bluuebunny/crossref_metadata_2025 huggingface dataset:
Almost strong properness
Authors: Mohammadpour Rahman
Published: May 2021

We introduce the forcing property “almost strong properness” which sits between properness and strong properness. As an application, we introduce a simple forcing with finite conditions to force Mapping Reflection Principle.
Statistical approaches for differential expression analysis in metatranscriptomics
Authors: Zhang Yancong , Thompson Kelsey N , Huttenhower Curtis , Franzosa Eric A
Published: May 2021

Motivation

Metatranscriptomics (MTX) has become an increasingly practical way to profile the functional activity of microbial communities in situ. However, MTX remains underutilized due to experimental and computational limitations. The latter are complicated by non-independent changes in both RNA transcript levels and their underlying genomic DNA copies (as microbes simultaneously change their overall abundance in the population and regulate individual transcripts), genetic plasticity (as whole loci are frequently gained and lost in microbial lineages) and measurement compositionality and zero-inflation. Here, we present a systematic evaluation of and recommendations for differential expression (DE) analysis in MTX.

Results

We designed and assessed six statistical models for DE discovery in MTX that incorporate different combinations of DNA and RNA normalization and assumptions about the underlying changes of gene copies or species abundance within communities. We evaluated these models on multiple simulated and real multi-omic datasets. Models adjusting transcripts relative to their encoding gene copies as a covariate were significantly more accurate in identifying DE from MTX in both simulated and real datasets. Moreover, we show that when paired DNA measurements (metagenomic data) are not available, models normalizing MTX measurements within-species while also adjusting for total-species RNA balance sensitivity, specificity and interpretability of DE detection, as does filtering likely technical zeros. The efficiency and accuracy of these models pave the way for more effective MTX-based DE discovery in microbial communities.

Availability and implementation

The analysis code and synthetic datasets used in this evaluation are available online at http://huttenhower.sph.harvard.edu/mtx2021.

Supplementary information

Supplementary data are available at Bioinformatics online.
Last Resort or Best Interest? Exploring the Risk and Safety Factors That Inform the Rates of Relocation for Young People Abused in Extra-Familial Settings
Authors: Firmin Carlene , Wroe Lauren , Bernard D
Published: May 2021

When young people are harmed in extra-familial settings children’s services may place them into care at a distance from their home authority to remove them from contexts in which they are considered ‘at risk’. Guidance and regulation suggest such intervention be used as a last resort and only in a child’s best interests. Using survey and interview data, this article examines how relocations are used in response to extra-familial harm (EFH) in thirteen children’s services departments inEngland and Wales—exploring the extent to which they are intended to mitigate risk, or build safety, for young people. Findings demonstrate that rates at which relocations were used varied across participating services. Interview data suggest that variation may be informed by the strategic position a service takes on the use of relocation, the goal(s) of interventions used in cases of EFH, and the target of these interventions. In considering each of these factors, the authors recommend further study into the national (varying) rates of relocation and the role of those who review care plans for relocated young people; both intending to create conditions in which young people can safely return to their communities should they choose to do so.
Automatic Diagnosis of Diabetic Retinopathy from Retinal Abnormalities: Improved Jaya-Based Feature Selection and Recurrent Neural Network
Authors: Ravala Lavanya , G K Rajini
Published: May 2021

Accurate diagnosis of lesions bears the highest significance in the early detection of diabetic retinopathy (DR). In this paper, the combination of intelligent methods is developed for segmenting the abnormalities like ‘hard exudates, hemorrhages, microaneurysm and soft exudates’ to detect the DR. The proposed model involves seven main steps: (a) image pre-processing, (b) optic disk removal (c) blood vessel removal, (d) segmentation of abnormalities, (e) feature extraction, (f) optimal feature selection and (f) classification. The pre-processing of the input retinal fundus image is performed by two operations like contrast enhancement by histogram equalization and filtering by average filtering. For the segmentation of abnormalities, the same Circular Hough Transform followed by Top-hat filtering and Gabor filtering is used. Next, the entropy-scale-invariant feature transform (SIFT), grey level co-occurrence matrices and color morphological features are extracted in feature extraction. The optimally selected features are subjected to the classification part, which uses a modified deep learning algorithm called optimized recurrent neural network (RNN). As the main novelty, the optimal feature selection and optimized RNN depends on an improved meta-heuristic algorithm called fitness oriented improved Jaya algorithm. Hence, the beneficial part of the optimization algorithm improves the feature selection and classification.
Senescence mechanisms and targets in the heart
Authors: Chen Maggie S , Lee Richard T , Garbern Jessica C
Published: May 2021

Cellular senescence is a state of irreversible cell cycle arrest associated with ageing. Senescence of different cardiac cell types can direct the pathophysiology of cardiovascular diseases (CVDs) such as atherosclerosis, myocardial infarction, and cardiac fibrosis. While age-related telomere shortening represents a major cause of replicative senescence, the senescent state can also be induced by oxidative stress, metabolic dysfunction, and epigenetic regulation, among other stressors. It is critical that we understand the molecular pathways that lead to cellular senescence and the consequences of cellular senescence in order to develop new therapeutic approaches to treat CVD. In this review, we discuss molecular mechanisms of cellular senescence, explore how cellular senescence of different cardiac cell types (including cardiomyocytes, cardiac endothelial cells, cardiac fibroblasts, vascular smooth muscle cells, and valve interstitial cells) can lead to CVD, and highlight potential therapeutic approaches that target molecular mechanisms of cellular senescence to prevent or treat CVD.
Update on management of hypokalaemia and goals for the lower potassium level in patients with cardiovascular disease: a review in collaboration with the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy
Authors: Krogager Maria Lukács , Kragholm Kristian , Thomassen Jesper Qvist , Søgaard Peter , Lewis Basil S , Wassmann Sven , Baumgartner Iris , Ceconi Claudio , Schmidt Thomas Andersen , Kaski Juan Carlos , Drexel Heinz , Semb Anne Grete , Agewall Stefan , Niessner Alexander , Savarese Gianluigi , Kjeldsen Keld Per , Borghi Claudio , Tamargo Juan , Torp-Pedersen Christian
Published: May 2021

Hypokalaemia is common in patients with cardiovascular disease. In this review, we emphasize the importance of tight potassium regulation in patients with cardiovascular disease based on findings from observational studies. To enhance the understanding, we also describe the mechanisms of potassium homeostasis maintenance, the most common causes of hypokalaemia and present strategies for monitoring and management of low potassium levels. We propose elevation of potassium in asymptomatic patients with lower normal concentrations and concurrent cardiovascular disease. These proposals are intended to assist clinicians until more evidence is available.
The long-term development of temperate woodland creation sites: from tree saplings to mature woodlands
Authors: Fuentes-Montemayor Elisa , Park Kirsty J , Cordts Kypfer , Watts Kevin
Published: May 2021

Tree planting is at the forefront of the current environmental agenda to mitigate climate change and tackle the biodiversity crisis. In the United Kingdom (UK), tree planting has been a priority for more than a century and has helped increase woodland cover from a historic low of 5 per cent at the beginning of the 20th century to a current figure of 13 per cent. However, we still know relatively little about the long-term development of woodland creation sites (particularly of native woodlands) over ecologically realistic timescales. We surveyed a chronosequence of 133 temperate woodland patches encompassing 106 woodland creation sites (10–160 years old) and 27 mature ‘ancient’ woodlands (>250 years old), using a combination of field surveys and remote sensing techniques to quantify vegetation structural changes associated with woodland development. Woodland creation sites displayed similar vegetation development patterns to those described for other woodland systems, i.e. a gradual transition as woodlands undergo ‘stand initiation’, ‘stem exclusion’ and ‘understorey re-initiation’ stages, and became more similar to ‘ancient’ woodlands over time. Structural heterogeneity, average tree size and tree density were the attributes that varied the most among woodland developmental stages. In general, structural heterogeneity and average tree size increased with woodland age, whilst tree density decreased as would be expected. Younger sites in stand initiation were strongly dominated by short vegetation, stem exclusion sites by taller trees and older sites had a more even vegetation height distribution. There was a large degree of overlap between the vegetation characteristics of woodlands in understorey re-initiation stages and older ancient woodlands (partly driven by a lack of regeneration in the understorey); these results suggest that it takes between 80 and 160 years for woodland creation sites to develop certain vegetation attributes similar to those of mature ancient woodlands included in this study. Woodland management practices to create canopy gaps and reducing grazing/browsing pressure to promote natural regeneration are likely to accelerate this transition, increase the structural heterogeneity and biodiversity value of woodland creation sites and enable adaptation and resilience to climate change.
Perimortem Distribution of U-47700, Tramadol and Their Main Metabolites in Pigs Following Intravenous Administration
Authors: Nordmeier Frederike , Doerr Adrian A , Potente Stefan , Walle Nadja , Laschke Matthias W , Menger Michael D , Schmidt Peter H , Meyer Markus R , Schaefer Nadine
Published: May 2021

In spite of a decreasing number of new releases, new synthetic opioids (NSOs) are gaining increasing importance in postmortem (PM) forensic toxicology. For the interpretation of analytical results, toxicokinetic (TK) data, e.g., on tissue distribution, are helpful. Concerning NSOs, such data are usually not available due to the lack of controlled human studies. Hence, a controlled TK study using pigs was carried out, and the tissue distribution of U-47700 and tramadol as reference was examined. Twelve pigs received an intravenous dose of 100 µg/kg body weight (BW) U-47700 or 1,000 µg/kg BW tramadol. Eight hours after administration, the animals were put to death with T61. Relevant organs, body fluids and tissues were sampled. After homogenization and solid-phase extraction, quantification was performed applying standard addition and liquid chromatography--tandem mass spectrometry. At the time of death, the two parent compounds were determined in all analyzed specimens. Regarding U-47700, concentrations were highest in duodenum content, bile fluid and adipose tissue (AT). Concerning tramadol, next to bile fluid and duodenum content, highest concentrations were determined in the lung. Regarding the metabolites, N-desmethyl-U-47700 and O-desmethyltramadol (ODT) were detected in all analyzed specimens except for AT (ODT). Higher metabolite concentrations were found in specimens involved in metabolism. N-desmethyl-U-47700 showed much higher concentrations in routinely analyzed organs (lung, liver and kidney) than U-47700. To conclude, besides the routinely analyzed specimens in PM toxicology such as blood, urine or standard specimens like kidney or liver, AT, bile fluid and duodenum content could serve as alternative matrices. In case of U-47700, quantification of the main metabolite N-desmethyl-U-47700 is highly recommendable.
Association ofCYP4G19Expression With Gel Bait Performance in Pyrethroid-Resistant German Cockroaches (Blattodea: Ectobiidae) From Taiwan
Authors: Hu I-Hsuan , Tzeng Hau-You , Chen Mei-Er , Lee Chow-Yang , Neoh Kok-Boon
Published: May 2021

Overexpression of a cytochrome P450 gene, CYP4G19, is known to associate with pyrethroid resistance in the German cockroach, Blattella germanica (L.) (Blattodea: Ectobiidae). In this study, we investigated the CYP4G19 expression level in 20 field-collected strains of B. germanica in Taiwan. We also examined the level of adult male susceptibility to imidacloprid, fipronil, indoxacarb, and hydramethylnon using single-diagnostic dose bioassays and their susceptibility to corresponding gel baits to determine how the CYP4G19 expression level influences the cockroach gel bait performance. Results showed that the CYP4G19 gene expression level among the field-collected German cockroach was 1.8- to 9.7-fold higher than that of the susceptible strain. It was negatively correlated (P < 0.05) with the % mortality after treatments with imidacloprid and fipronil diagnostic doses. However, no correlation was found between CYP4G19 gene expression with the % mortality after treatment with indoxacarb and hydramethylnon diagnostic doses. Indoxacarb and hydramethylnon baits showed high efficacy against the field strains with a mean mortality of 97.58 ± 1.35% and 90.95 ±1.65%, respectively. This study provided the first evidence of cross-resistance to imidacloprid and fipronil in pyrethroid-resistant German cockroaches due to overexpression of CYP4G19.
Host-Seeking Behavior ofAphidius gifuensis(Hymenoptera: Braconidae) Modulated by Chemical Cues Within a Tritrophic Context
Authors: Song Yunzhe , Liu Changming , Cai Pumo , Chen Weibin , Guo Yaqing , Lin Jia , Zhang Shufang
Published: May 2021

Aphidius gifuensis Ashmaed is a generalist endoparasitoid that parasitizes a variety of aphid species. In China, it is widely used as a biological control agent to protect vegetables and tobaccos in open fields; control efficiency is largely dependent on its host-seeking ability. In this study, a six-choice olfactometer was used to investigate the olfactory responses of A. gifuensis to tobacco plants that had suffered damage (either varying degrees of mechanical damage or from aphid-feeding at different time intervals) and tobacco volatiles with different dosages. Furthermore, the regularity of A. gifuensis females’ response toward an aphid/tobacco complex was monitored using a Y-tube olfactometer. Our findings suggest that tobacco plants are significantly attractive to A. gifuensis after they have been punctured with 50 holes, or housed with Myzus persicae (Sulzer) at a density of 400 aphids, except at an infestation time of 12 h. Moreover, aphid density had a more significant effect on the response than the time interval since aphid application. Aphidius gifuensis was found to be active during the daytime and preferred to search for their aphid hosts at 14:00 h. Five EAG-active tobacco volatiles (trans-2-hexenal, methyl salicylate, benzaldehyde, cis-3-hexen-1-ol, and 1-hexanal) were found to significantly attract A. gifuensis females at different concentration ranges. The practical implications of these results are discussed in the framework of the sustainable biological control of pest aphids in agricultural production systems.
Bronchogenic cyst of the floor of mouth combined with ankyloglossia: an extremely rare presentation of rare anomaly
Authors: Wongprakob Nuttadon , Sae-Guay Suthida , Burusapat Chairat , Wongchansom Kittisak , Wanichjaroen Nutthapong
Published: May 2021

Bronchogenic cyst (BC), cyst lined by respiratory epithelium, is uncommon congenital anomaly of bronchial tree. Intraoral BC is extremely rare lesions. Here, we report the unusual presentation of 2-year-old boy with symptomatic cystic lesion at floor of month combined with ankyloglossia. The operation was performed under general anesthesia. Frenotomy was performed. Complete cystic removal was successful with minimal leakage of cyst wall. Sclerosing agent was injected at surgical site to prevent the residual undetected cystic malformation. Pathological examination was demonstrated a unicystic lesion lined by ciliated pseudostratified columnar and cuboidal cells. The final diagnosis was bronchogenic cyst. No postoperative complication was found. The long-term course was uneventful with no signs of recurrence at 1 year. To our best knowledge, a rare example of BC at the floor of mouth combined with ankyloglossia has never been reported.
Sandpaper Sensation in the Shoulder
Authors: Cuevas-Trisan Ramon
Published: May 2021

The evaluation of patients with shoulder pain should follow a systematic approach, initially separating extrinsic (referred pain) and intrinsic (pain from the shoulder girdle structures) causes, followed by evaluation of glenohumeral versus extraglenohumeral causes of pain. Shoulder (glenohumeral) osteoarthritis is not an uncommon cause of intrinsic shoulder pain, with a prevalence that is higher in Caucasians, predominantly affecting males older than age 45 years and females older than age 55 years, as well as overweight and inactive individuals. Evaluation of shoulder pain in the setting of an acute traumatic shoulder injury usually requires imaging studies, whereas imaging requirements in nontraumatic cases should be carefully guided by the patient’s history and examination findings. Management of shoulder osteoarthritis should follow a stepwise approach, from conservative to minimally invasive and, last, surgical.
A Softball Weekend Warrior’s Nightmare
Authors: Martinez-Silvestrini Julio A.
Published: May 2021

Shoulder impingement syndrome is the most common condition causing shoulder pain, occurring in 44–65% of patients who complain of shoulder pain. Subacromial bursitis, rotator cuff tendinopathy, biceps tendinopathy, calcific tendinosis, and rotator cuff tears are specific problems that may be seen in patients with this syndrome. Other painful shoulder conditions, such as adhesive capsulitis and osteoarthritis, are commonly confused with impingement. Adequate history and examination help distinguish these entities, yet in some cases imaging studies are required. Simple analgesics and physical therapy are very effective for managing this condition. Injections or surgical care should be considered when patients have tried and failed conservative management.
Very Bothersome Ballooning Arm
Authors: Motta-Valencia Keryl , Correa-Mendoza Ady M.
Published: May 2021

Primary and secondary lymphedema are plausible, albeit rare, etiologies of upper limb pain and dysfunction. This chapter summarizes the clinical comprehensive assessment, which supported by laboratory and imaging tests can validate significant clinical parameters to define the lymphedema stages and facilitate therapeutic decisions. Clinical criteria for considering nonsurgical and surgical care are presented, as are considerations for preventive and lifestyle management to be implemented throughout all lymphedema stages. Identifying and managing the risk factors can impact patient outcomes of pain, quality of life, psychological health, disability, and socioeconomic sequelae. The comprehensive assessment of lymphedema is complex. It entails careful clinical examination, testing with labs/imaging, and surveying for psychological health and quality of life.
Fetal Physiology and Antepartum Fetal Surveillance
Authors: Streiff Agathe , Spitzer Yelena
Published: May 2021

Fetal surveillance is an integral part of prenatal care, especially in the last trimester. In order to understand antepartum fetal surveillance modalities, clinicians must be familiar with fetal physiology. This chapter will describe fetal cardiac physiology, which is primarily monitored. The authors will also describe fetal respiratory physiology and neurologic function to understand the impact of fetal distress, which may result in lifelong sequelae. In the subsequent sections, antepartum fetal surveillance technology is described, including nonstress tests, the biophysical profile, and umbilical artery Doppler velocimetry. The indications and limitations of these studies will be described. The purpose of this chapter is to educate clinicians on the roles of these modalities and the assessment they offer.
Pharmacology and Non-anesthetic Drugs During Pregnancy and Lactation
Authors: Wendling Adam L.
Published: May 2021

Medication use during pregnancy and lactation is very common yet understudied. There is a long history of medication use in pregnancy and lactation, although the dangers involved, including loss of the pregnancy and birth defects, have not always been well understood. In addition to concerns regarding teratogenicity, the physiologic changes of pregnancy can dramatically alter the pharmacokinetics of various medications. There can be clear indications for the use of medications during pregnancy and lactation, as untreated disease may have serious adverse outcomes for both the mother and baby. Specific medications have their own risks and benefits but, ultimately, the risk of untreated disease must be weighed against the potential risk of medication exposure during pregnancy and/or lactation.
Opioid Analgesia
Authors: Izadpanah Najmeh , Lee Seung , Gattu Kanchana , Watterworth Blake
Published: May 2021

This chapter focuses on the different systemic opioids that can be used during labor, including the side effects of each, advantages and disadvantages of using one agent over another, and routes of administration for each particular agent. Analgesia during labor can be administered via several routes. Neuraxial analgesia remains the most commonly employed technique for pain management during labor primarily due to its lower maternal and fetal systemic effects. There are circumstances, however, that prevent the use of neuraxial analgesia for labor pain including contraindications to neuraxial analgesia, unavailability of neuraxial analgesia, unsuccessful placement of neuraxial analgesia, or simply patient refusal. Nonpharmacologic and nonopioid alternatives exist, yet systemic opioids remain the most widely used non-neuraxial analgesia technique in the world. Advantages to using systemic opioids include ease of administration, lower cost, and lack of specialized equipment or personnel. Disadvantages include the inability to provide adequate or predictable analgesia; nausea, vomiting, pruritus; maternal and fetal respiratory depression; and decreased fetal heart rate variability and movement due to the ability of systemic opioids to cross the placenta. Several different systemic opioids can be used during labor including meperidine, morphine, fentanyl, alfentanil, remifentanil, codeine, and tramadol. Mixed agonist-antagonist agents like nalbuphine and butorphanol can also be used. The chapter also reviews the treatment of labor pain in opioid-tolerant parturients. Choice of labor analgesia is one that is individualized to patient-specific risks, goals, and comorbidities and is a choice that should be made by joint decision making between the parturient, obstetrician, and anesthesiologist.
General Anesthesia for Cesarean Delivery
Authors: Straube Lacey E.
Published: May 2021

“General anesthesia for cesarean delivery” examines the pertinent perioperative anesthetic concerns in the parturient, focusing specifically on techniques to keep both the mother and neonate safe. It touches on the unique physiology and anatomic changes of the parturient that impact anesthetic care. This chapter explores the implications of medications and anesthetic technique on uterine tone, placental transfer, fetal well-being, and breastfeeding. It also reviews prevention and treatment of many of the major risks of general anesthesia for cesarean delivery, including supine hypotension, aspiration, difficult airway, intraoperative awareness, postoperative pain, and uterine atony with subsequent hemorrhage.
Neuroscience for Clinicians
Authors: Benarroch Eduardo E.
Published: May 2021

The aim of this book is to provide the clinician with a comprehensive and clinical relevant survey of emerging concepts on the organization and function of the nervous system and neurologic disease mechanisms, at the molecular, cellular, and system levels. The content of is based on the review of information obtained from recent advances in genetic, molecular, and cell biology techniques; electrophysiological recordings; brain mapping; and mouse models, emphasizing the clinical and possible therapeutic implications. Many chapters of this book contain information that will be relevant not only to clinical neurologists but also to psychiatrists and physical therapists. The scope includes the mechanisms and abnormalities of DNA/RNA metabolism, proteostasis, vesicular biogenesis, and axonal transport and mechanisms of neurodegeneration; the role of the mitochondria in cell function and death mechanisms; ion channels, neurotransmission and mechanisms of channelopathies and synaptopathies; the functions of astrocytes, oligodendrocytes, and microglia and their involvement in disease; the local circuits and synaptic interactions at the level of the cerebral cortex, thalamus, basal ganglia, cerebellum, brainstem, and spinal cord transmission regulating sensory processing, behavioral state, and motor functions; the peripheral and central mechanisms of pain and homeostasis; and networks involved in emotion, memory, language, and executive function.
Organization of Cell Membranes
Authors: Benarroch Eduardo E.
Published: May 2021

Cell membranes are lipid bilayers that separate cells from their environment and also define different compartments within the cell. Cell membranes are composed of lipids and proteins. The main membrane lipids are phospholipids, sphingolipids, and cholesterol. They determine the biophysical properties of the membrane and its compartmentalization into domains called lipid rafts. Phospholipids and sphingolipids are also the source metabolites that mediate intracellular or intercellular signaling. There is a dynamic exchange of lipid components between the plasma membrane and the different intracellular membranous organelles. Membrane proteins contain domains that interact with the lipid bilayer; they include transporters, ion channel, receptors, and adhesion molecules that have a crucial role in cell physiology and cell–cell interactions. These proteins have a selective distribution in different functional domains of the membrane and undergo dynamic recycling in response to neuronal activity and other signals. Maintenance of the functional integrity of cell membranes is critical for cell function and survival. Disorders of membrane lipids or proteins provide the basis for a large number of neurologic disorders.
Intracellular Signaling
Authors: Benarroch Eduardo E.
Published: May 2021

Interactions between cells in the nervous system are bidirectional and involve a large number of chemical signals. These interactions occur via receptors located at presynaptic terminals, postsynaptic processes, or at a distance. Activation of membrane receptors by neurotransmitters, growth factors, cytokines, or other extracellular signals triggers downstream intracellular signaling pathways that affect a wide range of cellular functions. The final common mechanism is regulation of the state of phosphorylation of multiple crucial proteins in membranes, cytosol, cytoskeleton, and nucleus. The coupling between extracellular signals and these intracellular responses depends on transduction pathways that include G proteins that function as molecular switches; second messenger molecules such as cyclic nucleotides and phosphatidylinositol metabolites; intracellular calcium transients; and activation of protein kinases and phosphatases. Alterations of these fundamental cellular mechanisms provide the bases for a large number of disorders of the nervous system as well as potential therapeutic targets.
Growth Factors, Survival, and Regeneration
Authors: Benarroch Eduardo E.
Published: May 2021

Neurotrophic factors and hypoxia-inducible factors participate in fundamental processes including growth, differentiation, survival, and plasticity in the nervous system. They activate downstream cascades that promote protein synthesis and inhibit cell death mechanisms of apoptosis and autophagy. Axonal injury triggers retrograde neurotrophic signaling to the nucleus to regulate transcription of genes involved in axonal repair. Hypoxia induces expression of genes that control angiogenesis, erythropoiesis, and glycolysis. Growth factor and hypoxia-inducible signals are regulated by products of tumor suppressor genes. Excessive activation of these pathways lead to genetic tumor syndromes, many of them associated with epilepsy. Experimental models indicate that growth factors have neuroprotective effects against neurodegeneration. However, several human studies using growth factors administered systemically or via genetic methods have so far failed to show consistent beneficial effects. This has been attributed to inadequate dosing and delivery and enrollment of patients at late stage of disease. Approaches to promote axonal regeneration by targeting are an active area of research.
Synaptic Transmission and Presynaptic Synaptopathies
Authors: Benarroch Eduardo E.
Published: May 2021

Transmission of information in the nervous system largely occurs via chemical synapses, which are sites of bidirectional communication. Chemical synapses have a complex morphologic and molecular organization. Presynaptic events include synthesis and vesicular storage of the neurotransmitter; trafficking, docking, and priming of the synaptic vesicles at the presynaptic active zones; calcium-dependent neurotransmitter release by exocytosis, and recycling of synaptic vesicles by endocytosis. Postsynaptic events are mediated by neurotransmitter-gated ion channels (ionotropic receptors) that mediate fast excitatory or inhibitory effects (classical neurotransmission) and G protein-coupled receptors that mediate neuromodulatory effects. The precise development and functional apposition of presynaptic and postsynaptic elements via scaffolding proteins and transsynaptic adhesion molecules assures fast and precise synaptic transmission and plasticity. Genetic disorders affecting presynaptic events may manifest with paroxysmal dyskinesia, congenital myasthenic syndrome, and some forms of familial Parkinson disease (PD). Presynaptic membrane proteins are also targets of toxic and autoimmune disorders.
Inhibitory Amino Acid Neurotransmission and Synaptopathies
Authors: Benarroch Eduardo E.
Published: May 2021

Inhibitory neurotransmission is critical to determine neuronal excitability, limits the magnitude and duration of firing of other CNS neurons, and shapes the activity of neuronal networks. The main inhibitory neurotransmitter in the CNS is γ-aminobutyric acid (GABA), which is expressed in local inhibitory neurons and in some projection neurons such as Purkinje cells and neurons in the striatum and globus pallidus. Glycine, together with GABA, is critical in inhibitory circuits of the brainstem and spinal cord. Given its importance the importance of GABAergic and glycinergic inhibition in controlling excitability in neurons and neuronal networks, impaired inhibitory transmission manifests with seizures, myoclonus, spasticity, ataxia, and pain. Several drugs used for treatment of these disorders act by increasing GABAergic inhibition.
Episodic Memory
Authors: Benarroch Eduardo E.
Published: May 2021

The medial temporal lobe, including the hippocampus and surrounding areas, is critical for episodic memory, which is the ability to learn, store, and retrieve events of daily life. The hippocampal circuits provide a framework for relating experiences that constitute the individual autobiographic events. Information processed in the hippocampus is conveyed back to the neocortex for consolidation of episodic memories. The medial temporal lobe participates in an anterior circuit for recognition based on familiarity and a posterior circuit involved in visual navigation. These circuits are also components of the default mode network involved in processing of inner thoughts. The medial temporal lobe circuits are susceptible to aging, Alzheimer disease, and other disorders causing episodic memory disturbances.
Perioperative Management of Lower Extremity Revascularization
Authors: Janardhanan Divya , Delvadia Radha , Podolnick Jason , Chen Michelle , Gage Parr K. , Lutzker Tatiana N. , Nikolaidis Melissa
Published: May 2021

Anesthetic care of the patient with peripheral artery disease of the lower extremity is often complicated. As peripheral artery disease is in reality a systemic disease and other organ systems such as the cardiopulmonary, endocrine and renal systems are often involved, a complete workup of these patients must be done prior to administering any anesthetics. Once the patient is adequately evaluated, preoperative optimization is necessary to make sure that the proper medications are held or given, diabetic medications are appropriately dosed, and dialysis occurs in a timely fashion, if necessary. The choice of appropriate anesthetic is dependent on the patient; patient’s medications and comorbidities; and preferences of the patient, surgeon, and anesthesiologist. Monitoring will also depend on the surgery, patient, and comorbidities. Finally, postoperative care should be at an acuity level to closely monitor these often frail patients for postoperative complications.
Open Abdominal and Thoracoabdominal Aortic Aneurysm Repair
Authors: Robinson Albert R. , Powell Thomas R. , Deng Yi
Published: May 2021

This chapter describes the challenges that anesthesiologists face in the surgical repair of abdominal aortic aneurysms (AAAs) and thoracoabdominal aortic aneurysms (TAAAs). The anesthetic management of these patients includes caring for acutely sick patients who typically also present with some combination of hypertension, diabetes, hypercholesterolemia, and cardiac, pulmonary, and renal comorbidities. The aorta must be cross clamped and unclamped in AAA and TAAA repair, leading to hemodynamic instability as well as absolute and/or relative hypovolemia. Lung isolation is desirable in TAAA repair to facilitate access to the descending aorta. Techniques such as cerebrospinal spinal fluid drainage and hypothermia are used in at-risk cases to afford enhanced spinal cord protection. An understanding of a patient’s coagulation status and epidural anesthesia is important intraoperatively to decrease general anesthetic requirements as well as for postoperative pain management. Postoperatively, patients require continuous monitoring for bleeding and fluid management.
Monitoring for Vascular Surgical Procedures
Authors: Brennan Meghan , McGough Edward
Published: May 2021

Given the diversity of vascular surgical procedures, ranging from low-risk angiography to high-risk open aortic repairs, a wide variety of anesthetic techniques may be used, and different monitoring techniques are needed to ensure patient safety. A broad range of techniques ranges from solely regional techniques for angiography and arteriovenous fistula placement to general endotracheal anesthesia for open abdominal aortic aneurysm repairs. This broad range of monitoring techniques is required for patients undergoing vascular surgical procedures and must be considered due to the type and complexity of the surgery and coexisting disease. In addition to the standards for anesthetic monitoring set by the American Society of Anesthesiologists, other neurologic and/or cardiac monitoring techniques may be required.
Airway Devices for Thoracic Anesthesia and Ventilatory Techniques
Authors: Neeraj Kumar , Gupta Priya , Chakraborty Indranil
Published: May 2021

Lung isolation techniques are used extensively in operating rooms for surgical procedures involving the lungs or the mediastinum, out of the operating room for procedures performed by interventional pulmonologists, and in critical care units where a patient’s medical or surgical conditions require selective lung isolation or ventilation. This chapter outlines both adult and pediatric lung isolation devices currently in use. It also explains the physiological changes during one-lung ventilation and discusses ventilatory techniques recommended during lung separation. Individual one-lung ventilation devices are discussed in detail, including available sizes and availability for adult and pediatric populations. The chapter details the technique of using each device, advantages, disadvantages, and possible complications associated with the use.
Surgical Airway Management
Authors: Feng Zipei , Wu Mengjie , Nikolaidis Melissa , Deng Yi
Published: May 2021

Surgical airway management is used to address a variety of diseases affecting the larynx, such as anatomic pathologies, tumors, and voice disorders. The management is typically the purview of otorhinolaryngologists, although other specialties such as pulmonary and surgical critical care physicians have lately begun performing percutaneous procedures as well. In this chapter we outline the approaches to common surgical airway management procedures as performed by otorhinolaryngologists, including direct laryngoscopy and bronchoscopy with intervention, cricothyroidotomy, and tracheostomy. Only traditional open procedures are described in detail here as these serve as the foundational knowledge for more advanced endoscopic interventions.
Introduction
Authors: Ferguson Robert J. , Gillock Karen Lee
Published: May 2021

This introduction presents a review of the current research on the background, significance, and causes of cancer-related cognitive impairments (CRCI); the theoretical foundations of Memory and Attention Adaptation Training (MAAT), as well as MAAT research to date. It also presents an overview of the MAAT treatment plan, including the four components of MAAT (education/reattribution, self-awareness training, self-regulation exercises, and compensatory strategy development) and a complete MAAT training schedule. The broad consensus of the research literature suggests that approximately 50% of people undergoing cancer treatment experience some form of memory and attention problems following—and often many years after—treatment. The causes reviewed here—primarily chemotherapy, genetic vulnerability, vascular damage/inflammation, and hormonal/endocrine disruption—are those thought to be most helpful in rounding out the MAAT clinician’s basic understanding of the variety of mechanisms that can contribute to CRCI. Regardless of the source of the cognitive problems, cancer survivors can likely compensate for memory and attention problems if they learn specific, adaptive behavioral strategies. The compensatory strategy approach highlighted in MAAT has been found to effectively generalize (or “transfer”) across multiple settings better than repetitive practice (computerized) interventions that limit improvement to trained tasks. The results of research to date on MAAT presented suggest it is efficacious and can be delivered via telehealth services to enhance survivor healthcare access.
Metabolic syndrome
Authors: Neligan Patrick J.
Published: May 2021

Obesity is a metabolic disease that arises from excessive energy consumption. The development of non-alcoholic fatty liver disease appears to be an early indicator of escalating endocrine and metabolic dysfunction. Fatty liver results in insulin resistance. This is a precursor to type 2 diabetes, metabolic syndrome, steatohepatitis, and cirrhosis. Obesity increases the risk for cardiovascular, cerebrovascular, and neoplastic disease. This probably results from a combination of dyslipidaemia, dysregulation of glycaemic control, and ongoing inflammation associated with adipocytokines. Central obesity, characterized by a large reservoir of metabolically active visceral fat, closely correlates with cardiovascular risk, and is the key component of a constellation of symptoms known as the metabolic syndrome. There is little or no epidemiological data available regarding the diagnosis of metabolic syndrome and perioperative risk. No guidelines are available. Risk reduction associated with modulation of the specific components of this syndrome, cardiovascular disease, dyslipidaemia, and hyperglycaemia, are currently in a state of flux.
Cardiac surgery in obese patients
Authors: Ushakumari Deepu S. , Machovec Kelly A.
Published: May 2021

Obesity is a preventable disease with rising incidence, affecting 13% of the world’s adult population. The World Health Organization and the National Heart, Lung, and Blood Institute of the National Institutes of Health consider obesity to be a problem of epidemic and even pandemic proportion. Several classification schemes are utilized to categorize obesity. The Society of Thoracic Surgeons follows the classification scheme used by American Society for Metabolic and Bariatric Surgery guidelines using body mass index (BMI). BMI is the most commonly used and validated population-level measure of obesity. A recent National Health and Nutrition Examination Survey evaluation revealed an obesity prevalence of 35% among United States adults older than 20 years. The changing demographic of patients presenting for cardiac surgery reflects obesity in the general population. While the specific prevalence of obesity among patients presenting for cardiac surgery is not known, obesity is an independent risk factor for cardiovascular diseases and confers a higher risk of cardiac comorbidities, leading to increased likelihood of obesity among those requiring cardiac procedures. The BARI 2D trial, in examining a cohort of patients with central obesity, demonstrated that both BMI and waist circumference are independently associated with increased atherothrombotic risk. Frequent comorbid conditions, including diabetes mellitus, hypertension, and hyperlipidaemia, along with obesity-induced systemic inflammation, pose a challenge to care during cardiac surgical procedures, particularly those requiring cardiopulmonary bypass. Obesity is associated with significantly reduced quality of life in patients with diabetes and coronary artery disease, independent of comorbidities. This chapter reviews the perioperative preparation, intraoperative management, postoperative considerations, and pertinent outcomes for the patient with obesity presenting for cardiac surgery.
Preoperative evaluation of the morbidly obese patient
Authors: Subramaniam Rajeshwari , Pushparaj Hemkumar , Aravindan Ajisha
Published: May 2021

With the steeply increasing bariatric population throughout the world, including the affluent morbid obese and super-obese in developed countries and in the economically ‘middle class’ population in developing countries, anaesthesia for surgical procedures in bariatric patients is set to become routine. This is reflected by the increasing incidence of bariatric surgery, even in children. Bariatric patients usually present with systemic comorbidities. The presence of comorbidities and procedure-related risks has led to bariatric surgery being classified as an intermediate to high-risk non-cardiac procedure. Since bariatric surgery results in significant reversal of hypertension, diabetes mellitus, obstructive sleep apnoea, and pulmonary hypertension, preoperative optimization of these patients will minimize surgical risk.
Difficult airway management
Authors: Collins Jeremy , Mittal Brita M.
Published: May 2021

Difficult airway management in the morbidly obese population is an important topic as the physiological changes of obesity can lead to grave consequences when oxygenation is not rapidly established following anaesthetic induction. The correlation between elevated body mass index and direct laryngoscopy is unclear, probably because excess adipose tissue has a variable distribution among morbidly obese patients. The reader will be able to identify the subset of morbidly obese patients where difficult airway management is indeed expected. In such patients, optimizing modifiable factors such as preoxygenation, apnoeic oxygenation, positioning, and minimizing atelectasis is of primary importance. Alternative strategies for tracheal intubation other than direct laryngoscopy are discussed in this chapter, as well as safe extubation strategies for the difficult airway.
Venous thromboembolismIncidence, prophylaxis, and management
Authors: Valentine Elizabeth A.
Published: May 2021

Venous thromboembolism (VTE) is a disease spectrum ranging from deep vein thrombosis to pulmonary embolism. Venous thromboembolic disease is a leading cause of morbidity and mortality in bariatric surgery. Both medical and surgical risk factors make this patient population particularly high risk for VTE. Venous thromboembolic disease can have a variety of presentations and can be particularly difficult to diagnose in the bariatric population. While no clear consensus exists on best practice for perioperative VTE prophylaxis, it is appropriate to treat this population as high risk for VTE. Combined prophylaxis with both mechanical as well as pharmacological measures should be considered for most patients.
Enhanced recovery after bariatric surgery
Authors: Livelsberger Jon , Spivak Alla
Published: May 2021

The purpose of this chapter is to educate the reader on evidence-based management of surgery in the obese population, including obesity surgery. Included are strategies for patient education, optimization, and management during all phases of care starting with outpatient preoperative visits and ending once the patient has safely recovered from surgery. While the anaesthesiology team often serves to employ many of the management strategies discussed, it is most certainly a multidisciplinary approach. The main purposes are to improve patient experiences, improve patient outcomes, and reduce complications while ensuring that safe universal practices are underway. The final outcome, however, depends on the cooperation of the patient, perioperative team, and any specialized consultants involved.
Medicolegal issues and the obese patient
Authors: Berkeley Abiona , Ahmed Muhammad , Sosa-Herrera Jose
Published: May 2021

In the United States alone, it is estimated that 15,000–19,000 medical malpractice suits are brought against physicians each year. A retrospective analysis of malpractice claims filed in the United States from 2005 to 2009 uncovered a total of 58,667 claims against American physicians. Of those claims, 96.9% (56,850 claims) were settled with only 3.1% (1817 claims) proceeding to trial. Of those malpractice claims taken to court, obstetrical and surgical claims, as opposed to clinic-based or diagnostic claims, predominated. Although data related to unsuccessful claims which were dropped or dismissed prior to trial or in which findings were in favour of the physician have been difficult to quantify, some authors report that these may comprise as many as 50% of all filed legal malpractice actions.
Stromal cells in Sjögren’s syndrome
Authors: Nayar Saba , Colafrancesco Serena , Barone Francesca
Published: May 2021

The formation of tertiary lymphoid structures, defined as aggregates of lymphoid cells, developing ectopically in nonlymphoid locations, characterized by B-/T-cell segregation, differentiation of high endothelial venules, and development of follicular dendritic cells networks, supporting a germinal centre response, is a common histological feature associated with Sjögren’s syndrome. This ectopic lymphoid organization of immune cells is accompanied by the production of lymphoid chemokines and cytokines, responsible for leukocyte organization and survival. Interestingly, many of these factors detected within lymphoid structures are derived from nonhaemotopoietic stromal cells. This suggests that stromal cell activation is critically important for the maintenance and organization of tertiary lymphoid structures in inflammatory conditions.