bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hederagenin reduces Aβ-induced oxidative damage, decreases Aβ deposition, and promotes cell survival by the P13K/Akt signaling pathway
Authors: Xie Kunpeng , Wang Hao , Yao Xin , Lv Jialin , Wang Qingyu , Zhao Yu , Yang Shuhan , Xu Lipeng , Shi Yuhua , Hu Jiliang , Shan Yaming 
Published: May 2024

Abstract
Alzheimer's disease (AD) is a neurodegenerative disease characterized by memory loss and cognitive impairment. β-Amyloid (Aβ) is one of the typical pathological features of AD, and its accumulation leads to neuronal death from oxidative stress. Here, we found that hederagenin (HG), a natural product, exhibits antitumor, anti-inflammatory, antidepressant, antineurodegenerative biological activities. However, whether HG has anti-Aβ activity remains unclear. Based on the characteristics of HG, it is hypothesized that HG has biological activity against Aβ injury. Therefore, Aβ-injured SH-SY5Y cells were constructed, and the protective effect of HG against Aβ injury was further evaluated using Caenorhabditis elegans. The results showed that HG increased superoxide dismutase activity, effectively reduced Aβ-induced oxidative damage, and reduced apoptosis via the PI3 K/Akt signaling pathway. HG inhibited Aβ deposition and delayed senescence and paralysis in the C. elegans strain, CL4176. HG showed inhibitory effects on Aβ; therefore, more natural active products are expected to be applied in AD therapy.
Unshared Minds, Decaying Worlds: Towards a Pathology of Chronic Loneliness
Authors: Corbin Ian Marcus , Dhand Amar 
Published: May 2024

Abstract
The moment when a person’s actual relationships fall short of desired relationships is commonly identified as the etiological moment of chronic loneliness, which can lead to physical and psychological effects like depression, worse recovery from illness and increased mortality. But, this etiology fails to explain the nature and severe impact of loneliness. Here, we use philosophical analysis and neuroscience to show that human beings develop and maintain our world-picture (our sense of what is true, important, and good) through joint attention and action, motivated by friendship, in the Aristotelian sense of “other selves” who share a sense of the true and the good, and desire the good for each other as much as for themselves. The true etiological event of loneliness is the moment one’s world-picture becomes unshared. The pathogenesis is a resultant decay of our world-picture, with brain and behavior changes following as sequelae.
Automated deep learning segmentation of neuritic plaques and neurofibrillary tangles in Alzheimer disease brain sections using a proprietary software
Authors: Ingrassia Lea , Boluda Susana , Potier Marie-Claude , Haïk Stéphane , Jimenez Gabriel , Kar Anuradha , Racoceanu Daniel , Delatour Benoît , Stimmer Lev 
Published: May 2024

Abstract
Neuropathological diagnosis of Alzheimer disease (AD) relies on semiquantitative analysis of phosphorylated tau-positive neurofibrillary tangles (NFTs) and neuritic plaques (NPs), without consideration of lesion heterogeneity in individual cases. We developed a deep learning workflow for automated annotation and segmentation of NPs and NFTs from AT8-immunostained whole slide images (WSIs) of AD brain sections. Fifteen WSIs of frontal cortex from 4 biobanks with varying tissue quality, staining intensity, and scanning formats were analyzed. We established an artificial intelligence (AI)-driven iterative procedure to improve the generation of expert-validated annotation datasets for NPs and NFTs thereby increasing annotation quality by &gt;50%. This strategy yielded an expert-validated annotation database with 5013 NPs and 5143 NFTs. We next trained two U-Net convolutional neural networks for detection and segmentation of NPs or NFTs, achieving high accuracy and consistency (mean Dice similarity coefficient: NPs, 0.77; NFTs, 0.81). The workflow showed high generalization performance across different cases. This study serves as a proof-of-concept for the utilization of proprietary image analysis software (Visiopharm) in the automated deep learning segmentation of NPs and NFTs, demonstrating that AI can significantly improve the annotation quality of complex neuropathological features and enable the creation of highly precise models for identifying these markers in AD brain sections.
Lower Extremity
Authors: Samba Amit , Nickless Alexandria 
Published: May 2024

Abstract
The lower extremity includes the part of the body extending from the hip to the toes. The lower extremity is used for weight support, posture and standing, and ambulating. It also counts toward a significant portion of a person’s body mass. An understanding of the anatomy will allow for the creation of a safe and effective anesthetic plan in the perioperative setting. This could include minimizing the risk of injury during patient positioning, performing regional anesthesia, or anesthetic management of a patient’s pathophysiology. This chapter will identify the anatomy (osseous, vasculature, and nervous structures) with possible complications associated with these structures.
Concentration Effect
Authors: Jun Charles , Nasr Ned F. 
Published: May 2024

Abstract
In anesthesia, the volatile anesthetic is quintessential in defining and paving the field of anesthesiology. With the use of volatile agents, there are many properties that interplay in delivering anesthetics to patients. The concentration effect helps to explain how changes in fractional inspired concentration, or FI, determines the rate at which the fractional alveolar concentration, or FA, and the alveolar concentration can be attained. Ultimately, the concentration effect clinically leads to a faster uptake and onset of effect. The gases that can exert the concentration effect often have the ability to quickly diffuse into bloodstream from the alveoli.
Non-Circle Systems
Authors: Jun Charles , Nasr Ned F. 
Published: May 2024

Abstract
The non-circle system was the beginning of an evolution of breathing systems meant to provide anesthetic gases and ventilation to patients. Though a very rudimentary way of providing anesthetic agents, it was nonetheless a very important development in the field of the anesthesia. The non-circle system could be subdivided into two categories: open systems and semi-open systems. The open system is an indirect and noninvasive way to deliver anesthetic agents to patients; specifically, this method is still utilized to provide anesthesia to pediatric patients. The open system has no reservoir for gases to accumulate and thus eliminates any possibility of rebreathing. As for semi-open systems, this system utilizes the reservoir system to create a storage space for gases with only mild rebreathing at worst.
Oxygen Supply Systems
Authors: Hutchinson David , Giordano Chris 
Published: May 2024

Abstract
The anesthesia machine is an integral and complex part of safely providing anesthesia services in the operating room. Among its complexities, providing a constant supply of oxygen may be the single most important feature; therefore, oxygen supply is carefully regulated. The anesthesia machine delivers oxygen from a centralized healthcare facility supply and a secondary reserve tank system, both of which have gas inlet pressure gauges for monitoring. Many safety features aid in the regulation of adequate and safe oxygen flow to the patient, ranging from physical connections to the oxygen supply, including the Pin Index and Diameter Index safety systems, to tactile and audible cues such as flowmeter dial shapes and low-flow alarms. Furthermore, given the diversity of medical gases that may be administered to the patient, strict pressure and mixture regulation exists to prevent the delivery of over-pressurized gases and hypoxic or anoxic mixtures.
Safety Features
Authors: Brennan Meghan , Giordano Chris 
Published: May 2024

Abstract
Appropriate knowledge of operating room (OR) equipment, safety features, and alarms is fundamental to the prevention of patient injury. Mechanical ventilators frequently contain built-in pressure sensors and alarms designed to alert to ventilator disconnections, circuit leaks, fresh gas flow failures, inappropriate ventilator settings, and scavenging system failures. Preoperatively, an anesthesia machine check is recommended to verify that the high- and low-pressure systems are functioning appropriately, the circuit contains no leaks, the oxygen sensors are calibrated, the unidirectional inspiratory and expiratory valves are intact, and the scavenging system and carbon dioxide absorbent are working. Intraoperatively, a systematic approach to evaluating causes of the low-pressure alarm is key to rapid detection and prevention of patient injuries. ORs may contain two different types of electrical systems: a grounded system, similar to most homes and buildings, that contains a ground fault circuit interrupter; or an isolated electrical system containing an isolation transformer and line isolation monitor. Knowledge of OR electrical systems is important when connecting equipment to power sources because a piece of equipment may lose power if there is current leakage or a patient or provider could be at risk for an electric shock if alarms are triggered.
Methods of Monitoring Oxygen
Authors: Varshney Shivani , Nowak Tina 
Published: May 2024

Abstract
Oxygen is essential for cellular metabolism in the body. Standard basic anesthesia monitoring requires that the anesthesiologist continuously evaluate blood oxygenation of the patients during all anesthetics and protect them from significant hypoxemia. Pulse oximetry is a simple, safe, noninvasive monitoring device that estimates the oxygen saturation of the hemoglobin in the peripheral arterial blood (SpO2). It helps in early detection of hypoxia and is now often considered the fifth vital sign. However, it has limitations and cannot identify dyshemoglobinemias. Co-oximetry is a laboratory-based instrument that is helpful in such conditions.
Echocardiography
Authors: Mori Benjamin B. G. , Jindi Piotr Al 
Published: May 2024

Abstract
Echocardiography has demonstrated utility in the perioperative management of those patients with underlying cardiac disease and intraoperative transesophageal echocardiography is now standard in most major cardiac surgeries. There is also growing evidence for its use in the noncardiac surgical patient, including in the preoperative assessment of those patients with known or suspected cardiac valvular disease, and it is helpful in guiding management, postoperatively, in the ICU setting. In this chapter, the general indications, contraindications, and recommendations of perioperative echocardiography are discussed. Furthermore, the standard 20 transthoracic echocardiographic views, set forth by the American Society of Echocardiography and the Society of Cardiovascular Anesthesia, are summarized.
Pressure Transducers
Authors: Schlecht Kathy D. 
Published: May 2024

Abstract
Pressure transducers convert mechanical energy (pressure waveforms in fluid tubing) into electrical energy (electrical signal displayed as a pressure waveform). The displayed pressure waveform can be influenced by damping and resonance. Damping (overdamping) occurs when the mechanical energy of the pressure waveform is dissipated prior to reaching to the diaphragm of the pressure transducer, decreasing the amplitude of the displayed waveform. Resonance occurs when the frequency of the arterial pressure wave is augmented by the natural frequency of the oscillating transducing system, increasing amplification, ringing, and overshooting of the systolic blood pressure (underdamping). Transducers must be zeroed to ambient atmospheric pressure to set a “zero” reference point and leveled to align the transducer to a point on the body.
Warming devices and techniques
Authors: Guruswamy Jayakar , Rao Akshatha Gururaja 
Published: May 2024

Abstract
Mean core body temperature is 36.5°C–37.3°C. Effector response occurs at threshold temperature. Thermoregulation is altered during anesthesia, leading to perioperative hypothermia. Most anesthetics increase warm response and reduce cold response thresholds. Hypothermia (core temperature &lt;36⁰C) is associated with impaired coagulation, increased transfusion requirement, wound infection, and cardiac complications. Perioperative heat loss mostly occurs via radiation and convection. Active warming devices and passive insulation are used to prevent hypothermia. Active warming includes forced air warming devices, resistive warming devices, circulating water mattress or garments, negative pressure water warming system, and radiant warmers. Forced air warmers are commonly used perioperatively. These work by convection, prevent radiant heat loss, can increase temperature by 0.7⁰C/hour, and are more effective when a larger surface area is covered. Passive warming includes cotton blankets, surgical drapes, sleeping blankets, and space blankets. Cotton blankets are simple, inexpensive, and are easily available. Layer of trapped air prevents up to 30% radiant heat loss.
Etomidate
Authors: Ferguson Kris , Papapetrou Peter 
Published: May 2024

Abstract
Etomidate is an intravenous anesthetic agent used for the induction of anesthesia. Etomidate can also be utilized for brief procedures such as reduction of dislocated joints, cardioversion, and electroconvulsive therapy. It has rapid onset of action and relatively quick offset of action due to redistribution. Etomidate is painful upon injection because of the propylene glycol in which it is dissolved. If cardiac stability is a concern, etomidate has minimal impact on the cardiovascular system and maintains cerebral autoregulation. Etomidate is often the induction agent of choice in emergency situations as there is limited respiratory depression, a lack of histamine release and in traumatic brain injury, and it decreases intracranial pressure. There is a common side effect of myoclonus upon injection. Adrenal suppression is also present, as etomidate inhibits adrenal enzymes.
Ketamine
Authors: Papapetrou Peter , Ferguson Kris 
Published: May 2024

Abstract
Ketamine was first synthesized to be used as a milder hallucinogenic than phencyclidine. It is an NMDA receptor antagonist that has several useful properties in perioperative anesthesia. It produces a dissociative anesthetic state that does not reduce ventilatory drive, unlike other intravenous anesthetics. It maintains hemodynamic stability due to its indirect sympathomimetic properties in most patients but can cause negative inotropic effects if a patient has reached their maximum catecholamine level. It is a bronchodilator and can be used during bronchospasm. Though it does have several benefits, it should not be used in patients with increased ICP or in those patients at high risk for PONV. Postoperatively, it can reduce pain and opioid use when infused at a low dose.
Preparation for Anesthesia/Premedication
Authors: Yao Caylynn , Peterson Elisha 
Published: May 2024

Abstract
Prior to the induction of anesthesia, a series of medications may be administered which are referred to as premedication. These medications are not considered a component of either the patient’s usual medical regimen or of the anesthetic. Rather, premedication is administered to reduce anxiety, initiate amnesia, control pain, decrease airway secretions and the risk of aspiration pneumonitis, and lower the incidence of postoperative nausea and vomiting. Depending on the patient’s comorbid conditions, beta-blockade and glucocorticoid therapy may be considered for premedication. Other medications used in the preoperative setting, such as erythropoietin in the setting of anemia, are less common in standard practice. Mainstay premedication in anesthesia is discussed.
Increased Cerebrospinal Fluid Pressure
Authors: Tian Ling , Nguyen Christina T. 
Published: May 2024

Abstract
This chapter discusses increased cerebrospinal fluid (CSF) pressure from pathophysiology to treatment. It includes a table of common causes of increased CSF pressure and discusses how this translates to increased intracranial pressure (ICP), lower cerebral perfusion pressure, and the consequences of elevated ICP on neurophysiology. It goes on further to give an overview of treatment methods for increased CSF pressure, including noninvasive, pharmacologic, and invasive measures such as lumbar puncture and continuous ICP monitoring.
NPO Status and Full Stomach
Authors: Nebergall Mallory , Albert Mazin T. 
Published: May 2024

Abstract
Aspiration of gastric or oropharyngeal contents during anesthesia administration is an adverse event with significant morbidity and mortality. Nil per os (NPO) guidelines were developed to decrease the presence of particulate matter, acidic contents, or gastric volume present at time of induction in attempt to reduce the risk of aspiration or complications related to aspiration. In addition, preoperative interventions such as gastric decompression via nasogastric tube and reducing the acidity of gastric contents with medications, as well as intraoperative techniques using rapid sequence intubation with/without the application of cricoid pressure, and placement of an endotracheal tube can be used in an attempt to reduce the risk of aspiration. In the event aspiration occurs, treatment strategies are broad, including supportive care, suctioning gastric contents, changing patient positioning, intubation with an endotracheal tube, or even antibiotic administration.
Neuroaxial Anesthesia in Obstetrics
Authors: Penner John 
Published: May 2024

Abstract
The neuraxial anesthetic techniques of subarachnoid block, epidural block, and combined spinal epidural are used extensively in obstetric anesthesia. These techniques can provide both labor analgesia and surgical anesthesia. They are safe, effective, and are low risk for both the patient and fetus. Each technique has advantages and disadvantages, and can be done using just local anesthetics, or local anesthetics combined with opioids. This chapter will discuss the role of neuraxial techniques in the management of the parturient patient, both during labor and delivery as well as cesarean section. The process of placing neuraxial anesthetics is discussed elsewhere in this book.
Stages and Signs of Anesthesia
Authors: Gotlib Daniel , Lawrence Melinda M. 
Published: May 2024

Abstract
An understanding of the stages and signs of anesthesia is important for medical personnel providing an anesthetic. Personnel administering an anesthetic must appropriately monitor the patient and confirm that the appropriate level of anesthesia and analgesia is being administered for the case at hand. Dr. Arthur Guedel was the first to take a systematic approach, monitoring and classifying the stages of anesthesia. The American Society of Anesthesiologists has developed specific definitions for general anesthesia and all levels of sedation and analgesia.
Techniques of General Anesthesia
Authors: Gluncic Vicko 
Published: May 2024

Abstract
General anesthesia is a state of unconsciousness accompanied by reversible amnesia, analgesia, hypnosis, muscle relaxation, and suppression of autonomic responses, and the patient is unable to respond to voice or painful surgical stimulus. It can be achieved by injection or inhalation of anesthetic agents (induction phase). Once the state of general anesthesia is achieved, it can be maintained by an anesthetic given intravenously or by inhalation (maintenance phase). The most common intravenous hypnotics are propofol, etomidate, thiopental, and ketamine, while sevoflurane, isoflurane, desflurane, and nitrous oxide are typical inhalation anesthetics. Painful stimuli are blocked by opioids (sufentanil, fentanyl, alfentanil, remifentanil), while immobility is achieved by neuromuscular blocking agents (NMBA; rocuronium, vecuronium, atracurium, cisatracurium, succynilcholine). The choice of which agents will be used for the induction and maintenance of general anesthesia depends primary on the state and characteristics of the patient (age, hemodynamic stability, specific diseases, risk of aspiration, potentially difficult airway), but the type of surgical procedure (surgical site, length, level of pain) also plays a role. In addition, the anesthesiologist can choose from several different techniques of general anesthesia: total intravenous anesthesia, total inhalation anesthesia, or balanced anesthesia.
Techniques for Managing Airway (Including Difficult Airway Algorithm)
Authors: Sharma Sahil , Sharma Archit 
Published: May 2024

Abstract
Airway management is critical and includes mask ventilation, laryngoscopy, endotracheal intubation, and extubation of the patient. Difficulty can be encountered at any of these stages, potentially resulting in significant complications. Airway management is an acquired skill that requires knowledge of various anatomical, physiological, pathological features in addition to various methods and tools developed for getting an airway. Thorough careful planning and preparation and a thorough preoperative assessment, one can reduce the potential for complications. The American Society of Anesthesiologists (ASA) developed and recently revised guidelines for the management of the difficult airway that focusses on strategies for intubation as well as alternative airway techniques that can be used when a patient with a difficult airway is encountered.
Trauma
Authors: Nebergall Mallory , Albert Mazin T. 
Published: May 2024

Abstract
The administration of anesthesia is not without risks. Most patients tolerate general anesthesia without any issues. Even those who do suffer from side effects or minor complications experience mild, transient symptoms that are easily managed, such as sore throat, nausea, vomiting, lacerations to lips/oral mucosa, hypotension, etc. Complications as the result of general anesthesia are often multifactorial, but human error accounts for a large portion of morbidity for patients and a source of liability for anesthesiologists. Epistaxis is a common complication of nasal manipulation, but the most common iatrogenic injuries involve the larynx, pharynx, esophagus, and eyes. Knowing common complications associated with specific surgery procedures, as well as the complications common to airway manipulation and how to properly and promptly identify complications, can help minimize the risk of physical injury to the patient while under anesthesia and sequela as a result of such injuries.
Burns
Authors: Mahboobi Sohail K. , Sohail Ramaiza 
Published: May 2024

Abstract
Burns are not uncommon, with approximately 486 000 burn injuries receiving treatment and more than 3000 deaths annually, according to the American Burn Association report. In first few hours, the initial shock phase is followed by generalized edema due to increased capillary permeability, and release of inflammatory substances. Replacement of intravascular volume, to keep perfusing vital organs, should start with balanced salt solutions and with monitoring of urine output, used as an indicator of adequate resuscitation. Certain formulas are used based on body weight and percentage of burn area to help calculate required fluids. Carbon monoxide and cyanide poisoning should always be suspected, particularly with signs of smoke inhalation. If patient requires anesthesia, lower doses of anesthetic agents should be used due to decreased circulating volume and decreased perfusion to liver and kidney. Over a few weeks, the hypermetabolic phase starts with protein catabolism and decreased immunity. Succinyl choline should be avoided after 24 hours of burn due to risk of hyperkalemia. Burn contractures can make airway management challenging. In this phase and due to the hypermetabolic state of the body, higher than usual doses of anesthetic agents may be required. With timely resuscitation and early surgical intervention, these patients have a survival rate of approximately 97%. This chapter discusses the pathophysiology and anesthetic management of burn injuries.