bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of electromigration induced by field emission current flowing through Au nanogaps in ambient air
Authors: Inoue Kazuki , Yagi Mamiko , Ito Mitsuki , Ito Tomoyuki , Shirakashi Jun-ichi
Published: August 2017

We developed a simple and controllable nanogap fabrication method called “activation.” In the activation technique, electromigration is induced by a field emission current passing through the nanogaps. Activation enables the electrical properties of Ni nanogaps in a vacuum to be controlled and is expected to be applicable to Au nanogaps even in ambient air. In this study, we investigated the activation properties of Au nanogaps in ambient air from a practical point of view. When activation was performed in ambient air, the tunnel resistance of the Au nanogaps decreased from over 100 TΩ to 3.7 MΩ as the preset current increased from 1 nA to 1.5 μA. Moreover, after activation in ambient air with a preset current of 500 nA, the barrier widths and heights of the Au nanogaps were estimated using the Simmons model to be approximately 0.5 nm and 3.3 eV, respectively. The extracted barrier height is smaller than that of 4.6 eV resulting from activation in a vacuum and much lower than the work function of bulk Au. This difference implies the presence of atmospherically derived moisture or contamination adsorbed on the nanogaps. These results suggest that activation can be utilized for Au nanogap fabrication even in ambient air.
Local gene therapy durably restores vestibular function in a mouse model of Usher syndrome type 1G
Authors: Emptoz Alice , Michel Vincent , Lelli Andrea , Akil Omar , Boutet de Monvel Jacques , Lahlou Ghizlene , Meyer Anaïs , Dupont Typhaine , Nouaille Sylvie , Ey Elody , Franca de Barros Filipa , Beraneck Mathieu , Dulon Didier , Hardelin Jean-Pierre , Lustig Lawrence , Avan Paul , Petit Christine , Safieddine Saaid
Published: August 2017

Significance

Hearing and balance impairments are major concerns and a serious burden for public health, but still lack an effective curative therapy. We assessed inner ear functions in a mouse model of Usher syndrome type 1, a developmental disorder characterized by profound congenital deafness and balance deficit, after local gene therapy. Viral transfer of the wild-type cDNA to the inner ear of the mutant mice shortly after birth resulted in a partial restoration of hearing and a long-lasting, almost complete, removal of the balance defect. The present results provide a basis for future clinical trials in humans.
Quantum processing by remote quantum control
Authors: Qiang Xiaogang , Zhou Xiaoqi , Aungskunsiri Kanin , Cable Hugo , O’Brien Jeremy L
Published: August 2017

Client-server models enable computations to be hosted remotely on quantum servers. We present a novel protocol for realizing this task, with practical advantages when using technology feasible in the near term. Client tasks are realized as linear combinations of operations implemented by the server, where the linear coefficients are hidden from the server. We report on an experimental demonstration of our protocol using linear optics, which realizes linear combination of two single-qubit operations by a remote single-qubit control. In addition, we explain when our protocol can remain efficient for larger computations, as well as some ways in which privacy can be maintained using our protocol.
Low-affinity binding incisto P2Y2R mediates force-dependent integrin activation during hantavirus infection
Authors: Bondu Virginie , Wu Chenyu , Cao Wenpeng , Simons Peter C. , Gillette Jennifer , Zhu Jieqing , Erb Laurie , Zhang X. Frank , Buranda Tione
Published: August 2017

Pathogenic hantaviruses bind to the plexin-semaphorin-integrin (PSI) domain of inactive, β3integrins. Previous studies have implicated a cognate cis interaction between the bent conformation β5/β3integrins and an arginine-glycine-aspartic acid (RGD) sequence in the first extracellular loop of P2Y2R. With single-molecule atomic force microscopy, we show a specific interaction between an atomic force microscopy tip decorated with recombinant αIIbβ3integrins and (RGD)P2Y2R expressed on cell membranes. Mutation of the RGD sequence to RGE in the P2Y2R removes this interaction. Binding of inactivated and fluorescently labeled Sin Nombre virus (SNV) to the integrin PSI domain stimulates higher affinity for (RGD)P2Y2R on cells, as measured by an increase in the unbinding force. In CHO cells, stably expressing αIIbβ3integrins, virus engagement at the integrin PSI domain, recapitulates physiologic activation of the integrin as indicated by staining with the activation-specific mAB PAC1. The data also show that blocking of the Gα13protein from binding to the cytoplasmic domain of the β3integrin prevents outside-in signaling and infection. We propose that the cis interaction with P2Y2R provides allosteric resistance to the membrane-normal motion associated with the switchblade model of integrin activation, where the development of tensile force yields physiological integrin activation.
Direct fluorescent-dye labeling of α-tubulin in mammalian cells for live cell and superresolution imaging
Authors: Schvartz Tomer , Aloush Noa , Goliand Inna , Segal Inbar , Nachmias Dikla , Arbely Eyal , Elia Natalie
Published: August 2017

Genetic code expansion and bioorthogonal labeling provide for the first time a way for direct, site-specific labeling of proteins with fluorescent-dyes in live cells. Although the small size and superb photophysical parameters of fluorescent-dyes offer unique advantages for high-resolution microscopy, this approach has yet to be embraced as a tool in live cell imaging. Here we evaluated the feasibility of this approach by applying it for α-tubulin labeling. After a series of calibrations, we site-specifically labeled α-tubulin with silicon rhodamine (SiR) in live mammalian cells in an efficient and robust manner. SiR-labeled tubulin successfully incorporated into endogenous microtubules at high density, enabling video recording of microtubule dynamics in interphase and mitotic cells. Applying this labeling approach to structured illumination microscopy resulted in an increase in resolution, highlighting the advantages in using a smaller, brighter tag. Therefore, using our optimized assay, genetic code expansion provides an attractive tool for labeling proteins with a minimal, bright tag in quantitative high-resolution imaging.
CESAR 2.0 substantially improves speed and accuracy of comparative gene annotation
Authors: Sharma Virag , Schwede Peter , Hiller Michael
Published: August 2017

Motivation

Homology-based gene prediction is a powerful concept to annotate newly sequenced genomes. We have previously demonstrated that whole genome alignments can be utilized for accurate comparative coding gene annotation.

Results

Here we present CESAR 2.0 that utilizes genome alignments to transfer coding gene annotations from one reference to many other aligned genomes. We show that CESAR 2.0 is 77 times faster and requires 31 times less memory compared to its predecessor. CESAR 2.0 substantially improves the ability to align splice sites that have shifted over larger distances, allowing for precise identification of the exon boundaries in the aligned genome. Finally, CESAR 2.0 supports entire genes, which enables the annotation of joined exons that arose by complete intron deletions. CESAR 2.0 can readily be applied to new genome alignments to annotate coding genes in many other genomes at improved accuracy and without necessitating large-computational resources.

Availability and implementation

Source code is freely available at https://github.com/hillerlab/CESAR2.0

Supplementary information

Supplementary data are available at Bioinformatics online.
Enabling reproducible real-time quantitative PCR research: the RDML package
Authors: Rödiger Stefan , Burdukiewicz Michał , Spiess Andrej-Nikolai , Blagodatskikh Konstantin
Published: August 2017

Motivation

Reproducibility, a cornerstone of research, requires defined data formats, which include the setup and output of experiments. The real-time PCR data markup language (RDML) is a recommended standard of the minimum information for publication of quantitative real-time PCR experiments guidelines. Despite the popularity of the RDML format for analysis of quantitative PCR data, handling of RDML files is not yet widely supported in all PCR curve analysis softwares.

Results

This study describes the open-source RDML package for the statistical computing language R. RDML is compatible with RDML versions ≤ 1.2 and provides functionality to (i) import RDML data; (ii) extract sample information (e.g. targets and concentration); (iii) transform data to various formats of the R environment; (iv) generate human-readable run summaries; and (v) to create RDML files from user data. In addition, RDML offers a graphical user interface to read, edit and create RDML files.

Availability and implementation

https://cran.r-project.org/package=RDML. rdmlEdit server http://shtest.evrogen.net/rdmlEdit/. Documentation: http://kablag.github.io/RDML/.

Supplementary information

Supplementary data are available at Bioinformatics online.
How cooperation contributes to scientific advances†
Authors: Paffenhöfer Gustav-Adolf
Published: August 2017

The idea behind the various papers called Food for Thought was to show how advanced researchers developed their careers, informing about successes and misfortunes. This presentation reports not only on the experiences made by the author; it includes those researchers who provided ideas and support for the author which then led to progress. It often occurs that cooperative efforts are actually needed to advance. The interdisciplinary oceanographic studies reported here were made possible by truly cooperative planning and data-sharing efforts of several individuals which then led to our pioneering advances. Similarly, the successes on obtaining the actual feeding behaviour data of calanoid copepods, after decades of guesswork, could only be achieved through cooperation. Much of the credit goes to my colleagues at the Food Chain Research Group at Scripps Institution of Oceanography who pioneered the combination of field and laboratory efforts to arrive at an understanding of biological processes in the ocean. Overall, not so much my initiative-taking but the repeated encouragement by and feed-back from my colleagues and friends both at Scripps, at Skidaway and other institutes made advances possible.
Teamwork and Crisis Resource Management
Authors: Watkins Scott C. , Cropsey Christopher L. , Furse Cory M.
Published: August 2017

By definition, a team is two or more people who are working together. Teamwork can be thought of as the dynamic behaviors, cognitions, attitudes, and skills that allow a team to perform its stated goal. Concerning healthcare teamwork, nearly two decades ago, the Institute of Medicine issued the report To Err Is Human, which identified teamwork as a key target for improving the quality and safety of patient care. Over the last twenty-five years, crisis resource management has become synonymous with a style of teamwork and performance epitomized by healthcare providers in high acuity, time-pressured environments such as acute care practice. This chapter discusses the major themes of crisis resource management.
Cognitive Aids in Current Practice
Authors: Cropsey Christopher L. , Watkins Scott C. , McEvoy Matthew D.
Published: August 2017

The use of cognitive aids in clinical practice has been encouraged for almost 100 years. However, while the use of such aids in the aviation and nuclear power industries, the overall uptake and use in healthcare has been lacking until recent years. Recent publications are beginning to demonstrate not only the process by which a cognitive aid should be created, but also the proper methods by which to test and implement use in simulated and clinical practice. This chapter discusses the evolution of the science of cognitive aids with a particular focus on how the reader should consider their use in practice, particularly in high-stakes perioperative events.
Introduction to Perioperative Cardiac Urgencies and Emergencies
Authors: O’Neal Jason B. , Shaw Andrew
Published: August 2017

Cardiac arrest in the perioperative period is distinct from cardiac arrest in other scenarios, given that the event is typically witnessed and real-time vital signs are often being monitored. Additionally, having a mental framework by which to consider and refine the differential diagnosis is paramount, as this then guides the selection of a suitable treatment plan. However, in order to establish the correct diagnosis, one must have an adequate understanding of normal cardiac physiology, of cardiovascular pathology, and the ways in which this may adversely affect cardiac function. This chapter provides an overview of how to approach the patient with cardiovascular instability. Subsequent chapters in this section discuss specific treatment plans for the major life-threatening pathophysiologies one could encounter.
Severe Valvular Disease
Authors: Liang Yafen , Shaw Andrew
Published: August 2017

The pathophysiology of valvular diseases follows the fundamental principles of fluid and pressure dynamics. Alteration in any of the major components that determine forward flow can translate into a change in stroke volume, which in turn results in a change in cardiac output. The goal of managing severe valvular disease in the perioperative period is to maintain the forward flow required for end organ perfusion and minimize regurgitation. Accordingly, this chapter discusses the major principles involved in the pathophysiology of valve disease, as well as the perioperative assessment of disease severity and appropriate management based upon the type of lesion being encountered.
Introduction to Shock
Authors: Fiza Babar , Moitra Vivek
Published: August 2017

The chapter “Introduction to Shock” reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on end organ perfusion and the pathogenesis of shock. This chapter reviews the compensatory mechanisms in shock that cause the signs and symptoms, along with organ manifestations, reported in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion and reverse the shock state.
Cardiogenic Shock
Authors: Chen Martin , Trinh Muoi
Published: August 2017

Heart failure and cardiogenic shock are important causes of perioperative morbidity and mortality that require prompt recognition prior to the institution of specialized monitoring and treatment, including the consideration of circulatory assist devices. Patients at risk for perioperative heart failure require special consideration with respect to preoperative evaluation, medical optimization prior to proceeding with surgery, and monitoring throughout the perioperative period. The intraoperative and postoperative management need to be carefully planned in order to avoid the development of acute decompensated heart failure and cardiogenic shock. This chapter reviews the perioperative assessment and management of heart failure patients as well as the management of perioperative cardiogenic shock.
Distributive Shock
Authors: Lee Angela , Wagener Gebhard
Published: August 2017

The distributive shock chapter reviews the definition, classification, epidemiology, pathophysiology, clinical manifestations, and therapeutic goals of shock. It examines the cardiovascular factors and mechanisms leading to impaired oxygen delivery and its effect on the pathogenesis of shock. It reviews the compensatory mechanisms in shock that cause symptoms and organ manifestations in patients with acute circulatory failure. This chapter also discusses the limitations and benefits of different monitoring modalities during shock management including central venous pressure, mixed venous oxygen saturation, and echocardiography. Finally, it considers therapeutic goals and treatments to restore perfusion to reverse the shock state.
Obstructive Shock
Authors: Sobol Julia , Louro Jack
Published: August 2017

In the perioperative period, various mechanisms can lead to the development of shock. The type of shock needs to be rapidly elucidated and initial management steps initiated to minimize the time of tissue hypoperfusion. Obstructive shock is caused by physical obstruction of circulation either into or out of the heart. The mechanisms that lead to obstructive shock either prevent blood from entering the right heart during diastole such as a tension pneumothorax or pericardial tamponade, or prevent the heart from ejecting the blood due to a physical obstruction, as in the case of pulmonary embolism or left ventricular outflow obstruction. While supportive care with volume resuscitation and inotropes to maintain cardiac output is crucial, early determination of the cause with prompt treatment is needed to prevent circulatory collapse. This chapter reviews the pathophysiologic mechanisms leading to obstructive shock and management steps to stabilize the patient and treat the underlying cause.
Introduction to Pulmonary Urgencies and Emergencies
Authors: Mitchell John D. , Brzezinski Marek
Published: August 2017

The lungs exchange gases and also provide for some metabolic functions. Respiratory failure can be grouped into types I-IV. Type I (hypoxemic) and type II (hypercapnic) are the most prominent; type III is perioperative and often considered a subset of type I, while type IV is due to shock. Pulmonary urgencies and emergencies require rapid diagnosis and treatment in order to avoid morbidity and mortality. Identification of risk factors for desaturation and the application of an appropriate management algorithm can facilitate diagnosis and management. The ABCD-A SWIFT CHECK algorithm and its subalgorithms represent a logical approach to rapid diagnosis and management.
Difficult Airway
Authors: Ilic Romina G.
Published: August 2017

The difficult airway chapter focuses on preparing the clinician for a challenging airway. Management of both the expected, as well as the unexpected, difficult airway is critical to the care of the perioperative patient. Proper patient evaluation, organization, and preparation with a variety of airway tools are imperative to successfully securing the airway. The chapter reviews the difficult airway algorithm and discusses advanced airway techniques such as the use of awake intubation, airway exchange catheters, supraglottic airway devices, and surgical airway. Gaining familiarity with and using these advanced airway techniques in non-urgent situations will help ensure success when they are needed in emergencies.
Laryngospasm
Authors: Furse Cory M. , McEvoy Matthew D.
Published: August 2017

Laryngospasm is one of the most vexing problems in anesthesia and perioperative care. The onset of which carries the risk of oxygen desaturation, bradycardia, aspiration, and cardiac arrest. In this chapter, the mechanisms involved in producing laryngospasm are covered in detail, and an anatomical review of both sensory and motor innervation is included. Risk factors associated with the development of laryngospasm, including those specific to the patient, the type of surgery, and/or the anesthesia techniques are discussed. Proper patient assessment and prompt treatment for this life-threatening emergency are essential skills needed for safe patient care in the peri-operative arena.
Aspiration Pneumonitis
Authors: Trzcinka Agnieszka
Published: August 2017

Aspiration pneumonitis during the perioperative period is a serious complication and involves passage of sterile gastric contents into the airway resulting in alveolar damage. The mechanism of aspiration pneumonitis is characterized by a significant inflammatory reaction. The risk of aspiration is highest during anesthesia induction, but it is also present during emergence and extubation. The risk factors include delayed gastric emptying (gastritis, pain, pregnancy, obesity, elevated intracranial pressure), emergency surgery, upper abdominal surgery, and difficulty securing the airway. Anesthesiologists should focus on prevention of pulmonary aspiration with consideration of the patient’s NPO status and risk factors when planning anesthesia induction and emergence. If aspiration of gastric contents occurs, the patient may exhibit a variety of symptoms, with severity based on the volume and pH of the aspirate. Subsequently, patients with observed or suspected aspiration need supportive treatment that varies depending on the severity of symptoms.
Mechanical Airflow Disruption
Authors: Sodickson Alissa , Hardy James
Published: August 2017

Disruption in airflow can result in a life-threatening emergency due to inadequate gas exchange, and being able to quickly acknowledge and resolve this critical issue is key to the successful management of patients in perioptherative arena. While it may arise from several mechanisms, two clinically important ones that are often encountered are endobronchial intubation and foreign-body aspiration. Endobronchial intubation is the most common. It is easily treated, often goes unrecognized, and may result in patient harm. Foreign-body aspiration may present in a number of different ways and with varying clinical acuity. This chapter discusses the signs, symptoms, consequences, and management of airflow disruption arising from these two potential causes.
Disruption of Diffusion
Authors: Shaefi Shahzad , Mittel Aaron
Published: August 2017

Acute respiratory distress syndrome (ARDS), transfusion-related acute lung injury (TRALI), and transfusion-associated circulatory overload (TACO) are common conditions in critically ill patients that lead to pulmonary edema and hypoxemia. The nonhydrostatic edema characteristic of ARDS and TRALI is caused by an intense inflammatory response leading to increased microvascular permeability and alveolar injury. TACO is an acute hydrostatic edema temporally associated with events that precipitate lung injury. Lung-protective ventilation is the mainstay of therapy for ARDS and TRALI; optimizing gas exchange is the goal for all three. Prompt recognition is an important skill for perioperative practitioners.
Pneumothorax
Authors: Oliver Jennifer , Mizuguchi K. Annette
Published: August 2017

This chapter examines the diagnosis and management of an unexpected pneumothorax in a patient undergoing general anesthesia. It reviews the mechanisms and risks associated with development of a pneumothorax in the perioperative period, further characterizing the various types of pneumothoraces, including spontaneous, traumatic, and iatrogenic pneumothorax. General anesthesia can alter many of the presenting signs and symptoms normally associated with the development of a pneumothorax, making diagnosis difficult. These variances are discussed, and information regarding the step by step management of a tension pneumothorax is included. It also describes common procedures associated with an increased risk of developing a pneumothorax.
Porphyria
Authors: Dierdorf Stephen F.
Published: August 2017

Heme, and iron containing compound that forms the nonprotein portion of hemoglobin, is essential to life. Heme synthesis requires eight enzymatic steps, and a deficiency in any one of the eight enzymes can lead to the accumulation of potentially toxic intermediates. Some forms of porphyria may be asymptomatic until the patient receives a triggering agent, and acute porphyrias can also be difficult to diagnose because of the nonspecific clinical features. The most serious of the clinical manifestations is severe neurologic dysfunction. An attack can be triggered by medications administered during the perioperative period, and failure to act promptly can result in mortality rates as high as 5%.
Perioperative Adrenal Crisis
Authors: Tao Jing , Schwartz Jeffrey J.
Published: August 2017

Perioperative adrenal insufficiency (AI) (adrenal crisis) is an uncommon life-threatening condition manifested by distributive shock that is poorly responsive to the administration of fluids and vasopressors. Timely treatment with high doses of glucocorticoids can be life saving. The difficulty is in recognizing the patient at risk, suspecting the diagnosis, and distinguishing it from other forms of shock. The incidence of adrenal crisis is rare, in large part, due to the liberal use of perioperative “stress dose” steroids in patients already receiving steroids. In this chapter we review the pathophysiology involved in both primary and secondary AI, and provide step-by-step treatment recommendations for patients as risk for this condition.
Diabetic Ketoacidosis
Authors: Newcomer Anne , Gropper Michael
Published: August 2017

Perioperative clinicians caring for patients with diabetes should understand the underlying mechanisms, diagnosis, and treatment of hyperglycemic crises. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) require prompt recognition and treatment. Disturbances such as these can create acute problems associated with intravascular volume and electrolyte abnormalities, as well as effect postoperative recovery and wound healing. Common precipitants, clinical manifestations, and basic treatment algorithms aimed at safely correcting the underlying cause, as well as the associated problems, are described in this chapter. Perioperative glycemic control is an area of recent intense investigation, and specific recommendations are provided herein.
Hyperglycemic Hyperosmolar State
Authors: Akhtar Shamsuddin
Published: August 2017

The incidence of diabetes mellitus has rapidly increased in recent years. Perioperative care of patients with diabetes presents challenges of glycemic control and management of associated cardiovascular disease. Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are life-threatening complications of diabetes that require emergent therapy. Although elective surgery in patients with DKA or HHS is contraindicated, there are times when an emergent surgical condition may require anesthesia in the presence of DKA or HHS. There are many different factors that may precipitate these disorders and an understanding of the underlying pathophysiology and treatment is important for successful management of anesthesia.
Hypoglycemia
Authors: Hardacker Doris M.
Published: August 2017

The detrimental effects of hyperglycemia have been enumerated in critically ill patients, and more rigid control of glucose during the perioperative period has been advocated. The more liberal use of intraoperative continuous insulin infusions, however, has unfortunately led to an increased incidence of hypoglycemia. Anesthetized patients exhibit few, if any, signs of severe hypoglycemia. Because the brain is dependent on glucose as a primary energy source, the most devastating result of unrecognized hypoglycemia may be permanent neurologic injury or death. Therefore, it is imperative that the anesthesiologist recognize patients who are at risk for this complication and frequently measure glucose levels to avoid inadvertent hypoglycemia.
Acute Liver Failure
Authors: Wang Cynthia , Braunfeld Michelle Y.
Published: August 2017

Acute liver failure produces widespread physiologic derangements including encephalopathy, coagulopathy, peripheral vasodilation, a systemic inflammatory response, and multiorgan failure. Morbidity is significant, and mortality is 50%. The classification of liver failure and the various etiologies, including viral hepatitis, drug-induced, toxins, and autoimmunity are reviewed here. The multisystem effects of acute liver failure influence all aspects of perioperative care and adequate supportive care during this time is crucial to providing the best possible outcome for the patient. Specific treatment objectives and recommendations are discussed, and the anesthetic management with regard to drug choices, hemodynamic goals, and intraoperative monitoring is reviewed.
Hyponatremia/Hypernatremia
Authors: Egan Brian N.
Published: August 2017

lSodium is the most abundant cation in the extracellular fluid and is important for regulation of plasma water concentrations and cell volume. Sodium cannot readily cross the blood-brain barrier, and changes in plasma sodium levels by altering free water movement can expand or shrink brain cells. Changes in brain cell volume can cause brain cell dysfunction and apoptosis. Correction of both high and low sodium levels must be done gradually, as rapid correction of dysnatremias can also damage brain cells. In this chapter we review the physiology of sodium regulation, and discuss the clinical implications of these disorders as well as present a treatment plan for safe correction.
Hypocalcemia/Hypercalcemia
Authors: Dierdorf Stephen F.
Published: August 2017

Calcium is critical to many vital physiologic functions. These functions include cardiac rhythm and contractility, neuromuscular transmission, and skeletal muscle contractility. 45% of the calcium in the blood is ionized, which is more revalent to the physiologic function of calcium as opposed to the fraction that is bound. Serum ionized calcium levels are closely regulated by the parathyroid gland via calcium-sensing receptors and parathormone secretion. Low or high levels of calcium can result in life-threatening cardiac dysrhythmias and skeletal muscle weakness leading to respiratory failure. The anesthesiologist must be aware of the clinical conditions that place patients at risk for calcium abnormalities. This will allow for early recognition of the signs and symptoms, so that measurements can take place and rapid treatment can be given.
Obstetric Life Support
Authors: Hsu Nathaniel N. , Month Richard C.
Published: August 2017

Although rare, cardiac arrest during pregnancy poses unique challenges to the code response team, including both physiologic changes as well as the concern for two patients: the mother and fetus. Enhanced healthcare provider knowledge of important changes for resuscitation of the pregnant patient may be needed. Thus, this chapter serves to educate providers on most common etiologies for cardiac arrest in pregnancy as well as the key modifications to current advanced cardiac life support (ACLS) protocol according to the recent 2010 AHA guidelines on resuscitation of the pregnant patient in cardiac arrest.
Systemic Inflammatory Response Syndrome and Sepsis in the Pregnant Patient
Authors: Moaveni Daria M.
Published: August 2017

The chapter “Systemic Inflammatory Response Syndrome and Sepsis in the Pregnant Patient” reviews diagnostic criteria for sepsis in pregnant women, as well as the etiology, risk factors, workup, and treatment of this preventable and treatable cause of maternal morbidity and mortality. It also briefly reviews the history and epidemiology of sepsis. It compares the original diagnostic criteria for systemic inflammatory response syndrome established in 1992, the sepsis diagnostic criteria from the Surviving Sepsis Campaign, and the Sepsis in Obstetrics Score. It discusses the initial workup and resuscitation, fluid management, vasopressor choice and dosing, and antimicrobial treatment for pregnant women with sepsis. It also reviews the obstetric implications of septic parturients.
Severe Preeclampsia
Authors: Sasso Uma , McQuaid-Hanson Emily
Published: August 2017

Preeclampsia and other hypertensive diseases during pregnancy are common causes of maternal morbidity and increase the risk for adverse fetal outcomes. Women are monitored for changes in blood pressure throughout pregnancy and depending on gestational age, once such changes are noted providers may opt to move toward delivery. Blood pressure control and magnesium sulfate are the cornerstone of therapy as well as the key to preventing progression to eclampsia. A thorough understanding of this disease process is essential for anesthesiologists and other anesthesia providers to provide optimal and safe care for labor analgesia and cesarean delivery, or to manage sequelae of advanced disease processes, such as seizure.
Asthma and Pregnancy
Authors: Lynde Grant C.
Published: August 2017

Asthma’s progression during pregnancy is highly variable. Improvement in symptoms can be seen in 18%–34% of patients, while worsening of symptoms can be seen in 20%–42% of patients. Acute exacerbations of asthma are most frequently seen late in the second trimester and are associated with a viral upper-respiratory infection. An acute exacerbation of asthma in the parturient can result in increased risk of maternal mortality, preterm delivery, and low-birth-weight infants. In patients with moderate to severe asthma, good control with inhaled corticosteroids, such as budesonide, is a cornerstone of reducing morbidity and mortality. The four components of care for the asthmatic patient are education, control of environmental factors, medications, and monitoring of symptoms.
Acute Stroke
Authors: Moore Laurel E.
Published: August 2017

Stroke is the leading cause of disability in the United States, and in terms of mortality is second only to ischemic heart disease worldwide. Medical management for acute ischemic stroke (AIS) was limited to supportive care until 1995, when the National Institute of Neurological Disorders and Stroke (NINDS) trial demonstrated improved outcomes with systemic thrombolysis for AIS. Since December 2014, four major articles have been published in support of endovascular intervention for AIS, making this a central focus of this chapter. Other related topics for this chapter include the timing of elective surgery following stroke, how to assess perioperative risk for patients having a history of remote stroke, and implications for postoperative morbidity and mortality associated with perioperative stroke in noncardiac surgery.
Seizures and Status Epilepticus
Authors: Aggarwala Neha , Manninen Pirjo H.
Published: August 2017

Seizures are common with 5%–10% of the general population experiencing a seizure in their lifetime and 1%–3% having a seizure disorder. Patients undergoing neurosurgical procedures are at an increased risk of perioperative seizures, including seizures occurring during surgery. To prevent and minimize perioperative seizures, the preoperative optimization of patients with seizures is crucial, including administration of regular antiepileptic agents. Status epilepticus is a true neurological emergency, with early and aggressive treatment being imperative for successful management. This chapter reviews the diagnosis, risk factors for seizures, and the initial treatment of an acute perioperative seizure as well as the management of status epilepticus.
Neurogenic Shock
Authors: Abcejo Arnoley S. , Pasternak Jeffrey J.
Published: August 2017

Neurogenic shock is a pathophysiologic state of systemic hypoperfusion characterized by a significant decrease in systemic vascular resistance secondary to loss of sympathetic tone. Neurogenic shock is most commonly seen in the setting of acute spinal cord injury (SCI) but can also occur following significant brain injury. Interruption of sympathetic fibers causes loss of basal vascular sympathetic tone, commonly allowing unopposed parasympathetic tone. As a result, severe hypotension and bradycardia can further exacerbate neurologic injury and organ perfusion. Understanding the physiologic and anatomic changes of neurogenic shock can help direct appropriate resuscitation efforts. Physiologic goals should focus on reversing hypotension, preventing hypoxia, and optimizing perfusion of the injured central nervous system and other critical organs.
Hepatic Encephalopathy
Authors: Alvis Bret , Robertson Amy
Published: August 2017

Hepatic encephalopathy is a complication of both acute and chronic liver failure. The disease can range from mild cognitive deficits to deep coma. Ammonia accumulation and inflammation are the two most accepted causes of hepatic encephalopathy. It is important to confirm an elevated serum ammonia level and rule out alternative causes of neurological derangements. Nonabsorbable disaccharides are the mainstay of treatment; however, the only definitive treatment is liver transplantation. Pertinent anesthetic considerations include avoiding benzodiazepines, understanding the implications of diminished hepatic function, and recognizing factors that may contribute to increased intracranial cerebral pressure. Proper assessment and management of the patient presenting with hepatic encephalopathy will be discussed.
Emergency Noncardiac Surgery in the Congenital Heart Disease Patient
Authors: Hassid Marc , Redding Amanda T.
Published: August 2017

Some of the most difficult cases that an anesthesiologist may encounter involve anesthesia for patients with congenital heart disease for noncardiac surgery. These cases pose a number of unique challenges due to the wide range of anatomic and physiologic abnormalities that may be encountered, and various interventions that need to take place in order to maintain hemodynamic goals. This chapter explores the perioperative considerations for patients with repaired or palliated congenital heart disease presenting for emergency noncardiac surgery. It provides a brief review of the anatomy and physiology after repair of the tetralogy of Fallot, of the systemic right ventricle, and of the single ventricle. The chapter further explores strategies for preoperative preparation and intraoperative management of these patients in the event that they present for emergency surgery.
Post-Tonsillectomy Bleeding
Authors: Rovner Michelle Sher
Published: August 2017

Post-tonsillectomy bleeding is a well-described complication that can rapidly evolve into one of the most challenging clinical situations in anesthesia. Tonsillectomy and adenoidectomy is one of the most common pediatric surgical procedures. A frequent indication for this procedure is adenotonsillar hyperplasia associated with obstructive sleep apnea. These children may be very challenging to care for and may have significant respiratory and fluid management issues postoperatively. This situation requires immediate attention and action with regard to resuscitation in a hypovolemic patient in combination with the challenges of a potentially difficult airway. This chapter discusses obstructive sleep apnea and its associated increased risk of postoperative complications with regard to tonsillectomy and adenoidectomy. It also reviews risk factors for postoperative tonsillar bleeding and the considerations in treating these children.
Introduction to Perioperative Crisis Management
Authors: Hand William R.
Published: August 2017

Management of perioperative emergencies caused by toxins, whether consumed by a patient or iatrogenic, requires a rapid assessment of patient stability and unique inquiry into the historical and clinical context leading to the patient condition. Unlike many other crises in the perioperative period, toxin-related end-organ instability often has a specific therapeutic agent required for reversal and recovery. In this section, each perioperative crisis will be described according to the pathophysiologic derangements that a clinician will encounter in both physical exam and laboratory findings. This will be followed with recommendations concerning proper patient assess for diagnosis and the a description of recommended management steps to be undertaken.
Local Anesthesia Systemic Toxicity
Authors: Barton Joel , Martin Gavin
Published: August 2017

Regional anesthesia can deliver multiple benefits to patients undergoing surgery. However, administering even appropriate doses of local anesthetic agents for regional anesthesia can be life threatening, and the risks must be well understood. Local anesthetic systemic toxicity (LAST) is a spectrum or sequence of symptoms and dysfunction that affects the nervous and cardiopulmonary systems. Management of LAST revolves around recognition, supportive care, and, specifically, administration of lipid emulsion. The American Society of Regional Anesthesia practice advisory for management of LAST is an excellent point-of-care reference for anesthesiologists practicing regional anesthesia.
Cocaine Intoxication and Hypertensive Emergency
Authors: Ramamoorthy Jagan , Murphy Noreen E.
Published: August 2017

Cocaine is a highly addictive, illegal drug with sympathomimetic properties that is responsible for nearly 500,000 emergency room visits per year. In at least one study, nearly 40% of trauma surgery patients and 1% of patients presenting for elective surgery tested positive for recent cocaine use. Given these numbers, anesthesiology providers must understand the physiological effects of cocaine and be able to safely manage these patients in both the intraoperative and perioperative phases. Anesthetic management of cocaine-using patients should focus on avoiding hemodynamic extremes and minimizing the ischemic consequences of vasospasm. This chapter reviews the basic pharmacology of cocaine, the physiologic effects of cocaine use, and the anesthetic management of the cocaine-using patient.
Anticholinergic Overdose
Authors: Fanapour Philip , White Peggy , Fahy Brenda G.
Published: August 2017

Anticholinergic toxidrome can be a side effect of medications or herbal therapies or can result from intentional or inadvertent overdose of prescribed medications or abused substances. The diagnosis of anticholinergic toxicity involves symptomatology, including tachycardia, hyperthermia, central nervous system dysfunction including delirium, and urinary retention. The diagnosis can be challenging, as it is based on clinical symptoms with presentation mimicking other etiologies. Early diagnosis and intervention with treatment are key with the specific identification of the agent involved and other confounding substances. Discontinuation of the agent(s) involved as early as possible and providing supportive care are early interventions, with additional therapeutic options determined by the severity of the toxicity and the agent(s) involved.
Introduction to cancer biology
Authors: Hodgkiss Andrew
Published: August 2017

A brief introduction to cancer biology, aimed at psychiatrists, is offered. Selective DNA transcription, the cell cycle, receptor tyrosine kinases, and cell signalling pathways are introduced, using the EGFR/RAS/MAPK pathway as an exemplar. The molecular pathology of oncogenesis is summarized, including discussion of oncogenes, tumour suppressor genes, and examples of driver mutations. The exploitation of such mutations in stratified medicine, using molecularly targeted agents, is mentioned. Finally, Hanahan and Weinberg’s six hallmarks of cancer are listed, adding angiogenesis and metastasis to the picture of oncogenesis.
Psychiatric consequences of particular cancers
Authors: Hodgkiss Andrew
Published: August 2017

Certain tumour types can cause psychopathology through direct biological mechanisms such as metastatic spread to the brain, release of onconeuronal antibodies, ectopic hormone secretion, or release of pro-inflammatory cytokines. Lung cancers, adenocarcinoma of the pancreas, brain tumours, and ovarian tumours are considered in detail. Confusional states due to brain metastases, syndrome of inappropriate ADH secretion, hypercalcaemia of malignancy, and anti-Hu encephalitis are found in lung cancers. Severe depression, due to interleukin-6 release and its actions on the HPA axis and tryptophan metabolism, is common in adenocarcinoma of the pancreas. Anti-NMDA-receptor limbic encephalitis, clinically indistinguishable from acute schizophrenia, can complicate teratomas. Gliomas, pituitary tumours, and thyroid, adrenal, and testicular tumours can also disrupt mental health through various biological mechanisms described here.
Psychiatric consequences of cancer treatments: surgery and radiotherapy
Authors: Hodgkiss Andrew
Published: August 2017

Surgery and radiotherapy for cancers can disrupt mental health through direct biological mechanisms in addition to the well-described psychological distress associated with the physical consequences of treatment. Upper bowel surgery and bilateral oophorectomy both frequently provoke psychopathology. Total gastrectomy, or ileal resection, causes an inevitable vitamin B12 deficiency. The molecular mechanisms by which these surgical treatments provoke depressive symptoms, or even a dementia, are considered. Raised homocysteine levels and reduced SAM availability are involved. Chronic gonadal oestrogen deprivation increases the risk of anxiety, depression, and dementia in later life. The likely molecular basis for this is discussed. Hypothyroidism, with its associated psychopathology, complicates radiotherapy for head & neck cancers in 40 per cent of patients. The chapter closes with a review of the effects of whole-brain radiotherapy on cognitive function, and the psychopathology arising from radiation-induced hypopituitarism.
Psychiatric consequences of cancer treatments: therapeutic monoclonal antibodies
Authors: Hodgkiss Andrew
Published: August 2017

The adverse psychiatric consequences of a range of monoclonal antibodies used to treat cancer are reviewed. Bevacizumab disrupts endothelial function at the blood–brain barrier and can provoke posterior reversible encephalopathy syndrome. The immune checkpoint inhibitors cause autoimmune hypophysitis and thyroiditis with associated psychopathology. Rituximab causes profound immunosuppression of B lymphocytes, and hence can reactivate childhood JC virus infection to cause progressive multifocal leucoencephalopathy. The marked neuropsychiatric toxicity of blinatumomab is described.
Opportunities for prevention, or early detection, of psychopathology
Authors: Hodgkiss Andrew
Published: August 2017

The value of informing patients and carers about the possible psychiatric consequences of specific cancers and cancer treatments is emphasized. Eight examples follow, of cancer treatments where formal consent concerning possible adverse psychiatric effects is indicated. Modest modifications of certain oncological treatments can reduce the incidence of psychopathology—seven examples are offered. Proactive monitoring of endocrine status, serum electrolytes, or vitamin B12 levels during or after particular treatments is advocated to prevent psychopathology. The chapter closes with practical recommendations for screening for delirium, depression, and alcohol dependence in defined groups of patients with cancer. Such early detection opens the possibility of prompt treatment and may reduce the risk of harm to self or others.
Clinical psychiatric assessment of patients with cancer
Authors: Hodgkiss Andrew
Published: August 2017

This chapter offers an approach to the clinical psychiatric assessment of the patient with cancer. A narrative medicine approach to history-taking is recommended, followed by assessments of mood, cognitive function, and risk. In the main body of the chapter the emphasis is on the assessment and medical investigation of psychopathology arising from the tumour or its treatment through direct biological mechanisms. Much of this material was presented in Chapters 4–9 but is organized here strictly by tumour type as a reference source for clinicians. The common psychological and psychosexual problems associated with particular cancers and their treatment are also briefly described, but much fuller accounts of adjustment and identity issues are available in more comprehensive psycho-oncology textbooks.
Influence of pulmonary blood flow on management and outcome
Authors: Thorne Sara , Bowater Sarah
Published: August 2017

This chapter discusses the influence of pulmonary blood flow on management and outcome, including pulmonary vascular development in early life, cyanotic heart disease, and pulmonary blood flow.