bluuebunny/crossref_metadata_2025_split huggingface dataset:
Analysis of hsa-miR-19a-3p and hsa-miR-19b-3p modulation and phosphodiesterase type 5 expression in the vaginal epithelium of premenopausal women with genital arousal disorder
Authors: Caruso Giuseppe , Falzone Luca , Palermo Gaia , Ricci Daria , Mazza Gabriele , Libra Massimo , Caruso Salvatore , Gattuso Giuseppe 
Published: April 2023

AbstractBackgroundFew studies have investigated the role of the phosphodiesterase type 5A (PDE5A) isoenzyme in female genital tissue disorders, exclusively taken from cadavers, as well as the epigenetic mechanisms responsible for the regulation of PDE5A levels.AimThe aim was to study the in vivo association between microRNA (miRNA) expression and the expression levels of PDE5A in women with female genital arousal disorder (FGAD) compared with healthy women.MethodsPremenopausal women affected by FGAD (cases) and sexually healthy women (control group) underwent microbiopsy of the periclitoral anterior vaginal wall for the collection of tissue samples. Computational analyses were preliminarily performed in order to identify miRNAs involved in the modulation of PDE5A by using miRNA–messenger RNA interaction prediction tools. Differences in the expression levels of miRNAs and PDE5A were finally investigated in cases and control subjects by using the droplet digital polymerase chain reaction amplification system and stratifying women considering their age, number of pregnancies, and body mass index.OutcomesExpression levels of miRNAs were able to target PDE5A and the tissue expression in women with FGAD compared with healthy women.ResultsThe experimental analyses were performed on 22 (43.1%) cases and 29 (56.9%) control subjects. Two miRNAs with the highest interaction levels with PDE5A, hsa-miR-19a-3p (miR-19a) and hsa-miR-19b-3p (miR-19b), were identified and selected for validation analyses. A reduction of the expression levels of both miRNAs was observed in women with FGAD compared with the control subjects (P &lt; .05). Moreover, PDE5A expression levels were higher in women with FGAD and lower in women without sexual dysfunctions (P &lt; .05). Finally, a correlation between body mass index and the expression levels of miR-19a was found (P &lt; .01).Clinical ImplicationsWomen with FGAD had higher levels of PDE5 compared with control subjects; therefore, the administration of PDE5 inhibitors (PDE5 inhibitors) could be useful in women with FGAD.Strengths and LimitationsThe strength of the current study was to analyze genital tissue obtained in vivo from premenopausal women. A limitation was to not investigate other factors, including endothelial nitric oxide synthetases, nitric oxide, and cyclic guanosine monophosphate.ConclusionThe results of the present study indicate that the modulation of selected miRNAs could influence PDE5A expression in genital tissues in healthy women or in those with FGAD. Such findings further suggest that treatment with PDE5 inhibitors, as a modulator of PDE5A expression, could be indicated for women with FGAD.
Understanding Bipolar Disorder
Authors: Evans Dwight L. , Benton Tami D. , Ellison Katherine 
Published: April 2023

Abstract
This chapter focuses on bipolar disorder that affects the lives of people. It starts with how taking care of children with bipolar disorder might take over a parent’s life. The characteristic definition of bipolar disorder ranges between mania and depression. Professional help is advised when red flags like bouts of explosive rage or repeated high-risk behavior have been recorded. The chapter explains the process of diagnosing bipolar disorder, especially when the condition is often mistaken for attention-deficit/hyperactivity disorder or schizophrenia. Moreover, bipolar disorder often exists side by side with other emotional and behavioral issues known as comorbid conditions or comorbidities. The chapter also highlights the role of biology in mood disorders.
Treatment
Authors: Evans Dwight L. , Benton Tami D. , Ellison Katherine 
Published: April 2023

Abstract
This chapter tackles psychotherapy as a method of treatment for bipolar disorder. It clarifies that medication is often not sufficient by itself, so psychotherapy will provide the greatest chance of lifelong success in treating the condition. Imaging studies have shown psychotherapy leads to physical changes in the brain. Moreover, bipolar disorder affects the person with the condition and their respective family. A therapist using cognitive-behavioral therapy challenges a patient’s unhealthy thinking patterns while simultaneously encouraging problem-solving skills and healthier choices. The chapter also explores other psychotherapy approaches such as interpersonal psychotherapy, dialectical behavior therapy, and family-focused treatment. It then covers the duration and side-effects of psychotherapy.
Surviving School
Authors: Evans Dwight L. , Benton Tami D. , Ellison Katherine 
Published: April 2023

Abstract
This chapter advises parents to be vigilant about their children with bipolar disorder and what happens in their school. It starts with the alarming statistics of students being sleep-deprived, having stress-related health symptoms, and being constantly anxious about academics. School is a critically important environment at a key time in a child’s life due to its constant and powerful potential impacts on mental health. Heightened stress is especially hard on kids with bipolar disorder and can trigger a downward spiral. The chapter tackles the influence of bullies, isolation, and boycotts on a child’s school experience. If treatment plans, medication, and psychotherapy do not work, parents essentially have three choices: change the school, homeschool, or work with what they’ve got.
Understanding Depression
Authors: Evans Dwight L. , Rynn Moira A. , Ellison Katherine 
Published: April 2023

Abstract
This chapter elaborates on depression, which is an illness that affects the brain and body with subsequent emotional, mental, behavioral, and physical consequences. The clinical definition of major depressive disorder is a pervasive feeling of sorrow, hopelessness, or apathy that lasts more than a couple of weeks for a good part of each day, interferes with daily life, and may not respond to changing circumstances. The chapter provides an overview of diagnosing symptoms of depression, bipolar disorder, and disruptive mood dysregulation disorder. Scientists have found clear evidence linking depression to variation in brain architecture and brain chemistry. The chapter also explains the correlation of depression to gender, race, stress, and genes.
Treatment
Authors: Evans Dwight L. , Rynn Moira A. , Ellison Katherine 
Published: April 2023

Abstract
This chapter explains how medications help treat depression. Even though medication is not a panacea for treating depression, antidepressants have aided many millions of children, adolescents, and adults to ward off depression. Selective serotonin reuptake inhibitors (SSRIs) are known to be the front-line treatment for youth with depression and anxiety. Additionally, suicidal thoughts and behaviors are one of the potential side-effects of SSRIs. The chapter tackles the side-effects of taking medication, citing that patience is needed to achieve the right medication and dose. It advises going to the hospital immediately if the side-effects turn into a high fever, extreme dizziness, blood in stools, fainting, seizures, or suicidal behavior. On the other hand, many prescribers often suggest taking an off-label prescription, which either means it hasn’t been approved by the Food and Drug Administration or it is a medication approved for adults but not for adolescents. The chapter suggests other approaches to treat depression, such as neuromodulation, electroconvulsive therapy, and ketamine.
Life After High School
Authors: Evans Dwight L. , Rynn Moira A. , Ellison Katherine 
Published: April 2023

Abstract
This chapter explores the steps parents can take as their children prepare to complete highschool and plan for their future. Parents with their child need to consider the potential options, manage expectations, and provide open communication in order to figure out the best next step. If the decision is to pursue college, parents should utilize The JED Foundation that offers advice for parents concerned about selecting the right college that will support their child’s mental health needs. Parent with their college bound child need to understand the school’s approach to handling emergencies and informing parents. Young people experiencing significant depression symptoms might want to consider paths that will minimize stress and provide additional time to prepare for school or the work force. The chapter also provides information on government support for people disabled with mental illness.
Why Do We Need Intensive Treatment for OCD?
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Why Do We Need Intensive Treatment for OCD” provides an overview of the fundamentals of obsessive compulsive disorder (OCD), guidelines for how to use this book, and a description of the book’s target audience. It provides an overview of OCD epidemiology and clinical presentation, followed by a review of standard treatments for OCD, including exposure and response prevention (ERP) and selective serotonin reuptake inhibitors (SSRIs). It reviews the evidence base supporting ERP and SSRIs alone and in combination. It discusses limitations of standard treatment, the rationale for intensive and concentrated OCD treatment, and populations of patients for whom one should consider intensive treatment. The continuum of care for OCD is reviewed along with how intensive outpatient treatment fits within it. A review of the literature and case presentations are used in the chapter.
Evidence for Intensive Treatment Programs
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Evidence for Intensive Treatment Programs” reviews the evidence base behind intensive treatment programs. While original treatment protocols for obsessive compulsive disorder (OCD) are based on a “one-session-per-week” outpatient format, there is ample and growing support for providing OCD treatment in a more intensive manner. An advantage to this treatment model is that it is not actually one rigid model, but an umbrella term referring to intensifying treatment, which can be done in many ways. Intensive treatment tends to span 3 to 15 hours a week and can provide the same skills and intervention in a condensed time period or the same treatment at a higher “dose” or intensity. These treatments are gaining popularity, are as effective as weekly therapy, and have unique benefits for special populations.
Clinical Benefits of Intensive Pediatric OCD Treatment Models
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Clinical Benefits of Intensive Pediatric OCD Treatment Models” discusses the practical benefits of an intensive treatment model and describes the type of patient population that can greatly benefit from an intensive treatment approach. Providing an increased number of intervention hours in a given week can allow for faster traction on symptom reduction. The potentially greater gains and symptom reduction in a shorter period of time may decrease functional impairment, which allows patients to return to age-appropriate and expected activities. Patients with OCD symptoms in the moderate-to-severe range are ideal candidates for intensive treatment. While there are many practical benefits of intensive treatment for pediatric OCD, this chapter reviews important considerations to determine whether intensive treatment is an appropriate fit for each family.
Program Format: Balancing Structure and Flexibility
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Program Format: Balancing Structure and Flexibility” describes the specific considerations related to an intensive treatment program’s structure. These include daily program hours, total number of hours per week, relative number of group versus individual sessions, and how to provide flexibility and options for individual participants within a larger program framework. Examples of program hours and activities are provided, as well as considerations for group and/or individual treatment components, rolling admissions when treatment includes multiple group members, and telehealth considerations. The chapter closes with a review of optimal facilities and physical space in various settings, as well as ideal institutional support for maintaining an intensive program in the long term.
Barriers, Challenges, and Solutions: Planning for Successful Program Implementation
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Barriers, Challenges, and Solutions: Planning for Successful Program Implementation” examines factors specific to providers, consumers, and systems/infrastructure to consider when developing an intensive treatment program for obsessive compulsive disorder (OCD). It describes how providers must consider personal temperament and interests, time allocation, and clinical staffing before launching an intensive treatment program. It then considers potential patient barriers, including cost, geography, time commitment, and personal preferences. Finally, it describes systems and infrastructure factors that must be considered. Topics discussed include clinical space, target patient populations, community needs, finances, regulations, and managed care. The chapter emphasizes the need to carefully reflect on these topics before starting an intensive treatment program for OCD. It also encourages flexible thinking and creativity to create a program that considers the specifics of a given provider, consumer population, and system.
Treatment Pathway: From Referral to Aftercare
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Treatment Pathway: From Referral to Aftercare” describes the four phases of the treatment process, including preintake screening, intake assessment, active treatment, and treatment tapering. It provides a step-by-step guide on how clinicians can consider each part of the process, from the first phone call to assess eligibility before a full intake assessment and through the full and comprehensive intake, which determines eligibility and additionally provides rich clinical information to inform the treatment plan. Clinicians and providers should consider each phase from the beginning of treatment to ensure that the tapering of and ending of treatment are smooth and successful. Various comorbidities are considered that may make treatment challenging, and practical advice is provided on how to sequence different treatment plans to maximize success.
Medication in the Context of an Intensive Treatment Program
Authors: Falk Avital , Bennett Shannon , Rozenman Michelle , Mohatt Justin , Bergman R. Lindsey 
Published: April 2023

Abstract
“Medication in the Context of an Intensive Treatment Program” describes the role of medication in the treatment of obsessive compulsive disorder (OCD), special considerations for intensive treatment programs, and common medication-related questions encountered by clinicians providing intensive treatment. It explains why it is critical that therapists have some working knowledge of medications and their role in OCD treatment. It reviews first-line medical treatments, including selective serotonin reuptake inhibitors (SSRIs) and clomipramine, as well as risks associated with using as needed (PRN) medications such as benzodiazepines. It describes the evidence base for cognitive behavioral therapy (CBT), SSRIs, and combination treatment. It provides an overview of medication dosing in children and adolescents with OCD and considers how to sequence medication, CBT, and exposure and response prevention (ERP) and duration of treatment.
Treating Chronic Breathlessness in Severe Chronic Obstructive Pulmonary Disease
Authors: Reinke Lynn F. , Roberts Mary M. , Smith Tracy A. 
Published: April 2023

AbstractThe patient whose case is discussed in this chapter has severe chronic obstructive pulmonary disease (COPD) and experiences breathlessness on a daily basis, both at rest and on mild exertion. These acute breathlessness episodes are frightening to him and induce panic. The intensity of the patient’s breathlessness is worsening due to inactivity, and he feels helpless. His wife needs to help him with activities of daily living. His underlying COPD means that he has reduced gas exchange and he is dependent on supplemental oxygen therapy. This chapter discusses the physiology of breathlessness and the psychosocial needs of patients and presents evidence-based nonpharmacological and pharmacological approaches to managing acute and chronic breathlessness in patients with COPD.
Panting for Breath in End-Stage Dementia
Authors: Goderie-Plomp Hermien W. , Parsons Carole , Mehr David R. , van der Steen Jenny T. 
Published: April 2023

Abstract
When a person with advanced dementia develops respiratory symptoms, infection, pulmonary embolism, and heart failure are considerations. Pneumonia often has a high mortality rate and high symptom burden. While a decision to focus on palliative treatment is often appropriate, even with prior discussions families may experience considerable distress. Dyspnea can usually be controlled with opioids, typically morphine. Other symptoms, such as reduced oral intake and dehydration, pain, fever, and neuropsychiatric symptoms, are also discussed. The need for careful symptom monitoring, preferably with observation scales, and swift interventions to alleviate the symptom burden is highlighted. Family support and guidance on a daily basis are important treatment foci.
Topographic Anatomy and Physiologic Considerations
Authors: Harvey N. Robert , Wilson Sylvia H. 
Published: April 2023

Abstract
The ability to select the optimal regional technique requires a detailed understanding of anatomy and local anesthetic properties. Anatomic knowledge must include gross surface anatomy as it corresponds with neurologic innervation and include basic neurologic anatomy. Further, neuraxial blocks require an intricate knowledge of the dermatomal distribution where analgesia is needed, combined with the posterior anatomic landmarks that will guide correct needle placement to deliver targeted analgesia. In the same way, comprehension of peripheral nerve and plexus anatomy is also needed to ensure that anesthetic coverage is maximized and analgesia optimized during placement of plexus, peripheral nerve block, or fascial blocks. Similarly, various factors may impact both the onset and duration of neuraxial and peripheral techniques. In this regard, comprehension of local anesthetic characteristics, basic nerve properties, and the risks and benefits of different regional techniques is needed. Ultimately the regional technique, local anesthetic type, and local anesthetic dose and volume will depend on patient factors and procedure factors.
Prolonging Nerve Blocks
Authors: Alexander Brenton , Gabriel Rodney 
Published: April 2023

Abstract
The anesthesia community has been interested in prolonging nerve blockade for over 100 years. While continuous analgesia via peripheral nerve catheters (PNCs) remains the best option for extending block duration, many adjuvants to local anesthetics (LAs) have been investigated and used clinically. This chapter reviews the available clinical research for the most popular perineural LA additives, with the intention of providing the reader with clinical education and practice guidance. While there is an abundance of publications exploring this topic, and some recommendations can be made, there remain significant knowledge gaps that must be addressed before any of the options can be confidently recommended.
Cervical Plexus Block for Carotid Endarterectomy
Authors: Farkas Shimon Gabriel , Vlassakov Kamen V. 
Published: April 2023

Abstract
Carotid artery stenosis is a life-threatening condition caused by accumulation of atheromatous plaques in the carotid arteries, typically at the carotid bifurcation. These plaques restrict blood flow and can shower micro emboli into the ipsilateral cerebral hemisphere, causing transient ischemic attacks, as well as fatal ischemic strokes. The treatment options for carotid stenosis depend on symptomology, severity of stenosis, and whether the risk of surgery outweighs the risk of intraoperative myocardial infarction or stroke. Medical management focuses on optimizing blood pressure, cholesterol, cessation of smoking, and anti-platelet therapy, but the mainstay therapy remains surgical correction with a carotid endarterectomy (CEA), which has been shown to be very effective in specific patient populations. Patients with atherosclerotic carotid disease typically have other comorbidities, such as coronary artery disease (CAD), hypertension, diabetes, and peripheral vascular disease, complicating intraoperative management. Currently, most institutions employ either general endotracheal or regional anesthesia techniques for CEA, with each having their specific benefits, but with comparable records of efficacy and safety. Cervical plexus block (CPB), in its variety of techniques, has been shown to be very effective at providing surgical anesthesia. However, due to perceived technical difficulty and the potential complication risks on one hand, and surgeon and patient preferences on the other hand, this method remains relatively underutilized, leading to further lack of consistent clinical teaching and practice across US training programs.
Breast Surgery
Authors: Chiao Franklin , Chin Simon , Nada Eman 
Published: April 2023

Abstract
Breast surgery is a common surgical procedure. It includes a range of surgeries as an excisional biopsy, lumpectomy, mastectomy, cosmetic surgery, and mastectomy with breast reconstruction. Mastectomy with autologous breast reconstruction is a big surgery. The graft is usually taken from the rectus abdominus muscle, latissimus dorsi, or the gluteal muscles. The breast and the donor sites are sources of significant postoperative pain; however, the donor site is usually more painful. Without nerve blocks, patients use significant amounts of opioids. This chapter discusses the different regional anesthesia techniques for treating postoperative pain control in breast reconstructive surgery and their pros and cons. It also discusses the breast-enhanced recovery program and its impact on the length of hospital stay.
Emergency Exploratory Laparotomy
Authors: Salinas Francis V. 
Published: April 2023

Abstract
Emergent exploratory laparotomy is not an uncommon procedure faced by the practicing anesthesiologist. The most common surgical approach (incision) is via a midline vertical incision. The extent of the incision is determined by the underlying surgical pathology, and the exposure required to explore the abdominal cavity and associated visceral and vascular organs of interest. The incision may be limited to the upper abdomen, lower abdomen, periumbilical region, or may extend from the xiphoid to the pubic symphysis. Regional anesthesia-analgesia with ultrasound-guided nerve blocks of the thoracolumbar nerves supplying the anterolateral abdominal wall can provide clinically relevant analgesia after emergent exploratory laparotomy and may offer a wider application and decreased risk profile compared to thoracic epidural analgesia. A thorough understanding of the anatomy and sensory innervation of the anterolateral abdominal wall is the key to choosing which approach to utilize, maximizing the success rate for correct placement of local anesthetic injection, and decreasing the incidence of potential complications.