bluuebunny/crossref_metadata_2025_split huggingface dataset:
MicroRNA-125b protects liver from ischemia/reperfusion injury via inhibiting TRAF6 and NF-κB pathway
Authors: Huang Zuotian , Zheng Daofeng , Pu Junliang , Dai Jiangwen , Zhang Yuchi , Zhang Wanqiu , Wu Zhongjun 
Published: January 2019

ABSTRACT
MicroRNA-125b (miR-125b), which was previously proved to be a potential immunomodulator in various disease, attenuated mouse hepatic ischemia/reperfusion (I/R) injury in this study. miR-125b was decreased in RAW 264.7 cells exposed to hypoxia/reoxygenation (H/R). The expression of IL-1β, IL-6 and TNF-α in both serum and supernate were reduced in miR-125b over-expression groups. The hepatic histopathological changes were reduced in miR-125b agomir groups. In the miR-125b antagomir groups, serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were significantly elevated compared with negative control (NC) groups. The protein expression of TNF receptor-associated factor 6 (TRAF6), IL-1β and the phosphorylation of p65 (p-p65) were suppressed by the up-regulation of miR-125b. Furthermore, the nuclear translocation of p-p65, measured by immunofluorescence, was enhanced by the miR-125b inhibitors. In conclusion, our study indicates that miR-125b protects liver from hepatic I/R injury via inhibiting TRAF6 and nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) signal pathway.
Psychological Characteristics of Inflammatory Bowel Disease Patients: A Comparison Between Active and Nonactive Patients
Authors: Leone Daniela , Gilardi Daniela , Corrò Bianca E , Menichetti Julia , Vegni Elena , Correale Carmen , Mariangela Allocca , Furfaro Federica , Bonovas Stefanos , Peyrin-Biroulet Laurent , Danese Silvio , Fiorino Gionata 
Published: January 2019

Abstract

Background and aims
The role of new psychological factors such as psychopathological patterns and defense mechanisms in the care of inflammatory bowel disease (IBD) has been poorly investigated. We aimed to assess the psychological characteristics and defense mechanisms of IBD patients.

Methods
This was a single-center, observational, cross-sectional study. Consecutive adult IBD patients were enrolled and stratified according to disease activity. Sociodemographic and clinical data were collected, and validated questionnaires (Symptom Checklist-90-R [SCL-90-R]) for psychological distress, Defense Mechanism Inventory (DMI) for psychological defense mechanisms, and Inflammatory Bowel Disease Questionnaire (IBDQ) for quality of life (QoL) were administered.

Results
Two hundred one patients were enrolled: 101 in remission and 100 with active disease. The mean score for IBDQ was below the cutoff level (156.8 ± 37.8), with a significantly greater impairment of QoL in subjects with flares (136.5 vs 177.5, P < 0.001). Lower scores were associated with female gender. No patients had psychological scores above the cutoff for normality. Statistically higher SCL-90-R scores were found in active patients for obsessive-compulsive disorder (P = 0.026), depression (P = 0.013), anxiety (P = 0.013), phobic anxiety (P = 0.002), psychoticism (P = 0.007), global severity index (GSI) (P = 0.005) and positive symptom total (PST) (P = 0.001). A significantly increased probability of higher global indexes was associated with Crohn’s disease and disease flares. None of the defensive Defense Mechanism Inventory (DMI) styles resulted above the cutoff in our cohort.

Conclusions
Further data are needed to demonstrate the potential key role of psychological intervention in the therapeutic strategies utilized for IBD patients, and the identification of specific psychological patterns based on the patients profile is necessary to optimize psychological intervention.
Plasmodium vivax Relapse Rates Following Plasmodium falciparum Malaria Reflect Previous Transmission Intensity
Authors: Ashley Elizabeth A , Phyo Aung Pyae , Carrara Verena I , Tun Kyaw Myo , Nosten Francois , Smithuis Frank , White Nicholas J 
Published: January 2019

Abstract
From 2003 through 2009, 687 of 2885 patients (23.8%) treated for Plasmodium falciparum malaria in clinical studies in Myanmar or on the Thailand-Myanmar border had recurrent Plasmodium vivax malaria within 63 days, compared with 18 of 429 patients (4.2%) from 2010 onward (risk ratio [RR], 0.176; 95% confidence interval, .112–.278; P &lt; .0001). Corresponding data from 42 days of follow-up revealed that 820 of 3883 patients (21.1%) had recurrent P. vivax malaria before 2010, compared with 22 of 886 (2.5%) from 2010 onward (RR, 0.117; 95% CI, .077–.177; P &lt; .0001). This 6-fold reduction suggests a recent decline in P. vivax transmission intensity and, thus, a substantial reduction in the proportion of individuals harboring hypnozoites.
Physiology of Cardiac Ischemia
Authors: Sylvies Fiona R , Thomas Gregory S. , Ellestad Myrvin H. 
Published: January 2019

Abstract
The Physiology of Cardiac Ischemia chapter provides an in depth review of coronary blood flow alterations and manifestations of myocardial ischemia. Ischemia is based on insufficient coronary blood flow (CBF) to meet myocardial oxygen demands at rest or during exercise testing resulting in ischemia or infarction. Ischemia promotes a cascade of physiological responses, including enhanced vasomotion, nitric oxide release, and metabolic shifts resulting in altered levels of free fatty acids and lactic acid often leading to ST depression and angina. The mechanism of the electrocardiographic changes of ischemia and ST depression in coronary artery disease (CAD) are reviewed. While our understanding of cardiac ischemia is incomplete, curiosity of this fascinating condition continues to motivate researchers in their search for increasingly effective therapies, opportunities and therapeutic options.
Blood Pressure Measurements during Exercise Testing
Authors: Thomas Gregory S. , Ellestad Myrvin H. 
Published: January 2019

Abstract
``The chapter Blood Pressure Measurement During Exercise reviews the 3 methods of sphygmomanometry to measure blood pressure and normal and abnormal blood pressure responses to exercise. Mercury, aneroid, and oscillometric assessment of Korotkoff sounds provide accurate measurement. Periodic calibration is important for aneroid and oscillometric devices. With verification, automated oscillometric measurements during exercise can be accurate. The normal blood pressure response to exercise testing is an incremental increase in systolic blood pressure with minimal change in diastolic blood pressure. Exercise induced hypotension, particularly early in exercise, is predictive of severe coronary artery disease (CAD). Its occurrence at peak exercise at a high level of exertion may occur in normal individuals secondary to exhaustion. An exaggerated systolic response to exercise is modestly predictive of future hypertension. A slow decrease is systolic blood pressure during recovery is suggestive of CAD, likely secondary to less vagal tone, analogous to a slow decrease in heart rate during recovery.
The Impact of Changing Global Patterns of Atherosclerosis on Stress Testing
Authors: Samtani Sonia R. , Thomas Gregory S. 
Published: January 2019

Abstract
The Impact of Changing Global Atherosclerosis Patterns on Stress Testing chapter reviews changes in cardiovascular death (CVD) mortality in developed and developing countries and its impact on exercise testing. Age-adjusted CVD mortality in the United States decreased by 75% between 1950 and 2014. Similar decreases have occurred in other developed countries. The causes of this decrease represent decreases in risk factor burden and improvement in medical and surgical care. With a decreasing burden of CVD in many countries patients are presenting for exercise testing with less severe coronary artery disease. CVD mortality in developing countries, however, including in India and China, is increasing. The wide availability and cost-effectiveness of exercise testing makes it an ideal first test for most patients being evaluated for CVD in both developed and developing countries. .
The Impacts of Procedural Stress
Authors: Chorney Jill , Howlett Melissa 
Published: January 2019

Abstract
Children often experience stress around medical procedures. High procedural stress can interfere with the quality or outcome of a procedure and the ease with which it is accomplished. High, unmanaged procedural stress is also associated with more pain, longer recovery times, behavioral disturbances, and increased procedural stress and fear about future medical procedures. Both malleable and nonmalleable factors are predictive of children’s procedural stress, as well as their use of coping behaviors. While nonmalleable factors cannot be changed at the time of the procedure, the presence of such factors can alert healthcare providers to children in need of support. Many well-researched strategies are available to target malleable predictors and thereby mitigate procedural stress, such as adequate preparation for both children and parents, and effective use of coping behaviors. Implementation of such strategies can facilitate optimal procedure completion and foster a positive medical experience for children, thereby giving them greater confidence for future medical encounters.
Sedation Effects
Authors: Linzer Jeffrey 
Published: January 2019

Abstract
While respiratory concerns tend to be the first consideration with sedation medications, many can have important effects on the cardiovascular system that need to be managed. Changes in heart rate, blood pressure, and cardiac work have to be considered. While most of these medications will affect arterial blood pressure in one way or another, some will have no effect on heart rate. While one agent may work well in majority of patients, that same medication could have potentially devastating effects because of a patient’s underlying condition. Additionally, simply changing the rate of drug administration can potentially reduce or increase the cardiovascular effects.
Fasting and Aspiration Risk in Procedural Sedation
Authors: Bhatt Maala , Roback Mark G. 
Published: January 2019

Abstract
There is a documented increase in the risk of aspiration of stomach contents during airway management for general anesthesia. This risk of a serious complication has resulted in strict regulatory recommendations concerning preprocedural fasting even for moderate and deep sedation. The physiology and evidence for fasting recommendations before procedural sedation care in children are discussed here.
Discharge Considerations
Authors: Rhoads Michelle M. , Campbell Tracy 
Published: January 2019

Abstract
Preparation for discharge should begin well before the patient arrives in the recovery room. To ensure a safe and timely discharge, goals must be established for each patient. Elements of a successful discharge include collaboration of team members, use of evidence-based policies and procedures, and adequate patient preparation. Readiness for discharge can be determined by using objective and measureable discharge criteria, taking into consideration the needs of the patient and family. Assessment for discharge readiness should include use of validated discharge criteria or sedation score, postoperative nausea and vomiting evaluation, management of pain, postprocedural/sedation care education, and an understanding of follow-up needs. Adherence to these essential criteria will not only help to ensure a timely and safe discharge but will also improve patient and family satisfaction.
Definition and Incidence of Adverse Events
Authors: Fagin David 
Published: January 2019

Abstract
To perform effective and safe procedural sedation, one must be knowledgeable about the adverse events that can occur with the administration of various sedatives and analgesics. Adverse events (sometimes thought of as complications of care) are often predictable if the sedationist properly assesses the patient’s physiologic and psychological conditions and understands the side effects of the medications administered and the procedural conditions that may exacerbate risk. With such preparation, the sedationist can monitor for the event and can either prevent it or provide supportive care in a timely manner. The American Academy of Pediatrics and other national organizations have developed guidelines for caring for patients requiring procedural sedation with the intent of informing sedationists of the risks involved in sedation care and the skills and equipment needed to ameliorate or prevent patient harm. Adverse events can be classified as minor, moderate, and major.
Moderate Adverse Events
Authors: Chumpitazi Corrie E. 
Published: January 2019

Abstract
The incidence of sedation-related adverse events depends on (1) the medications used; (2) the type, duration, invasiveness, and location of the procedure; and (3) patient factors (e.g., age, medical condition, psychological factors). For the purposes of this chapter, moderate adverse sedation-related events represent physiologic change that is extremely likely to lead to significant patient harm if unnoticed or responded to ineffectively by the sedationist. Apnea, airway obstruction, and laryngospasm are examples. The relative likelihood of events of this type (1 of every 400 sedation episodes) provides significant impetus for effective preparation and training so that sedationists can effectively respond to these adverse events or preempt them. Even though they are categorized as “moderate” and may not be associated with harm in and of themselves, these events may certainly progress to produce significant harm.
Major Adverse Events
Authors: Chumpitazi Corrie E. 
Published: January 2019

Abstract
The incidence of sedation-related adverse events depends on medication characteristics, procedure conditions, and preexisting patient physiologic and psychological conditions. Major adverse sedation-related events represent extreme physiologic change causing significant patient harm that may be long-lasting or permanent, particularly if responded to ineffectively by the sedationist. Large safety studies of pediatric sedation events suggest that events of this type occur very rarely when well-organized, equipped, and trained sedation teams are present. However, sporadic reports of death during pediatric sedation continue to surface, providing significant impetus for effective preparation and training for sedationists. Major adverse sedation-related events discussed here are aspiration, cardiovascular collapse, respiratory failure, and death.
Methods of Rescue/Response
Authors: Rees Chris A. , Chumpitazi Corrie E. 
Published: January 2019

Abstract
Sedation in pediatric patients can lead to decreased muscle tone and subsequent tissue relaxation and airway narrowing. Thus, sedated children are at risk of respiratory depression, laryngospasm, airway obstruction, apnea, and loss of airway reflexes. Hypotension and cardiopulmonary arrest may also occur, although these complications usually result from failure to recognize and correct respiratory compromise. Despite careful presedation assessment, appropriate medication and dose selection, and appropriate cardiovascular monitoring during the procedure, the risks associated with sedation cannot be eliminated entirely. As it is common for children to pass from the intended level of sedation to deeper levels of sedation, providers should be capable of providing appropriate rescue interventions from one level of sedation deeper than what is intended. Algorithms for response to monitored changes in ventilation and oxygenation are presented that can aid the sedationist in responding effectively to an event, preventing the spiral to a condition producing lasting harm to the patient.
The Obese Child
Authors: Hertzog James H. 
Published: January 2019

Abstract
Given that the incidence of obesity is increasing worldwide for both adults and children, sedationists will encounter obese children in their practice. Understanding the obesity-related risks of pediatric procedural sedation will assist the sedationist in managing and mitigating these risks. Obesity is associated with an increase in airway-related adverse events and the need for airway interventions during sedation. Obese patients also need modifications in the dosing of sedative and analgesic agents. Obstructive sleep apnea is commonly associated with obesity and should be identified during the presedation evaluation. With proper screening and preparation, obese patients may be safely and successful sedated for diagnostic and therapeutic interventions.
Voiding Cystourethrography
Authors: Scherrer Patricia , Bredbenner Laura 
Published: January 2019

Abstract
The voiding cystourethrogram (VCUG), which involves bladder catheterization and then fluoroscopic imaging of bladder filling and voiding, is the “gold standard” procedure for the diagnosis of vesicoureteral reflux in children. However, it can be associated with significant distress and discomfort for children. Child Life Specialists are essential to preprocedure preparation and coping strategies for all children, but some patients may also require procedural sedation. Oral or intranasal midazolam and nitrous oxide are the two most commonly used agents, each with its own advantages. Some children may benefit from even deeper levels of sedation, including dissociative sedation/analgesia with oral or intravenous ketamine, deep sedation with intravenous propofol, or even general anesthesia with inhaled anesthetics such as sevoflurane. The choice of regimen should be a joint decision among the multidisciplinary team members to best meet the needs of the child.
Endoscopy
Authors: Dilos Barbara , Gooden Cheryl K. 
Published: January 2019

Abstract
Esophagogastroduodenoscopy (EGD) and colonoscopy are two gastrointestinal procedures that are commonly performed in the pediatric population. For the most part, they can be performed with sedation; generally deeper levels are required for the younger, less cooperative child. However, in some clinical scenarios these procedures will require general anesthesia and artificial airway maintenance. Sedating a child for EGD and/or colonoscopy can present challenges because of the necessity for a cooperative, immobile child who maintains spontaneous breathing. While sedation care is usually associated with lower costs and resource utilization compared with general anesthesia, the sedationist has the responsibility to balance safety, efficiency, and cost-saving measures.
Pulmonary
Authors: Smith Paul G. 
Published: January 2019

Abstract
Sedation is used for virtually all children undergoing fiberoptic airway endoscopy. Because the sedating and procedural physicians “share the airway,” overlapping responsibilities necessitate coordination between them. This section describes the components of a directed preprocedural assessment, emphasizes the need for communication with the bronchoscopist, gives an overview of sedation options, and outlines anticipated complications. Procedural considerations for common FAE indications are highlighted, along with how they influence the choice of setting and sedation agents and methods. Use of short-acting and ultrashort-acting agents will be stressed, as they are ideal sedatives to allow rapid return of normal respiratory drive. Adjuvant medications to facilitate the procedure will also be reviewed.
Cutaneous
Authors: Barber Judson , Cooper Jacinta 
Published: January 2019

Abstract
Lacerations, abscesses, and burns are common presenting complaints evaluated in outpatient settings, urgent care centers, and emergency departments. These conditions are often painful, and the treatment procedures may cause additional pain or anxiety. The location and severity of the wound and the chronologic and developmental age of the patient influence the need for local anesthesia or systemic medications to make procedures tolerable for the patient. This section discusses the safe administration of medications to facilitate laceration repair, incision and drainage of abscesses, and burn debridement. General principles of the types of analgesia or sedation that are useful for these procedures are discussed.
Botox Injections for Spasticity and Sialorrhea
Authors: Mannix Christina 
Published: January 2019

Abstract
In patients with cerebral palsy, injections of botulinum toxin type A (Botox) into muscle groups to reduce spasticity may decrease spasmodic pain and improve movement by increasing range of motion, thereby facilitating care and potentially lessening contracture development. This procedure requires little time but is painful, and repeated treatments are necessary. The level of sedation used for this procedure varies among institutions and from patient to patient, ranging from no sedation at all to general anesthesia. Minimal to moderate sedation with nitrous oxide is an effective method of sedation for this procedure. The sedationist must be prepared to handle complications such as emesis and aspiration. Injection of the submandibular and parotid glands for sialorrhea is a growing indication for Botox injection; deeper levels of sedation are required for sialorrhea than for spasticity to allow localization of the gland and precise delivery of the treatment.
Sedation in the Pediatric Dental Practice
Authors: Unkel John H. 
Published: January 2019

Abstract
A contemporary dental practice offers a variety of sedation medications and routes of administration. Most dental sedation is delivered to children by inhalational and oral routes, although the nasal route is gaining acceptance. Minimal and moderate sedation are the levels that the dentist, acting as both the sedationist and the proceduralist, will wish to achieve in the dental office. Combinations of medications offer the ability to achieve ideal moderate sedation. Nitrous oxide, benzodiazepines, antihistamines, and other agents are discussed. Dental procedures are invasive and unique in that they occur in the oral airway. To achieve a successful outcome, sedationists and proceduralists must take into account instrumentation, loud noises, treatment duration, delivery of local anesthetics, and oropharyngeal protective barriers. Local anesthetic administration can be painful when delivered in the oral cavity. As this is the initial invasive step the child will encounter during the dental experience, providing sedation care may be of value in addition to topical anesthetic.
Intranasal Medications
Authors: Tsze Daniel S. , Reynolds Jason 
Published: January 2019

Abstract
The intranasal route is an effective means of administering sedatives and analgesics. It is a needle-free alternative to intravenous or intramuscular routes, it is not subject to first-pass metabolism, and its efficacy approaches that of intravenous administration. There is absorption through the highly vascular nasal mucosa, as well as utilization of the nose–brain pathway that bypasses systemic circulation and the blood–brain barrier and transports medications directly to the brain. Intranasal administration of sedative and analgesic medications has been shown to be safe and effective for children in a variety of settings. It provides an opportunity to avoid intravenous line placement in many situations, which may reduce the pain and anxiety associated with many diagnostic and therapeutic procedures in children. More studies are needed to compare important sedation outcomes between intranasal sedation regimens and the more common intravenous sedation regimens in order to guide best practice.