bluuebunny/crossref_metadata_2025 huggingface dataset:
Multiparameter study for a new ground-based telescope in Egypt
Authors: Darwish Mohamed S , Badreldin Hazem , Ahmed Nasser M , Morsy Mostafa , Kohil E E , Hassan Hany M , Helmy I , Shokry Ahmed , Hassan M A , Saad S M , Hamed G M , Ghatass Z F , Ata S A
Published: October 2023

A multiparameter analysis was conducted to evaluate the impact of meteorological parameters, night sky brightness and seismic hazards on proposed sites for the new optical/infrared Egyptian astronomical telescope. The European Centre for Medium-Range Weather Forecasts (ECMWF) Reanalysis v5 (ERA5) data set is used to obtain the following meteorological parameters: total cloud coverage fraction, precipitable water vapour, relative humidity, wind speed and direction, and air temperature. To estimate the aerosol optical depth, we used the Modern-Era Retrospective analysis for Research and Applications version 2 (MERRA-2). Light pollution over the candidate sites was measured using the Visible Infrared Imaging Radiometer Suite (VIIRS) day/night band. In order to assess the seismic hazards for the candidate sites, the seismic input in terms of maximum acceleration and response spectra was computed using a physics-based ground motion approach to assess the seismic hazards and, consequently, the designation of a seismic-resistant structure for the proposed sites. Of the seven nominated sites, two sites are found to have the best measurements and might be considered as future sites for the new Egyptian astronomical telescope. The first site is located in the south of the Sinai peninsula, while the second site is located in the Red Sea mountains region.
Observational signatures of forming young massive clusters: continuum emission from dense H ii regions
Authors: Inoguchi Mutsuko , Hosokawa Takashi , Fukushima Hajime , Tanaka Kei E I , Yajima Hidenobu , Mineshige Shin
Published: October 2023

Young massive clusters (YMCs) are the most massive star clusters forming in nearby galaxies and are thought to be a young analogue to the globular clusters. Understanding the formation process of YMCs leads to looking into very efficient star formation in high-redshift galaxies suggested by recent JWST observations. We investigate possible observational signatures of their formation stage, particularly when the mass of a cluster is increasing via accretion from a natal molecular cloud. To this end, we study the broad-band continuum emission from ionized gas and dust enshrouding YMCs, whose formation is followed by recent radiation hydrodynamics simulations. We perform post-process radiative transfer calculations using simulation snapshots and find characteristic spectral features at radio and far-infrared frequencies. We show that a striking feature is long-lasting, strong free–free emission from a ∼10-pc-scale H ii region with a large emission measure of ≳107 cm−6 pc, corresponding to the mean electron density of ≳103 cm−3. There is a turnover feature below ∼10 GHz, a signature of the optically thick free–free emission, often found in Galactic ultracompact H ii regions. These features come from the peculiar YMC formation process, where the cluster’s gravity effectively traps photoionized gas for a long duration and enables continuous star formation within the cluster. Such large and dense H ii regions show distinct distribution on the density–size diagram, apart from the standard sequence of Galactic H ii regions. This is consistent with the observational trend inferred for extragalactic H ii regions associated with YMCs.
EndoQuad: a comprehensive genome-wide experimentally validated endogenous G-quadruplex database
Authors: Qian Sheng Hu , Shi Meng-Wei , Xiong Yu-Li , Zhang Yuan , Zhang Ze-Hao , Song Xue-Mei , Deng Xin-Yin , Chen Zhen-Xia
Published: October 2023

G-quadruplexes (G4s) are non-canonical four-stranded structures and are emerging as novel genetic regulatory elements. However, a comprehensive genomic annotation of endogenous G4s (eG4s) and systematic characterization of their regulatory network are still lacking, posing major challenges for eG4 research. Here, we present EndoQuad (https://EndoQuad.chenzxlab.cn/) to address these pressing issues by integrating high-throughput experimental data. First, based on high-quality genome-wide eG4s mapping datasets (human: 1181; mouse: 24; chicken: 2) generated by G4 ChIP-seq/CUT&Tag, we generate a reference set of genome-wide eG4s. Our multi-omics analyses show that most eG4s are identified in one or a few cell types. The eG4s with higher occurrences across samples are more structurally stable, evolutionarily conserved, enriched in promoter regions, mark highly expressed genes and associate with complex regulatory programs, demonstrating higher confidence level for further experiments. Finally, we integrate millions of functional genomic variants and prioritize eG4s with regulatory functions in disease and cancer contexts. These efforts have culminated in the comprehensive and interactive database of experimentally validated DNA eG4s. As such, EndoQuad enables users to easily access, download and repurpose these data for their own research. EndoQuad will become a one-stop resource for eG4 research and lay the foundation for future functional studies.
PacBio sequencing of human fecal samples uncovers the DNA methylation landscape of 22 673 gut phages
Authors: Ding Yanqiang , Zhao Liuyang , Wang Guoping , Shi Yu , Guo Gang , Liu Changan , Chen Zigui , Coker Olabisi Oluwabukola , She Junjun , Yu Jun
Published: October 2023

Gut phages have an important impact on human health. Methylation plays key roles in DNA recognition, gene expression regulation and replication for phages. However, the DNA methylation landscape of gut phages is largely unknown. Here, with PacBio sequencing (2120×, 4785 Gb), we detected gut phage methylation landscape based on 22 673 gut phage genomes, and presented diverse methylation motifs and methylation differences in genomic elements. Moreover, the methylation rate of phages was associated with taxonomy and host, and N6-methyladenine methylation rate was higher in temperate phages than in virulent phages, suggesting an important role for methylation in phage-host interaction. In particular, 3543 (15.63%) phage genomes contained restriction-modification system, which could aid in evading clearance by the host. This study revealed the DNA methylation landscape of gut phage and its potential roles, which will advance the understanding of gut phage survival and human health.
GLIOMA-07 E.R.A.S. IN NEURO-ONCOLOGY
Authors: Moro Mario
Published: October 2023

BACKGROUND

We performed a retrospective study assesses the efficacy and safety of a protocol for the enhanced recovery after surgery for supratentorial gliomas and metastasis.The protocol applied to the Ca' Foncello Hospital in Treviso starts from the recommendations on the subject that the medical literature reported up to December 2018.Briefly, three main sections:1) preoperative functional status evaluation, preoperative oral carbohydrate loading; 2) minimally invasive surgery, scalp incision anesthesia, nonopioid analgesia; 3) early urinary-catheter removal, standing and feeding resumption within 3-4 hours from surgery.

METHODS

We analyzed data on 28 patients operated on ERAS protocol and compared them to a control group (22 patients). The main clinical variables are: age, ASA and Charlson comorbidity index; times urinary-catether removal, adherence ambulation, taking food by mouth; hospital long of stay (LOS). We also collected studies from 2016 to 2020 describing data about ERAS and craniotomy and we pooled these into a meta-analysis.

RESULTS

Postoperative pain was significantly lower in the ERAS group (2.47 vs. 3.95, p-value=0.0007)) as long as time to removal of urinary catheter (3.1 vs. 25.0 hours, p-value < 0.001), adherence to ambulation (4 vs. 25 hours, p-value < 0.001), and first oral solid food intake (5.3 hours vs. 23.7 hours, p-value < 0.001). The mean LOS was 2.9 days in the ERAS group and 4.8 days in the control group (p-value < 0.001), and no differences in terms of surgical and medical complications, 30 days readmission rate, and time between surgery and RT were found. Our data are in line with those reported in the literature as highlighted by our meta-analysis, where hospital LOS and moderate to severe postoperative pain rates (> 4 points on NPRS) were significantly lower in ERAS patients.

CONCLUSIONS

Our protocol for ERAS in neuro-oncology appears to have significant benefits over conventional management: it may accelerate functional recovery and decrease length of stay
GLIOMA-12 GLIOSARCOMA: A SERIES OF FOUR CASES TREATED
Authors: Drogba Landry , Djonde Grace , Nitcheu Igor , Gbazi Marc , Meuga Innocent , Diaby Raissa , Oka Dominique Ndri
Published: October 2023

INTRODUCTION

Gliosarcoma is a rare central nervous system malignancy, characterized by classical biphasic histological pattern with both glial and sarcomatous component. It usually affects fifth and sixth decade of life with slight male preponderance. In this report, we reviewed the clinical and radiological presentation, pathologic diagnosis, and treatment outcomes for a series of 4 patients diagnosed with gliosarcoma.

MATERIAL AND METHODS

We carried out a retrospective analysis of four patients with gliosarcoma diagnosed between March 2019 and March 2023. Demographic data, clinicopathological data, treatment strategies employed, details of recurrence, and survival patterns are reviewed.

RESULTS

Four patients, males, respectively aged of 56, 39, 54 and 57 years, presented with signs and symptoms consistent with an expanding intracranial mass,including headache, seizure, hemiparesis. Median duration of presenting symptoms was 3.5 months. The tumor was located in temporo-parieto-occipital region, fronto-parietal region, fronto-temporal region, and temporal region. All patients underwent craniotomy with attempt to achieve gross total surgical resection. Unfortunately, total resection could be achieved in only two patients; remaining two patients underwent subtotal resection. Surgery was followed by adjuvant radiotherapy and temozolomide-based chemotherapy for three patients. All patients died at 1 week, 6 months, 7 months and 10 months.

CONCLUSION

As gliosarcoma is considered as a variant of glioblastoma, it is treated similarly to glioblastoma but optimum treatment recommendations are yet to be defined. In this series, we have reported four cases of gliosarcoma who have been treated on the lines of glioblastoma. The prognosis is still poor despite aggressive surgical resection and adjuvant multi-modality therapy is given.
METASTASES-01 OUTCOME OF BRAIN METASTASES TREATED WITH GAMMA KNIFE STEREOTACTIC RADIOSURGERY (GKSR): COHORT RETROSPECTIVE STUDY ON 205 CASES
Authors: Bankole Nourou Dine Adeniran , Melhaoui Adyl , Arkha Yasser , Afaf Semmar , Bouyakhlef Khalid , Boutarbouch Mahjouba , Jiddane Mohamed , El Khamlichi Abdeslam
Published: October 2023

BACKGROUND

Brain metastases (BMs) are the most common expansive intracranial lesions in adults. Approximately 50% of patients diagnosed with new brain metastases have more than one brain metastasis at the time of diagnosis.

OBJECTIVE

We report our experience of brain metastases treated with GKSR and evaluate the outcome.

METHODS

Patients treated by Gamma Knife stereotactic radiosurgery (GKSR) in our institution between 2008 and 2021 for BM were recorded retrospectively.

RESULTS

A total of 205 patients (56.6% females) were included, with a median age of 59 (25-83) years old. Breast (n=85, 42.5%) and lung (n=76, 38%) were the common original locations for the primary tumors (Table 1). There were 103 patients (50.3%) with single BM and 102 patients (49.7%) with multiple BM⩾2. The median number of multiple BM treated was 4 (2-43). The overall mean survival time was 6.00(95% CI, 5.07-6.93) months for all BM. The median percentage of tumor control after radiosurgery treatment was 65% (20-99) over the median follow-up time of 6.00(3-84) months. In the overall population, the 1-year OS rate was 37.55%, the 2-year OS rate was 25.12%, and the 5-year OS was 18.51%. The mean survival time among patients with BM was higher in those with multiple BM than those with single BM ([10 (95%CI 6.67-13.33) months vs 5(4.21-5.70) months, P (0.03)]). Retreatment, tumor stability (control), and progression influence the overall survival of BM, whether single or multiple (P<0.001).

CONCLUSION

Stereotaxic Radiosurgery provides good results in terms of Overall survival and better Quality of Life for BM, whether single or multiple. Stability and retreatment influenced the overall survival of BM.
TRANSLATIONAL RESEARCH-03 MULTIPLE MECHANISMS MODULATE TEMOZOLOMIDE RESISTANCE AND ARE POTENTIAL TARGETS FOR GLIOBLASTOMA THERAPY.
Authors: Kitange Gaspar , Sarkaria Jann
Published: October 2023

Glioblastoma (GBM) is the most common and aggressive primary brain tumor. Temozolomide (TMZ) is the only drug currently been used for treatment of newly diagnosed GBM patients but the benefit from this agent has been hampered by the primary and secondary resistance. Thus, there is a strong need for uncovering the mechanisms of TMZ resistance. The DNA repair protein O6-methylguanine-DNA-methyltransferase (MGMT) is the main driver of primary TMZ resistance and lacking MGMT expression due to promoter hypermethylation has been associated with a significant survival prolongation. However, the MGMT-independent resistance mechanisms remain poorly understood. To investigate TMZ resistance mechanisms, we developed in vivo TMZ resistant models using GBM patient derived xenografts (PDXs) by treating animals bearing flank PDXs with clinically relevant 3-cyles of TMZ. The recurrent tumors were all resistant to TMZ through multiple mechanisms, including MGMT re-expression, elevated homologous recombination (HR) and/or non-homologous end joining (NHEJ) repair activities, and loss of mismatch repair (MMR). However, other tumors developed resistance due to unknown mechanisms. To identify novel modulators of TMZ sensitivity, we performed genome wide screening using shRNA library, and we identified over 600 druggable targets. Validation experiments identified RBBP4 gene as one of the candidates involved in TMZ sensitivity. Silencing RBBP4 in GBM cells sensitized both MGMT-methylated and -unmethylated GBM cells to TMZ. Mechanistically, RBBP4 interacts with p300 to form a chromatin remodeling complex that control expression of DNA damage repair genes, and silencing RBBP4 or p300 significantly blocked the recovery of TMZ induced DNA double strand breaks causing cell death. We also found the nuclear pore exporter XPO1 is the modulator of TMZ sensitivity, and the XPO1 inhibitor Selinexor is currently being evaluated for GBM treatment in a clinical trial. Collectively, our work has uncovered multiple mechanisms of TMZ resistance that are potential targets for GBM therapy.
The fetus as patient
Authors: Boué André , Muller F
Published: October 2023

Twenty years ago, in utero fetal examination was done by tape measure and wooden stethoscope. Ultrasound, introduced by Ian Donald, was, at that time, a technology of mediocre quality and was little used. In 1972, Campbell et al. made the first ultrasound diagnosis: anencephaly. In 1967-68 the first prenatal diagnoses using laboratory techniques had been achieved: diagnosis of chromosomal anomalies using cells from amniotic fluid, diagnosis of inborn errors of metabolism, and diagnosis of primary rubella virus infection by measurement of IgM-specific antibodies in maternal blood. (See for example Jacobson and Barter, 1967; Vesikan and Vaheri, 1968.)
Introduction
Authors: Boué André
Published: October 2023

Data from the European Surveillance Program based on 770 000 births from 1980-1983 in 17 European centres (Dewals and Lechat, 1986), provides an assessment of different types of malformations observed at birth (Table I).
Ultrasound Indications for Laboratory Testing
Authors: Boué André , Muller F
Published: October 2023

Fortuitous finding of anomaly on ultrasound examination is a frequent indication for laboratory analyses which are increasingly indispensable in the appropriate management of cases. In terms of diagnosis, the indication may be for diagnosis of cause (e.g. chromosomal anomaly), or for more precise diagnosis (e.g. acetylcholinesterase for neural tube defect).
Disorders of the cerebral circulation
Authors: Bannister Sir Roger
Published: October 2023

Disorders of the cerebral circulation are the commonest neurological disorders of middle age and old age because the cells of the brain can only function for a few minutes at the most if their oxygen or glucose supply is reduced below a critical level. Stroke, the lay term for a vascular incident causing disability, whether occlusive or haemorrhagic, afflicts about 1 per cent of our population and a quarter of these are below the age of 65, though stroke is uncommon under the age of 40. In one prospective study 60 per cent of strokes were due to atheroma and thrombosis, 15 per cent to haemorrhage, and 15 per cent to embolism.
Parkinsonism and movement disorders
Authors: Bannister Sir Roger
Published: October 2023

When abnormalities of movement or posture result from dysfunction of parts of the brain other than the corticospinal pathways or cerebellum they are generally classified as movement disorders. The principal structures involved are the basal ganglia or central grey matter of the cerebrum. Diseases of the basal ganglia are associated with changes in distribution and concentration of neurotransmitter substances and are classified into those disorders associated with a reduction or slowness of movement (hypokinesia) or an excess of involuntary movement (hyperkinesia).
Disorders of the spinal cord
Authors: Bannister Sir Roger
Published: October 2023

The spinal cord lies within the vertebral canal, extending from the foramen magnum, where it is continuous with the medulla oblongata, to the level of the first or second lumbar vertebra (see Fig. 18.1). The concept of segmentation of the spinal cord is based upon the fact that the ventral and dorsal root filaments unite at intervals to form on either side a dorsal or posterior root, upon which is situated a ganglion, and a ventral or anterior root. One ventral and the corresponding dorsal root on one side join together just distally to the dorsal root ganglion to form a spinal nerve (see Fig. 18.2). Thus from each side there arises a series of spinal nerves, and the spinal cord is regarded as divided into segments, one corresponding to each pair of spinal nerves.
Neurological syndromes and associated malignant diseases
Authors: Bannister Sir Roger
Published: October 2023

An increasing variety of neurological syndromes has been recognized. in association with malignant disease. These are not due to direct invasion or metastasis and consist of two groups of reactions. The first are remote effects due to factors which are known, such as hypocalcaemia, hypoglycaemia, or, in one interesting example, inappropriate antidiuretic hormone (ADH) production. In this, usually associated with an oat cell bronchial carcinoma, the clinical picture is one of lethargy, confusion, and even epileptic fits and coma. The cause is inappropriate production of ADH thought to be secreted by the oat cell bronchial carcinoma leading to a low plasma sodium (below 110 E/1) and a low plasma osmolality, in the presence of high urinary osmolality. If the tumour cannot be removed, treatment is attempted either by water restriction or by causing a water diuresis with fludrocortisone.
Physical mechanisms of fatigue
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

This chapter is concerned with the mechanism of fatigue in health and disease. As we saw in Chapter 1, fatigue may be conceptualized as either a decrement in performance or as a feeling. This book is concerned with the latter definition of fatigue, and apart from a brief excursion into the physiology of muscle fatigue, the main focus of this chapter is on fatigue as a feeling.
From neurasthenia to CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

Much of the early part of this book concerned fatigue as a symptom. With the introduction of neurasthenia came the concept of fatigue as the principal symptom of a diagnostic entity. This chapter describes the origins of the latest disease of abnormal fatigue and fatigability, chronic fatigue syndrome, and its variants.
CFS: muscles and nerves
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

When considering the history of neurasthenia, we have seen how the early models of the physical nature of the illness considered that fatigue was of peripheral, neuro muscular origin, but these were superseded by concepts of fatigue resulting from central nervous system dysfunction. At least part of the same progression can be observed in studies of CFS. Initially, particularly in the United Kingdom, suggested aetiologies of CFS revolved around possible neuromuscular dysfunction. This is not surprising - patients are clearly limited in the amount of physical activity they can undertake, and are ‘only too aware of the muscle pain or ache located only too painfully in the muscle’’. It is therefore reasonable to suggest that such symptoms and disabilities have a primary neuromuscular cause. A considerable body of literature now exists to address this question.
Other chronic fatigue syndromes
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

This book is about chronic fatigue and chronic fatigue syndrome (CFS). However, CFS is not the only chronic fatigue syndrome. We have already made frequent reference to other disorders characterized by similar symptoms. When bowel symptoms are prominent in a subject with chronic fatigue, irritable bowel syndrome is a likely diagnosis; when muscle pain is prominent, the result may be fibromyalgia; and when chest pain and breathlessness are important complaints, effort syndrome may be diagnosed.
Treatment of CFS: the evidence
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

It is hard to imagine any illness for which more unproven remedies have been advocated with greater enthusiasm than CFS. Contemplating the extensive popular literature1-6 one is struck by the range of treatments advocated: from aspirin to aromatherapy, antidepressants to acupuncture, and magnesium to massage. It is striking how often these books plead for a holistic approach, rightly complaining that modern medicine often focuses too much on diseases instead of the individual, but then falling into the same trap. Many of the treatments recommended are based only on anecdotal improvements some sufferers have made, or on unproven theories of immune dysfunction, candida infestations, dietary deficiencies, and so on. Very little treatment advice is based on the results of randomized controlled trials. Much the same could also be said about the medical management of CFS.
Maternal-fetal conflicts: ethical and policy issues
Authors: Cohen Wayne R
Published: October 2023

One of the great appeals of obstetrics for its practitioners and its aspirants is that medical decision-making affects simultaneously the well-being of mother and fetus. This duality confers a pattern of complexity on clinical problem-solving that is often intriguing and provocative. From this unique quality of obstetrics a number of abstruse challenges to modern bioethics have emerged.
Organ transplantation
Authors: Peabody Joyce L
Published: October 2023

Case 1: Baby J. was born at term to a Gravida 2, Para 1, Ab 0, 24-year-old white female. The pregnancy was uneventful and labor and delivery proceeded well. Apgars were 9 and 9 at 1 and 5 minutes respectively. The baby was admitted to the normal newborn nursery of a small community hospital. Routine care was administered and the infant began breast-feeding shortly after birth. Mother, father, and a two-year-old brother were all ecstatic regarding the new addition to their family. Both sets of grandparents were notified of the new arrival and immediately booked plane reservations to visit and to begin spoiling their new granddaughter. Two days following the delivery, the obstetrician and pediatrician discharged the mother and newborn to home, with follow-up appointments at one week for routine post-partum and pediatric care. However, on the morning of the planned discharge, Baby J. demonstrated perioral cyaliosis during breast-feeding. The nursing staff reassured the mother that this was not uncommon and notified the pediatrician. The pediatrician decided to keep the infant in the hospital for an additional day of observation. Throughout the day, episodes of central cyanosis developed, and a chest radiograph demonstrated an enlarged heart. By evening, the infant was refusing all feedings and had developed a metabolic acidosis. The pediatrician requested transfer of the infant to the nearby tertiary-care medical center for further evaluation. Soon after admission, an echocardiogram demonstrated the findings of hypoplastic left-heart syndrome. The cardiologist and neonatologist called the family and scheduled an appointment to discuss their findings and the options for treatment. One hour later the neonatologist was informed that the parents and both sets of grandparents were anxiously awaiting the physicians in the family waiting-room.
The boundary between therapeutic and non-therapeutic research
Authors: Tyson Jon
Published: October 2023

The obstetric faculty in a large perinatal center decide to order a cord blood pH determination at birth routinely. This decision was made partly to help assess the quality of obstetric and neonatal care, partly to understand better the problems of individual infants, partly to increase knowledge about the physiology of birth asphyxia and the relationship of cord blood pH to perinatal outcome, and partly to avoid unjustified malpractice litigation. (A normal pH value indicates that severe asphyxia was not present at birth.) Cord blood pH determinations are part of ‘standard care’ in many teaching hospitals, and a low pH value may prompt immediate therapy of the infant for acidosis. Yet it is unclear whether such treatment would improve, worsen, or have no effect on outcome. No special effort will be made to obtain and report the pH determinations as quickly as possible.
The economics of perinatal care in the United States
Authors: Harvey Birt
Published: October 2023

Appropriate prenatal and newborn care should minimize low birthweight, lower newborn mortality and morbidity, and--consequently--decrease sub sequent chronic illness and handicapping conditions. Barriers to appropriate prenatal and newborn care are not only financial; but lack of financial access is a major deterrent. Insurance coverage (status) influences both quality of care and outcome.
Preparation Of The Patient And Preoperative Checks
Authors: Hosie H , Holmes E
Published: October 2023

The ward staff start preparing the patient for anaesthesia and surgery by assessing the patient. Theatre staff continue this process but also take on the responsibilities of caring for a patient whose judgement may be impaired due to premedicant drugs or who may be unconscious. The role of the anaesthetic assistant includes acting as the patient’s advocate, protecting the patient’s dignity and rights, and ensuring that the correct procedures are adhered to. Many units have designed a checklist to record the preparation of the patient (an example is shown below). Unfortunately, most checklists are based on physical measurements and assessments and may have little or no space to document the psychological preparation or effects of premedication on the patient, although this is of great importance.
Breathing
Authors: Hosie H , Morton N S
Published: October 2023

Respiratory arrest or apnoea is the cessation of breathing. Breathing is controlled by the respiratory centre, which is found in the brainstem. There are three separate areas of function, the inspiratory centre, the pneumotaxic centre and the expiratory centre. In normal inspiration (breathing in) there is increasing electrical activity in the inspiratory centre. Nervous impulses are conducted along the phrenic and intercostal nerves and cause contraction of the diaphragm and sometimes the intercostal muscles. This causes a negative intrathroacic pressure, air enters and expands the lungs. As the lungs stretch and expand, stretch receptors are activated which send impulses to the pneumotaxic centre. This inhibits the inspiratory centre and stops further expansion of the lungs. Normally air is then expelled passively with the elastic recoil of the lung tissue. Occasionally the expiratory centre becomes active, contracting expiratory muscles and causing air to be blown out.
Monitoring The Recovering Patient
Authors: Holmes E , Morton N S
Published: October 2023

The main aim of recovery care is to ensure the patient’s safety and comfort in the early postoperative period and has been defined as protective care. This is complimentary to the principles of ‘total’ safety of the patient in the operating department.
Diagnosis And Management Of Early Postoperative Problems
Authors: Holmes E , Gillies G
Published: October 2023

An early feature of most respiratory problems when the patient is breathing room air is a fall in oxygen saturation revealed by the pulse oximeter. This can be treated by administering oxygen whilst further help is summoned. If the patient is apnoeic or is making very little respiratory effort, positive pressure ventilation by self-inflating bag and mask should be given by the assistant or anaesthetist or a tracheal tube should be inserted by the anaesthetist without delay.
Transplantation
Authors: Morton N S
Published: October 2023

Transplantation surgery is a highly specialized field where advances are limited by the shortage of donor organs. Organs for transplantation are usually preserved by being filled with a special fluid solution while being cooled. This reduces the cell metabolism and preserves the cell function. Kidneys can be preserved for up to 48 hours, the liver for up to 24 hours, lungs for about 8 hours and the heart for 4 to 6 hours. Organs are obtained from certified brain dead patients after consent has been obtained from relatives. The donor operation can be upsetting to theatre staff but, although the patient is certified as brain dead, they are afforded the same care and respect given to all patients.
Respiratory
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Care should be exercised when moving the neck if a history of trauma is given. Initially, patients may only he symptomatic during exertion. lnspiratory stridor is an ominous sign. Epiglottitis can also occur in adults.
Poisoning
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Usually the history is obvious. Physical signs may be absent or confused due to ingestion of mixed poisons. Urgent advice should be sought from a poisons information centre. Some poisons may cause toxicity without ingestion, e.g. by inhalation or through the skin. Blood levels of salicylate and paracetamol are required in all cases of poisoning since active treatment will be required. A qualitative drug screen is a useful aid to diagnosis. In some cases the effects of poisoning are late (e.g. paracetamol, paraquat).
Miscellaneous
Authors: Singer Mervyn , Webb Andrew R
Published: October 2023

Numerous causes exist, the commonest being related to drugs (or drug/alcohol withdrawal), infection, respiratory failure, metabolic causes (especially hypoglycaemia), head trauma and cerebral hypoperfusion (e.g. severe heart failure).
Ultrasonography of the joints
Authors: Jadoul Michel , Berg, Bruno Vande , Malghem Jacques
Published: October 2023

Ultrasonography (US) of joint capsules and tendons has been proposed as a potentially useful instrument for the diagnosis of dialysis-related amyloidosis (van Ypersele et al. 1988). In this chapter we review the rationale of this proposal, the methodology of ultrasonographic examination of capsules and tendons, and the results obtained with this technique in dialysed patients. The sensitivity and specificity of US for the diagnosis of dialysisrelated amyloidosis are reviewed and the potential pitfalls, limitations, and reproducibility of the technique are discussed. Finally, the perspectives for the use of US in the diagnosis and monitoring of dialysis-related amyloidosis are considered.
Composition of β ß2-microglobulin deposits
Authors: Gejyo Fumitake , Nishi, Shinichi , Arakawa Masaaki
Published: October 2023

Dialysis-related amyloidosis (Af32m) occurs predominantly in the articular synovial membrane. Common findings in such patients are arthralgias and carpal tunnel syndrome (CTS). When the deposits are studied by light microscopy, the amyloid initially shows a granular deposition which then gradually spreads along the synovial membrane of the tendon to form nodular deposits. These deposits are characterized by: (1) an amorphous appearance on light microscopy; (2) Congo red positivity; (3) apple-green birefringence of the Congo red-stained material in polarized light; and (4) amyloid fibrils measuring 6-12 nm observed on electron microscopy. Dialysis-related amyloid fibrils are relatively short and aligned in one direction to form a bundle (Fig. 7.1), whereas AA- and AL-type fibrils are randomly arrayed running in all directions. Dialysis-related amyloid fibrils are therefore easily distinguishable from those of other types of amyloidosis.
Characteristics of ß2-microglobulin metabolism
Authors: Deppisch R , Ritz, E , Stein G
Published: October 2023

Beta 2-microglobulin ([32m) derived amyloid is found in patients with impaired renal function either as urinary concretions or as systemic, mostly osteoarticular, deposits. Such amyloid is rarely seen in the predialysis phase (Linke et al. 1986; Moriniere et al. 1991), but is a very common complication after institution of dialysis (Campistol et al. 1990; Ritz and Bommer 1988). Generation of amyloid is dependent on increased plasma [32m concentrations. The increase of plasma [32m concentration is mainly due to diminished renal excretion of the 11.8 kDa microprotein which is normally eliminated via glomerular filtration (Vincent and Revillard 1980). The high plasma [32m concentrations in dialysed patients may not simply be the result of renal retention.
Physiological rhythms at rest
Authors: Reilly T , Atkinson G , Waterhouse J
Published: October 2023

The existence of physiological rhythms at rest must be taken into consideration by the exercise scientist. First, measurements at resting state should be controlled for the time of day to avoid potential misinterpretation later. Second, the time of day may influence the preparedness of the subject for submaximal and maximal exercise performance. As a background to understanding circadian rhythms in human performance, the rhythms of relevant physiological systems at rest are briefly described in this chapter.
Epilepsy
Authors: Hopkins Anthony , Appleton Richard
Published: October 2023

Epilepsy: The Facts, written by a neurologist and a pediatric neurologist, explains in clear and simple terms everything about the causes and effects of epilepsy. This book, strengthened by the contributions of a new new coauthor, has been considerably revised for the new edition. Intended for sufferers of epilepsy and their relatives, the authors explain what is meant by epilepsy, describe different types of epileptic seizure and of epilepsy syndromes in childhood and adult life, and offer an explanation of how epilepsy is investigated. Recent advances in the management of epilepsy by the use of drugs and therapy are considered in depth, as is the impact of new imaging techniques. The authors emphasize throughout the positive possibilities for people with epilepsy as well as advising on how to cope with problems as and when they arise in day-to-day living. They take many aspects of a normal life such as schooling, pregnancy, driving, and work, and describe how epilepsy can affect these. In the final chapter, the future of epilepsy is covered. The authors have succeeded in making this complex field interesting and understandable for people with epilepsy and their relatives.
Acute Respiratory failure
Authors: Frca R F Armstrong
Published: October 2023

A 60-year-old male patient was admitted with a 5-day history of malaise, cough with purulent sputum, and increasing breathlessness. Central cyanosis; dyspnoea; using accessory muscles of respiration; tongue dry; temperature 38°C; pulse irregular 140/min. Blood pressure (BP) 80/60 mmHg; respiratory rate :40/min. Chest dull to percussion on left with reduced air entry. Central venous pressure (CVP) 0 mmHg. Chest X-ray revealed opacification of the whole of the left lung.
Acute respiratory distress syndrome (ARDS)
Authors: Phd T W . Evans Md Frcp , Frcs R Sayeed
Published: October 2023

A 26-year-old woman approaching term during her first pregnancy developed a widespread vesicular rash with associated dyspnoea of effort. Chest radiography revealed bilateral reticular shadowing. She was admitted to ITU because of refractory hypoxaemia, where a clinical diagnosis of varicella pneumonitis was made, and she proceeded to an emergency Caesarean section.
The high-risk surgical case
Authors: frca o. boyd mrcp
Published: October 2023

A 75-year-old female presented to the surgical team with a 12-hour history of abdominal pain. She took regular NSAIDS. for osteoarthritis. One year previously she was admitted to the same hospital with a myocardial infarction, since when she had taken regular frusemide and enalapril for shortness of breath. She lived in a bungalow with social services support. Pulse rate 120/min; BP 100/50 mmHg; temperature 38°C; respiratory rate 25/min with shallow breaths and decreased air entry at the bases. Auscul tation revealed a gallop rhythm and the abdomen was tense and silent.
Myocardial infarction
Authors: Mrcp M Singer Md
Published: October 2023

A 55-year-old man is admitted with a 1-hour history of crushing central chest pain and breathlessness. There is a past history of duodenal ulcer surgery 5 years previously and recent onset anginal symptoms. On arrival he is drowsy, tachypnoeic (30/min), tachycardic (120/min), and hypotensive (70/45 mmHg). Auscultation. reveals widespread end-inspiratory crackles and a gallop rhythm.
Tuberculosis
Authors: Frcp S G Spiro Md
Published: October 2023

A 24-year-old Sierra Leonese lady was admitted to hospitalwith a 1-week history of increasing dyspnoea, fever, cough, and no sputum. Her last menstrual period was 3 months ago as she had had a Caesarian section and was breast-feeding her baby. She entered the United Kingdom to live with her cousin also 3 months ‘ago. She was single arid was previously healthy. She was on no medication and did not appear to be oh any drugs of addiction.
Legionnaires’ disease
Authors: Frcpath. G L Ridgway Md Mrcp
Published: October 2023

A 64-year-old chronic bronchitic consulted his GP complaining of increas ing dyspnoea, and a cough producing yellow sputum. He smoked 15-20 cigarettes daily, and drank 20 units of alcohol per week. It was noted that he kept a budgerigar. The GP prescribed oral amoxycillin; 36 hours later he was referred to hospital as he had become peripherally cyanotic, severely dyspnoeic at rest, and mentally confused.
Toxic shock syndrome
Authors: Fanzca B D Sharpe
Published: October 2023

A 17-year-old girl presented to a district hospital with a 2-day history, of mild fever and abdominal discomfort Examination revealed a rise in temperature to 37.8°C; mildly tender abdomen; and a WCC of 12 000 x 109/f. She was transferred to theatre for appendicectomy and 5 minutes post-induction had a cardiac arrest in ventricular fibrillation which was successfully treated with 1 mg of adrenaline and a 200 J shock.
Head injury
Authors: Frca P S Withington
Published: October 2023

A previously fit, 22-year-old man was admitted to the intensive care unit following a road traffic accident. On arrival at A&E he was in a corna (GCS of 6) and was noted to have a head injury and fractured pelvis. A head CT scan revealed diffuse brain swelling with no focal lesion. lntracranial pressure (ICP) monitoring was instituted and external fixation applied to stabilize the pelvic fractures. Treatment included mannitol 100 g, gelofusine 2 litres, anaesthesia, and ventilation. Midazolam, fentanyl, pancuronium were used for sedation and muscle relaxation.
Renal failure
Authors: Frcp A Short
Published: October 2023

A 69-year-old male patient was admitted to hospital 12 hours after discharge following gall bladder surgery. He had a past history of hypertension for many years and took bendrofluazides and a calcium channel-blocker. Prior to his last admission he complained of episodes of abdominal pain and jaundice. He was referred for surgery by his GP. In hospital, ultrasound investigation revealed stones in the gall bladder but no evidence of stones in the common bile duct.
Phaeocromocytoma
Authors: Mrcp G Bellingan
Published: October 2023

A 29-year-old male was admitted with a 6-hour history of nausea, vomiting, and abdominal pain. On examination he was pyrexial and sweating with a heart rate of 70/min and BP of 155/85 mmHg. There was mild epigastric tenderness only. Apart from a white cell count of 18 X 109/1, his admission haematology, biochemistry, and microbiology tests were entirely normal as was his chest X-ray and ECG. The next morning he developed acute pulmonary oedema requiring mechanical ventilation. He suffered two asystolic arrests and was eventually stabilized on an adrenaline infusion. His chest X-ray was consistent with pulmonary oedema; PAOP was 24 mmHg; and cardiac output was 5.5 I/min. His ECG remained normal and there was no rise in his cardiac enzymes. An echocardiogram demonstrated mild ventricular hypokinesia and abdominal ultrasound showed a 6 cm mass over the right kidney.
Respiratory failure in the infant
Authors: Mrcp M Peters , Frcp R C Tasker
Published: October 2023

A 4 month-old Asian infant was admitted from the general paediatric ward. She had been an inpatient for 3 days with a respiratory illness, but was now requiring increasing oxygen supplementation and looked tired. Weight 3.5 kg; temp 37°C; respiratory rate 80/min; heart rate 175/min; BP 60/40 mmHg; SpO 82% (70% head box oxygen); palpable 2cm liver edge.
Pre-operative assessment and checks
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

Patients at low risk of heart disease do not require a pre-operative ECG. If performed a normal ECG does not exclude heart disease; and an abnormal ECG can be very difficult to interpret in a fit asymptomatic patient. However pre-operative ECGs should be done whenever suspicion of myocardial disease exists. Previous myocardial infarction (MI) is a major predictor of peri-operative MI.However the clinical diagnosis of MI can be difficult. In a recentstudy 28% of Mis were discovered only through the appearances of newECG changes. Hollenberg et al. identified five pre-operative factors which predictedpost-operative myocardial ischaemia. These were left ventricularhypertrophy on the ECG, history of hypertension, diabetes mellitustreated with drugs, coronary artery disease, and treatment withdigoxin. Raby et al. demonstrated that pre-operative ischaemia on the ECGpredicted post-operative and intra-operative ischaemia as well aspost-operative cardiac events. These were more likely to occur in patientsover the age of 70 years with a history of angina or coronary disease.98% of the post-operative ischaemic events occurred within 48 hours of operation. Two of Goldman’s pre-operative cardiac risk factors are identified bythe ECG: rhythm other than sinus, and ventricular ectopy with five ormore premature ventricular beats per minute. (But note that in contrastto Goldman’s findings, O’Kelly and associates found no correlationbetween ventricular arrhythmias and post-operative cardiac morbidityand death.)
Cardiovascular
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

Although fusion or capture beats help to identify VT, it is sometimes impossible to distinguish SVT from VT. In the presence of haemodynamic compromise it is safer to assume it is ventricular in origin and treat with lignocaine and/or DC shock. Response to a test dose of adenosine is diagnostic of SVT. Always treat the cause. Adenosine has a rapid onset and a short duration of effect (approx. 10 seconds). Thus any hypotension is shortlived and doses can be given atfrequent intervals. Verapamil is contraindicated in beta blockade and should be avoided injunctional rhythm. Verapamil-induced hypotension can be treated with 10 ml 10% calciumchloride . Hypoxia is a potent cause of bradycardia. Too many patients have beengiven atropine when oxygen was needed. Always check oxygenation in thesecircumstances. In an emergency intravenous potassium chloride can be given at a rate of1 mmol/min. A common dilution in these circumstances is 40 mmol in100 ml saline. A more dilute solution (40 mmol/1) is safer and should beused whenever possible at a slower rate (40 mmols in 1 litre over 2 hrs). Whenever potassium is used intravenously continuous ECG monitoring and frequent checks of K+ are mandatory. If using intravenous boluses make sure each administration is in the circulation before giving more.
General medical
Authors: Armstrong R F , Aveling W , Grundy E M
Published: October 2023

There is an increase in cardiac output and stroke volume in the obese patient. This may lead to LVH. Right ventricular malfunction may result from pulmonary vasoconstriction caused by chronic hypoxia. Hypertension, ischaemic heart disease, CVAs, acute Mis, cardiac arrhythmias, and sudden deaths are also more common in this group of patients. Oxygen consumption and carbon dioxide excretion are both increased. Lowcompliance leads to increased respiratory work. Intra-operatively the FRCcan fall to such low levels that it is within the closing capacity thus causingV/Q mismatch, increased shunting, and hypoxia. Post-operatively there isprolonged hypoxaemia and a high percentage of patients developrespiratory complications. There is a high incidence of hiatus hernia and gastro-oesophageal reflux.This is compounded by high intra-abdominal pressure. Because of highresting gastric volumes and low gastric pH, anti-aspiration prophylaxis(ranitidine 150 mg p/o) should be prescribed the night before surgeryand repeated 2 hours before surgery. Metoclopramide may be addedpre-operatively and 30 ml sodium citrate (0.3 molar) drunk 3 minutes beforeinduction. A rapid sequence induction is recommended. Ensure a comprehensive pre-operative assessment is carried out including ECG, blood gases, CXR, and respiratory function tests. Exclude medical illnesses associated with obesity. Be prepared for difficult airway problems. Avoid opiates as premedication. Positioning the patient is important. Head down, supine, or prone positions may not be tolerated. Lateral or head and shoulders up will allow better respiratory function.