefficient = −0.30, p = 0.325).

Conclusion

The majority of diabetes patient education materials reviewed scored poorly using the PEMAT. Future development of diabetes patient education materials should be designed with the goal of increasing understandability and actionability.
Resource allocation trade-offs and the loss of chemical defences during apple domestication
Authors: Whitehead Susan R , Poveda Katja
Published: January 2019

Background and Aims

Most crops have been dramatically altered from their wild ancestors with the primary goal of increasing harvestable yield. A long-held hypothesis is that increased allocation to yield has reduced plant investment in defence and resulted in crops that are highly susceptible to pests. However, clear demonstrations of these trade-offs have been elusive due to the many selective pressures that occur concurrently during crop domestication.

Methods

To provide a robust test of whether increased allocation to yield can alter plant investment in defence, this study examined fruit chemical defence traits and herbivore resistance across 52 wild and 56 domesticated genotypes of apples that vary >26-fold in fruit size. Ninety-six phenolic metabolites were quantified in apple skin, pulp and seeds, and resistance to the codling moth was assessed with a series of bioassays.

Key Results

The results show that wild apples have higher total phenolic concentrations and a higher diversity of metabolites than domesticated apples in skin, pulp and seeds. A negative phenotypic relationship between fruit size and phenolics indicates that this pattern is driven in part by allocation-based trade-offs between yield and defence. There were no clear differences in codling moth performance between wild and domesticated apples and no overall effects of total phenolic concentration on codling moth performance, but the results did show that codling moth resistance was increased in apples with higher phenolic diversity. The concentrations of a few individual compounds (primarily flavan-3-ols) also correlated with increased resistance, primarily driven by a reduction in pupal mass of female moths.

Conclusions

The negative phenotypic relationship between fruit size and phenolic content, observed across a large number of wild and domesticated genotypes, supports the hypothesis of yield–defence trade-offs in crops. However, the limited effects of phenolics on codling moth highlight the complexity of consequences that domestication has for plant–herbivore interactions. Continued studies of crop domestication can further our understanding of the multiple trade-offs involved in plant defence, while simultaneously leading to novel discoveries that can improve the sustainability of crop production.
admixr—R package for reproducible analyses using ADMIXTOOLS
Authors: Petr Martin , Vernot Benjamin , Kelso Janet
Published: January 2019

We present a new R package admixr, which provides a convenient interface for performing reproducible population genetic analyses (f3, D, f4, f4-ratio, qpWave and qpAdm), as implemented by command-line programs in the ADMIXTOOLS software suite. In a traditional ADMIXTOOLS workflow, the user must first generate a set of text configuration files tailored to each individual analysis, often using a combination of shell scripting and manual text editing. The non-tabular output files then need to be parsed to extract values of interest prior to further analyses. Our package simplifies this process by automating all low-level configuration and parsing steps, making analyses as simple as running a single R command. Furthermore, we provide a set of R functions for processing, filtering and manipulating datasets in the EIGENSTRAT format. By unifying all steps of the workflow under a single R framework, this package enables the automation of analytic pipelines, significantly improving the reproducibility of population genetic studies.

Availability and implementation

The source code of the R package is available under the MIT license. Installation instructions, reference manual and a tutorial can be found on the package website at https://bioinf.eva.mpg.de/admixr.

Supplementary information

Supplementary data are available at Bioinformatics online.
multiHiCcompare: joint normalization and comparative analysis of complex Hi-C experiments
Authors: Stansfield John C , Cresswell Kellen G , Dozmorov Mikhail G
Published: January 2019

Motivation

With the development of chromatin conformation capture technology and its high-throughput derivative Hi-C sequencing, studies of the three-dimensional interactome of the genome that involve multiple Hi-C datasets are becoming available. To account for the technology-driven biases unique to each dataset, there is a distinct need for methods to jointly normalize multiple Hi-C datasets. Previous attempts at removing biases from Hi-C data have made use of techniques which normalize individual Hi-C datasets, or, at best, jointly normalize two datasets.

Results

Here, we present multiHiCcompare, a cyclic loess regression-based joint normalization technique for removing biases across multiple Hi-C datasets. In contrast to other normalization techniques, it properly handles the Hi-C-specific decay of chromatin interaction frequencies with the increasing distance between interacting regions. multiHiCcompare uses the general linear model framework for comparative analysis of multiple Hi-C datasets, adapted for the Hi-C-specific decay of chromatin interaction frequencies. multiHiCcompare outperforms other methods when detecting a priori known chromatin interaction differences from jointly normalized datasets. Applied to the analysis of auxin-treated versus untreated experiments, and CTCF depletion experiments, multiHiCcompare was able to recover the expected epigenetic and gene expression signatures of loss of chromatin interactions and reveal novel insights.

Availability and implementation

multiHiCcompare is freely available on GitHub and as a Bioconductor R package https://bioconductor.org/packages/multiHiCcompare.

Supplementary information

Supplementary data are available at Bioinformatics online.
Treatment Effectiveness of Azithromycin and Doxycycline in Uncomplicated Rectal and Vaginal Chlamydia trachomatis Infections in Women: A Multicenter Observational Study (FemCure)
Authors: Dukers-Muijrers Nicole H T M , Wolffs Petra F G , De Vries Henry , Götz Hannelore M , Heijman Titia , Bruisten Sylvia , Eppings Lisanne , Hogewoning Arjan , Steenbakkers Mieke , Lucchesi Mayk , Schim van der Loeff Maarten F , Hoebe Christian J P A
Published: January 2019

Background

Rectal infections with Chlamydia trachomatis (CT) are prevalent in women visiting a sexually transmitted infection outpatient clinic, but it remains unclear what the most effective treatment is. We assessed the effectiveness of doxycycline and azithromycin for the treatment of rectal and vaginal chlamydia in women.

Methods

This study is part of a prospective multicenter cohort study (FemCure). Treatment consisted of doxycycline (100 mg twice daily for 7 days) in rectal CT–positive women, and of azithromycin (1 g single dose) in vaginally positive women who were rectally untested or rectally negative. Participants self-collected rectal and vaginal samples at enrollment (treatment time-point) and during 4 weeks of follow-up. The endpoint was microbiological cure by a negative nucleic acid amplification test at 4 weeks. Differences between cure proportions and 95% confidence intervals (CIs) were calculated.

Results

We analyzed 416 patients, of whom 319 had both rectal and vaginal chlamydia at enrollment, 22 had rectal chlamydia only, and 75 had vaginal chlamydia only. In 341 rectal infections, microbiological cure in azithromycin-treated women was 78.5% (95% CI, 72.6%–83.7%; n = 164/209) and 95.5% (95% CI, 91.0%–98.2%; n = 126/132) in doxycycline-treated women (difference, 17.0% [95% CI, 9.6%–24.7%]; P < .001). In 394 vaginal infections, cure was 93.5% (95% CI, 90.1%–96.1%; n = 246/263) in azithromycin-treated women and 95.4% (95% CI, 90.9%–98.2%; n = 125/131) in doxycycline-treated women (difference, 1.9% [95% CI, –3.6% to 6.7%]; P = .504).

Conclusions

The effectiveness of doxycycline is high and exceeds that of azithromycin for the treatment of rectal CT infections in women.

Clinical Trials Registration

NCT02694497.
The Juncture Between Clostridioides difficile Infection and Inflammatory Bowel Diseases
Authors: Beniwal-Patel Poonam , Stein Daniel J , Munoz-Price L Silvia
Published: January 2019

The detection of Clostridioides difficile in inflammatory bowel disease (IBD) patients is a common occurrence, in part due to the standard clinical practice of testing for the presence of C. difficile during acute IBD exacerbations. Given the clinical overlap between C. difficile infections and acute IBD exacerbations (ie, increased frequency of loose stools, abdominal pain), it is hard to differentiate C. difficile infections versus colonizations in patients with underlying IBD who test positive for C. difficile. Here, we review the epidemiology, clinical presentation, risk factors, diagnosis, treatment, and outcomes of IBD patients with positive C. difficile tests.
Relevant Infections in Inflammatory Bowel Disease, and Their Relationship With Immunosuppressive Therapy and Their Effects on Disease Mortality
Authors: Zabana Yamile , Rodríguez Lorena , Lobatón Triana , Gordillo Jordi , Montserrat Antonia , Mena Raquel , Beltrán Belén , Dotti Marina , Benitez Olga , Guardiola Jordi , Domènech Eugeni , Garcia-Planella Esther , Calvet Xavier , Piqueras Marta , Aceituno Montserrat , Fernández-Bañares Fernando , Esteve Maria
Published: January 2019

Background and Aims

There is controversy as to whether the risk of relevant infection in IBD is related to immunosuppressants or the disease itself. The aims of this study were to evaluate: [1] the life-long prevalence and types of relevant infections in patients with IBD related to immunosuppressive treatment, and [2] the relationship of both infection and patient comorbidity to mortality.

Methods

Observational multicentre retrospective study of IBD patients that presented a relevant infection. For each case, four periods of infection exposure were analysed: P1: pre-IBD diagnosis, P2: from IBD diagnosis to immunosuppressant initiation, P3: during immunosuppressant therapy, and P4: after treatment withdrawal.

Results

The life-long prevalence of relevant infection in the total cohort of patients [6914] was 3%, and 5% in immunosuppressed patients [4202]. 366 relevant infections were found in 212 patients [P1: 9, P2: 17, P3: 334, and P4: 6]. Differences between periods were significant [p < 0.0001]. The most frequent types of infection were respiratory, intestinal and urinary. The most frequent opportunistic infections were tuberculosis [prevalence: 2.6/1000] and herpes zoster [prevalence: 3.9/1000]. Herpes zoster infection was associated with thiopurines alone or in combination with anti-TNF in 75% of the cases, whereas tuberculosis was associated with anti-TNF in 94% of patients. The overall mortality was 4.2%. Infection-related mortality was 2.8% and it was not influenced by comorbidity.

Conclusions

Relevant infections in IBD patients are rare and appear to be related to immunosuppression. Relevant infection is a major cause of death in IBD.
Why Parental Unemployment Matters for Children’s Educational Attainment: Empirical Evidence from The Netherlands
Authors: Mooi-Reci Irma , Bakker Bart , Curry Matthew , Wooden Mark
Published: January 2019

This study examines the effect of parents’ unemployment on their children’s subsequent educational attainment. Its theoretical significance lies on its focus to test the mediating role of parents’ changing work ethics during spells of unemployment. Integrating multiple survey and administrative data sources, our estimates are based on a sample of Dutch children (n = 812) who were exposed to their parents’ unemployment during the previous economic crisis in the early 1980s. Our results reveal a direct negative effect between fathers’ unemployment duration and their children’s educational attainment and also an indirect effect through mothers’ changing attitudes towards work. We also find empirical evidence that mothers’ and fathers’ whose views about work become more pessimistic lead to reduced educational attainment among their children.
Blockade of the fractalkine–CX3CR1 axis ameliorates experimental colitis by dislodging venous crawling monocytes
Authors: Kuboi Yoshikazu , Nishimura Miyuki , Ikeda Wataru , Nakatani Tomoya , Seki Yukie , Yamaura Yui , Ogawa Kana , Hamaguchi Akiko , Muramoto Kenzo , Mizuno Keiko , Ogasawara Hideaki , Yamauchi Toshihiko , Yasuda Nobuyuki , Onodera Hiroshi , Imai Toshio
Published: January 2019

Chemokine systems modulate inflammatory and immune responses in inflammatory bowel disease (IBD). The colons of IBD patients show increased levels of fractalkine (FKN) and high numbers of FKN receptor-positive (CX3CR1+) cells; however, the FKN–CX3CR1 axis’s role in intestinal inflammation, especially in intravascular leukocyte behaviors, still remains unclear. Here, we show that interruption of the FKN–CX3CR1 axis by anti-FKN monoclonal antibody (mAb) ameliorates murine colitis through regulation of intravascular monocyte behaviors in murine colitis models. FKN expression was detectable in vascular endothelium and CX3CR1+ macrophages accumulated in the mucosal lamina propria and submucosa of the inflamed colons. CD115+ monocytes tethered to the venous endothelium and expressed pro-inflammatory mediators. The anti-FKN mAb improved colitis symptoms, markedly reduced pro-inflammatory factors in the colon, maintained blood vessel integrity and reduced tethered monocytes in the inflamed veins. Intravital imaging revealed that CD115+Gr-1low/− monocytes crawled on the apical surfaces of venous endothelium, and anti-FKN mAb rapidly dislodged the crawling monocytes and inhibited their patrolling behavior. These findings suggest that the FKN–CX3CR1 axis triggers the patrolling behavior of crawling monocytes on the venous endothelium of inflamed colons, and accelerates the subsequent leukocyte activation and infiltration by locally producing inflammatory cytokines and chemokines. The mAb also ameliorated symptoms in another IBD model, T-cell-transferred colitis. Blocking the FKN–CX3CR1 axis with an anti-FKN mAb considerably inhibits the colitis-triggered inflammatory cascades, which may be an alternative strategy to treat IBD.
Blast Traumatic Brain Injury Mechanisms
Authors: McNeil Elizabeth , Bailey Zachary , Guettler Allison , VandeVord Pamela
Published: January 2019

Blast traumatic brain injury (bTBI) is a leading cause of head injury in soldiers returning from the battlefield. Primary blast brain injury remains controversial with little evidence to support a primary mechanism of injury. The four main theories described herein include blast wave transmission through skull orifices, direct cranial transmission, thoracic surge, and skull flexure dynamics. It is possible that these mechanisms do not occur exclusively from each other, but rather that several of them lead to primary blast brain injury. Biomechanical investigation with in-vivo, cadaver, and finite element models would greatly increase our understanding of bTBI mechanisms.
Adult and Pediatric Mild and Moderate Head Injury Management in Scandinavian Countries
Authors: Olivecrona Zandra , Undén Johan
Published: January 2019

The Scandinavian Neurotrauma Committee (SNC) was initiated by the Scandinavian Neurosurgical Society to improve the care of neurotrauma patients. The SNC has presented evidence-based guidelines for initial management of minimal, mild, and moderate head injuries. Separate guidelines are presented for children and adults. The biomarker S100β‎ is included in the adult guidelines in an attempt to reduce computed tomography (CT) usage and costs. The aim of the guidelines is to guide physicians in the emergency department during initial management of adult and pediatric patients with minimal, mild, and moderate head injuries, specifically to decide which patients are to receive CT scanning, admission, or discharge from the emergency department.
Translational Mild Traumatic Brain Injury Research: Bridging the Gap Between Models and Clinical Uncertainty
Authors: Park Eugene , Baker Andrew J.
Published: January 2019

Accurate clinical diagnosis of mild traumatic brain injury (mTBI) is limited by assumptions of underlying pathophysiology based on external examination, self-reporting, and limited imaging capabilities. Translational research bridges pathophysiology from animal models to address clinical uncertainty. These studies have been crucial to understanding underlying mechanistic events in greater detail and in identifying putative therapeutic targets and strategies. However, the clinical unknowns and attempts to understand them through translational research inevitably lead to disconnects between translational models and clinical reality. Contributing factors include the validity of animal models of mTBI and what information can be reliably extrapolated to human pathophysiology. Accurate diagnosis for an injury that can manifest as subclinical not only presents a significant hurdle in determining the epidemiological magnitude of mTBI but also presents technical difficulties in translational model building. This chapter highlights efforts in translational and clinical research to address the complex and heterogeneous challenges of mTBI.
Animal Models of Pediatric Traumatic Brain Injury: Lessons Learned
Authors: Huh Jimmy W. , Hanlon Lauren A. , Raghupathi Ramesh
Published: January 2019

A predominant focus of both clinical and preclinical pediatric traumatic brain injury (TBI) research is to combat secondary injury processes in the acute posttraumatic period that may contribute to pathologies that lead to long-term functional impairments. Identified therapeutic targets must undergo rigorous preclinical testing in relevant animal models of pediatric TBI. Animal models for pediatric TBI use injury mechanisms such as fluid-percussion, rotational-acceleration, weight-drop, and controlled cortical impact. These models span species (mice, rats, rabbits and pigs) and several age groups to encompass the developmental time points and utilize various injury severities to reproduce the pathologies such as atrophy, ventriculomegaly, white matter injury, and behavioral impairment. This review focuses on the validation of these preclinical models using clinical observations of structural and functional impairment in the acute and chronic period following TBI. In addition, the limitations of the current animal models are discussed within the context of strategies for further development of clinically relevant outcomes and therapeutic strategies.
Autoimmunity Responses in Traumatic Brain Injury and Spinal Cord Injury
Authors: Yang Zhihui , Bahmad Hisham F. , Zhu Tian , Wong Aaron T. , Kothari Isha , Kobeissy Firas , Wang Kevin K. W.
Published: January 2019

Traumatic brain injury (TBI) and traumatic spinal cord injury (SCI) cause the release of brain-specific proteins that may trigger an autoantibody response. These brain proteins are treated by the immune system as foreign antigens and can evoke the systemic production of both IgM and IgG isoforms. Increasing evidence shows that, in a subset of TBI patients, there are circulating autoantibodies recognizing a range of brain proteins. Autoantibodies against these are identified in SCI patients. Autoimmunity is triggered in TBI or SCI, targeting a range of brain-specific antigens in a subset of TBI patients. Such autoantibodies might be useful for biofluid-based diagnosis to identify patients who might benefit from immunotherapy. This chapter discusses how autoimmunity is triggered after TBI or SCI and summarizes identified brain antigens to which an autoimmune response has been observed as well as their clinical implications.
Basic Principles of Functional MRI
Authors: Tang Cheuk Ying
Published: January 2019

Blood oxygen level dependent (BOLD) MRI, also called functional MRI (fMRI), is one of the most widely used modalities for studying brain function. The underlying source of the fMRI signal is blood flow and the oxygenation state of hemoglobin. fMRI is mostly used to map out the location and intensity of brain activity that correlate with mental activities. In recent years, a new approach to fMRI has been developed that is called resting-state fMRI. The fMRI signal from this method does not require the brain to perform a goal-directed task; it is acquired with the subject at rest. It was discovered that there are low-frequency fluctuations in the fMRI signal in the brain at rest. These signals come from spatially distinct brain regions but exhibit coherent, time-synchronous fluctuations. Several of the networks have been identified and are called resting-state networks. The networks represent the strength of the functional connectivity between distinct brain regions and have been used as imaging biomarkers for various neurological and psychiatric diseases. Resting-state fMRI is also ideally suited for functional brain imaging in disorders of consciousness and in subjects under anesthesia. In this chapter, we provide an introductory review of the basic principles of fMRI: signal sources, acquisition methods, and data analysis.
Functional MRI Data Analysis
Authors: Gómez Francisco , Castellanos Gabriel
Published: January 2019

Functional MRI (fMRI) data analysis aims to characterize neuronal dynamics by using observations of the hemodynamic phenomena associated with neuronal activity. These observations are indirect and highly “noisy” and commonly require different models for data interpretation. Many techniques have been developed in recent years for analyzing fMRI data. Despite advances in fMRI, there are some limitations that have to be considered in obtaining successful characterization of neuronal activity from fMRI data. In this chapter, the fundamentals of fMRI data analysis are described. Initially, the basis of the hemodynamic phenomena associated with neuronal activity is presented. This is followed by a description of the principal models used to perform fMRI data analysis. Finally, some of the most critical aspects of fMRI data analysis are covered.
Classification of Neuropathic Pain
Authors: Kandil Abdullah , Perret Danielle
Published: January 2019

Neuropathic pain encompasses a category of chronic pain conditions that are caused by disease or lesion of the somatosensory nervous system. Depending on the location of the lesion or disease, neuropathic pain can be categorized as peripheral, central, or mixed. Peripheral neuropathic pain includes such common pain conditions as painful diabetic neuropathy, postherpetic neuralgia, radiculopathies, post-amputation stump pain, various nerve entrapment syndromes, and neuropathies due to immune, hereditary, metabolic, and toxic factors. Central neuropathic pain is pain caused by stroke, spinal cord injury, spinal infarction, syringomyelia, multiple sclerosis, Parkinson disease, and phantom limb pain. In contrast, some conditions may cause pain through both central and peripheral mechanisms, such spinal stenosis, complex regional pain syndrome type II, Charcot-Marie-Tooth disease, fibromyalgia, and cancer pain. Classification of neuropathic may not only help guide the diagnosis and treatment of these chronic pain conditions but may also provide the framework for research of the mechanisms of generation of neuropathic pain.
Ischemic Neuropathy
Authors: Devarajan Jagan , Minzter Beth H.
Published: January 2019

This chapter discusses the subset of ischemic neuropathy which is due primarily to peripheral arterial disease. Peripheral arterial disease affects 5% of men and 2.5% of women and results in ischemic pain and claudication. Disease progression occurs in a small minority of patients to a stage of critical ischemia with rest pain and threatens limb survival. Ischemic neuropathy encompasses pain due to several stages of progression of tissue ischemia. Patients may have multiple comorbid conditions due to the same pathological process that affects coronary, cerebral, and other circulations. Diabetes mellitus is commonly associated with vascular ischemia and results in arterial occlusive diseases. Pathological changes involve demyelination, axonal loss, and disorderly remyelination. In addition to simple palpation of a pulse, Doppler flow estimation and angiography are used to determine the location and extent of the disease process. Ankle-brachial index, toe-brachial index, and digital flow estimations are more sensitive methods used for early identification. In addition to controlling risk factors and the management of comorbid conditions, medication and procedures to restore blood flow play a prominent role in management of ischemic neuropathy. Sympatholysis and spinal cord stimulation are effective methods to help manage chronic pain in advanced cases that are refractory to conventional treatment measures.
Multiple Sclerosis
Authors: Samuel Samuel W. , Cheng Jianguo
Published: January 2019

Multiple sclerosis (MS) is a chronic autoimmune demyelinating disease of the central nervous system (CNS). The diagnosis is based on evidence of at lease two different lesions in the CNS, at least two different episodes in the disease course, and chronic inflammation of the CNS as determined by analysis of the cerebrospinal fluid. Central neuropathic pain is the most common form of pain in patients with MS, with an estimated prevalence of about 50%. Along with the classical neuropathic pain features, such as spontaneous pain (dysesthesia and burning) and evoked pain (allodynia and hyperalgesia), patients with MS may also suffer from intermittent neuropathic pain, such as trigeminal neuralgia, Lhermitte sign, and glossopharyngeal neuralgia. In addition to disease-modifying therapies of MS, multiple treatments are available to manage neuropathic pain secondary to MS, including medical, interventional, and surgical treatments with varying levels of evidence.
Cervical Radiculopathy
Authors: Samuel Samuel W. , Icaza Eduardo E.
Published: January 2019

This chapter discusses cervical radiculopathy, a common, painful condition from cervical root compression, irritation, or both. A thorough history and physical exam can often help in diagnosing the affected nerve root, without the need for reflexive imaging. A series of provocative tests can aid in the differential diagnosis. Most cases will be resolved with conservative management within several weeks of symptoms onset. Evidence-based conservative management includes physical therapy and oral NSAIDs. If symptoms indicate myelopathic changes or are refractory to 6 to 8 weeks of conservative management, advanced imaging such as MRI should be considered. Patients with imaging evidence of a compressive etiology and refractory to conservative therapy should have a surgical consultation. Either an MRI or CT should be obtained before surgical decompression. Both interventional and surgical treatments have had positive outcomes in the short term, but long-term outcomes appear comparable to those with conservative therapies. It is recommended that conservative treatment strategies be used for 6–8 weeks before pursuing procedural or surgical intervention.
Thoracic Radicular Pain
Authors: Foorsov Victor , Pastoriza Sarah M.
Published: January 2019

Thoracic radiculopathy presents an uncommon spinal disorder that can often be overlooked because numerous structures surround the thoracic spine. Radiculopathy typically originates from mechanical nerve root compression due to degenerative spine changes such as disc herniation, spondylosis, or osteoporosis and its associated vertebral compression fractures. The presentation of radicular pain in the thoracic region is more common in the upper thoracic and, with lateral disk herniations, often associated with some amount of axial pain. Clinical symptoms are leg weakness, numbness and tingling across the chest or abdomen or shoulders, spasticity, and bowel or bladder dysfunction. The vast majority of patients with thoracic pain return to their previous functional level without surgical intervention. Strengthening, postural optimization, and general exercise and mobility comprise the cornerstone of all treatment and prevention of thoracic radicular pain. Medication may include a variety of choices, ranging from NSAIDs to anticonvulsants. Medications to address specific health issues leading to thoracic radiculopathy (diabetes mellitus and osteoporosis) may be of additional benefit. Thoracic epidural injections or paravertebral blocks with corticosteroids and local anesthetics may be a treatment consideration. Surgical intervention is reserved for patients in whom conservative management has failed and who have persistent pain symptoms. Myelopathy is an indication for surgical intervention. Spinal cord stimulation may be effective to address chronic radiculopathy in selected patients.
Lumbar Radicular Pain
Authors: Rimmalapudi Varun , Grandhe Radhika
Published: January 2019

This chapter addresses lumbar radicular pain, which is pain that can be attributed to a lesion affecting fibers of a spinal nerve, the nerve root, or the dorsal root ganglia. Causes of radicular pain are diverse and may include mechanical causes such as herniated intervertebral discs and lumbar foraminal stenosis or systemic causes such as diabetic neuropathy and lupus. A thorough history and meticulous examination are necessary to delineate the involved nerve root and to rule out other conditions. Imaging modalities must be judiciously used to determine the site of compression. Management may start with noninvasive management measures, including physical therapy and medications. It should be guided by patient response, progression of symptoms, and the natural progression of disease.
Arachnoiditis
Authors: Malik Zeeshan , Patil Shilpadevi , Arulkumar Sailesh , Shah Rinoo V.
Published: January 2019

Arachnoiditis is a rare debilitating condition characterized by back pain, paresthesias, decreased truncal movement, lower extremity weakness, and decreased reflexes. The arachnoid mater is the middle layer of the meninges that envelope the spinal cord and brain. The dura mater lies on the outer layer of the meninges, arachnoid mater in between, and the pia mater lying closest to the neural tissue. These three layers provide protection and blood supply to the areas they surround. Arachnoiditis is the inflammation of the arachnoid layer that can occur after an insult is encountered to this layer. It causes swelling of the arachnoid layer, which eventually leads to scarring from collagen deposition over time. Arachnoiditis may become a chronic condition that can be difficult to treat.
Persistent Idiopathic Facial Pain
Authors: Van Oostrom Trevor
Published: January 2019

Persistent idiopathic facial pain (PIFP) is an enigmatic condition which has caused a great deal of suffering yet has been difficult to define and remains a challenging disorder to treat. In addition, the presentation of PIFP has considerable overlap with many other causes of facial pain making the malady a diagnostic challenge. The condition is often resistant to treatment and patients often have comorbid syndromes or psychological factors. This chapter reviews the history and development of the current diagnostic criteria of PIFP according to the latest edition of the International Classification of Headache Disorders (ICHD). Using a case-based approach, the pathophysiology, epidemiology, differential diagnosis, and treatment options of PIFP are explored.
Complex Regional Pain Syndrome
Authors: Kim Brian A. , Furnish Timothy
Published: January 2019

Complex regional pain syndrome (CRPS) is a challenging pain condition with incompletely elucidated pathophysiology, most often affecting a single extremity after an inciting injury. The most common clinical finding is burning pain out of proportion to any identifiable initiating event, with a combination of sensory, vasomotor, sudomotor, and motor/trophic signs and symptoms. The management of CRPS emphasizes early diagnosis and aggressive multimodal treatment based on physical therapy, psychological therapy, and pain management with frequent reassessments of patient progression. In order to prevent permanent life-altering disability, all modalities including interventional therapies should be escalated in tandem, based on assessments of patient responsiveness. Clinicians should consider escalating therapy frequently if no improvement is observed, and introducing psychological evaluation if symptoms persist. Lastly, the use of interventional techniques such as sympathetic blocks or spinal cord stimulation should be employed early in refractory cases.
Vascular Pathology
Authors: Hauw Jean-Jacques , Feske Steven K. , Amarenco Pierre , De Girolami Umberto
Published: January 2019

The classification of vascular diseases of the central nervous system proposed here considers at first two large groups of entities: large intraparenchymal hemorrhage due to rupture of blood vessels and then, infarction from occlusion of major vessels. The underlying vessel abnormality is discussed, as are the reactions over time of nervous tissue to irreversible injury. Intracranial hemorrhages can also be seen in the context of rupture of vessels, with outpouring of blood into the subarachnoid spaces in cases of ruptured aneurysm or of vascular malformation. Small vessel disease is considered separately, these are instances of lesions affecting the microcirculation; clinical manifestations include dementia, encephalopathies, or multifocal neurologic deficits, the result of multiple microhemorrhages, small infarcts, or both. Vascular diseases affecting the small blood vessels include hypertensive cerebrovascular disease and cerebral amyloid angiopathy. Less common entities include hereditary disorders (i.e., cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and vasculitides).
Gastrointestinal Emergencies
Authors: Dhillon Sukhjit , McCue James , Riccoboni Steven , Sunde Caleb
Published: January 2019

Gastrointestinal disorders and emergencies are one of the most common presentations to an emergency department (ED). Symptoms frequently seen in the ED include abdominal pain, nausea, vomiting, diarrhea, and fever. The differential diagnosis changes depending on the age and gender of the patient, duration of symptoms, the systemic effects, recent travel or exposures, and the description of the symptoms. Life-threatening emergencies include abdominal aortic aneurysm, mesenteric ischemia, foreign body ingestion, gastrointestinal bleeding, acute pancreatitis, spontaneous bacterial peritonitis, aortoenteric fistula, and acute bilirubin encephalopathy, among others. It is the emergency physician’s job to recognize these life-threatening conditions of the gastrointestinal tract and start treatment.
Cardiovascular Emergencies
Authors: Brueggeman Kurt , Eidemiller Seth , Kukurza Michael , Manis Leann , McCue James
Published: January 2019

Cardiovascular emergencies are common presentations to the emergency department (ED) and run the gamut from acute coronary syndrome to congenital cardiac defects. Many of these disease processes can lead to death if not quickly identified and treated properly. However, patients can present with benign processes that manifest similar to the diseases that are potentially fatal. It is the emergency providers’ task, both in the ED and in test-taking situations, to pick up on clues in the presentation that help to make the right diagnosis and provide the best treatment in a timely fashion.
Environmental Emergencies
Authors: Darracq Michael A.
Published: January 2019

Although environmental emergencies are not the most common presentations to the emergency department (ED), as humans continue to explore more remote areas of the planet and as large populations encounter environmental change at increasing rates, it is important for emergency clinicians to know how to manage these conditions. From extremes of temperature, to extremes of pressure, to drownings and lightning strikes, to a myriad of possible envenomations, environmental emergencies are interesting and diverse. This chapter presents questions related to the diagnosis, clinical effects, best first response in the ED, and most appropriate treatment of a wide range of these environmental emergencies.
Nontraumatic Musculoskeletal Disorders
Authors: Derksen Brenna Jane McCarney
Published: January 2019

Nontraumatic musculoskeletal disorders affect both the adult and pediatric populations and are common reasons that people present to the emergency department. They range from mild, self-limited disease processes, such as lower back strain, to potentially life- or limb-threatening diseases such as septic arthritis and cancer. It is important that the emergency medicine clinician be able to identify and treat the disease processes correctly and separate the serious from the inconvenient. It is also important to recognize that musculoskeletal complaints may be the primary presentation of more systemic disease processes.
Psychobehavioral Disorders
Authors: Hersevoort Shawn , Hurwitz Stephen , Thornton Stephen
Published: January 2019

Emergency departments (EDs) have seen an increase in patients presenting with psychobehavioral emergencies in the past 20 years. Some of this increase is due to the severe shortage of mental health professionals across the country, and some is due to an increase in the incidence of psychiatric disorders. Patients can present to the ED themselves or can be brought in by emergency medical services or law enforcement under an involuntary hold. The presentations range from intentional ingestions and other suicide attempts to depression, psychosis, and medication interactions. Substance abuse is also common in this population and can exacerbate underlying conditions. Patients who present for other medical complaints and have an underlying history of mental illness are usually taking psychiatric medications that can have drug interactions. It is imperative that a practicing emergency medicine physician be aware of the multitude of drug interactions and side effects.
Renal and Genitourinary Emergencies
Authors: Storkan Michelle
Published: January 2019

Renal and genitourinary complaints are common presentations to the emergency department. Urinary tract infections are among the top three sites of infection in patients presenting to the emergency department. Nephrolithiasis is also a common reason for patients to present due to the severe associated pain. Greater than 20 million patients in the United States are diagnosed with a sexually transmitted infection yearly and many of these present to the emergency department due to the associated discomfort and related symptoms. Other conditions related to the renal and genitourinary systems, though less common, are important for emergency providers to be adept at managing.
Trauma and Orthopedic Emergencies
Authors: Gupta Anjali , Harp Jordan , Crane Desiree
Published: January 2019

Trauma is the leading cause of death for individuals in the United States younger than 45 years, and globally it is anticipated to become the third largest contributor to the burden of disease by 2020. Road traffic accidents account for most deaths worldwide; however, injuries and death due to firearms are a unique concern in the United States. Emergency clinicians play a vital role in the stabilization, diagnosis, and treatment of trauma patients and must be able to manage a full spectrum of patients, from those presenting with isolated, minor trauma to patients with severe multisystem trauma.
Public Health
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 5 (“Public Health”) contains 21 works of art that tell the story of efforts by societies throughout the ages to protect the health of their citizens. Of the measures instituted, some of the oldest and the most important with regard to impact on life expectancy, disability, and quality of life have been ones concerned with provision of a clean water supply and proper waste management. Numerous works featured in this chapter speak to the dire consequences of poor sanitation, insect-borne infections, pollution, and plagues, such as the Black Death, leprosy, tuberculosis, syphilis, influenza, and AIDS. They also tout the miracle of immunizations, while decrying the medical profession’s inability to lighten society’s addiction burden or substantially improve the care provided to incarcerated patients.
Genetics
Authors: Mackowiak Philip A.
Published: January 2019

Chapter 8 (“Genetics”) chronicles an aspect of medicine whose history covers less than two centuries. The modern science of genetics traces its origin only as far back as the work of Gregor Mendel, published in 1866 C.E. The images included in this chapter depict genetic disorders ranging from Down syndrome to Cri-du-Chat syndrome. They also illustrate the high price in genetic defects paid by royal families for excessive inbreeding, since the time of Egypt’s 18th dynasty. The chapter’s final work, a portrait of Henrietta Lacks, speaks to the chromosomal theory of the pathogenesis of cancer, one first clearly enunciated by Theodor Boveri in 1914 C.E.
Syncope
Authors: Kenaan Mohamad , Eagle Kim
Published: January 2019

This chapter guides the reader on the diagnosis and management of syncope in hospitalized patients.
Acute Dyspnea
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of acute dyspnea in hospitalized patients.
Pneumonia
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the diagnosis and management of pneumonia in hospitalized patients.
Respiratory Failure
Authors: Mendez Michael P.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of respiratory failure in hospitalized patients.
Liver Failure
Authors: Saini Sameer D. , Waljee Akbar K.
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of liver failure in hospitalized patients.
Overview of Nephrology
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader to a general overview of inpatient nephrology.
Nephritic Syndrome
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of nephritic syndrome in hospitalized patients.
Urinary Tract Infections
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the diagnosis and management of urinary tract infections in hospitalized patients.
Approach to Acid-Base Disorders
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of acid-base disorders in hospitalized patients.
Hypertension
Authors: McGuire Matthew , Pennathur Subramaniam
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of hypertension in hospitalized patients.
Approach to Microbiology
Authors: Shuman Emily
Published: January 2019

This chapter guides the reader on the general overview of microbiology as it relates to inpatient care.
Acute Leukemia
Authors: Bixby Dale
Published: January 2019

This chapter guides the reader on the diagnosis and management of acute leukemia in hospitalized patients.
Hypercalcemia
Authors: Choksi Palak , Lash Robert W.
Published: January 2019

This chapter guides the reader on the diagnosis and management of hypercalcemia in hospitalized patients.
Seizure Disorders
Authors: Burke James
Published: January 2019

This chapter guides the reader on the general principles, clinical manifestations, and management of seizure disorders in hospitalized patients.
Meningitis
Authors: Burke James
Published: January 2019

This chapter guides the reader on the diagnosis and management of meningitis in hospitalized patients.
Perioperative Pulmonary Risk Assessment and Reduction Strategies
Authors: Grant Paul J.
Published: January 2019

This chapter guides the reader on the approaches and considerations in managing preoperative pulmonary risk assessment and reduction strategies in hospitalized patients.
Immune Mechanisms and Central Nervous System (CNS) Development
Authors: Simões e Silva Ana Cristina , Moreira Janaina Matos , Magalhães Rafael Coelho , Zeni Cristian Patrick
Published: January 2019

Multiple factors and mechanisms may influence the healthy development of the embryo and fetus during the gestational period. Inflammation is a physiological response that mediates the clearance of cellular debris and release of neurotrophic factors. Inflammation also eludes or minimizes threats. The same developmental mechanisms that promote plastic changes may expose the organism to adverse outcomes. Several mechanisms related to the immune system, including the release of cytokines and activation of T cells, may contribute to neuroinflammation. An exacerbated inflammatory response has been associated with the occurrence of central nervous system (CNS) injuries that may determine, in the short term and/or long term, structural and functional consequences for CNS development. Evidence suggests that immune dysfunction may affect brain development and may play a role in several neurodevelopmental/psychiatric disorders.
Immune Dysfunction
Authors: Oliveira José , Tabouy Laure , Leboyer Marion
Published: January 2019

Immune dysfunction plays an important etiological role in several psychiatric disorders, thus appearing as a transnosological feature potentially associated with worse clinical outcomes such as early onset, severity of symptoms, treatment resistance, and suicide, as well as with the development of other metabolic and autoimmune comorbidities. In this chapter, evidence for the existence of a chronic low-grade inflammation and oxidative and nitrosative stress in major psychiatric disorders is documented. In addition, elements likely to be the consequence of this immune dysfunction and suggesting that psychiatric disorders should be considered as multisystem disorders are discussed, such as the comorbidity with metabolic and autoimmune disorders, alterations of gut permeability and microbiota, and the reactivation of human endogenous retroviruses. In this context, potential constitutive (genetic) and environmental determinants (childhood stress and early-life infection) of immune dysfunction are discussed.