bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breast Surgery
Authors: Wardhan Richa , Greengrass Roy 
Published: May 2019

Abstract
Breast surgery is commonly performed under general anesthesia. Opioids are often utilized for pain management. Regional anesthesia is superior to opioids in many ways, and opioids are best avoided in patients with cancer due to their immunosuppressant effect. Regional anesthesia can be effectively utilized not only as postoperative pain management but also as intraoperative anesthesia. This chapter discusses anatomic considerations to analgesia in breast surgery, detailing the innervation of the breast and the chest wall. It also discusses techniques for providing surgical anesthesia and postoperative analgesia, focusing on the various regional nerve blocks that are available to achieve anesthesia and analgesia of the breast and the chest wall.
Complex Spine
Authors: Edwards David A. , Sobey Christopher 
Published: May 2019

Abstract
Patients undergoing extensive spine surgery suffer from significant pain throughout the perioperative period. Of note, many patients utilize opioid medications preoperatively, which increases the risk of postoperative pain and numerous other risks. This chapter describes how central sensitization plays an essential role throughout the perioperative period and should be considered when planning tailored analgesic regimens. The chapter also details how NMDA antagonists such as ketamine can be used in the postoperative setting to reduce pain intensity and decrease opioid use. It concludes with a discussion of how the risk of opioid-induced ventilatory impairment can be managed postoperatively, including with nursing evaluation for somnolence and sedation at regular intervals in the first 4 hours after discharge from the postanesthesia care unit.
Craniotomy
Authors: Grasu Roxana , Raty Sally 
Published: May 2019

Abstract
This chapter discusses postcraniotomy headache (PCH), a common yet frequently underdiagnosed and undertreated occurrence, with up to 30% of patients experiencing persistent headache after surgery. The chapter identifies risk factors for the development of acute and persistent PCH and describes mechanisms for its development, such as injury to the sensory nerves supplying the scalp and underlying tissues or to the perivascular nerves that supply sensation to the dura mater. Pain management following craniotomy is a balancing act of achieving adequate analgesia while avoiding oversedation, respiratory depression, hypercapnia, nausea, vomiting, and hypertension. Current evidence suggests that a balanced, multimodal approach to the treatment of acute PCH is often required to optimize pain control, minimize undesired side effects, and prevent the development of persistent PCH.
Sickle Cell Pain Crisis
Authors: Bansal Vikram , Sharma Deva , Shastri Uma 
Published: May 2019

Abstract
Acute sickle cell pain crises pose a significant challenge to acute pain medicine physicians. Knowledge of underlying mechanisms, whether vaso-occlusive or not, can be useful in planning successful analgesic regimens. This chapter describes the pathophysiology and epidemiology of sickle cell disease. It also addresses how anesthesiologists should evaluate patients with sickle cell disease and acute pain. The chapter then presents numerous opioid delivery options that should be judiciously utilized to optimize patient function. Nonopioid adjuncts, such as acetaminophen or ketamine, should be aggressively pursued, and in some scenarios, perineural interventions may be appropriate. In any scenario, a comprehensive team-based approach is encouraged.
Pediatrics
Authors: Sofer Michale , Kraemer Francis Wickham 
Published: May 2019

Abstract
Following surgery, pediatric patients suffering from pain warrant consistent and frequent pain assessments. This chapter describes a variety of scales that can be used and that must be tailored to the developmental stage of the child. Examples of commonly used pediatric scales include the Neonatal Pain, Agitation and Sedation Scale (N-PASS); Face, Legs, Activity, Cry, Consolability (FLACC); Numerical Rating Scale (NRS); and the Wong Baker FACES Pain Scale. In the setting of open abdominal surgery, certain interventional techniques (continuous epidural, peripheral truncal blockade) can be used to significantly decrease pain and must be tailored to the individual patient and specific surgical subtype. Separate from interventional techniques, older children may also use patient-controlled analgesia (PCA) devices to deliver systemic opioids. For patients who are too young or are unable to press a PCA device, a variety of nurse-controlled analgesic protocols exist to deliver such systemic analgesic therapies.
Pediatrics: Scoliosis Repair
Authors: Sobey Jenna , Menser Carrie 
Published: May 2019

Abstract
This chapter discusses scoliosis repair, one of the most common major orthopedic surgeries performed in pediatric patients. Adolescent idiopathic scoliosis is the most common form and affects 1% to 3% of children and adolescents between the ages of 10 and 16. The anesthetic management of these patients can be challenging due to potential physiologic derangements that may be present. Adequate perioperative pain management is crucial, given the potential for significant postoperative and chronic pain conditions following repair. The rate of chronic postsurgical pain following scoliosis repair in pediatric patients averages about 20%. A balanced approach to analgesic management is best utilized to optimize pain relief while limiting side effects. Proper preparation for the perioperative experience, including setting expectations and planning for pain management, is a key factor in a successful recovery.
Pregnancy and lactation
Authors: Banerjee Anita , Banerjee Debasish , Jha Vivekanand 
Published: May 2019

Abstract
Cardiovascular disease in pregnancy remains a significant cause of morbidity and mortality worldwide. In the developed world, congenital heart disease remains the most frequently encountered presentation, and in the developing world, it is rheumatic heart disease. However, with ageing of the maternal population and cardiovascular risk factors, women are presenting with familiar cardiac conditions such as heart failure. Pre-pregnancy counselling and appropriate and timely management lead to an optimal outcome for the mother and baby. This chapter describes the physiology and provides up-to-date guidance on drug therapy of cardiovascular disease in pregnancy.
The nature of strong H i absorbers probed by cosmological simulations: satellite accretion and outflows
Authors: Rhodin N H P , Agertz O , Christensen L , Renaud F , Fynbo J P U 
Published: May 2019

ABSTRACT
We use cosmological hydrodynamic zoom simulations to study the neutral gas distribution in and around galaxies that gives rise to high column density H i Ly α absorption (damped Ly α systems (DLAs) and sub-DLAs) in background quasar spectra. Such simulations often sacrifice numerical resolution for volume that affects the lower density galaxy halo gas, and simulations have difficulties reproducing the span of projected separations (b) between absorbing clouds and their hosts. Our simulations produce (sub-)DLAs over the entire probed parameter space ($b\lesssim 50\, \mathrm{kpc}$ and metallicity −4 ≲[M/H]≲ 0.5) at all redshifts (z ∼ 0.4 − 3.0), enclosing spectroscopically confirmed absorber-galaxy pairs. Recovering (sub-)DLAs at b ≳ 20 − 30 kpc from a massive host galaxy requires high numerical resolution and efficient feedback, and we show that these lines-of-sight are associated with dwarf satellites in the main halo, stripped metal-rich gas, and outflows. H i disc- and halo gas significantly contributes to (sub-)DLAs around galaxies. At large redshifts the halo plays an increasingly important role, while at 0.4 < z < 1 the disc and halo contribute with ∼60(80) and ∼40(20) per cent to column densities above the sub-DLA(DLA) lower limits. The distribution of b for sub-DLAs and DLAs overlap at z ∼ 2 − 3, but evolves so that sub-DLAs on average are located at twice larger b by z ∼ 0.5. A weak correlation suggests that sub-DLA covering fractions increase with stellar mass more rapidly than those of DLA. This can explain why sub-DLAs are preferentially selected in more massive galaxies in the low-z Universe.
Characterization of the stimulators of protein-directed ribosomal frameshifting in Theiler's murine encephalomyelitis virus
Authors: Napthine Sawsan , Bell Susanne , Hill Chris H , Brierley Ian , Firth Andrew E 
Published: May 2019

AbstractMany viruses utilize programmed –1 ribosomal frameshifting (–1 PRF) to express additional proteins or to produce frameshift and non-frameshift protein products at a fixed stoichiometric ratio. PRF is also utilized in the expression of a small number of cellular genes. Frameshifting is typically stimulated by signals contained within the mRNA: a ‘slippery’ sequence and a 3′-adjacent RNA structure. Recently, we showed that −1 PRF in encephalomyocarditis virus (EMCV) is trans-activated by the viral 2A protein, leading to a temporal change in PRF efficiency from 0% to 70% during virus infection. Here we analyzed PRF in the related Theiler's murine encephalomyelitis virus (TMEV). We show that 2A is also required for PRF in TMEV and can stimulate PRF to levels as high as 58% in rabbit reticulocyte cell-free translations and 81% during virus infection. We also show that TMEV 2A trans-activates PRF on the EMCV signal but not vice versa. We present an extensive mutational analysis of the frameshift stimulators (mRNA signals and 2A protein) analysing activity in in vitro translation, electrophoretic mobility shift and in vitro ribosome pausing assays. We also investigate the PRF mRNA signal with RNA structure probing. Our results substantially extend previous characterization of protein-stimulated PRF.
Proteomic characterization of chromosomal common fragile site (CFS)-associated proteins uncovers ATRX as a regulator of CFS stability
Authors: Pladevall-Morera David , Munk Stephanie , Ingham Andreas , Garribba Lorenza , Albers Eliene , Liu Ying , Olsen Jesper V , Lopez-Contreras Andres J 
Published: May 2019

Abstract
Common fragile sites (CFSs) are conserved genomic regions prone to break under conditions of replication stress (RS). Thus, CFSs are hotspots for rearrangements in cancer and contribute to its chromosomal instability. Here, we have performed a global analysis of proteins that recruit to CFSs upon mild RS to identify novel players in CFS stability. To this end, we performed Chromatin Immunoprecipitation (ChIP) of FANCD2, a protein that localizes specifically to CFSs in G2/M, coupled to mass spectrometry to acquire a CFS interactome. Our strategy was validated by the enrichment of many known regulators of CFS maintenance, including Fanconi Anemia, DNA repair and replication proteins. Among the proteins identified with unknown functions at CFSs was the chromatin remodeler ATRX. Here we demonstrate that ATRX forms foci at a fraction of CFSs upon RS, and that ATRX depletion increases the occurrence of chromosomal breaks, a phenotype further exacerbated under mild RS conditions. Accordingly, ATRX depletion increases the number of 53BP1 bodies and micronuclei, overall indicating that ATRX is required for CFS stability. Overall, our study provides the first proteomic characterization of CFSs as a valuable resource for the identification of novel regulators of CFS stability.
Krill spatial distribution in the Spanish Mediterranean Sea in summer time
Authors: Ventero Ana , Iglesias Magdalena , Córdoba Pilar 
Published: May 2019

Abstract
We documented krill distribution in the Spanish Mediterranean Sea for the first time using acoustic methods, highlighting the method’s suitability to study marine communities restricted to specific areas with patchy aggregation behavior. The 2009–2017 acoustic time series analysis revealed that krill distribution, mainly located on the continental shelf edge, was driven by the presence of fronts and submarine canyons. On the other hand, areas of persistent krill distribution included from Cape La Nao to the eastern part of Almeria Bay, although an interannual northwards increase of krill presence had been detected in 2015–2017 likely related to the position of the Balearic front. We provide information on the aggregation characteristics and biological parameters of three krill species, Nyctiphanes couchii, Nematoscelis megalops and Meganyctiphanes norvegica. N. couchii and N. megalops formed patchy pelagic aggregations in the neritic and oceanic zone, respectively, and they were the most common species in the net tows. By contrast, M. norvegica formed a large demersal aggregation on the continental shelf edge and was only found in 2017; nevertheless, its 861-kg catch represented a unique milestone in the Mediterranean. Finally, krill species shared distribution area with Maurolicus muelleri; thus, coexistence between them are also described.
Why Thomas Reid Matters to the Epistemology of the Social Sciences
Authors: Jaffro Laurent , Freitas Vinícius França 
Published: May 2019

AbstractLittle attention has been paid to the fact that Thomas Reid's epistemology applies to ‘political reasoning’ as well as to various operations of the mind. Reid was interested in identifying the ‘first principles’ of political science as he did with other domains of human knowledge. This raises the question of the extent to which the study of human action falls within the competence of ‘common sense’. Our aim is to reconstruct and assess Reid's epistemology of the sciences of social action and to determine how it connects with the fundamental tenets of his general epistemology. In the first part, we portray Reid as a methodological individualist and focus on the status of the first principles of political reasoning. The second part examines Reid's views on the explanatory power of the principles of human action. Finally, we draw a parallel between Reid's epistemology and the methodology of Weberian sociology.
Poverty and Excess Length of Hospital Stay in Neonatal Opioid Withdrawal Syndrome
Authors: Vesoulis Zachary A. , Lust Christopher E. , Cohlan Barbara A. , Liao Steve M. , Mathur Amit M. 
Published: May 2019

Objectives:
To study the impact of sociodemographic factors on length of stay (LOS) for infants with neonatal opioid withdrawal syndrome (NOWS) secondary to fetal opioid exposure.

Methods:
In this retrospective cohort study, we included term infants with NOWS, excluding those with other significant medical issues. Comprehensive clinical and sociodemographic data were collected. Multivariate regression modeling was used to identify factors which contributed to excess LOS, which was defined as the number of days beyond the standard monitoring and/or treatment protocol.

Results:
In all, 129 infants were identified; mean gestational age of 37.9 ± 1.3 weeks and mean body weight of 2880 ± 496 g. Among them, 68% of infants were exposed to opioids; 27% were exposed to methadone; and 67% required pharmacologic treatment. The degree of poverty was assessed using the Area Deprivation Index (ADI) based on the mother's address at the time of birth. Median LOS for treated infants was 23 days versus 8 days for those who did not need pharmacologic treatment. The median excess LOS was 4 days (range 0–24).
Excess hospital days were strongly correlated with degree of deprivation in the mother's community (r = 0.55, P < 0.01). ADI remained a strong predictor of excess LOS, even when controlling for pharmacologic treatment, placement in state's custody, race, and gestational age at birth.

Conclusions:
These results suggest poverty is associated with excess LOS and that early allocation of resources for at-risk families may help to reduce overall length of hospital stay.
The role of epigenetics in paediatric rheumatic disease
Authors: Charras Amandine , Hedrich Christian M. 
Published: May 2019

Purpose of reviewAutoimmune/inflammatory disorders can be stratified along a spectrum based on the primary involvement of innate vs. adaptive mechanisms. Stratifying patients based on molecular mechanisms rather than clinical phenotypes may allow for target-directed and individualized treatment.Recent findingsEpigenetic events are gene regulatory mechanisms that contribute to inflammation across inflammatory diseases and resemble shared mechanisms that may be used as disease biomarkers and treatment targets. Significant progress has been made dissecting the epigenome in paediatric rheumatic diseases and identifies associations with clinical phenotypes, treatment responses and disease outcomes. Here, we will summarize and discuss epigenetic patterns in autoimmune/inflammatory disorders, underlying molecular alterations and their effects on gene expression and immune phenotypes.SummaryStructured investigation of epigenetic events, their causes and effects on immune phenotypes in autoimmune/inflammatory, will improve our understanding of disease, deliver new diagnostic tools and treatment options.
Anthropometric Changes in a Prospective Study of 100 Patients Requesting Breast Reduction
Authors: Hudson Donald A. , Lelala Ngoato B. 
Published: May 2019

Background:
The anthropomometry of the “ideal” breast is well described, but changes that occur with enlarged breasts are not. The aim of this study was to assess the prevalence of nipple asymmetry in the horizontal plane and changes in the inframammary fold (IMF) in patients presenting with macromastia (defined as excessive development of the mammary glands by Merriam-Webster dictionary).

Methods:
One hundred patients (200 breasts) presenting to the Plastic Surgery Clinic for bilateral breast reduction were enrolled in this study. Patients’ characteristics captured for this study included age, body mass index (BMI), and breast anthropometric measurements, such as suprasternal notch to nipple, nipple to IMF, IMF projected to cubital fossa, midhumeral point, and nipple measurement from meridian. Basic univariate statistical analyses were performed to evaluate the impact of nipple asymmetry.

Results:
The average age was 37 years (SD 12 years), and the median BMI was 33 (IQR 28–37). More patients presented with nipple asymmetry, of whom 45% were classified as lateral to the meridian, 19% were classified as medial to the meridian, and 36% were classified as central to the meridian. Patients with lateral asymmetry and medial asymmetry had a significantly higher BMI (median BMI 35) compared with patients with central positioning (median BMI 30). Increasing breast size was positively associated with nipple asymmetry, whereas BMI (R = −0.30, P = 0.003) and macromastia correlated negatively with IMF position (R = −0.38, P = 0.0001).

Conclusion:
In macromastia, nipple displacement from the breast meridian, especially lateral displacement, is common and is aggravated by an increase in BMI. The IMF also descends, and this is also more common in patients with a raised BMI. These changes have clinical implications.
Peripherally Inserted Central Catheters as Potential Risk Factors for Failure in Pedicled Latissimus Dorsi Flaps
Authors: Efanov Johnny Ionut , Bouhadana Gabriel , Danino Michel A. 
Published: May 2019

Summary:
Pedicled latissimus dorsi musculocutaneous flaps are reliable options for reconstruction of torso and head and neck defects. After ensuring that no kink or external compression occurs on the pedicle, the survival rate exceeds 99%. However, we experienced a complete necrosis of the flap after insertion of a peripherally inserted central catheter line. Intraoperative findings demonstrated thrombosis of the subclavian vein over a large segment, which was found to be the cause of flap failure. The clinical significance of this case report is aimed at raising awareness against insertion of peripherally inserted central catheter lines on the ipsilateral arm of a pedicled latissimus dorsi flap.
Lag Screw in Mandibular Plate Technique for Sagittal Splitting Mandibular Fractures
Authors: Reyad Khaled A , Al Mahmoudy Niveen F 
Published: May 2019

Summary:
Mandibular fractures with sagittal splitting and splaying of both the near and far cortices pose a challenge in their fixation as screws may push the far cortex during screw tightening, resulting in more widening. Screw lagging inside the lower mandibular plate technique may help approximation of the near and far cortices during screw tightening, and this was applied for 4 cases with mandibular fractures. The splaying improved using this technique. Using the screw lagging inside the plate technique may be a safe technique used in mandibular fractures that have cortical splaying.
Sensory profiles and immune-related expression patterns of patients with and without neuropathic pain after peripheral nerve lesion
Authors: Held Melissa , Karl Franziska , Vlckova Eva , Rajdova Aneta , Escolano-Lozano Fabiola , Stetter Christian , Bharti Richa , Förstner Konrad U. , Leinders Mathias , Dušek Ladislav , Birklein Frank , Bednarik Josef , Sommer Claudia , Üçeyler Nurcan 
Published: May 2019

AbstractIn this multicenter cross-sectional study, we determined sensory profiles of patients with (NL-1) and without neuropathic pain (NL-0) after nerve lesion and assessed immune-related systemic gene expression. Patients and matched healthy controls filled in questionnaires and underwent neurological examination, neurophysiological studies, quantitative sensory testing, and blood withdrawal. Neuropathic pain was present in 67/95 (71%) patients (NL-1). Tactile hyperalgesia was the most prominent clinical sign in NL-1 patients (P< 0.05). Questionnaires showed an association between neuropathic pain and the presence of depression, anxiety, and catastrophizing (P< 0.05 toP< 0.01). Neuropathic pain was frequently accompanied by other chronic pain (P< 0.05). Quantitative sensory testing showed ipsilateral signs of small and large fiber impairment compared to the respective contralateral side, with elevated thermal and mechanical detection thresholds (P< 0.001 toP< 0.05) and lowered pressure pain threshold (P< 0.05). Also, more loss of function was found in patients with NL-1 compared to NL-0. Pain intensity was associated with mechanical hyperalgesia (P< 0.05 toP< 0.01). However, quantitative sensory testing did not detect or predict neuropathic pain. Gene expression of peptidylglycine α-amidating monooxygenase was higher in NL patients compared with healthy controls (NL-1,P< 0.01; NL-0,P< 0.001). Also, gene expression of tumor necrosis factor-α was higher in NL-1 patients compared with NL-0 (P< 0.05), and interleukin-1ß was higher, but IL-10 was lower in NL-1 patients compared with healthy controls (P< 0.05 each). Our study reveals that nerve lesion presents with small and large nerve fiber dysfunction, which may contribute to the presence and intensity of neuropathic pain and which is associated with a systemic proinflammatory pattern.