bluuebunny/crossref_metadata_2025 huggingface dataset:
Running Critical Power and W´: Influence of the Environment,
Timing and Time Trial Order
Authors: Ruiz-Alias Santiago A. , Ñancupil-Andrade Alberto A. , Pérez-Castilla Alejandro , García-Pinillos Felipe
Published: October 2023

This study aimed to determine the influence of the testing environment (track vs.
treadmill), time trial order (long-short vs. short-long), and timing
(within-session vs. between-sessions) on the critical power (CP) and work over
CP (W´), using the power metric in runners. Fifteen highly trained
athletes performed three test sessions composed of two time trials of 9- and
3-min, separated by a 30-min rest period. One session was performed on a track,
and two sessions on a treadmill, alternating the order of the time trials. The
CP and W´ values determined on the track were significantly greater and
lower than on the treadmill, respectively (p<0.001;
CP≥89 W; W´≥3.7 kJ). Their degree of
agreement was low (SEE CP>5%; W´>10%)
and therefore was not interchangeable. There were no performance differences in
the timing of the time trials (p=0.320). Lastly, performing the 9-min
trial first resulted in a greater power output compared to when executed last
(p<0.001; 4.9 W), although this resulted in similar CP and
W´ values (Bias<5 and 10%, respectively). In conclusion,
it is feasible to test CP and W´ in a single testing session,
irrespective of the time trial order, although not interchangeably between track
and treadmill.
Chemoselective Reduction of Barbiturates by Photochemically Excited Flavin Catalysts
Authors: Storch Golo , Foja Richard , Walter Alexandra
Published: October 2023

Photocatalytic reductive cyclizations are powerful methods for obtaining structurally complex molecules. Achieving noninherent reactivity in substrates with more than one potential site of reduction is a difficult challenge. We disclose the use of flavin catalysis for the chemoselective reductive cyclization of barbiturates with additional reactive functional groups. Our method provides orthogonal selectivity in comparison to the well-established reductant samarium(II) iodide, which preferentially reduces substrate ketone groups. Flavin catalysis first leads to barbiturate reduction and allows a complete change of chemoselectivity in barbiturates with appended ketones. Additionally, flavin photocatalysis enables the reductive cyclization of substrates with appended oxime ethers in >99% yield, which is not possible with SmI2.
The Evaluation of Prognostic Value and Immune Characteristics of Ferroptosis-Related Genes in Lung Squamous Cell Carcinoma
Authors: Su Jialin , Tan Shuhua , Gong Houwu , Luo Yongzhong , Cheng Tianli , Yang Hua , Wen Xiaoping , Jiang Zhou , Li Yuning , Zhang Lemeng
Published: October 2023

Background The purpose of our study was to construct a prognostic model based on ferroptosis-related gene signature to improve the prognosis prediction of lung squamous carcinoma (LUSC).

Methods The mRNA expression profiles and clinical data of LUSC patients were downloaded. LUSC-related essential differentially expressed genes were integrated for further analysis. Prognostic gene signatures were identified through random forest regression and univariate Cox regression analyses for constructing a prognostic model. Finally, in a preliminary experiment, we used the reverse transcription-quantitative polymerase chain reaction assay to verify the relationship between the expression of three prognostic gene features and ferroptosis.

Results Fifty-six ferroptosis-related essential genes were identified by using integrated analysis. Among these, three prognostic gene signatures (HELLS, POLR2H, and POLE2) were identified, which were positively affected by LUSC prognosis but negatively affected by immune cell infiltration. Significant overexpression of immune checkpoint genes occurred in the high-risk group. In preliminary experiments, we confirmed that the occurrence of ferroptosis can reduce three prognostic gene signature expression.

Conclusions The three ferroptosis-related genes could predict the LUSC prognostic risk of antitumor immunity.
Double transition metal MBenes: A family of 2D MXenes with tunable magnetic properties
Authors: Wang Yanxia , Jiang Xue , Wang Yi , Zhao Jijun
Published: October 2023

The emergence of two-dimensional (2D) magnetic materials is critical to the development of nanoscale spintronic devices. However, the lack of intrinsic magnetism limits their applications. In this work, we propose a universal strategy to develop experimentally feasible 2D MBenes with intrinsic magnetism. Using high-throughput first-principles calculations, 546 kinds of ordered double transition metal MBenes with chemical formula (M′2/3M″1/3)2B2 (M′ and M″ = Sc, Y, Ti, Zr, Hf, V, Nb, Ta, Cr, Mo, W, Mn, Fe, and Co) were developed and studied in detail. Among them, we have identified 21 (M′2/3M″1/3)2B2 with robust magnetic ordering and good structural stability, including 15 ferromagnetic metals, 1 ferromagnetic half-metal, 3 antiferromagnetic metals, and 2 antiferromagnetic semiconductors. Remarkably, (Cr2/3Zr1/3)2B2 is a ferromagnetic half-metal with a high Curie temperature of 610 K and a strong out-plane magnetic anisotropy energy of 305 μeV per Cr atom. (Mn2/3Sc1/3)2B2 and (Fe2/3Nb1/3)2B2 are antiferromagnetic semiconductors with Néel temperatures of 257 and 462 K, respectively. These excellent magnetic properties make the double transition metal MBenes desirable for 2D spintronics.
Flow regime and critical deposition velocity of liquid–solid two-phase flow in pipeline: Progress and perspectives
Authors: Feng Yue , Lei Yiming , Zheng Meng , Li Zhixuan , Zhao Ning , Ren Jianqiang , Fang Lide
Published: October 2023

Pipeline liquid–solid two-phase flow is a significantly important multiphase flow phenomenon widely encountered in both industrial and natural settings. The flow regime of liquid–solid two-phase flow in pipelines plays a crucial role as it represents the macroscopic manifestation of the suspension diffusion mechanism and the slip deposition law of solid particles. This paper provides an overview of research related to flow regimes and critical deposition velocity (CDV) in liquid–solid two-phase flow in pipelines. After briefly reviewing pioneering theoretical research in this field, the paper focuses on recent research in flow regime identification and prediction using state-of-the-art experimental methods and techniques. The review also rigorously assesses the reliability and validity of the methods, results, and conclusions related to the establishment of the CDV, identifying the deficiencies in the current research. Drawing on dimensional analysis and Pearson correlation analysis, the particle Reynolds number is introduced to establish a highly accurate correlation for predicting the CDV under conditions of wide volume concentration. The new correlation yields a mean absolute percentage error of 9.23% and a root mean square error of 10.29% within the volume concentration range of 0.7%–50.8%. This paper aims to provide clear guidance to researchers and professionals in related industries, enabling them to conduct more in-depth investigations according to their research interest and enhance their understanding of liquid–solid two-phase flow systems within pipelines.
Wine environments
Authors: Balbuena Torezano M. del Carmen
Published: October 2023

The wine lexicon has multiple semantic domains that represent the
confluence of different specialized languages, and that constitute an
ontological classification of great usefulness for the translator. In this
paper we will present a study of three mechanisms of word formation
(composition, derivation and abbreviation) in German language for terms
belonging to the domain [winegrowing].
Simultaneous measurement of temperature and refractive index based on plastic optical fiber knots and F–P interferometer
Authors: Zhao Hongxia , Wang Feng , Han Zhaojia , Cheng Peihong , Wang Yong
Published: October 2023

A reflective sensor based on F–P interferometer (FPI) and plastic optical fiber (POF) knots is proposed for simultaneously measuring the temperature and refractive index (RI). The FPI is fabricated by curing a polyvinyl chloride film on the end of a POF, and it is used to detect the temperature shifts. Meanwhile, the high sensitivity measurement of RI of the glucose solution is realized based on the POF knots. Finally, the RI and temperature are detected simultaneously with the help of the wavelength and reflected light intensity of an interference peak. The experimental results indicate that the proposed sensor achieves a maximum RI sensitivity of 2381.73%/RIU in the RI range of 1.33–1.374, and it can detect temperature simultaneously. The maximum relative deviations between the measured results and actual values of RI and temperature are only 0.038% and 2.76% respectively, and they have good repeatability. Furthermore, the proposed sensor has potential applications in biochemistry and food safety monitoring due to the unmodified and simple preparation process.
Research on real-time perception method of key targets in the comprehensive excavation working face of coal mine
Authors: Zhao Dongyang , Su Guoyong , Cheng Gang , Wang Pengyu , Chen Wei , Yang Yuhao
Published: October 2023

Aiming at the real-time perception problem of key target objects caused by harsh environmental factors of high dust, low illumination, motion blur, and multi-target mixing in the comprehensive excavation working face of coal mine, a multi-target detection and tracking algorithm based on DDEB-YOLOv5s and StrongSORT is proposed. First, the YOLOv5s model is improved by using C3-Dense module, decoupled head, ECIoU loss function, and weighted bi-directional feature pyramid network to enhance the detection performance of the model in complex backgrounds of coal mine and complete the design of the DDEB-YOLOv5s multi-target detection network. Second, the DDEB-YOLOv5s algorithm is used as a detector and combined with the StrongSORT tracking algorithm to track critical equipment and miners in the complex context of coal mine. Experiments were conducted on the dataset of comprehensive excavation working face, and the experimental results show that the proposed DDEB-YOLOv5s has the best integrated detection performance compared with other YOLO series target detection algorithms, and its mean value of detection accuracy reaches 91.7%, which is 4.9% higher than that of the original YOLOv5s model. In addition, compared to the three tracking models, (YOLOv7-tiny)-(BoT-SORT), YOLOv5s-DeepSORT, and YOLOv8s-Bytetrack, the (DDEB-YOLOv5s)-StrongSORT model has the best tracking performance (with a mean tracking accuracy of 94.2%) and the least number of identifier switches. Finally, the real-time perception method proposed in this study for the key target of the coal mine working face can provide new technical support and effective guarantee for coal mine safety production.
Image reconstruction of ECT based on second-order hybrid sensitivity matrix and fuzzy nonlinear programming
Authors: Zhang Lifeng , Chen Da
Published: October 2023

In the derivation of the sensitivity matrix of electrical capacitance tomography, only the linear portion of the sensitivity coefficient is usually retained, while the neglected nonlinear part also contains important imaging information. In order to improve the accuracy of image reconstruction, a second-order hybrid sensitivity matrix is presented based on the capacitance normalization model and second-order item of sensitivity coefficients in this paper. Then, a fuzzy nonlinear programming algorithm based on the second-order hybrid sensitivity matrix (SHS-FNP) is proposed. Simulation and experiments are carried out. Reconstructed images using the presented method are compared with those of the Tikhonov algorithm, first-order hybrid Landweber algorithm, second-order hybrid Landweber algorithm, and fuzzy linear programming algorithm. The experimental results show that the SHS-FNP algorithm considerably enhances the quality of the reconstructed image.
Amplitude-dependent edge states and discrete breathers in nonlinear modulated phononic lattices
Authors: Rosa Matheus I N , Leamy Michael J , Ruzzene Massimo
Published: October 2023

We investigate the spectral properties of one-dimensional spatially modulated nonlinear phononic lattices, and their evolution as a function of amplitude. In the linear regime, the stiffness modulations define a family of periodic and quasiperiodic lattices whose bandgaps host topological edge states localized at the boundaries of finite domains. With cubic nonlinearities, we show that edge states whose eigenvalue branch remains within the gap as amplitude increases remain localized, and therefore appear to be robust with respect to amplitude. In contrast, edge states whose corresponding branch approaches the bulk bands experience de-localization transitions. These transitions are predicted through continuation studies on the linear eigenmodes as a function of amplitude, and are confirmed by direct time domain simulations on finite lattices. Through our predictions, we also observe a series of amplitude-induced localization transitions as the bulk modes detach from the nonlinear bulk bands and become discrete breathers that are localized in one or more regions of the domain. Remarkably, the predicted transitions are independent of the size of the finite lattice, and exist for both periodic and quasiperiodic lattices. These results highlight the co-existence of topological edge states and discrete breathers in nonlinear modulated lattices. Their interplay may be exploited for amplitude-induced eigenstate transitions, for the assessment of the robustness of localized states, and as a strategy to induce discrete breathers through amplitude tuning.
THz driven field emission: energy and time-of-flight spectra of ions
Authors: Karam M , Houard J , Damarla G , Rousseau L , Bhorade O , Vella A
Published: October 2023

We present an experimental and numerical study of ion field evaporation from LaB6 nanotips using single-cycle terahertz (THz) transients and a static bias voltage. Varying the amplitude and phase of the THz pulses and the value of the bias, we explore the THz-induced reshaping of the ions energy and their time-of-flight spectra. These results prove that short THz transient of about 1 ps can induce ionization and emission of ions from LaB6 samples by a field effect: the THz transient acts as an ultra-short electrical pulse. Moreover, comparing numerical and experimental results, we prove that the response time of surface atoms to the THz transient is shorter than 1 ps, corresponding to the vibration times of acoustic phonons in LaB6.
Fault diagnosis of a computer interlocking system for railway signal control
Authors: Zhou Fang , Li Fengying
Published: October 2023

The signal control of the railway transportation system is crucial for operational safety. This paper briefly introduces the computer interlocking system for railway signal control, describes the tree-structured neural network used for fault diagnosis of the interlocking system, and introduces the particle swarm optimization (PSO) algorithm for improvement. Finally, a simulation experiment was conducted on a railway station to compare the traditional back-propagation neural network (BPNN), the support vector machine, the traditional tree-structured neural network, and the improved tree-structured neural network for fault diagnosis. It was found that the topological structure of the device distribution in the railway station could be transformed into a tree structure, and with the introduction of hidden nodes, it could become a binary tree structure where each leaf node represents a device; the improved tree-structured neural network had the highest recognition performance for both two-class tasks (determining system failure or not) and multi-class tasks (identifying fault type).
Iterative multitask learning and inference from seismic images
Authors: Gao Kai
Published: October 2023

Seismic interpretation aims to extract quantitative and interpretable attributes from a seismic image produced using some migration method to inform characteristics of a subsurface reservoir or target of interest. Current paradigms for computing seismic attributes mostly rely on single-task algorithms. We develop an iterative, multitask machine learning method to learn and infer multiple attributes from a seismic image. This method is composed of two stages: a multitask inference stage and a multimodal, multitask refinement stage. The basic mechanism of this method is that we train a multitask inference neural network to estimate a set of attributes, including a relative geological time volume, a denoised higher-resolution seismic image and multiple fault attributes (including probability, dip and strike), from a low-resolution, noisy seismic image; then we input the inferred attributes to a multitask refinement NN to enhance the raw inference results iteratively. The two multitask neural networks are trained separately based on synthetic seismic images and associated labels generated by geological modelling. Applications of this multitask learning and inference method to synthetic and field seismic images show that our method can improve the structural consistency among output seismic attributes compared with single-task neural networks, leading to more reliable automatic interpretation and subsurface characterization.
Magnification bias estimators for realistic surveys: an application to the BOSS survey
Authors: Wenzl Lukas , Chen Shi-Fan , Bean Rachel
Published: October 2023

In addition to the intrinsic clustering of galaxies themselves, the spatial distribution of galaxies observed in surveys is modulated by the presence of weak lensing due to matter in the foreground. This effect, known as magnification bias, is a significant contaminant to analyses of galaxy-lensing cross-correlations and must be carefully modelled. We present a method to estimate the magnification bias in spectroscopically confirmed galaxy samples based on finite differences of galaxy catalogues while marginalizing over errors due to finite step size. We use our estimator to measure the magnification biases of the CMASS and LOWZ samples in the SDSS BOSS galaxy survey, analytically taking into account the dependence on galaxy shape for fibre and PSF magnitudes, finding αCMASS = 2.71 ± 0.02 and αLOWZ = 2.45 ± 0.02 and quantify modelling uncertainties in these measurements. Finally, we quantify the redshift evolution of the magnification bias within the CMASS and LOWZ samples, finding a difference of up to a factor of three between the lower and upper redshift bounds for the former. We discuss how to account for this evolution in modelling and its interaction with commonly applied redshift-dependent weights. Our method should be readily applicable to upcoming surveys and we make our code publicly available as part of this work.
GLIOMA-14 ELUCIDATING THE CELL-CELL INTERACTIONS AND GEO-SPATIAL ORIENTATION OF M2 POLARIZED MACROPHAGES/MICROGLIA WITHIN GBM'S TME AND INVESTIGATING THEIR IMMUNOSUPPRESSIVE EFFECT ON DENDRITIC CELLS
Authors: Reid Alexandra , Jin Dan , Dean Bayli DiVita , Falceto-Font Laura , Francis Connor , Flores Catherine
Published: October 2023

Glioblastoma (GBM) is an incredibly aggressive and prevalent primary CNS tumor with dismal survival outcomes. GBM’s intra-tumor heterogeneity and lack of anti-tumor immune cell infiltration have proved to be formidable challenges to developing effective therapies. To overcome these hurdles, it is vital that we garner a better understanding of the cell-cell interactions occurring within the tumor microenvironment (TME) in situ. Accounting for the complexity and the spatial orientation of the components within the TME may offer insight into the multitiered layers of immunosuppression capitalized on by GBM tumors, thus elucidating the factors responsible for poor response to therapy and uncovering potential therapeutic targets that may offer more favorable therapeutic results for immunotherapies. Current in vitro and in vivo models, however, sorely limit our ability to probe these distinct attributes while preserving the intricate nature of the TME. To bridge this gap, we have devised a novel organotypic brain slice culture (BSC) model using tumor-bearing C57BL/6J mice, allowing us to characterize the tumor milieu in situ. We have identified a large infiltration of macrophages and microglia polarized to the M2 anti-inflammatory phenotype within the TME. Leveraging this platform, we sought to define further the factors contributing to the dynamic impacts of GBM immunosuppression, such as the tolerogenic response in dendritic cells (DC) upon interaction with the TME. We have demonstrated outcomes similar to those seen in vivo following the introduction of DCs to tumor-bearing BSCs, further supporting the physiological relevancy of this model, and have since worked to unravel elements responsible for this response.
OTHER-02 BRAIN TUMORS: CLINICAL PRESENTATION AT THE NATIONAL CENTER FOR NEUROLOGICAL SCIENCES IN KHARTOUM 2019-2022
Authors: Nasr Arwa , Ahmed Nidaa , Mohamoud Mai , Mosaad Montasir , Amara Zainab , Khalil Reem , Hamid Safa
Published: October 2023

Brain tumors are intracranial neoplastic proliferation of cells. They are implicated in high patient morbidity and mortality. Malignant brain tumors are less common in relevance to other types of malignancies, yet they are enumerated as the tenth leading cause of death worldwide. Diagnosis of these tumors mainly depends on clinical features and imaging. This study aims to describe the clinical presentation and associated factors of brain tumors and has been conducted as a retrospective cross-sectional 4-year facility-based study at the National Center for Neurological Sciences (NCNS), a center in Khartoum state that receives all neurological patients from all over Sudan. Data were collected from records of patients of all ages who have been diagnosed with brain tumors from 2019 to 2022. The data included demographic information, clinical presentation, and the anatomical site of tumors. Data analysis was done using SPSS version 22 and ethical approval was obtained from the institutional review board. The total number of patients with brain tumors was 182. Female to male ratio was 1.3:1 and most of the patients were adults in 131. Headache was found to be the most frequent symptom and motor deficit was the most frequent sign. The commonest anatomical site was supratentorial. Brain tumors despite being more common in adults, share the same most frequent clinical presentation, and with the anatomical site came in consistence with the worldwide population, apart from the gender distribution as females are more affected than males.
PAEDIATRIC-01 SURGICAL OUTCOME OF MEDULLOBLASTOMA IN ETHIOPIA
Authors: Akililu Yemisirach Bizuneh , Woldemariam Mersha Abebe
Published: October 2023

OBJECTIVE

Medulloblastoma is one of the commonest CNS[1] tumors in pediatric patients. This study tries to assess surgical treatment outcome and prognostic factors in patients diagnosed with medulloblastoma in Ethiopia, a LIC[2].

MATERIALS AND METHODS

Retrospective study involving twenty-seven patients (21 pediatrics & 6 adults) who underwent surgery for medulloblastoma (January 1, 2010-April 30, 2018), at two neurosurgical centers. Structured questionnaire was used to collect patients’ data & surgical treatment outcome variables were assessed by suitable statistical tests.

RESULTS

1-year and 6-month survival probability were 29% and 41 % respectively with a median survival of 107 days (95% CI: 49,166). Median survival was 66 days (95% CI: 27,105), with 6 months and one-year survival rate of 24 % (p=0.031) for pediatric patients. Majority (61.90%) of pediatric deaths were in the first two months of surgery. Six months & one-year PFS[3] were around 83% and 44% respectively with median PFS of 9 months (95%CI: 7, 12). Younger age at presentation, postoperative open EVD[4], longer SICU[5] stay, lack of radiation treatment & postoperative complications were negative outcome predictors.

CONCLUSION

Overall median and PFS of operated patients <15 years old is poor. Patients with negative outcome predictors have higher mortality& poor postoperative functional status. Standardization of treatment with surgery & CSI[6] ± chemotherapy yields longer survival rates in both pediatric and adult patients.

[1] Central Nervous System

[2] Low Income Country

[3] Progression Free Survival

[4] External Ventricular Drainage

[5] Surgical Intensive Care Unit

[6] Craniospinal Irradiation
PAEDIATRIC-06 PEDIATRIC RECURRENT PRIMARY OCCIPITAL SYNOVIAL SARCOMA: A CASE REPORT
Authors: Bergene Eyerusalem , Equar Dr Samuel
Published: October 2023

BACKGROUND

Synovial sarcoma is one of the malignant soft tissue sarcomas with an unknown histological origin. It has a unique t(X;18) (p11.2; q11.2) chromosomal translocation, resulting in the SYT-SSX fusion protein. The intracranial occurrence is mainly metastatic, and primary intracranial synovial sarcoma is extremely rare, with few case reports and case series in the literature.Surgical resection of the tumor followed by adjuvant radiotherapy and chemotherapy, regardless of the extent of tumor resection, has been shown to have a significant benefit.

CASE PRESENTATION

Here we report the case of an eleven-year-old male patient who presented with a four-month history of swelling at the occipital area and intermittent headache. Imaging showed a destructive skull vault lesion with infiltration of the ipsilateral cerebellum. A subtotal resection of the tumor was achieved, and histopathology examination revealed a biphasic variant of synovial sarcoma. The patient disappeared from follow-up without receiving adjuvant radiotherapy and presented two years later with a swelling at the previous surgical site. After imaging was done, a recurrence was diagnosed, and he was reoperated with near total excision.

CONCLUSION

Primary intracranial synovial sarcoma is an extremely rare malignant tumor. Surgical resection with adjuvant radiation should be the standard of care to prevent recurrence. In low-income countries, patients disappear from follow-up, making post-operative management difficult. Furthermore, radiation services should be made widely available to address issues with compliance.
Planning and implementation II
Authors: Jelliffe Derrick B , Jelliffe E F Patrice , Zerfas Alfred , Neumann Charlotte G
Published: October 2023

There are two major considerations in sampling: sample design and sample size. Sample design involves the method of sampling and carrying it out. The need for a random sample with acceptable coverage and response rate is essential for cross-sectional surveys. Errors related to this are often difficult to estimate and may cause serious doubts concerning the acceptance of the sample data as reflecting the population of concern. Sample size, on the other hand, is concerned with the ‘precision’ of results, (i.e. how the results vary from that which would be obtained if the entire population were surveyed.) Hence, results from samples include as estimate and a range of statistical confidence (‘confidence interval’) (Appendix 4) around the estimate.
Introduction
Authors: Boué A Bou
Published: October 2023

Recent developments in ultrasound have improved the clinical assessment of the fetus. Not only can the external anatomy be examined in search of malformations such as anencephaly or limb defects, but the internal morphology can also be examined for malformations of the brain, heart, kidney, gut, and spine. Real-time ultrasound permits the examination of fetal movement and an assessment of the development of the central nervous system. Finally, ultrasound guidance techniques permit fetal sampling, thus opening the door to prenatal diagnosis.
Prenatal diagnosis of single-gene disorders
Authors: Poenaru L
Published: October 2023

Enzymopathies make up the majority of single-gene disorders. They are inborn errors which consist of absences, deficiencies, or alterations in the metabolic pathway of an enzyme or group of enzymes.
Maternal infection
Authors: Boué André
Published: October 2023

More than forty years after Gregg’s description of the congenital rubella syndrome, microbiological, clinical immunological and epidemiological studies have provided much information on fetal and neonatal risks as a consequence of transmission of maternal infection. Despite these studies, much remains obscure, mainly because of methodological difficulties inherent in such investigations.
Prenatal diagnosis and its applications
Authors: Boué André , Muller F
Published: October 2023

If one knows the indications for prenatal diagnosis, the techniques available and how to use them, it is appropriate to apply these techniques in all at-risk pregnancies and to evaluate their effects on the incidence of malformations at birth.
Ethical issues
Authors: Boué André
Published: October 2023

Applications of fetal medicine bring ethical considerations to the forefront. In this area, the laboratory has a particular responsibility; the result of an analysis will be a determining factor in the parents’ decision to pursue or terminate a pregnancy.
The examination of the patient
Authors: Bannister Sir Roger
Published: October 2023

In the diagnosis of nervous diseases the history of the patient’s illness is often of greater importance than the discovery of his abnormal physical signs. The group of physical signs may be common to several disorders and only an accurate knowledge of their mode of development may enable the correct diagnosis to be made.
The cranial nerves
Authors: Bannister Sir Roger
Published: October 2023

Before concluding that anosmia, or loss of the sense of smell, is due to a nervous lesion it is necessary to exclude disorders of the nose itself. There are patients who say that they lost their sense of smell many years previously and cannot account for it. In neurological practice there are only two important causes of anosmia. Bilateral loss of smell is sometimes seen after a head injury. This is usually not associated with a fracture of the skull, and if improvement does not occur within a few weeks of the injury it is likely to be permanent. Unilateral loss of the sense of smell may be an early sign of a tumour, especially a meningioma of the olfactory groove, pressing upon the tract. Such a tumour may eventually lead to bilateral anosmia.
Injuries to the brain
Authors: Bannister Sir Roger
Published: October 2023

In civil life most head injuries are due to direct violence resulting from motor and industrial accidents. It is estimated that 100 000 cases of head injury are admitted to hospitals in Britain each year, and of these some 400 injuries cause unconsciousness lasting more than a month. Of the survivors with permanent brain damage, half are not able to work again. Less frequently head injuries are produced by indirect violence after falls. Penetrating wounds are comparatively rare. The brain may be extensively damaged without the skull’s having been fractured, and on the other hand fracture of the skull may occur without severe brain injury. Compound fractures of the skull, especially those involving the base, are liable to lead to infection of the intracranial contents and thus to cause meningitis or intracranial abscess.
Disorders of nerve roots and peripheral nerves
Authors: Bannister Sir Roger
Published: October 2023

As elsewhere in the nervous system, accurate diagnosis rests upon anatomy and physiology, for the symptoms of a lesion depend upon the distribution of the motor and sensory fibres which happen to be grouped together in the nervous pathway at the site of which the lesion occurs. In the case of lesions of the nerve roots and peripheral nerves, however, the pathological nature of the lesion is particularly important, since it may influence both the character and the extent of the symptoms (see Fig. 19.1).
Disorders of muscle
Authors: Bannister Sir Roger
Published: October 2023

A voluntary muscle is composed of muscle fibres, each of which is a multinucleated cell, consisting of contractile substance with a sarcolemma and its nuclei, and a· motor end-plate in which the nerve fibre terminates. The lower motor neuron ends in relation with a bundle of 150 or more muscle fibres. Skeletal muscle fibres are not homogeneous and contain two distinct types of fibre. The type I fibre is smaller and has a high concentration of enzymes which are concerned with aerobic metabolism. The type II fibre is large with coarse myofibrils and has a higher concentration of glycogen and of enzymes which are concerned with anaerobic metabolism.
Acquired immune deficiency syndrome (AIDS) and retrovirus infections
Authors: Bannister Sir Roger
Published: October 2023

Retroviruses are RN A viruses which are capable of using an enzyme reverse transcriptase to make DNA copies of themselves. This copy becomes incorporated into the host cell DNA, so creating latent and essentially life long infection. Viral proteins are manufactured by infected cells and infectious virions are released from the cell surface by budding. Not all retroviruses are pathogenic. They were first recognized to cause disease in animals-’leukaemias· or lymphomas and slow virus infections such as visna. In 19 80 a human leukaemia (adult T-cell leukaemia) was discovered which was associated with human T cell leukaemia virus type 1 (HTLV-1). In 1981 pneumocystis pneumonia and Kaposi’s sarcoma were found in previously well, young, homosexual men, associated with a profound impairment of cell-mediated immunity.
Syphilis of the nervous system
Authors: Bannister Sir Roger
Published: October 2023

Neurosyphilis was becoming an uncommon disease after the introduction of penicillin but recently there has been an increased incidence in parts of the United States and possibly other countries as a result of promiscuity in urban societies, in particular among male homosexuals. Only a small proportion perhaps 10 per cent —of persons infected with the Treponema pallidum subsequently show evidence that the organism has invaded the nervous system. However, 30 per cent of patients with secondary syphilis have an abnormal cerebrospinal fluid. This may occur as early as during the secondary stage. Early invasion of the nervous system may be followed by an asymptomatic period of several years while the infection remains dormant.
Multiple sclerosis and demyelinating diseases
Authors: Bannister Sir Roger
Published: October 2023

Multiple sclerosis (MS) is one of the commonest nervous diseases. It is characterized by the widespread occurrence of patches of demyelination followed by gliosis in the white matter of the nervous system (Fig. 26.1). A striking feature is the tendency to remissions and relapses, so that the course of the disease may be prolonged for many years. The early symptoms are those of focal lesions of the nervous system, while the later clinical picture is one of progressive dissemination. The cause of the disorder is not known.
Motor neuron disease
Authors: Bannister Sir Roger
Published: October 2023

Motor neuron disease, or amyotrophic lateral sclerosis, is so called because it is characterized by a selective degeneration of the motor neuron involving both the corticospinal pathways and those which originate in the motor nuclei of the brainstem and the anterior horn cells of the spinal cord, though in some patients only spinal motor neurons appear to be involved, at any rate until the late stages of the disease.
The neurobiology of CFS
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

Clinicians dealing with neurasthenia had no doubt that the illness affected not only the subject’s physical performance, but also the mental performance. Beard wrote that ‘memory is often temporarily weakened, and consecutive thought and sustained mental activity frequently impossible’1• When Janet singled out psychasthenia from the overburdened concept of neurasthenia, he drew attention to the psychological deficits that were at the core of the illness. ‘Tiredness and a horrible sense of fatigue is caused in psychasthenics by the least physical or psychological effort ... fatigue rapidly affects sensations and perceptions, intellect and movemenf2. Edward Cowles defined an early symptom of the disease as the inability to sustain ‘prolonged effort at attention’3• All the authorities recognized that mental effort exacerbated symptoms, and that various mental processes were affected.
Conclusions
Authors: Wessely Professor Simon , Hotopf Dr Matthew , Sharpe Dr Michael
Published: October 2023

We all recognize fatigue when we experience it, but establishing a satisfactory definition has not proven easy. We consider ‘fatigue’ to be a general term covering a range of phenomena that are often, but not necessarily, associated with exertion. The meaning of the term is therefore both intuitively obvious, based on one’s own experience, but also elusive. We propose that this ambiguity is inevitable and irreducible - instead it must simply be acknowledged. We can retain the concept, but must operationalize our definitions. In particular we must first distinguish between fatigue in performance and the feeling of fatigue.
Osteoporosis
Authors: Cooper Cyrus
Published: October 2023

Osteoporosis is a disorder characterized by low bone density, microarchitectural deterioration of bone tissue, and a consequent increase in fracture risk (Consensus Development Conference, 1991). Criteria for osteoporosis can be considered both in terms of bone density and fracture, both of which are epidemiologically relevant (Melton et al. 1992).
Introduction: a thematic overview
Authors: Stevenson, David K , Young Ernle W D
Published: October 2023

I swear by Apollo, by Asclepius, by Health, by Panacea and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture. To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the physician’s oath, but to nobody else. I will use treatment to help the sick according to my ability and judgment, but never with a view to injury or wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give a woman a pessary to cause an abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein. Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets. Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I transgress it and forswear myself, may the opposite befall me.
Medical futility: decision-making in the context of probability and uncertainty
Authors: Jecker Nancy S , Pagon Roberta A
Published: October 2023

As soon as the baby was delivered, a large, whole-thickness piece of skin sloughed from one leg, leaving a large denuded area in which muscles and tendons could be viewed. Now six days old, the tiny girl has been diagnosed with epidermolysis bullosa, a recessive genetic condition which causes blistering of the skin. She is unable to take fluids by mouth because of blistering of her mucous membranes. Third-degree burn-like erosions over her skin cause fluid and electrolyte imbalance problems and unremitting pain. Her condition is a lifelong disorder, for which there is no cure and no treatment to ameliorate the blistering and its effects.
The use of epidemiological data for prognostication and decision-making
Authors: Sinclair John C , Torrance George W
Published: October 2023

The first part of this chapter will review the physician’s role in using epidemiologic data in predicting the future course of disease (prognostication) and in deciding whether medical intervention is likely to do more good than Harm. By epidemiologic data we mean data obtained from groups of patients with the same disorder who have been observed over the time-course of their disease, or who have been subjected to treatment. By reference to such data, the physician infers the probable course of events if he/she should simply observe his/her patient, or intervene with treatment. Although the viewpoint adopted in this chapter is primarily that of the individual physician caring for the individual patient, we will also consider, when relevant, the factors which enter when comparable decisions are to be made from a societal viewpoint-for example in the planning and financing of treatment programs based on the health-care needs of populations.
Withholding and withdrawing therapy and actively hastening death
Authors: Stahlman Mildred
Published: October 2023

The heading of this chapter encompasses three separate decision-making processes, each with separate arguments for and against each act; and therefore initially they will be discussed separately. Since they are considered by some to be steps in the same decision-making process, they will also be discussed in this context.
Government regulations in the United Kingdom
Authors: Campbell A G M
Published: October 2023

In the United Kingdom, the current position can be stated quite simply. There are no Government Regulations that deal specifically with the care of newborn infants. Traditionally, the regulation and control of medical practice has been left to the medical profession, which through the General Medical Council (established by the Medical Act 1858), sets its own guidelines for professional conduct and discipline. Doctors are expected and, to a large extent, still trusted to act according to various principles or codes of medical ethics that have their roots in the Hippocratic Oath, but which have required reappraisal in the light of modern advances in medicine.
Preparation Of The Workplace And Equipment
Authors: Morton N S , Davis W
Published: October 2023

‘Be prepared’ is an old-fashioned motto but in anaesthesia it is a very important principle. When things go wrong during anaesthesia the speed of change can be alarming and the need for intervention must often be immediate to avoid harm to the patient. A good example is a patient having an abdominal operation; on opening the peritoneum the heart rate can slow dramatically within a few seconds - the treatment must be immediate or the heart rate may slow to dangerously low levels. The surgeon should stop pulling on the peritoneum - this causes the stimulation of the vagus nerves which cause the heart rate to slow - and the anaesthetist should give an intravenous bolus dose of atropine which blocks the effects of the vagus nerve on the heart.
The Airway And The Adequacy Of Ventilation
Authors: Morton N S
Published: October 2023

During maintenance of anaesthesia, keeping the airway open is critical to ensure adequate delivery of oxygen and anaesthetic gases and adequate carbon dioxide removal. If the airway is not open, the oxygen supply to the patient’s lungs will be impaired and transfer of oxygen to arterial blood and to the body tissues will decrease. Within minutes the lack of oxygen supply to brain, heart, muscle and other vital organs will cause damage. At the same time, CO2 elimination from the lungs will be impeded and the CO2 concentration in the blood will build up. High CO2 concentrations stimulate the breathing centre in the brain and cause an increase in heart rate, irritability of the heart muscle, an increase in blood pressure and increased blood flow to the brain. Very high concentrations of CO2 in the blood cause coma and eventually depression of breathing.
Maintenance And Monitoring Of The Circulation
Authors: Hosie H , Morton N S
Published: October 2023

The evolution of complex organisms made up of lots of cells from singlecelled creatures in prehistoric times has depended on the evolution of a system for delivery of nutrients to and removal of toxic wastes from every cell of the organism. In humans, like many other creatures, the transport medium is blood and the network system is the circulation.
Safety In The Anaesthetic Room And Theatre
Authors: Hosie H
Published: October 2023

Hospitals are potentially dangerous places with potent drugs, potentially dangerous chemicals and electrical and mechanical devices used every day. Transmission of infection to or from patients is another major danger. Anaesthetic rooms, theatres and recovery are areas where safety considerations are essential and should involve three groups of people - your patient, your col¬ leagues and yourself. It is your duty to be aware of local protocols, guidelines and procedures which have been drawn up to comply with recommendations and legislation to ensure safe work practices.
Circulation
Authors: Hosie H
Published: October 2023

Cardiac arrest is the cessation of pump action by the heart. This leads to cessation of blood flow to all organs and most importantly the brain. Cessation of blood flow to the brain for 3 min or more will result in hypoxic brain damage in normal circumstances. Recognition of cardiac arrest, prompt treatment of the underlying cause, if possible, and effective cardiopulmonary resuscitation is vital.
Preparation For Return To The Ward
Authors: Holmes E
Published: October 2023

All patients must be assessed prior to their return to the ward. This may be done by the anaesthetist caring for the patient or by a senior nurse within the unit. There should be a unit policy to determine the minimum acceptable criteria for fitness to leave recovery. It is important to take into account the individual needs of the patient and to consider the ward or unit they are being sent to.
Paediatric Surgery
Authors: Morton N S
Published: October 2023

Children are not small adults. The range of diseases they suffer from is different from adults and the child’s physical and psychological responses to these diseases are different. Congenital abnormalities or their complications are often the reason for the child coming into hospital for surgery or for emergency care. The child’s smaller size affects the equipment used for anaesthesia and the relatively large surface area of the small child means that heat loss and fluid losses are more of a problem. There are several differences in anatomy, physiology, psychology and pharmacology which have to be considered. All these variations are especially marked in the newborn and especially the premature baby.
Anaesthesia In The Isolated Location
Authors: Morton N S
Published: October 2023

Anaesthesia or anaesthetist-monitored sedation is often carried out in areas of the hospital which are isolated from the main operating theatre complex e.g. radiology department, CT scanner, MRI scanner, cardiac catheterization laboratory, radiotherapy suite, or the psychiatric unit (electroconvulsive therapy).

The principles are the same in all these areas: there must be adequate supplies of oxygen, suction equipment, anaesthesia equipment and drugs, monitoring as for all general anaesthetics, emergency drugs and equipment and defibrillator. For safety reasons there should be no compromise in these standards. Special problems include difficulty getting near to the patient, (e.g. in a scanner), adaptations of equipment for safety (e.g. non-magnetic equipment in MRI), allergic reactions to X-ray dyes (e.g. must be prepared to treat anaphylactic shock) and radiation protection of staff with lead aprons, thyroid protection collars and goggles.