bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Evaluation of the Elderly Surgical Patient
Authors: Wang Tracy S. , Roberts Jennifer
Published: January 2021

The following is a detailed approach to the preoperative evaluation of the elderly surgical patient. A focus is placed on physiologic changes in the elderly that predispose them to complications and a systems-based approach to appropriate perioperative evaluation. Specifically, recommendations on the workup of cardiovascular, pulmonary, and renal systems are discussed. We also introduce the concept of frailty as a measure of an elderly patient's overall physiologic reserve. Finally, a diagnostic approach to common elderly-specific disease processes such as decreased functional status, malnutrition, and delirium is outlined. Throughout, an emphasis is placed on how to carefully assess this specific patient population and optimize preoperative functional status to improve surgical outcomes in the elderly. This review has 1 figure, 4 tables, and 62 references.
Ileus and Obstruction in the Surgical Critical Care Patient
Authors: Benoit Eric , Adams Jr Charles A
Published: January 2021

Gastrointestinal dysfunction is a common occurrence in the critically ill surgical patient as both a contributor to disease progression and a consequence of critical illness. Failure of motility may ultimately progress to obstruction, either functional (e.g., paralytic ileus) or mechanical (e.g., small bowel obstruction). Obstruction leads to bowel distention, fluid sequestration in the lumen and wall of the bowel, alterations in mucosal integrity, and bacterial overgrowth, which results in not only local bowel ischemia but also distant organ damage due to the release of inflammatory cytokines. Although postoperative ileus is a common condition, in the critically ill patient, it may signify a serious complication such as anastomotic leak or sepsis; therefore, management is directed toward identification and treatment of the underlying cause. Regarding small bowel obstruction (SBO), management hinges on whether or not the bowel is strangulated, and the need for operation should be addressed at every step of the evaluation. Although most patients are successfully treated without operation, SBO is a surgical disease, a fact underscored by the improved outcomes seen in patients admitted to a surgical service. Large bowel obstruction is a surgical emergency that requires prompt decompression either by colonoscopy or surgery. Regardless of the etiology of gastrointestinal dysfunction, emergency surgery is required in patients with signs of bowel strangulation or perforation such as tachycardia, peritonitis, fever, or leukocytosis.
Key words: acute colonic pseudo-obstruction, adhesive small bowel disease, ileus, large bowel obstruction, Ogilvie syndrome, small bowel obstruction bowel perforation, volvulus
Primary Cutaneous Melanoma
Authors: Farley Clara R , Delman Keith A , Lowe Michael C
Published: January 2021

Melanoma presents a significant health burden as its incidence continues to rise in both sexes and remains the most common cause of skin cancer–related death. Risk factors for the development of melanoma include sun exposure, fair complexion, increasing age, previous melanoma, multiple dysplastic nevi, and familial syndromes. Wide local excision is the standard of care for those with early forms of melanoma, with sentinel lymph node biopsy in appropriate populations. Sentinel lymph node status contributes to the discussion as to whether to pursue completion lymphadenectomy. This review outlines surgical treatment of primary cutaneous melanoma, including wide local excision, sentinel lymph node biopsy, and completion lymphadenectomy.
 
This review contains 10 figures, 2 tables and 33 references
Key words: biopsy, cutaneous, lymphadenectomy, margin, melanoma, pathology, primary, sentinel node, surgery, treatment
Dizziness
Authors: Goldstein Joshua N.
Published: January 2021

Dizziness is a relatively common condition in the emergency setting. Patient descriptions of their symptoms can be vague and inconsistent. This review highlights the most important aspects of the history and physical examination that can help differentiate among different causes of dizziness. In addition, it covers the pathophysiology of inner ear disease, including diagrams of vestibular anatomy. For the history, it is critical to capture dizziness, duration, triggers for dizziness, and associated symptoms. For the physical examination, a focused neurologic assessment is important, including balance, coordination, as well as an oculomotor assessment. For treatment of benign positional vertigo, various canalith repositioning maneuvers are described and diagrams shown. For vestibular neuritis, treatment options including vestibular rehabilitation and steroids are discussed. Finally, medical options for symptomatic therapy are listed. 
Key words: Dizziness, benign positional vertigo, canalith repositioning maneuver, vestibular disorders.
This review contains 7 highly rendered figures, 7 tables, and 40 references.
Toxic Alcohols
Authors: Kreitzer Natalie , Adeoye Opeolu
Published: January 2021

Although alcohols share a common metabolic pathway, the toxicity of each is unique. This review discusses the common toxic alcohols, including ethanol, isopropanol, methanol, and ethylene glycol, and summarizes the principles of toxicity, immediate stabilization, diagnosis and definitive therapy, and disposition and outcome for each. A special consideration is also given to diethylene glycol due to its historical significance as a contaminant of multiple different drugs. Figures show type B lactic acidosis; the Mellanby effect; the role of thiamine in aerobic metabolism; the metabolism of isopropanol, methanol, formate, and ethylene glycol; and the relationship between the osmol gap and the anion gap over time. Tables list treatment recommendations for Wernicke encephalopathy, alcoholic ketoacidosis, and alcohol withdrawal; the Clinical Institute Withdrawal Assessment–Alcohol Revised (CIWA-Ar); dosing recommendations for fomepizole and ethanol; serum alkalization; and indications for hemodialysis in ethylene glycol poisoning.

This review contains 8 figures, 10 tables, and 54 references.
Keywords: Poisoning, ethanol, isopropanol, ethylene glycol, methanol, fomepizole, withdrawal, Wernicke encephalopathy, alcohol dehydrogenase, aldehyde dehydrogenase
Trauma Resuscitation
Authors: Havens Joaquim M. , Raja Ali S.
Published: January 2021

Although patients with recently sustained traumatic injuries may present at any health care setting, this review focuses on resuscitation, stabilization, and management of the trauma patient in the emergency department. Patients with potentially severe traumatic injury often present to local, community hospitals and may require transfer to a trauma center after evaluation. Nevertheless, as long as it does not delay transfer unnecessarily, the initial evaluation can be undertaken in any setting. This review discusses assessment and stabilization, including triage and preparation, trauma team management, bedside evaluation, and supportive care and empirical therapy; diagnosis, including secondary evaluation and management, laboratory testing, and additional imaging following the secondary evaluation; treatment and disposition; and outcomes. Tables describe advanced trauma life support primary evaluation, the Glasgow Coma Scale, National Emergency X-Radiography Utilization Study low-risk criteria, criteria for a positive diagnostic peritoneal lavage, bedside airway tools and rescue airway devices, and difficult airway predictors. Figures include an illustration showing immobilization of the cervical spine, a computed tomographic scan of an open book pelvic fracture, left-sided traumatic hemothorax, focused abdominal sonography for trauma examination, and the appropriate intercostal spaces of needle insertion.
This review contains 5 highly rendered figures, 6 tables, and 115 references.
Thermal Injuries
Authors: Havryliuk Tatiana , Paterson Ryan
Published: January 2021

In the United States, an estimated 450,000 patients with burns are treated in medical facilities annually. On assessment of burn patients, Advanced Trauma Life Support protocols should be followed because these patients often suffer from concomitant trauma; chemical exposure and airway compromise should also be considered in the initial assessment. Mortality from burn injuries increases with the patient’s age, the extent of the burn, and the presence of inhalation injury. This review covers the epidemiology, pathophysiology, assessment and stabilization, diagnosis, treatment and disposition, and outcomes of patients with burn injuries. Figures show the structure of the skin, and photographs of partial-thickness and full-thickness burns. Tables list burn classification by depth, indications for intubation, American Burn Association 2010 guidelines for calculating IV fluid resuscitation, indications for escharotomy in patients with circumferential trunk and extremity burns, and indications for burn center referral.
This review contains 3 highly rendered figures, 5 tables, and 33 references.
Heat Injury
Authors: Salas Renee N. , Harris N. Stuart
Published: January 2021

Heat injuries present on a spectrum from mild (eg, miliaria rubra) to severe and life-threatening (heat stroke). The two main classifications of heat injury are exertional, which affects mainly young to middle-age individuals undergoing physical activity in hot environments, and classic, which typically affects young children and the elderly and results from an inability to dissipate heat. This review details the assessment and stabilization, diagnosis, treatments, disposition, and outcomes for patients with heat injury. Figures show the four mechanisms of passive heat transfer, physiologic responses to heat, the spectrum of heat injuries, risk factors for exertional versus classic heat stroke, a clinical algorithm to provide guidance in the diagnosis and management of heat stroke, the general pattern of organ dysfunction, and two evidence-based methods of rapid cooling for patients with heat stroke. Tables list factors affecting the efficiency of the mechanisms of passive heat transfer; minor to moderate heat injuries; exertional versus classic heat stroke; predisposing medical conditions, medications, and drugs for heat stroke; systemic inflammatory response criteria; key historical questions and physical examination items for heat stroke and differential diagnosis; signs, symptoms, and spectrum of pathology in heat stroke; comparison of pathology in exertional versus classic heat stroke; differential diagnosis for heat stroke; comparison of methods of cooling heat stroke patients; mortality data for heat stroke; and biologic variable prognostic indicators of mortality.
This review contains 7 highly rendered figures, 14 tables, and 193 references.
Human Trafficking 3: Intervention And Therapy
Authors: Macias-Konstantopoulos Wendy
Published: January 2021

Emergency department (ED) physicians must familiarize themselves with all mandatory reporting laws that apply to those whom they suspect of being the victims of human trafficking. Furthermore, ED physicians must be aware of when to require a forensic evaluation and when to enlist social services to help with the process of documentation, keeping in mind the medical, legal, and safety considerations of the patient. Subspecialty consultation should proceed in accordance with typical practice. Following the identification of a trafficked patient, a comprehensive interdisciplinary response should ensue: in addition to social workers, other hospital-based health professionals whose knowledge and skills may be needed include addiction service providers, child protection specialists, forensic and sexual assault nurse examiners, mental health providers, case managers, hospital legal counsel, and risk management specialists. Despite ED physician and related professional intervention, little is known regarding the outcomes of human trafficking.

This review contains 1 figure, 3 tables and 13 references
Key words: forensic evaluation, mandatory reporting laws, medical record documentation, neutral language, reported human trafficking, suspected human trafficking, trafficking in persons
On Being a Physician (SAGHE)
Authors: Nabel Elizabeth G
Published: January 2021

The role of a physician as healer has grown more complex, and emphasis will increasingly be on patient and family-centric care. Physicians must provide compassionate, appropriate, and effective patient care by demonstrating competence in the attributes that are essential to successful medical practice. Beyond simply gaining medical knowledge, modern physicians embrace lifelong learning and need effective interpersonal and communication skills. Medical professionalism encompasses multiple attributes, and physicians are increasingly becoming part of a larger health care team. To ensure that physicians are trained in an environment that fosters innovation and alleviates administrative burdens, the Accreditation Council for Graduate Medical Education has recently revamped the standards of accreditation for today’s more than 130 specialties and subspecialties.
This review contains 6 references.
Pathophysiology of Inflammatory Bowel Disease
Authors: Hamilton Matthew J. , Blumberg Richard S
Published: January 2021

The study of the pathogenesis of IBD has advanced tremendously in recent years, coinciding with novel scientific experimentation and computational analysis tools. Crohn disease (CD) and ulcerative colitis (UC) are the two major types, characterized by chronic relapsing and remitting intestinal inflammation, and their respective pathophysiologies are the focus of this review. Also examined are the genetic influences, environmental influences, immune defects, and clinical implications associated with IBD. Figures include presentations of UC and CD, the multidirectional relationship causing the pathogenesis of IBD, and functional programs identified through genetic associations in IBD. Table lists the current therapeutic strategies in IBD based on target.
This review contains 3 highly rendered figures, 1 table, and 131 references.
Infectious Diseases of the Esophagus
Authors: Lo Wai-Kit
Published: January 2021

This review considers the three most common infectious diseases affecting the esophageal mucosa: Candida organisms (particularly Candida albicans), cytomegalovirus (CMV), and herpes simplex virus (HSV), including their epidemiologies, pathogeneses, diagnoses, differentials, managements, complications, and prognoses. Infection is often indicated by the symptom of odynophagia, although more general gastrointestinal complaints such as dysphagia and heartburn can also be present. Esophageal candidiasis caused by C. albicans is the most common esophageal infection, detected in immunocompetent patients, as well as those with HIV infection, hematologic malignancies, or other immunologic disorders. Treatment of these diseases should target the fungal or viral pathogens involved using systemically active antibiotic regimens. As infectious esophagitis is frequently seen in immunocompromised hosts, assessment for HIV and malignancy should be considered with a new diagnosis. Figures show endoscopic images of Candida esophagitis and HSV esophagitis. Tables list risk factors for infectious esophagitis, possible symptoms of infectious esophagitis, pathogens causing infectious esophagitis and distinguishing characteristics, the Kodsi classification of Candida esophagitis severity on endoscopy, and treatment regimens for esophageal candidiasis,  CMV esophagitis in HIV/AIDS patients, and HSV esophagitis.
This review contains ­2 highly rendered figures, 8 tables, 38 references.
Key words: Candida albicans, Cytomegalovirus (CMV), Herpes simplex virus (HSV), HIV Complications, Immunosuppression Treatment for Candida, CMV, and HSV, Infections of the esophagus
Hepatitis B Virus
Authors: Lin Ming V. , Wall April
Published: January 2021

Chronic hepatitis B virus (HBV) infection is a major health burden worldwide, with approximately 257 million people with chronic infection. HBV is a small partially double-stranded DNA virus that replicates within the nucleus of the hepatocyte and commonly leads to chronic infection. Chronic HBV infection can cause cirrhosis, hepatocellular carcinoma, and extrahepatic manifestations such as glomerulonephritis or vasculitis. The latter is due to deposition of circulating immune complex in the different tissues. The natural history of HBV infection can be conceptualized as a spectrum encompassing different phases, including immune tolerance, immune clearance, inactive carrier, and reactivation and resolution. The diagnosis of the different phases of chronic HBV infection relies on various HBV serologies, liver enzyme levels, and histology findings. There are currently eight therapies approved for the treatment of HBV. Tenofovir alafenamide was the most recently approved therapy with a better side effect profile compared with tenofovir disoproxil fumarate. With the recent advances in the basic research in hepatitis B, new treatment options may become available in the near-future.
This review contains 9 figures, 11 tables and 80 references
Key words: cirrhosis, entecavir, Hepadnaviridae, hepatitis B virus, hepatocellular carcinoma, precore mutation, tenofovir
Ascites, Spontaneous Bacterial Peritonitis, and Hepatorenal Syndrome
Authors: Gordon Fredric D.
Published: January 2021

Ascites, a common occurrence in cirrhotic patients with portal hypertension, is the pathologic accumulation of fluid in the peritoneum. Associated conditions are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP occurs in 30% of patients with ascites and carries a 20% mortality, most often due to the severity of the underlying cirrhosis. HRS involves life-threatening sequela of refractory ascites with limited treatment options; a review that focuses exclusively on this disease can be found elsewhere in this section. The development of these diseases is a poor prognostic feature, and referral for liver transplantation should be a consideration. This review examines ascites, SBP, and HRS and their relation to each other. The primary focus is ascites, addressing its epidemiology, pathophysiology, diagnosis, differential diagnosis, and management. Figures show theories of ascites formation and pathophysiology of HPS. Tables list screening tests on ascitic fluid, serum ascites–albumin gradient, drugs and agents to avoid in patients with ascites, diagnostic criteria for HPS, and clinical features of type 1 HPS. Also included are two recommended, pertinent Web sites for those who wish to learn more about ascites, SBP, and HPS.
This review contains 2 highly rendered figures, 5 tables, and 73 references.
Hepatorenal Syndrome
Authors: Wright Stephen C
Published: January 2021

Hepatorenal syndrome (HRS) is a form of functional renal failure that develops as a consequence of portal hypertension in cirrhosis of the liver or other processes that acutely raise portal pressure, such as fulminant liver failure or severe alcoholic hepatitis. Its development is an independent risk factor for a poor post–liver transplantation outcome. This review addresses the epidemiology, pathophysiology, classification of subtypes of HRS, incidence, evaluation of the cirrhotic patient with renal insufficiency, prevention of HRS, and management. A figure shows the sequence of circulatory abnormalities in HRS, and a table lists the summary of the diagnostic criteria for HRS as established by the International Ascites Club.
This review contains 1 highly rendered figure, 1 table, and 28 references.
Eosinophilic Esophagitis in Children and Adolescents
Authors: Hait Elizabeth J
Published: January 2021

Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction in association with histologic evidence of eosinophilic infiltration of the esophageal mucosa. The diagnosis is based on esophageal biopsies showing more than 15 eosinophils per high-power field in the absence of pathologic gastroesophageal reflux. It can present with a wide array of upper gastrointestinal tract symptoms. Babies and toddlers typically present with feeding intolerance or refusal, vomiting, and failure to thrive. Older children often present with abdominal pain and reflux symptoms, whereas adolescents and adults typically present with solid-food dysphagia and/or food impaction. Diagnosis is also supported by a family history of EoE and other allergy-based disorders, such as asthma, seasonal allergies, and atopy. Topical corticosteroids and dietary elimination are acceptable first-line treatment approaches.
This review contains 7 figures, 5 tables, and 51 references.
Key words: dysphagia, elimination diets, endoscopic dilation, eosinophilic esophagitis, eotaxin-3, feeding dysfunction, interleukin-5, proton pump inhibitor–responsive esophageal eosinophilia, swallowed fluticasone, viscous budesonide
Disorders of Water Balance
Authors: Sterns Richard H , Silver Stephen M. , Hix John K. , Bress Jonathan W.
Published: January 2021

Guided by the hypothalamic antidiuretic hormone vasopressin, the kidney’s ability to conserve electrolyte–free water when it is needed and to excrete large volumes of water when there is too much of it normally prevents the serum sodium concentration from straying outside its normal range. The serum sodium concentration determines plasma tonicity and affects cell volume: a low concentration makes cells swell, and a high concentration makes them shrink. An extremely large water intake, impaired water excretion, or both can cause hyponatremia. A combination of too little water intake with too much salt, impaired water conservation, or excess extrarenal water losses will result in hypernatremia. Because sodium does not readily cross the blood-brain barrier, an abnormal serum sodium concentration alters brain water content and composition and can cause serious neurologic complications. Because bone is a reservoir for much of the body’s sodium, prolonged hyponatremia can also result in severe osteoporosis and fractures. An understanding of the physiologic mechanisms that control water balance will help the clinician determine the cause of impaired water conservation or excretion; it will also guide appropriate therapy that can avoid the life-threatening consequences of hyponatremia and hypernatremia.
Specific Antibiotic Agents
Authors: Letourneau Alyssa R. , Calderwood Michael S.
Published: January 2021

The simultaneous use of multiple antibiotics in a shotgun fashion should be avoided because of the problems of drug toxicity and hypersensitivity reactions, microbial superinfections, and antagonisms between certain agents. Most bacterial infections can be treated satisfactorily with a single antibiotic agent. There are a limited number of situations, however, in which the simultaneous administration of different antibiotics is warranted. This review covers specific antimicrobial agents, including β-lactam antibiotics, aminoglycosides, polymyxins, tetracyclines, macrolides, clindamycin, nitroimidazoles, chloramphenicol, vancomycin, lipoglycopeptides, oxazolidinones, daptomycin, streptogramins, sulfonamides and trimethoprim, fluoroquinolones, nitrofurantoin, fosfomycin, rifamycins, and fidaxomicin, and provides empirical therapy recommendations. Figures show an overview of penicillin antibiotics, an overview of β-lactam/β-lactamase inhibitor combinations, and a positive D-zone test for inducible clindamycin resistance. Tables list antibacterial guidelines for initial inpatient empirical therapy and empirical sepsis guidelines.
 
This review contains 3 figures, 5 tables, and 51 references.
Keywords: β-Lactam Antibiotics ,penicillins,Cephalosporins, Carbapenems , monobactams, Gentamicin, Tobramycin, Polymyxins, Tetracyclines, Clarithromycin, Clindamycin
Infections Due to Salmonella
Authors: Goldberg Marcia B , Paras Molly
Published: January 2021

Salmonella, which is acquired via ingestion, is classified as nontyphoidal or typhoidal disease. Typhoidal disease is caused by S typhi or S paratyphi, and nontyphoidal disease is caused by all other serovars. Salmonella causes a range of infectious syndromes that include gastroenteritis, bacteremia, endovascular infections, and enteric fever. For immunocompromised hosts or patients with extraintestinal disease, antibiotic therapy should be provided. Effective agents often include third-generation cephalosporins and fluoroquinolones, although rates of resistance of Salmonella isolates to many antibiotics are increasing. A carrier state exists whereby patients may shed bacteria despite being asymptomatic. To eradicate the carrier state, longer courses of antibiotics and, in rare instances, surgical removal of the reservoir, which is most commonly the gallbladder, may be required. 
This review contains 2 figures, 4 tables, and 24 references.
Key Words: Salmonella, typhoidal, non-typhoidal, enteric fever, endovascular infection, gastroenteritis, carrier, food-borne, antibiotic resistance
HIV Prevention
Authors: Johnson Jennifer A , Kuritzkes Daniel R
Published: January 2021

Although risk reduction counseling and barrier protection remain important strategies for prevention of HIV acquisition and other sexually transmitted infections, there have been significant advances in medication-based prevention strategies in recent years following advances in HIV treatment. There are now many safe and highly effective methods for HIV prevention, components of a prevention toolkit that clinicians may choose from or use in combination as appropriate for each patient. Treatment of HIV-infected individuals to achieve virologic suppression prevents transmission to others in nearly all cases. Treatment of HIV-infected pregnant women with combination antiretroviral therapy also prevents transmission to the infant in nearly all cases. Treating HIV-uninfected individuals with antiretroviral agents either before or after possible exposure has also been shown to be effective in significantly reducing the risk of HIV acquisition. Clinicians should use these effective tools to compose an HIV prevention strategy that is individualized to each patient. 
This review contains 1 figure, and 34 references.
Key words: circumcision, dolutegravir, emtricitabine, needle exchange, preexposure prophylaxis, prevention of mother-to-child transmission, postexposure prophylaxis, raltegravir, tenofovir, treatment as prevention
Dietary Patterns And Risk Of Cancer: Current Evidence And Future Directions
Authors: Zhang Fang Fang
Published: January 2021

Dietary patterns capture the overall diet and its constituent foods and nutrients, representing a powerful approach to identifying the effect of nutrition on health and disease. In this review, we describe the two main approaches being used to characterize dietary patterns: a prior approach that defines dietary patterns using predefined diet quality indices, and a posterior approach that derives dietary patterns using factor or cluster analysis. Methods to define diet quality indices (Healthy Eating Index, Alternative Healthy Eating Index, Alternative Mediterranean Diet Score, Dietary Approaches to Stop Hypertension Score) are presented, and their similarities and differences are discussed among the different approaches. We review the recent evidence on the relationships between dietary patterns and cancer outcomes, including all-cancer incidence and mortality and the incidence of colorectal, breast, prostate, and lung cancers. Despite the different methods that are used to characterize dietary patterns in different studies, results consistently suggest that adherence to existing dietary guidelines is associated with a reduced risk of cancer incidence and mortality. Given the important role of dietary patterns in cancer prevention, clinicians need to consider providing appropriate nutrition counseling  to improve patients’ dietary patterns. Continuous efforts need to be devoted to better characterize the relationships between dietary patterns and cancer risk by studying specific cancer types, different cancer subtypes, and population subgroups, with a better approach that can accurately assess dietary patterns throughout the life cycle.

This review contains 3 figures, 6 tables and 91 references
Key words: Alternative Healthy Eating Index, breast cancer, cancer incidence, cancer mortality, cluster analysis, colorectal cancer, Dietary Approaches to Stop Hypertension, dietary patterns, diet quality index, factor analysis, Healthy Eating Index, lung cancer, Mediterranean Diet Score, prostate cancer, Recommended Food Score
Energy Balance, Exercise, and Cancer Risk
Authors: Trujillo Elaine B
Published: January 2021

Excess body weight is a risk factor for most cancers. Furthermore, obesity is associated with worsened prognosis after a cancer diagnosis and negatively affects the delivery of systemic therapy, contributes to morbidity of cancer treatment, and may raise the risk of second malignancies and comorbidities. However, an obesity paradox may be occurring in patients with cancer; this paradox has been observed when cancer patients with an elevated body mass index (BMI) have improved survival compared with normal-weight patients, and this has been observed in a variety of cancer patients. The reliance on BMI as a measure of body fatness has limitations in the cancer population; hence, the use of tools that directly measure body fat may be more predictive of cancer risk. Despite public health recommendations for achieving and maintaining a healthy weight for cancer prevention and survivorship, few studies have evaluated the effect of intentional body weight loss on cancer risk, although the evidence is suggestive of a relationship. Future research needs to elucidate if weight loss after a cancer diagnosis decreases the risk of recurrence and mortality, and if so, how much weight loss is needed.

This review contains 4 figures, 1 table and 65 references
Key words: body weight, cancer, interventions, lifestyle, morbidity, mortality, obesity, prevention, risk, sedentary, survivorship, weight loss
Approach to the Patient with Kidney Disease
Authors: Arici Mustafa
Published: January 2021

Chronic kidney disease (CKD) has diverse presentations that are frequently subclinical early in its course but symptomatic in more advanced stages. Quite commonly, kidney disease is diagnosed as an incidental finding in blood or urine tests. It is therefore crucial to understand how to assess kidney function tests and know the diverse presentations of kidney diseases in clinical practice. Assessment of kidney function mainly comprises three important steps: measuring glomerular filtration rate (GFR), estimation of urine albumin or protein excretion, and urinalysis/sediment examination. Estimating GFR based on a filtration marker (usually serum creatinine) is now widely accepted as the initial test. Several GFR prediction equations that use serum creatinine or other filtration markers along with certain patient characteristics (such as age, gender, and race) are used to estimate GFR, though several limitations must be considered when interpreting their results. Measurement of proteinuria or albuminuria provides insights into etiology (glomerular versus other parenchymal kidney diseases) and an assessment of risk of progression (ie, greater proteinuria, higher risk of progression). A complete examination of urine should be performed in all kidney patients. Urinalysis/sediment examination provides important information for both differential diagnosis of acute kidney disease (AKD) and CKD and clues for underlying etiologies of kidney disease. Several serologic tests and selected imaging studies complement the assessment of kidney diseases. Renal biopsy is occasionally required to specify the exact diagnosis and direct the treatment. All these investigations should be performed to determine the duration of kidney disease (ie, acute or chronic), designate the specific etiology, assess the risk for progression, and evaluate the presence of complications. Recently, several risk stratification scores or prediction models were developed for early diagnosis or predicting prognosis of acute kidney injury or CKD. These risk models may help to decrease the huge burden of kidney diseases on the individual as well as social level.

This review contains 1 figure, 11 tables and 29 references
Key Words: albumin-creatinine ratio, albuminuria, biomarkers, eGFR, chronic kidney disease, cystatin C, history, imaging, glomerular filtration rate , physical examination, renal biopsy, serum creatinine, urinalysis
National Kidney Allocation System
Authors: Asch William S , Stewart Darren , Formica Richard N
Published: January 2021

Deceased donor kidneys for transplantation represent a scarce national resource. Therefore, allocation practices must be built on fair and equitable policies that ensure the best possible use of each kidney. The current kidney allocation policy was a decade in the making and required multiple rounds of public comment and revision to create a policy that balances utility and equity. The new allocation policy improves utility by maximizing life-years gained from kidney transplantation through longevity matching: pairing those patients with the longest expected life with kidneys expected to last the longest. It also, for the first time in kidney allocation, allocates kidneys based on need by prioritizing the highly sensitized patient and giving waiting time credit for time spent on dialysis prior to registration. Finally, the system attempts to both increase recovery and promote rapid placement of kidney from older donors. This is done through an opt-in system that attempts to allocate kidneys with a shorter duration of expected function and a higher Kidney Donor Profile Index to older recipients who would trade off a greater duration of function for more rapid transplantation. Coupled with the new allocation policy, the use of biopsy results from deceased donor grafts, characteristics of blood flow when placed on mechanical perfusion devices, and molecular biomarker measurement have the potential to expand the available pool of deceased donor kidneys. The new approach to kidney allocation in the United States provides a case study into how to thoughtfully and equitably distribute a scarce resource.
Chronic Allograft Dysfunction
Authors: Hemmett Juliya , Jevnikar Anthony M , Gunaratnam Lakshman
Published: January 2021

Premature renal allograft failure is a major problem in kidney transplantation as it is associated with high morbidity, mortality, and health care costs as patients return to dialysis. The most common cause of graft loss the first year after transplantation is death with a functioning graft, closely followed by what is now termed chronic allograft dysfunction (CAD). Development of donor-specific antibodies and chronic antibody rejection are emerging as the major pathophysiologic mechanisms responsible for this entity. There are currently no validated therapies for CAD, but improving adherence and reducing risk factors for CAD may improve outcomes. This review summarizes current understanding of the epidemiology, diagnosis, and pathophysiology of CAD, as well as potential treatment strategies.

This review contains 3 figures and 133 references
Kidney Transplantation 2: Care of the Kidney Transplant Recipient
Authors: Azzi Jamil , Lee Belinda T. , Chandraker Anil
Published: January 2021

Renal transplantation is the preferred therapy for patients with end-stage kidney disease, leading to increased life expectancy, improved quality of life, and reduced health care resource use. Owing to their preexisting burden of disease, caring for renal transplant recipients is complex. Patient management following successful renal transplantation involves a multifactorial approach to cardiovascular risk factor management, along with titration of immunosuppression, management of complications related to immunosuppression, and active monitoring of allograft function. Recent advances in immunosuppressive management hold promise for improved long-term allograft survival. Finally, immune monitoring of transplant recipients is an area of considerable research, with the ultimate aim of individualized management of immunosuppression and the ability to induce transplant-specific tolerance.
This review contains 7 figures, 11 tables, and 119 references.
Key words: cardiovascular disease, drug interactions, immunosuppression, infection, interstitial fibrosis and tubular atrophy, malignancy, rejection, tolerance
Mood Disorders
Authors: Baloch Hasan A , Soares Jair C.
Published: January 2021

Affective disorders are among the most common disorders in psychiatry. They are generally classified according to the persistence and extent of symptoms and by the polarity of these symptoms. The two poles of the affective spectrum are mania and depression. Bipolar disorder is characterized by the presence of the mania or hypomania and often depression. Unipolar depression is defined by depression in the absence of a lifetime history of mania or hypomania. These differences are not merely categorical but have important implications for the prognosis and treatment of these conditions. Bipolar disorder, for example, is better treated using mood-stabilizing medication, whereas unipolar depression responds optimally to antidepressant medications. In addition, prognostically, unipolar depression may sometimes be limited to one episode in a lifetime, whereas bipolar disorder is typically a lifelong condition. The course of both conditions, however, is often chronic, and frequently patients can present with unipolar depression only to later develop manic symptoms. A thorough understanding of both conditions is therefore required to treat patients presenting with affective symptomatology. This chapter discusses the epidemiology, etiology and genetics, pathogenesis, diagnosis, and treatment of unipolar depression and bipolar disorder. Figures illustrate gray matter differences with lithium use and the bipolar spectrum. Tables list the pharmacokinetics of commonly used antidepressants and medications commonly used in the treatment of bipolar disorder.
This review contains 2 figures, 2 tables, and 135 references.
Neurologic Complications of Cancer
Authors: Sengupta Soma , Lee Eudocia Q , Wen Patrick Y
Published: January 2021

Neurologic complications from cancer and its therapies can significantly impact mortality and morbidity. Early recognition and intervention are key to preventing permanent neurologic injury. This review discusses common and uncommon neurologic complications of cancer, including central nervous system metastases, treatment-related neurotoxicities (including immunotherapies), and paraneoplastic syndromes. Workup and management of these neurologic complications are also addressed.
Key words: cancer, chemotherapy, metastases, nervous system complications, paraneoplastic syndromes
Ears
Authors: Pruitt Peter , Stair Thomas Osborne
Published: January 2021

As the structure of the ear is made of little more than cartilage, a limited blood supply, and a thin layer of skin, trauma in this area can easily manifest from a variety of causes. Some common examples of trauma involve laceration, piercing (intentional or otherwise), infection causing chondritis, blunt trauma causing necrosis, rupture of the tympanic membrane, perforation of the ear drum, and acoustic trauma that may result in hearing disorders such as tinnitus and high-frequency hearing loss. Acute hearing loss shows in two forms: conductive hearing loss and sensorineural hearing loss, the latter of which is caused by damage to the anatomic or neurologic structures of the ear dedicated to hearing. Sensorineural hearing loss generally has a poor prognosis and mandates prompt referral to an otolaryngologist. 
This review contains 4 figures, 13 tables, and 32 references.
Keywords: Ear, auricular canal, trauma, otitis media, otitis externa, hearing loss, mastoiditis, cerumen, impaction
Tics
Authors: Sarna Justyna R , Pringsheim Tamara
Published: January 2021

Tourette syndrome (TS) was originally described and conceptualized by Gilles de la Tourette in 1885. Since then, our understanding of tic disorders has grown immensely and continues to evolve at a rapid pace. Tics are abrupt, usually brief and repetitive, nonrhythmic movements (motor tics) and sounds (vocal tics). Motor tics can be further subdivided into simple and complex motor tics. Simple tics are sudden, meaningless movements most commonly involving eye blinking, facial grimacing, mouth gestures, and shoulder shrugs. Complex motor tics typically involve a series of stereotyped movements that may appear to be purposeful. Vocal (also called phonic) tics are similarly subdivided into simple and complex types. This review covers disease definition/subclassification, epidemiology, etiology/genetics, pathophysiology and pathogenesis, diagnosis, differential diagnosis, and treatment of tic disorders. Figures show a risperidone safety monitoring template for children, an aripiprazole safety monitoring template for children, and adult antipsychotic safety monitoring recommendations. The video shows how to perform the extrapyramidal symptom rating scale. Tables list classification of tic disorders, medication dosing suggestions, and TS deep brain stimulation guidelines.
This review contains 3 highly rendered figures, 1 video, 3 tables, and 115 references.
Breastfeeding
Authors: Richardson Marcie
Published: January 2021

Breastfeeding is endorsed by the medical community as the optimal nutrition for infants during the first 6-12 months of life.1,2,3  Breastfeeding rates in the US and worldwide have varied over time and still vary geographically.4 There is robust literature addressing the physiology of lactation, composition of breast milk, and health advantages of breastfeeding for both the mother and infant as well as strategies for clinicians to promote and support breastfeeding. This chapter reviews breastfeeding history, how milk is made, why breastfeeding matters, and the somewhat controversial the World Health Organization’s Baby Friendly Hospital Initiative (BFHI)5 for successful initiation of lactation as well as some special situations.   
Key words:  breastfeeding, infant nutrition, human milk composition, breastfeeding advantages, lactation, lactation support, Baby Friendly Hospital Initiative, skin to skin contact
Fetal Macrosomia
Authors: Clifford Caitlin , Edlow Andrea G.
Published: January 2021

Excessive fetal growth and increased birth weight are associated with significant maternal and neonatal morbidity and have become increasingly common given the global obesity epidemic.  Fetal macrosomia is traditionally defined in developed countries as fetal weight greater than 4,000 grams or 4,500 grams regardless of gestational age.  Large-for-gestational-age is traditionally defined as birth weight equal to or greater than the ninetieth percentile for a given gestational age.  Both are associated with a continuum of risk for complications, including shoulder dystocia, birth trauma, stillbirth, and infant mortality.  Diabetes is strongly associated with macrosomia, and control of maternal hyperglycemia has been proven to decrease rates of macrosomia and associated adverse pregnancy outcomes. Pregnancy-based interventions to minimize gestational weight gain have failed to consistently demonstrate a significant impact on macrosomia.
This review contains 5 tables, and 77 references.
Keywords: pregnancy, macrosomia, large for gestational age, estimated fetal weight, diabetes, obesity, shoulder dystocia, cesarean delivery, stillbirth
Patient with Postthoracotomy Pain
Authors: Cheng Jianguo , Cheng Olivia T
Published: January 2021

Pain due to thoracotomy is among the most severe pain experienced after surgery. It has both neuropathic and myofascial components. About 50% of patients suffer from chronic postthoracotomy pain 1 year after surgery. Thoracic paravertebral block or thoracic epidural analgesia is recommended as the first-choice therapy for thoracotomy analgesia.  Preoperatively initiated thoracic epidural analgesia is associated with better pain control and decreased incidence (and intensity) of chronic postthoracotomy pain compared with postoperative (epidural or intravenous) analgesia. Compared with inhalation anesthesia, total intravenous anesthesia significantly reduced the incidence of chronic postthoracotomy pain syndrome, which is notoriously challenging to treat. Gabapentinoids and antidepressants may be beneficial for the neuropathic component of chronic postthoracotomy pain syndrome. A pregabalin and methylcobalamin combination has been shown to be safe and effective in the treatment of chronic postthoracotomy pain, with minimal side effects. Interventional therapies such as intercostal nerve block or ablation, spinal cord stimulation, and targeted subcutaneous neuromodulation may be indicated in more refractory and debilitating cases.
This review contains 1 table, and 57 references.
Key words: chronic postthoracotomy pain, cryoneurolysis, intercostal nerve block, open thoracotomy surgery, paravertebral block, postthoracotomy pain, postthoracotomy pain syndrome, spinal cord stimulation, thoracic epidural analgesia, thoracotomy, total intravenous analgesia, video-assisted thoracoscopic surgery
Bertolotti Syndrome
Authors: Wu Jiang , Cheng Jianguo
Published: January 2021

Bertolotti syndrome is caused by a lumbosacral transitional vertebra,  a congenital variation of the most caudal lumbar vertebra, characterized by an enlarged transverse process that articulates or fuses with the sacrum, ilium, or both. This syndrome accounts for 4.6 to 7% of cases of low back pain in adults and for more than 11% of patients with low back pain who are under 30 years old. The primary effect of lumbosacral transitional vertebra is reduced and asymmetrical motion between the transitional vertebra and the sacrum, resulting in early arthritic changes at pseudoarticulation; the secondary effect is the progressively compensatory modifications in the biomechanics of the mobile vertebral segments superior to the transitional vertebra related to restriction in rotation and bending motion at the lumbosacral articulation. Bertolotti syndrome should be considered in the differential diagnosis of low back pain. Clinical findings include low back pain in the midline or paramedian area that is reproduced with palpation along the base of the lumbosacral spine and near the posterosuperior iliac spine and aggravated by forward flexion, excessive extension, or lateralization of the back to the same side of the mega-apophysis. A plain x-ray is diagnostic; the extension-flexion lumbosacral radiographs in anteroposterior, lateral, and oblique views demonstrate lumbosacral transitional vertebra, with an enlarged unilateral or bilateral transverse process of the most distal lumbar vertebra, abnormally articulating with the ala of the sacrum and degenerative changes of the pseudarthrosis. Other imaging studies, such as computed tomography and magnetic resonance imaging of the lumbosacral spine and selective radiculography of the spinal nerve, could provide additional detailed anatomic information. Major differential diagnoses of Bertolotti syndrome include sacroiliac joint pain, myofascial pain, lumbar facet pain, lumbar disk herniation, compression fracture, and Baastrup disease/interspinous bursitis. These conditions are not mutually exclusive and, in fact, often coexist. A course of conservative management, including activity modification, medication management with nonsteroidal antiinflammatory drugs, muscle relaxants, and rehabilitative physical therapy, should be offered initially. Due to the multifactorial etiology of low back pain in patients with Bertolotti syndrome, procedures such as diagnostic intrapseudoarticular block for arthritis, medial branch block for facet arthropathy, diskography for diskogenic pain, and selective nerve roots block for radiculopathy can potentially help identify the primary and secondary origins of the pain. Surgical treatment of Bertolotti syndrome was only slightly better than conservative treatment and should only be used in very selective patients with disk pathology. To achieve long-term improvement by any of these therapeutic options, a continuing physical rehabilitation program is often needed.
Key words: Bertolotti syndrome, intrapseudoarticular block, transitional lumbosacral vertebra, transverse process