bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liposuction
Authors: Cole Alexandra N. , Sharma Balram 
Published: March 2023

Abstract
Liposuction is a popular cosmetic surgery technique used for expedient weight loss. The development of tumescent lidocaine has allowed for extensive liposuction with large volumes of aspiration and has quickly become the technique of choice. It is a cosmetic surgery procedure where metal cannulas are inserted through small incisions into the subcutaneous adipose tissue and large aspiration volumes are suctioned into a canister using negative pressure. Careful preoperative evaluation is necessary due to the toxicity of lidocaine and volume shifts associated with large-volume techniques. The maximum dose of lidocaine has been shown to be 35–55 mg/kg and reaches peak plasma level 10–14 hours after injection. The most common complication of liposuction is pulmonary embolism (thromboembolism or fat embolism).
Orthopedic Anesthesia
Authors: Thomas Alberto , Bang Jason 
Published: March 2023

Abstract
Tourniquet cuff pressure is recommended to be done with the lowest amount of pressure possible. Current methods, such as limb occlusion pressures (LOP), are utilized to minimize the required pressure. Although tourniquet time and pressure continue to be controversial, the recommended time of cuff inflation is 90–120 minutes, and if the anticipated time will last longer, the cuff should be deflated for 10 minutes every 1-hour interval. Air embolism in orthopedic procedures may occur when a pressure gradient is in favor of entry through a blood vessel that is open. This complication should be considered in any procedure where the surgical field is above the level of the heart. Fat embolism syndrome relates to fat embolization and bone marrow debris that, when released, may produce a vascular blockage. Another important complication to consider is compartment syndrome. Coexisting diseases such as rheumatoid arthritis will have disorders such as atlantoaxial subluxation and temporomandibular joint involvement. The use of regional anesthesia in orthopedic surgery has shown its advantages over general anesthesia. Among the most important advantages are postoperative pain management and reductions in perioperative complications, such as venous thromboembolism, myocardial infarction, respiratory depression, and bleeding complications.
Multiple Organ Dysfunction Syndrome
Authors: Shehata Peter , Sakr Esa Wael Ali 
Published: March 2023

Abstract
Multiple organ dysfunction syndrome (MODS) is a spectrum of physiologic maladaptation in separate organs that leads to significant morbidity and mortality in intensive care unit patients. This dysfunction is rooted in the dysregulated immune response and imbalance of the pro-inflammatory and anti-inflammatory responses to a degree that homeostatic mechanisms fail to self-regulate. As a result, multiorgan failure and significant organ injury occurs. MODS is defined and quantified by assessment of injury to six vital organ systems: cardiovascular, respiratory, hepatic, renal, hematologic, and neurologic systems. Some studies have defined a numerical scaling system to quantify the degree of organ dysfunction and relative outcome measures associated. To date, the best therapy is supportive care and avoidance of further injury. It is quite evident to us that the single most effective intervention is one of primary prevention, whereby we try to prevent the failure of organs as they show manifestations of early involvement.
Infection Control
Authors: Jury David , Noguera Edward 
Published: March 2023

Abstract
Nosocomial infections complicate patient management and increase hospital mortality. Hospital-related infections are, to a great degree, preventable. Healthcare providers are considered vectors of some hospital-related infections because of suboptimal hand hygiene habits. In addition, healthcare providers are potentially exposed to contagious infections that can be acquired due to poor compliance with infection prevention strategies. Standard precautions for infection prevention include hand hygiene, basic personal protective equipment (PPE), and safe injection practices and should be used with all patients. Situational awareness, optimization of infection precautions, standards compliance, and continuous quality improvement are of fundamental importance to protect the well-being of healthcare workers and patients.
Ethics, Practice Management, Professionalism, and Medicolegal Issues
Authors: Siddiqui Shahla 
Published: March 2023

Abstract
Aspects of ethical care, patient information confidentiality as well as patient safety are important aspects of professionalism and licensure, which are related in all aspects of patient care. Professionalism is one of the most important core competencies and is codified in the recent milestones advocated in the residency and fellowship training programs. The role of licensing bodies is to forge and ensure the trust between physicians and society is preserved by maintaining the highest standards of medical and professional conduct. Medical licensure is linked to the continued maintenance of the code of ethical and professional behaviors. These issues are discussed in this chapter and relevant guidelines are alluded to.
Costs of Medical/Anesthesia Care and Operating Room Management
Authors: Lebovitz Evan E. , Tsai Mitchell H. 
Published: March 2023

Abstract
Understanding operating room cost management is critical to hospital financial solvency. First, strategic decisions focus on long-term planning to set the perioperative players up for success. Tactical decisions occur several times per year and allow for optimum scheduling of cases and clinicians. Last, operational decisions are the daily bread and butter of clinical operating room directors in which they flex staff and cases as necessary to meet clinical demands. A keen focus on optimizing operational metrics that matter, including decreasing surgical case variability and overutilized time and putting decreased focus on less important factors, such as first-case start delays and turnover times, puts clinical directors in a position to succeed. In the future, software platforms guided by artificial intelligence are likely to assist schedule makers to allow for enhanced optimization of perioperative efficiency.
Reporting
Authors: Saad Ramsey , Hanna Joseph Salama 
Published: March 2023

Abstract
The advances in the field of anesthesia and safety in the operating room have been attributed to the various quality improvement programs, the first step of which involves adequate and efficient reporting. This chapter outlines the various reporting systems and their role in promoting patient safety. Medical errors are an unfortunate occurrence in medicine; however, when they do occur, reporting then becomes the ethical and professional responsibility of the physician and institution. The American Society of Anesthesiologists (ASA) established the Anesthesia Incident Reporting System (AIRS) in 2011 for anesthesia providers to report near misses or actual events. These reports are confidential.
Root Cause Analysis
Authors: Tueme Luis , Ragheb-Mueller Nawal E. 
Published: March 2023

Abstract
Root cause analysis (RCA) is a tool intended to analyze the roots of a problem in a structured and meticulous manner so that the underlying cause, contributing factors, or system vulnerabilities of an incident are identified and addressed in an effort to prevent future adverse events. Sentinel events (those that can cause death or severe temporary or permanent harm) are the usual focus of an RCA. To enhance the likelihood of preventing future events, RCA focuses on systemic and procedural flaws, rather than on individual performance. An RCA begins with the formation of a team to investigate a specific sentinel event. The team will define all issues clearly and in chronological order, brainstorm all possible contributing factors, and analyze each factor. Ultimately, the goal is to develop and implement systemic changes that will prevent future harmful events.
Pulmonary Function Tests
Authors: Helwege Sarah , Sharma Archit 
Published: March 2023

Abstract
Respiratory mechanics are an integral aspect of applied anesthetic practice for a multitude of reasons, including ventilator management, oxygenation and ventilation, use of inhalational agents, and respiratory consequences of hemodynamics. General anesthesia causes an alteration in the balance between inward forces (lung recoil) and outward forces (chest wall expansion) at the resting volume, namely, functional residual capacity (FRC), with a decrease in the outward forces, reducing the resting lung volume. Understanding the physiology behind the respiratory system allows one to troubleshoot, diagnose, and treat causes of hypoxemia and hypercapnia. This chapter focuses on ventilation, perfusion, alveolar-arterial O2 gradient, alveolar-arterial CO2 gradient, dead space ventilation, and intrapulmonary shunt.
Acute and Chronic Neck and Low Back Pain
Authors: Tennant Richard , Abd-Elsayed Alaa 
Published: March 2023

Abstract
Neck and back pain are among the most common pain conditions. Neck pain is the fourth leading cause of disability and has numerous causes. It is one of the top five most prevalent chronic pain conditions. Low back pain generally refers to pain over the lumbosacral area. Low back pain is one of the most common medical conditions leading patients to seek medical care and is the leading cause of disability worldwide. While most acute episodes resolve spontaneously, pain can become chronic in a small proportion of these patients. Both acute neck and acute back pain have a high rate of recurrence. There are many potential causes for pain, and attempting to find the underlying cause will help tremendously when considering the best treatment option.
Personality Disorders
Authors: Berman Carol W. 
Published: March 2023

Abstract
A personality disorder is an inflexible, lasting pattern of thinking, feeling, and behavior. Patients with personality disorders are stuck. They may be acting against themselves and others, but they cannot change. Many examples are seen in plays. Shakespeare presented Richard III, Iago, Macbeth, and Lady Macbeth, who were all antisocial personalities. Chekhov showed us Lomov in The Marriage Proposal as a passive-aggressive personality who cannot propose to his prospective bride. The categorizing of personality disorders does not help with predicting clinical outcomes or in treatment planning. There is also the problem of diagnostic reliability, co-occurrence, and inconsistent and arbitrary boundaries.
Radiotherapy side effects and their management
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Radiotherapy side effects occurring during or within 6 weeks of completion of radiotherapy are called early or acute, those occurring after 6 weeks but within 3 months of treatment are called subacute, and those occurring after 3 months are called late. The development of side effects depends on the total radiotherapy dose, dose fractionation, and kinetics of individual tissue. Acute effects are due to effects of radiotherapy on rapidly multi-plying normal tissues such as skin and mucosa, whereas late toxicities may be due to depletion of slowly proliferating stem cells and/or progressive damage to the microvasculature. This chapter discusses various side effects, their relationship with dose fractionation, and their management.
Emergency and palliative radiotherapy
Authors: Ajithkumar Thankamma 
Published: March 2023

Abstract
Emergency radiotherapy is given to achieve immediate symptom relief or preservation of function, or both, and should be given within 24 hours of diagnosis. Palliative radiotherapy aims to improve quality of life by preventing or improving symptoms in patients with limited life expectancy, and should be given as soon as possible. Studies have shown that most patients with advanced metastatic solid tumours do not live beyond a few weeks or months. Therefore, any theoretical risk of long-term toxicities should not deter clinicians from offering a potentially effective palliative treatment. This chapter discusses the role of radiotherapy in the emergency and palliative care settings and summarizes the evidence underpinning current clinical practice.
Could the serum glucose/potassium ratio offer an early reliable predictor of life-threatening events in acute methylxanthine intoxication?
Authors: Sharif Asmaa F , Kasemy Zeinab A , Mabrouk Heba A , Shoeib Osama , Fayed Manar M 
Published: March 2023

Abstract
Methylxanthines are widely used to manage pulmonary disorders, particularly in developing countries. Methylxanthines are unsafe due to their narrow therapeutic index and associated morbidity and mortality. The current study aimed to investigate the role of glucose/potassium ratio as a substantially useful early predictor of life-threatening events (LTEs) in the form of cardiovascular and neurological complications among methylxanthine users. A retrospective cohort study was conducted using medical records of patients diagnosed with acute methylxanthine intoxications and presented to an Egyptian Poison Control Center for 2 years. A total of 366 patients were enrolled. Of them, 59 patients (16.1%) were complicated with LTEs. The most frequent serious arrhythmia was T wave inversion (45.6% of patients with LTEs). Laboratory investigations that could significantly predict LTEs were the random blood glucose and potassium levels, glucose/potassium ratio, pH, liver transaminases, HCO3 level, hemoglobin, and platelet count (P &lt; 0.05). The glucose/potassium ratio was the best predictor of LTEs (odds ratio = 2.92, and 95% confidence interval = 2.02–4.23). With an excellent area under the curve (0.906) and at a cutoff of 2.44, that ratio could correctly classify the patients based on their risk of LTEs with an overall accuracy of 73% (sensitivity of 88% and specificity of 70%). The current study endorsed an important, feasible, and easily obtainable ratio that could predictor stratify the patients according to severity and risk of LTEs, which guides the decision-making and prioritizes the treatment lines in methylxanthine intoxicated patients.
Prognosis and conditional nomogram of cervical spine fracture in patients with severe spinal cord injury: a multicenter retrospective study
Authors: Huang Jinfeng , Yan Kang , Wu Chenyu , Tan Quan-Chang , Bai Hao , Wang Jing , Liao Bo , Wu Zi-Xiang 
Published: March 2023

Introduction:
Cervical spine fractures with severe spinal cord injury (SCI) are common following cervical spine trauma and are associated with a high mortality rate. Understanding the mortality patterns of patients with cervical spine fractures and severe SCI can offer valuable evidence to surgeons and family members who are required to make critical healthcare decisions. The authors aimed to evaluate the instantaneous death risk and conditional survival (CS) of such patients and developed conditional nomograms to account for different periods of survivors and predict the survival rates.

Methods:
Their instantaneous death risks were calculated using the hazard function, and the Kaplan–Meier method was used to evaluate the survival rates. Cox regression was used to choose the variables for the construction of the nomograms. The area under the receiver operating characteristic curve and calibration plots were used to validate the performance of the nomograms.

Results:
The authors finally included 450 patients with cervical spine fractures and severe SCI using propensity score matching. The instantaneous death risk was the highest during the first 12 months after injury. Surgical treatment can help decrease the instantaneous death risk quickly, especially in early-term surgery. The 5-year CS increased constantly from 73.3% at baseline to 88.0% after 2 years of survival. Conditional nomograms were constructed at baseline and in those who survived for 6 and 12 months. The area under the receiver operating characteristic curve and calibration curves indicated that the nomograms had a good performance.

Conclusion:
Their results improve our understanding of the instantaneous death risk of patients in different periods following injury. CS demonstrated the exact survival rate among medium-term and long-term survivors. Conditional nomograms are suitable for different survival periods in predicting the probability of survival. Conditional nomograms help in understanding the prognosis and improve the shared decision-making approaches.
Migrating hook wire that travels to the heart via the bloodstream: A case report
Authors: Chen Kuan-Hua , Wu Chen-Hao , Wei Hao-Ji , Chan Cheng-Wei , Hsia Jiun-Yi 
Published: March 2023

Rationale:
This report documents the intracardiac migration of a hook wire in a 47-year-old male patient after computed tomography (CT)-guided percutaneous hook wire localization of pulmonary ground-glass opacities.

Patient concerns:
The patient underwent CT-guided hook wire localization before video-assisted thoracoscopic surgery (VATS) wedge resection for a pulmonary nodule in the right upper lung field. However, the hook wire was not found in the specimen obtained from the wedge resection. A right upper lobectomy was performed to locate the hook wire; however, it was not found.

Diagnosis:
A transesophageal echocardiogram was performed, and the hook wire was found in the left ventricle (LV).

Interventions:
The patient subsequently underwent exploratory cardiotomy to remove the foreign body. The patient was admitted to the intensive care unit for postoperative care.

Outcomes:
Postoperatively, no complications were observed, and the patient was discharged from the hospital 7 days postoperatively. He received standard lung cancer treatment afterwards.

Lessons:
The present case was unique because the hook wire migrated through the bloodstream from the pulmonary vein to the left atrium, before finally reaching the LV. Based on the patient preoperative CT images, the ground glass opacities were proximal to a 2.5 mm wide vein, which drained into the pulmonary vein. The proximity of the hook wire to a blood vessel was reportedly attributed to an increased risk of hook wire migration through the bloodstream. Hematogenous hook wire migration into the heart can result in fatal complications. Early diagnosis and timely removal of the hook wire are recommended to prevent the worsening of this complication.
Ultrasound-guided brachial plexus nerve block in a patient with a left palmar schwannoma: A case report
Authors: Qu Yan , Yang Haomin , Wei Lichun , Su Guoning 
Published: March 2023

Rationale:
Ultrasound-guided brachial plexus block is a common anesthetic procedure used in upper extremity surgery. However, it may not be a suitable option for some patients.

Patient concerns:
A 17-year-old woman with the left palmar schwannoma scheduled for surgical treatment received ultrasound-guided brachial plexus block. The anesthesia modalities of the disease were discussed.

Diagnoses:
Based on the patient’s complaints and clinical appearance, provisional diagnosis of neurofibroma was considered.

Interventions:
In this case, we present a case of ultrasound-guided axillary brachial plexus block used for upper extremity surgery in this patient. It was not easily and painlessly reduced in the surgery, although the visual analogue scale score was 0 and no motor movements of the left arm and palm were observed. The pain was relieved by intravenous injection of 50 mcg remifentanil.

Outcomes:
Immunohistochemically labeled pathological examination confirmed the mass to be a schwannoma. There was no need to apply additional analgesia after surgery, although the patient felt numbness in the left thumb for 3 days follow up.

Lessons:
Even if there is painless when skin-cutting after implementation of brachial plexus block, the patient is painful when pulls the nerve around the tumor during excision. It is necessary to give an analgesic drug or anesthetize a single terminal nerve as a supplement for brachial plexus block in patients with schwannoma.
Jejunal Feeding by Gastrojejunal Tube in Pediatric Refractory Gastroesophageal Reflux Disease
Authors: Faccioli Nathan , Sierra Anaïs , Mosca Alexis , Bellaïche Marc , Lengliné Hélène , Bonnard Arnaud , Viala Jérôme 
Published: March 2023

Objectives:
The objective of this study is to determine whether jejunal nutrition by gastrojejunal tube (GJT) could be a therapeutic option for refractory gastroesophageal reflux disease (GERD), avoiding further antireflux surgery.

Methods:
A monocentric retrospective study was conducted for all children <18 years who underwent GJT placement to treat GERD. We collected data at the first GJT placement, 5 months after last GJT withdrawal, and at the end of the follow-up (June 2021).

Results:
Among 46 GERD patients with 86 GJT, 32 (69.6%) and 30 (65.2%) avoided antireflux surgery 5 and 28 months, respectively, after the definitive GJT removal. Five months after GJT removal, discharge from hospital, transition to gastric nutrition, GERD complications, and treatment were significantly improved. Median age and weight at the first GJT placement were 7 months and 6.8 kg. Patients had digestive comorbidities or complicated GERD in 69.6% and 76.1% patients, respectively. The median duration of jejunal nutrition using GJT was 64.5 days. GJT had to be removed in 63 (75.9%) cases for technical problems.

Conclusions:
Jejunal nutrition by GJT could be an alternative to antireflux surgery avoiding sustainably antireflux surgery in most of complicated GERD patients. The high frequency of mechanical complications raises that these devices should be technically improved.
Evaluating the role of inhibiting the biosynthesis of estrogens in the sex-specific antidepressant-like effects of ketamine in rats
Authors: Ledesma-Corvi Sandra , Jornet-Plaza Jordi , García-Fuster M. Julia 
Published: March 2023

AbstractKetamine has been recently approved to treat resistant depression; however preclinical studies showed sex differences in its efficacy. Sex steroids, such as estrogen and testosterone, both in the periphery and locally in the brain, are regarded as important modulators of these sex differences. Therefore, the present study evaluated the role of inhibiting estrogen biosynthesis with letrozole, an aromatase inhibitor that catalyzes the conversion of androgen into estrogen, in the differential antidepressant-like-response induced by ketamine with sex. We performed several consecutive studies in adult Sprague-Dawley rats to evaluate potential sex differences in the antidepressant-like effects of ketamine (5 mg/kg, 7 days, i.p.), letrozole (1 mg/kg, 8 days, i.p.) and their combination (letrozole pre-treatment 3 h before ketamine). Acute and repeated antidepressant-like responses were ascertained in a series of behavioral tests (forced-swim, novelty-suppressed feeding, two-bottle choice for sucrose preference). The main results proved clear sex differences in the antidepressant-like response induced by ketamine, which was observed following a repeated paradigm in adult male rats, but rendered inefficacious in female rats. Moreover, decreasing estrogen production with letrozole induced on itself an antidepressant-like response in female rats, while also improved ketamine’s response in male rats (i.e., quicker response, only after a single dose). Interestingly, both the antidepressant-like effects induced by ketamine in male rats or letrozole in female rats persisted over time up to 65 days post-treatment, suggesting long-term sex-directed benefits for these drugs. The present results demonstrated a sex-specific role for inhibiting estrogen biosynthesis in the antidepressant-like response induced by ketamine in male rats. Moreover, letrozole presented itself as a potential antidepressant for females with persistent effects over time. Clearly, estrogen production is key in modulating, in a sex-specific manner, affective-like responses and thus deserve further studies.