bluuebunny/crossref_metadata_2025 huggingface dataset:
Neural Dynamics of Reward-Induced Response Activation and Inhibition
Authors: Wang Lihui , Chang Wenshuo , Krebs Ruth M , Boehler C Nico , Theeuwes Jan , Zhou Xiaolin
Published: October 2018

Reward-predictive stimuli can increase an automatic response tendency, which needs to be counteracted by effortful response inhibition when this tendency is inappropriate for the current task. Here we investigated how the human brain implements this dynamic process by adopting a reward-modulated Simon task while acquiring EEG and fMRI data in separate sessions. In the Simon task, a lateral target stimulus triggers an automatic response tendency of the spatially corresponding hand, which needs to be overcome if the activated hand is opposite to what the task requires, thereby delaying the response. We associated high or low reward with different targets, the location of which could be congruent or incongruent with the correct response hand. High-reward targets elicited larger Simon effects than low-reward targets, suggesting an increase in the automatic response tendency induced by the stimulus location. This tendency was accompanied by modulations of the lateralized readiness potential over the motor cortex, and was inhibited soon after if the high-reward targets were incongruent with the correct response hand. Moreover, this process was accompanied by enhanced theta oscillations in medial frontal cortex and enhanced activity in a frontobasal ganglia network. With dynamical causal modeling, we further demonstrated that the connection from presupplementary motor area (pre-SMA) to right inferior frontal cortex (rIFC) played a crucial role in modulating the reward-modulated response inhibition. Our results support a dynamic neural model of reward-induced response activation and inhibition, and shed light on the neural communication between reward and cognitive control in generating adaptive behaviors.
Tenascin-C accelerates adverse ventricular remodelling after myocardial infarction by modulating macrophage polarization
Authors: Kimura Taizo , Tajiri Kazuko , Sato Akira , Sakai Satoshi , Wang Zheng , Yoshida Toshimichi , Uede Toshimitsu , Hiroe Michiaki , Aonuma Kazutaka , Ieda Masaki , Imanaka-Yoshida Kyoko
Published: October 2018

Aims

Tenascin-C (TN-C) is an extracellular matrix protein undetected in the normal adult heart, but expressed in several heart diseases associated with inflammation. We previously reported that serum TN-C levels of myocardial infarction (MI) patients were elevated during the acute stage, and that patients with high peak TN-C levels were at high risk of left ventricular (LV) remodelling and poor outcome, suggesting that TN-C could play a significant role in the progression of ventricular remodelling. However, the detailed molecular mechanisms associated with this process remain unknown. We aimed to elucidate the role and underlying mechanisms associated with TN-C in adverse remodelling after MI.

Methods and results

MI was induced by permanent ligation of the coronary artery of TN-C knockout (TN-C-KO) and wild type (WT) mice. In WT mice, TN-C was expressed at the borders between intact and necrotic areas, with a peak at 3 days post-MI and observed in the immediate vicinity of infiltrating macrophages. TN-C-KO mice were protected from ventricular adverse remodelling as evidenced by a higher LV ejection fraction as compared with WT mice (19.0 ± 6.3% vs. 10.6 ± 4.4%; P < 0.001) at 3 months post-MI. During the acute phase, flow-cytometric analyses showed a decrease in F4/80+CD206lowCD45+ M1 macrophages and an increase in F4/80+CD206highCD45+ M2 macrophages in the TN-C-KO heart. To clarify the role of TN-C on macrophage polarization, we examined the direct effect of TN-C on bone marrow-derived macrophages in culture, observing that TN-C promoted macrophage shifting into an M1 phenotype via Toll-like receptor 4 (TLR4). Under M2-skewing conditions, TN-C suppressed the expression of interferon regulatory factor 4, a key transcription factor that controls M2-macrophage polarization, via TLR4, thereby inhibiting M2 polarization.

Conclusion

These results suggested that TN-C accelerates LV remodelling after MI, at least in part, by modulating M1/M2-macrophage polarization.
Relative resistance to breaking of Pinus taeda and Pinus palustris
Authors: Garms Cory , Dean Thomas J
Published: October 2018

Patterns from hurricane damage indicate that longleaf pine is more windfirm than loblolly pine. Tree windfirmess has been attributed to many factors including species and material properties like wood strength and stiffness. Because longleaf pine wood is stronger and stiffer than loblolly pine wood, this study used static winching methodology to see if these properties account for differences in wind firmness by measuring bending force required to break stems (MMAX). Stress–strain diagrams were constructed for pulled trees to explore how they behave under increasing loads. Based on these diagrams, living trees appear to act as linear elastic materials as they experience increasing static lateral stress. As expected, longleaf pine stems were stiffer than loblolly pine wood in situ based on Young’s modulus of elasticity. Tree basal area was the best predictor of MMAX for both species, however, species had no significant effect on the maximum bending moment required to break tree stems of a given basal area for these trees under these conditions. The stiffness of the stems was higher for longleaf than loblolly as indicated by the modulus of elasticity, but the strength of the stems as indicated by the modulus of rupture was not significantly different between the species. Differences in the volumetric density of foliage, however, were consistent with the observed differences in stem failure between the species. For trees with the same diameter, loblolly pine had higher values of leaf area per unit crown length than longleaf pine.
Kit-independent mast cell adhesion mediated by Notch
Authors: Murata Akihiko , Hikosaka Mari , Yoshino Miya , Zhou Lan , Hayashi Shin-Ichi
Published: October 2018

Kit/CD117 plays a crucial role in the cell–cell and cell–matrix adhesion of mammalian mast cells (MCs); however, it is unclear whether other adhesion molecule(s) perform important roles in the adhesion of MCs. In the present study, we show a novel Kit-independent adhesion mechanism of mouse cultured MCs mediated by Notch family members. On stromal cells transduced with each Notch ligand gene, Kit and its signaling become dispensable for the entire adhesion process of MCs from tethering to spreading. The Notch-mediated spreading of adherent MCs involves the activation of signaling via phosphatidylinositol 3-kinases and mitogen-activated protein kinases, similar to Kit-mediated spreading. Despite the activation of the same signaling pathways, while Kit supports the adhesion and survival of MCs, Notch only supports adhesion. Thus, Notch family members are specialized adhesion molecules for MCs that effectively replace the adhesion function of Kit in order to support the interaction of MCs with the surrounding cellular microenvironments.
Epidemiology, Biology, Treatment, and Prevention of Ductal Carcinoma In Situ (DCIS)
Authors: Punglia Rinaa S , Bifolck Kaitlyn , Golshan Mehra , Lehman Constance , Collins Laura , Polyak Kornelia , Mittendorf Elizabeth , Garber Judy , Hwang Shelley E , Schnitt Stuart J , Partridge Ann H , King Tari A
Published: October 2018

Ductal carcinoma in situ (DCIS) is a highly heterogeneous disease. It presents in a variety of ways and may or may not progress to invasive cancer, which poses challenges for both diagnosis and treatment. On May 15, 2017, the Dana-Farber/Harvard Cancer Center hosted a retreat for over 80 breast specialists including medical oncologists, surgical oncologists, radiation oncologists, radiologists, pathologists, physician assistants, nurses, nurse practitioners, researchers, and patient advocates to discuss the state of the science, treatment challenges, and key questions relating to DCIS. Speakers and attendees were encouraged to explore opportunities for future collaboration and research to improve our understanding and clinical management of this disease. Participants were from Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Massachusetts General Hospital, Beth Israel Deaconess Medical Center, Duke University Medical Center, and MD Anderson Cancer Center. The discussion focused on three main themes: epidemiology, detection, and pathology; state of the science including the biology of DCIS and potential novel treatment approaches; and risk perceptions, communication, and decision-making. Here we summarize the proceedings from this event.
Epitope/Peptide-Based Monoclonal Antibodies for Immunotherapy of Ovarian Cancer
Authors: Lee Gregory
Published: October 2018

Two monoclonal antibodies, RP215 and GHR106, were selected, respectively, for the research and development of anti-cancer drugs targeting ovarian cancer and other types of human cancer. RP215 was shown to react with a carbohydrate-associated epitope located mainly in the variable regions of immunoglobulin heavy chains expressed on the surface of almost all cancer cells in humans. GHR106 was generated against a synthetic peptide corresponding to N1-29 amino acid residues in the extracellular domains of human GnRH receptor, which is surface-expressed by most cancer cells as well as the anterior pituitary. This monoclonal antibody was shown to serve as a bioequivalent analog to GnRH-derived decapeptides currently used clinically. The molecular mechanisms of action of these two antibody-based anti-cancer drug candidates were well elucidated following numerous biochemical, immunological, and molecular biological studies, mainly by using ovarian cancer as the model. Further preclinical studies with humanized forms of these two antibodies are essential.
Unique Challenges Facing Immunotherapy of Metastatic Ovarian Cancer
Authors: Messmer Michelle N. , Netherby Colleen S. , Abrams Scott I.
Published: October 2018

The immune system serves as an integral checkpoint to developing malignancies. However, when cancer ultimately becomes detectable, this implicates an inherent failure of effective immune control. One constant theme in cancer biology has been the ability of these “diseases,” in particular, ovarian cancer, to compromise immune-mediated mechanisms of neoplastic control. These empirical observations have subsequently laid the scientific foundation to investigate ways in which the immune system can be reengaged as a powerful therapeutic weapon, singly or in combination with other modalities. This field has been coined “cancer immunotherapy” and, importantly, strong progress has been made to date to justify its feasibility and potential merit. This chapter focuses on the fundamental immunologic principles that have guided the development of the cancer immunotherapy concept, as well as details both the successes and the limitations of cancer immunotherapy in patients with metastatic ovarian cancer.
PTSD and Medical Illness
Authors: Roy-Byrne Peter , Stein Murray B.
Published: October 2018

There has been increasing recognition of the important and reciprocal relationship between medical illness and depressive and anxiety disorders. This chapter examines the interrelationship between medical illness and post-traumatic stress disorder (PTSD), a unique disorder with features of depression and anxiety, from multiple perspectives. Medical illness, especially acute, unexpected illness and injury, can serve as a life-threatening traumatic stressor that precipitates PTSD through multiple mechanisms. PTSD, and even traumatic exposure without subsequent PTSD, may increase the risk of a variety of medical illnesses, with the most-studied illness being cardiovascular disease. PTSD may also worsen the course and outcome of already existing medical illness. Extant research has not addressed the possibility that medical Illness may worsen the course or outcome of PTSD, but similar research has shown only limited effects of medical illness on depression and anxiety outcomes. These reciprocal relationships are thought to exert their effects through mutually reinforcing neurobiological mechanisms as well as through effects on health behaviors.
Trauma and PTSD in the United States
Authors: Kessler Ronald C.
Published: October 2018

Trauma and PTSD in the United States reviews epidemiological data on the prevalence and correlates of trauma and PTSD in the United States. The chapter begins by examining the comparative prevalence, age-of-onset distributions, and socio-demographic distributions of a wide range of specific traumatic life experiences. Data on the clustering and time-lagged associations among these different types of traumas are then considered. The chapter then reviews evidence on the absolute and relative risks of PTSD and the socio-demographic predictors of PTSD. Data are then reviewed on the course of PTSD and the associations of trauma type and socio-demographic variables with the course of PTSD.
PTSD in Low- and Middle-Income Countries
Authors: Seedat Soraya , Suliman Sharain
Published: October 2018

The burden of post-traumatic stress disorder (PTSD) in low- and middle-income countries (LMIC) is high. In addition to trauma type and sociodemographic correlates, cultural and social drivers of the disorder are critical to consider in diagnosis and treatment provision. Sociocultural factors may underpin the cognitive and affective neural mechanisms of PTSD and its phenotypic presentation. Although steps have been taken to evaluate and disseminate empirically supported interventions for PTSD in LMIC that are feasible, affordable, and potentially sustainable despite the limited resources that exist in these countries, well-designed quantitative and qualitative randomized controlled trials are needed in order to gain a more nuanced understanding of the cultural expressions of PTSD.
PTSD and War
Authors: Wynn Gary H. , Benedek David M. , Morganstein Joshua C. , Ursano Robert J.
Published: October 2018

War and its psychological effects have always been a part of the human experience. The inextricable link between war and what we now term post-traumatic stress disorder (PTSD) has been evident across time, from early literature and accounts of war through the early stages of modern medicine. This chapter walks the reader through a brief history of PTSD as it existed prior to the creation of the diagnosis in 1980, followed by a discussion of the modern era of psychiatry and PTSD. The chapter concludes with a discussion about the future of war, given coming technological advances and the potential impacts of these changes on PTSD.
PTSD in Children
Authors: Espinel Zelde , Shaw Jon A.
Published: October 2018

This chapter reviews the psychobiological effects on children and adolescents upon exposure to a traumatic happening where there is a real or imaginary threat of bodily harm or death to the self and/or others. Morbidity may involve the classic symptoms associated with post-traumatic stress disorder such as a readiness to re-experience the psychological and physiological effects of trauma exposure, autonomic arousal, somatic ills and subsequent avoidant behavior as well as a host of other psychological morbidities such as depression, mood dysregulation and other internalizing and externalizing symptoms. Multimodal treatment approaches implementing family and social supports, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used, but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
PTSD and Women
Authors: Kornfield Sara L. , Epperson C. Neill
Published: October 2018

It is generally accepted that women are at greater risk of lifetime post-traumatic stress disorder (PTSD) than men. Both gender differences in trauma exposures and cognitive response to trauma as well as sex differences in neuroendocrine function are thought to contribute to the differences in prevalence of PTSD across the lifespan. For women, reproductive transitions such as puberty, pregnancy, and menopause are particularly relevant, as ovarian and stress hormones as well as neurosteroids exert profound effects on the central nervous system. Similarly, pregnancy and childbirth can be experienced as traumatic events leading to exacerbation or new-onset PTSD. This chapter reviews the relevant literature regarding PTSD in women to highlight the importance of considering gender and sex as risk and resilience factors. The chapter is organized according to reproductive stage, as PTSD symptoms and treatment implications vary across the female lifespan.
PTSD in the Lesbian, Gay, Bisexual, and Transgender (LGBT) Population
Authors: Wawrzyniak Andrew J. , Sabbag Samir
Published: October 2018

The emerging field of sexual minority health has begun to highlight the differential impact of post-traumatic stress disorder (PTSD) on lesbian, gay, bisexual, and transgender (LGBT) persons. This chapter addresses the higher prevalence of PTSD among LGBT persons and examines the biological underpinnings of PTSD in this population. The chapter also presents risk factors for PTSD experienced by LGBT individuals. It concludes with treatment recommendations. Treatment for PTSD in LGBT populations, in addition to treatment as usual for any patient, should recognize and acknowledge the patient’s sexual identity in forming a treatment plan. Future research in this field should aim to incorporate heterosexual controls as a reference group for comparison, where applicable.
Cognitive Functioning and Disability in Post-Traumatic Stress Disorder
Authors: Harvey Philip D. , Gould Felicia
Published: October 2018

In many respects, PTSD is a disorder of cognition and memory in specific: individuals with the condition have trouble remembering details of the trauma when they want to and remember them in other situations where they do not want to, such as in nightmares and flashbacks. In addition, a growing literature has explored performance on other cognitive performance measures in PTSD. A new development is the study of the ability to perform critical everyday functional skills, referred to as functional capacity, which themselves are highly cognitively demanding. Our review of the literature on cognition and PTSD suggests two main conditions. There are several areas of cognitive functioning where people with PTSD perform below normative standards, on average. These domains include memory, attention, and executive functioning. However, there is also substantial evidence to suggest that impairments in cognition are present before the onset of other symptoms and may be a risk factor for the development of PTSD. A careful examination of the levels of performance of PTSD patients suggests that performance may not be worse than pre-illness functioning. Interventions aimed at cognition may still be beneficial, because a small literature consistently finds that cognitive impairments are correlated with indicators of everyday disability in people with PTSD.
Functional Brain Imaging and PTSD
Authors: Heller Aaron S.
Published: October 2018

Post-traumatic stress disorder (PTSD) is associated with a host of neurobiological changes, including abnormalities in subcortical and cortical structure and function. The majority of neuroimaging studies have been motivated by a fear conditioning and extinction perspective to examine neural changes associated with PTSD. Several studies have found alterations in amygdala, hippocampal, and ventromedial prefrontal cortex. However, not all studies have replicated these findings. This suggests that more nuanced models of PTSD may be needed to account for the pathophysiology of the disorder. This chapter reviews neuroimaging findings related to this fear model and discusses additional considerations, including trauma type, age of trauma, and affective neurodynamics, that may help to account for the lack of consistent replications. Explicit consideration of these factors may facilitate greater coherence among studies going forward and advance our understanding of the neurobiological alterations associated with PTSD.
Neuroendocrinology of PTSD
Authors: Yehuda Rachel
Published: October 2018

Initial studies on the neuroendocrine basis of post-traumatic stress disorder (PTSD) showed a biological dysregulation of stress response systems that appeared to be incompatible with the stress response theories that had prevailed when PTSD was first established as a diagnosis. Cortisol levels were found to be lower and catecholamine higher in patients with PTSD than in those with major depression and other psychiatric disorders. There was no explanation for why levels of two stress hormones that are generally correlated—cortisol and norepinephrine—would be different, and it was also not clear why cortisol levels would be on the low end of the normal spectrum, when the classic stress response paradigms suggested stress results in elevated cortisol. The study of neuroendocrinology and hypothalamic–pituitary–adrenal (HPA) axis alterations in PTSD provides an object lesson in how paradoxical observations might be pursued toward a better understanding of the pathophysiology of a disorder. This chapter reviews HPA findings in PTSD in cross-sectional and prospective longitudinal studies.
Antidepressants in Post-Traumatic Stress Disorder
Authors: Koen N. , Amos T. , Ipser J. , Stein D.
Published: October 2018

This chapter discusses the use of antidepressants in treating symptoms of posttraumatic stress disorder (PTSD). Tricyclic antidepressants were the first psychotropic agents to be studied systematically and rigorously for the treatment of PTSD. While early studies focused both on the tricyclics and monoamine oxidase inhibitors (MAOIs), more recent work has centered on the selective serotonin reuptake inhibitors (SSRIs); and paroxetine and sertraline are currently approved by the U.S. Food and Drug Administration (FDA) for use in this disorder. However, given the relatively small effect sizes in SSRI trials of PTSD, there is a need for ongoing psychopharmacological research to understand underlying mechanisms of antidepressant efficacy and to optimize response to pharmacotherapy. Further data on pediatric PTSD and on medication prophylaxis are needed before routine antidepressant treatment can be endorsed in these contexts.
Pharmacological Treatment of Nightmares, Sleep Disturbance, and Daytime Hyperarousal in PTSD: The Role of Prazosin, Other Noradrenergic Modulators, and Sedative Hypnotics or Commonly Used Sedating Medications
Authors: Hendrickson Rebecca C. , Raskind Murray A.
Published: October 2018

Disruption of stress-response systems contributes to the pathophysiology of post-traumatic stress disorder (PTSD). Consistent with this, daytime hyperarousal and nighttime sleep disruption, including trauma-related nightmares, are core symptoms of the disorder, often requiring targeted pharmacologic treatment. Although a variety of medications that target sleep–wake and arousal mechanisms are commonly used for this purpose, there remains the best empirical support for prazosin, a brain-active antagonist of the α‎1 noradrenaline receptor, with emerging evidence for doxazosin, a longer-acting medication with the same mechanism of action. This chapter reviews the evidence for use of prazosin and doxazosin as well as for the sedative hypnotics (benzodiazepines, nonbenzodiazepine hypnotics, and related medications), antihistamines, and sedating antidepressants trazodone and nefazodone to address hyperarousal symptoms and trauma-associated nightmares in PTSD. Clinical recommendations for the use of prazosin in PTSD, as well as a discussion of emerging pharmacologic treatments, are also included.
The Role of Glucocorticoids in the (Mal)adaptive Response to Traumatic Experience
Authors: Cohen Hagit , Zohar Joseph
Published: October 2018

Glucocorticoids (GCs) play a major role in orchestrating the complex physiological and behavioral reactions essential for the maintenance of homeostasis. These compounds enable the organism to prepare for, respond to, and cope with the acute demands of physical and emotional stressors and enable a faster recovery with passage of the threat. A timely and an appropriate GC release commensurate with stressor severity enables the body to properly contain stress responses so as to promote recovery by rapidly restoring homeostasis. Inadequate GC release following stress not only delays recovery by disrupting biological homeostasis but can also interfere with the processing or interpretation of stressful information that results in long-term disruptions in memory integration. A salient example of such an impaired post-traumatic process is post-traumatic stress disorder (PTSD). The findings from recent animal models and translational and clinical neuroendocrine studies summarized in this chapter provide insights shedding light on the apparently contradictory studies of the HPA-axis response to stress. Also included is a review of the basic facts about PTSD and biological data.
Complementary and Integrative Health Approaches for PTSD
Authors: Edwards Emmeline , Reider Eve , Weber Wendy
Published: October 2018

Complementary and integrative health strategies are increasingly used by the public to treat a variety of health concerns and to improve wellness. Many individuals with mental health diagnoses, including post-traumatic stress disorder (PTSD), have incorporated a group of complementary and integrative health strategies known as mind and body practices in their health care regimen. These practices include meditation, acupuncture, deep breathing and relaxation techniques, massage therapy, yoga, and biofeedback/neurofeedback. Thus far, the literature on the efficacy of mind and body interventions for PTSD is limited and better studies are needed to test both efficacy and effectiveness. This chapter presents information on the use of mind and body practices for PTSD, referring primarily to systematic reviews and meta-analyses. The National Center for Complementary and Integrative Health recently released its fourth strategic plan, Exploring the Science of Complementary and Integrative Health, which emphasizes the development of a strong evidence base in complementary and integrative heath research.
Pain Pathways and Pain Physiology
Authors: Price Chane , Huq Zahid , Sivanesan Eellan , Sarantopoulos Constantine
Published: October 2018

Pain is a multidimensional sensory experience that is mediated by complex peripheral and central neuroanatomical pathways and mechanisms. Typically, noxious stimuli activate specific peripheral nerve terminals onto Aδ‎ and C nerve fibers that convey pain and generate signals that are relayed and processed in the spinal cord and then conveyed via the spinothalamic tracts to the contralateral thalamus and from there to the brain. Acute pain is self-limited and resolves with the healing process, but conditions of extensive injury or inflammation sensitize the pain pathways and generate aberrant, augmented responses. Peripheral and central sensitization of neurons (as a result of spatially and temporally excessive inflammation or intense afferent signal traffic) may result in hyperexcitability and chronicity of pain, with spontaneous pain and abnormal evoked responses to stimuli (allodynia, hyperalgesia). Finally, neuropathic pain follows injury or disease to nerves as a result of hyperexcitability augmented by various sensitizing mechanisms.
Long-Acting Perioperative Opioids
Authors: Candido Kenneth D. , Kusper Teresa M.
Published: October 2018

Opioid medications are extensively utilized in the management of acute and chronic pain in the outpatient and inpatient clinical settings, as well as being used worldwide during both routine and complex surgeries. They have a long-standing, proven history of providing pain control during the perioperative period and have become an indispensable element of postsurgical analgesia. This chapter describes perioperative application of opioid medications, with a special focus on the long-acting opioids, morphine and hydromorphone. Most common side effects engendered using these agents and the remedies available for the treatment of those side effects are briefly discussed. Finally, the chapter provides a concise summery of various factors influencing the effectiveness of opioid analgesics, as well as analgesic considerations for special patient populations.
Pain Management and Urinary Retention
Authors: Delpe Sophia , Norwich Amanda , Chai Toby C.
Published: October 2018

Normal bladder function relies on complex brain functions such as executive function, emotion, and awareness. Other individual factors also come into play such as local pathology, medications, compensatory abilities of the bladder, and the age and size of the patient. This chapter begins by explaining the anatomy of the lower urinary tract, which is comprised of the bladder and the urethra. It then explores neural considerations in bladder function and postoperative urinary retention (POUR), which is a term utilized to describe an individual who has “incomplete bladder emptying” or a patient with urinary retention who cannot void at all when there is a sufficient volume in the bladder. The chapter concludes with a management algorithm for POUR.
Pain Management for General Pediatric Surgery
Authors: Oliver Jodi-Ann , Oliver Lori-Ann , Casimir Michael , Walker Caroline
Published: October 2018

As the misconception that children and infants do not experience pain in the same way as adults has been vastly discredited, the management of perioperative pain in the pediatric population has become a rapidly developing field. Inadequate treatment of perioperative pain in this population can lead to serious long-term or permanent sequela for not only the patients but also their families. Postoperative pain management in children is best accomplished using a multimodal approach in which different classes of drugs such as opioids (short or long acting), non-opioid adjuncts (nonsteroidal anti-inflammatory drugs, acetaminophen), and antineuroleptics (gabapentin) are used alone or in combination with regional anesthesia techniques (peripheral nerve blocks, caudals, epidurals, or spinals). When placed prior to surgical incision, the use of peripheral and central blocks is beneficial not only in decreasing the total opioid consumption in the perioperative period but also in preventing activation of pain pathways that are ultimately responsible for the development of chronic pain.
Pain Management in the Patient with Substance Use Disorder
Authors: Hickey Thomas , Feinleib Jessica
Published: October 2018

Managing pain in the patient with substance use disorder can be challenging. This chapter describes those challenges and provides strategies to address them. Specifically it discusses the prevalence and specific considerations for commonly abused substances, the need for aggressive communication among perioperative clinicians, and a strategy to decrease acute postoperative pain and associated complications using opioid-sparing, multimodal analgesia. It includes a discussion of the concept of equianalgesic opioid doses and management of opioid-related side effects including respiratory depression, with regard to buprenorphine, naltrexone, and methadone. Specific consideration is given to the surgical patient treated with buprenorphine, and a defined clinical plan is outlined.
Clinical Consequences of Inadequate Pain Management and Barriers to Optimal Pain Management
Authors: Goodman Evan , Anitescu Magdalena , Malik Tariq M.
Published: October 2018

This chapter assesses the experience of pain from the perspective of the patient and the physician. Pain is defined, and the controversy of its undertreatment and the resulting physiologic, sociologic, and economic consequences are examined. Patient and physician-limiting barriers to treatment are listed, and modern methods for preventing inadequate pain management are discussed. Not every physician is comfortable treating pain, and the physician who attempts to mitigate it may face patients’ discontent. This chapter reveals what stands in the way of the modern physician’s attempt to manage pain and strategies that can be taken to overcome these barriers.
Perioperative Pain Management in Hand and Upper Extremity Surgery
Authors: Walker Marc E. , Tsai David M. , Thomson J. Grant
Published: October 2018

In the past three decades, the number of outpatient surgery centers in the United States has risen exponentially. Hand and upper extremity surgery is no exception, and in many respects, with the modern advancements in anesthesia care, surgery of the hand is one of the best-suited fields for such change. This chapter explores the physiologic aspects of pain, as well as both historical and modern interventions of pain management for such patients. The authors discuss perioperative pharmacological and procedural treatments including various anesthesia options, peripheral and regional nerve blockades, wide-awake local anesthesia no tourniquet (WALANT) technique, and postoperative pain management for hand and upper extremity surgery.
Migraine Headaches: Surgery and Pain Management
Authors: Austen Jr William G. , Hulsen John
Published: October 2018

Despite an incomplete understanding of the pathophysiology of migraine headache pain, there have been recent discoveries in neurobiology and craniofacial anatomy that suggest a peripheral nerve trigger point mechanism. The current mainstay of treatment for migraine headache is a combination of abortive and preventative medication. However, properly selected migraineurs with debilitating pain refractory to pharmacologic therapy may find substantial relief through surgical deactivation of peripheral nerve trigger sites. This chapter reviews accepted migraine diagnostic criteria, explains contemporary theories of migraine physiology, and discusses the evidence and rationale for the medical and surgical management of migraine headache pain.
Patient Monitoring
Authors: Fedeles Benjamin T. , Galvagno Samuel M. , Kodali Bhavani
Published: October 2018

The outside of the operating room (OOOR) environment is fraught with challenges and often requires a great deal of flexibility without compromising patient care. The expertise and skill of the modern anesthesiologist is increasingly required when anesthesia is administered for procedures performed OOOR. This chapter focuses on the physics, physiology, limitations, and recommendations for standard physiological monitors that should be utilized in the OOOR environment. A special emphasis is placed on pulse oximetry and capnography. By implementing standards for monitoring that are similar to standards used in the operating room, the safe delivery of an anesthetic for procedures in the OOOR environment can be consistently achieved.
Management of Staffing and Case Scheduling for Anesthesia Outside of the Operating Room
Authors: Macario Alex , Sharma Deepak
Published: October 2018

What does a manager need to think about when scheduling cases requiring anesthesia outside the operating room (OOOR)? This chapter aims to answer that question by discussing some key strategic points that can facilitate a more efficient workday. The concepts of block scheduling and utilization apply in the OOOR setting as they do in the operating room, but there are added challenges given the increased physical distance to the main operating room suite. These challenges will be identified and recommendations will be provided on how to evaluate and improve OOOR efficiency. With more procedures being done OOOR, it is important for anesthesia groups to be mindful of these challenges and position themselves appropriately.
Financial Analysis and Competitive Strategies for NORA
Authors: Vig Sanjana , Boggs Steven
Published: October 2018

The scientific and technical principles that form the basis of anesthesia practice are transferrable to any location where patients require monitoring, analgesia, and hypnosis. Most growth seen in anesthesia services in the past decade has occurred in non–operating room anesthesia locations. Anesthesiologists are critical for the safe and efficient functioning of these locations. However, with the ever-increasing pressure to reduce total health care delivery costs, anesthesiologists need to understand some of the financial metrics that will be used to measure their contribution to these locations. Moreover, anesthesiologists must be willing to articulate the rationale for their presence in these areas: patient safety, patient comfort, and increased throughput, to name a few.
Procedural Sedation by Nonanesthesia Providers
Authors: Metzner Julia , Domino Karen B.
Published: October 2018

Although anesthesiologists and certified registered nurse anesthetists are experts in sedation/analgesia outside of the operating room, extensive demand in the face of limited resources has resulted in sedation being routinely performed by nonanesthesia health care providers. Safe administration of procedural sedation/analgesia by nonanesthesia professionals requires an understanding of the continuum of sedation/general anesthesia; extensive training and credentialing of personnel performing sedation; appropriate patient preparation and selection, with an anesthesia consult for higher-risk patients; adherence to fasting guidelines, standard equipment, and monitoring procedures; and a thorough knowledge of the pharmacologic and physiologic properties of sedative and analgesic drugs. This chapter briefly reviews the essential elements needed to develop a safe policy for sedation by nonanesthesia practitioners.
Magnetic Resonance Imaging and Ultrasound-Guided Percutaneous Interventional Radiology Procedures
Authors: Bhagavatula Sharath K. , Patel Bijal , Tuncali Kemal , Silverman Stuart G. , Shyn Paul B.
Published: October 2018

Diagnostic and therapeutic interventions guided by magnetic resonance imaging (MRI) are performed in clinical practice with increasing frequency and for an increasing number of indications. Ultrasound (US) guidance remains a very common, relatively inexpensive, and versatile option for guiding percutaneous interventions. The need for procedural sedation and anesthesia for minimally invasive procedures continues to grow as the number of procedures and interventional applications increase. This trend will continue as the population ages and the complexity and array of imaging-guided interventional procedures expand. This chapter discusses common interventional procedures that are performed under MRI and US guidance and outlines patient issues, procedural techniques, safety, and other clinical considerations that pertain to both interventionalists and anesthesiologists.
Interventional Neuroradiology
Authors: Thiex Ruth , Frerichs Kai U.
Published: October 2018

Interventional neuroradiology evolved as a new medical subspecialty in the 1980s and focuses on the treatment of cerebrovascular, head and neck, and spinal diseases by using endovascular or other percutaneous routes to reach the target. This field has since tremendously expanded as a result of improved imaging capabilities, technical equipment, and safer contrast media, which brought it to the forefront in the management of aneurysms and various vascular malformations. Anesthesiologists are instrumental in ensuring patient safety and cooperation, thus allowing the interventionalist to focus on the procedure. This chapter is intended to provide the clinical practitioner with background information and specific descriptions of the anatomy, techniques, disorders, and procedures most commonly encountered in interventional neuroradiology.
Interventional Radiology Procedures
Authors: Scorza Leslie B.
Published: October 2018

Interventional radiology (IR) is a specialty often called on to help solve many different clinical problems. Sometimes, that help comes by obtaining a diagnosis, other times by treatment, and still other times by both. The array of problems for which an IR consultation can be helpful is quite broad. Some IR procedures, which are described in more detail in this chapter, include, Abscess drainage, Arterial procedures and interventions, Biliary procedures and interventions, Gastrointestinal procedures and interventions, Genitourinary procedures and interventions, Intraoperative cases, Noninvasive vascular imaging, Percutaneous oncologic interventions, Percutaneous biopsies, Venous procedures and interventions, Venous access. The anesthesia needed to accomplish these procedures, just like the procedures themselves, varies widely. Anesthesia support can range from none at all up to and including general anesthesia. However, the majority of these procedures can be successfully accomplished with the use of “sedation and analgesia,” also known as moderate sedation.
Radiation Safety
Authors: Maddy Erin M. , Abnet Kevin , Scriver Geoffrey , Shukla Mrinal
Published: October 2018

Exposure to ionizing radiation is increasing in modern anesthesia practice, due to both the number of procedures facilitated and the expanding role of imaging in surgical practice. International Commission on Radiological Protection (ICRP) recommends that physicians who assist with radiation procedures be educated on the basics of radiation including units, effects of radiation exposure, and radiation protection for both providers and patients. This chapter will mirror the recommendations of the ICRP and include an introduction to radiation production, terminology, units, effects on the human body, dose limits, best practices for radiation protection, and safety infrastructure.
Anesthesia for Interventional Pulmonology
Authors: Abdelmalak Basem
Published: October 2018

This chapter on anesthesia for interventional pulmonology (bronchoscopic) procedures addresses the anesthetic considerations and management for these procedures that are frequently performed in bronchoscopy suites outside of the operating room (OOOR). These include endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB) diagnostic procedures, as well as bronchoscopic therapeutic procedures. It discusses anesthesia techniques, different airway and ventilation options, anesthesia adjuvants, and helpful tips and clinical pearls aimed at ensuring patient safety while providing the best conditions to facilitate completion of the procedure. Utilizing standardized yet individualized protocols may help improve safety and clinical outcomes in these non–operating room anesthesia (NORA) service locations.
New Challenges for Anesthesiologists Outside of the Operating Room: The Cardiac Catheterization and Electrophysiology Laboratories
Authors: Gross Wendy L. , Cooper Lebron , Faillace Robert T. , Shook Douglas C. , Daves Suanne M. , Savage Robert M.
Published: October 2018

Invasive cardiology procedures have changed dramatically over the past 5–10 years. With technological advancement, diagnostic and therapeutic procedures have become broader in scope and complexity, and patient acuity has escalated dramatically. In parallel, the involvement of anesthesiologists has grown. In this chapter, we present an overview of the laboratory environment(s), the evolution and future pathways of current practice(s), cases performed in each venue, and current anesthetic approaches. In this new and changing arena, collaboration and planning between cardiologists and anesthesiologists maximizes patient safety and increases the probability of procedural success. A thorough understanding of the procedure to be performed is required in order for anesthesiologists to define and delineate the extent of their involvement, and is a clear prerequisite for the formulation of a safe and effective anesthetic plan. A common knowledge base and mutual respect for each contributing discipline form the basis for integration of cardiology and anesthesia services in pursuit of optimized patient care.
Office-Based Anesthesia
Authors: Hausman Laurence M.
Published: October 2018

An anesthetic performed in a surgical or medical office, as opposed to a standard operating room within a hospital or ambulatory surgery center, is known as an office-based anesthetic. This venue for surgery and anesthesia has been widely utilized for past several decades. The practitioner generally has improved ease in scheduling of cases and convenience of performing surgery within the same office as preoperative and postoperative care; sometimes, the proceduralist will receive an enhanced professional fee from insurance companies. Surgery in an office has become increasingly overseen by both state and federal governmental agencies. This oversight often has been driven by concerns for patient safety and suitability of the patient and the procedure for this surgical venue. Three accrediting bodies can accredit an office for use as a surgical site. Ultimately, safety will rest on the preparedness of the anesthesiologist, proceduralist, office staff, and suitability of the office itself.
Pediatric Anesthesia Outside of the Operating Room
Authors: Mahmoud Mohamed , Holzman Robert S. , Mason Keira P.
Published: October 2018

This textbook provides an important tool to cover major aspects of anesthesia care in non–operating room anesthesia (NORA) locations. It outlines perioperative concerns for the most commonly performed procedures in NORA settings. An overview of various anesthesia delivery techniques and tools required to optimize the patient before endoscopy, cardiac, and neuroradiology procedures are provided. The text also covers specialized situations, including a pediatric update on anesthesia/sedation strategies for dental procedures, electroconvulsive therapy, cosmetic procedures, ophthalmologic surgery, procedures in the emergency department, and infertility treatment. Practical recommendations based on current literature and author experience are presented, and current practice guidelines are reviewed.
Electromyography in Clinical Practice
Authors: Katirji Bashar
Published: October 2018

Clinical Electromyography in Clinical Practice provides case-based learning of clinical Electromyography (EMG) with a main mission of reducing the gap between theory and practice in the field of electrodiagnostic medicine. The book format includes four introductory chapters that acquaint the discipline and scope of the EMG Examination to the beginners. This include chapters on nerve conduction studies, needle EMG, and specialized testing including late responses, repetitive nerve stimulation and single fiber EMG. Discussion on the electrodiagnostic and clinical EMG findings in the numerous neuromuscular disorders including anterior horn cell disorders, peripheral neuropathies, neuromuscular junction disorders and myopathies. The second part of the book includes comprehensive presentations of 27 cases that encompass the most common disorders encountered in the EMG laboratory and are presented in a similar layout. These are subdivided into (1) focal disorders of the lower extremity, (2) focal disorders of the upper extremity, and (3) generalized neuromuscular disorders. The book focuses on problem solving through analysis of the data obtained on nerve conduction studies and needle EMG. This is meant to be a bedside analysis of data, similar to what occurs in the EMG laboratory on a daily basis. The exact values obtained on nerve conduction studies are examined and the details of the findings on needle EMG are studied. A final diagnosis is then made. This is followed by a detailed discussion of the clinical and electrodiagnostic findings of the disorder. Clinical Electromyography in Clinical Practice is an ideal book for physicians interested in learning and mastering the clinical practice of clinical EMG. This includes specialists in the field of neurology, physical medicine and rehabilitation, orthopedics, hand surgery, neurosurgery, spine, rheumatology and pain management.