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1
Preedy, Victor R. Beer in health and disease prevention. Amsterdam: Elsevier/Academic Press, 2009.
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2
Rätsch, Christian. Urbock: Bier jenseits von Hopfen und Malz : von den Zaubertränken der Götter zu den psychedelischen Bieren der Zukunft. Aarau [Switzerland]: AT Verlag, 1996.
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3
Turner, Thomas Bourne. Forward together: Industry and academia : history of the Alcoholic Beverage Medical Research Foundation, 1969-1991. Baltimore, Md: ABMRF, 1993.
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4
L, Bennett Virginia, and Alcoholic Beverage Medical Research Foundation., eds. Forward together: Industry and academia : history of the Alcoholic Beverage Medical Research Foundation, 1969-1991. Baltimore: The Foundation, 1993.
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5
Turner, Thomas Bourne. Forward together: Industry and academia : history of the Alcoholic Beverage Medical Research Foundation, 1969-1991. Baltimore: The Foundation, 1993.
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6
Beer Belly Blues Becoming The Ultimate Male Again What Every Aging Man And The Women In His Life Need To Know. Abundant Health Systems Inc., 2010.
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7
Mahon, Anthony D. Aerobic training. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199232482.003.0039.
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Aerobic training is defined as exercise training that involves whole body endurance activity that is sustained for a sufficient length of time and at a sufficient intensity in order to improve cardiorespiratory fitness.1 The effect of aerobic training on physiological function in children has been investigated for nearly four decades. Some of this research has focused on the health-related benefits of this type of training on children and adolescents and for good reason. With increasing rates of obesity, type 2 diabetes, metabolic syndrome, and many other physical inactivity-related disorders, there is ample reason to discern the health-related effects of aerobic training during the paediatric years.2,3 However, there also has been a concerted effort to study the effect of aerobic training on the physiological adaptations, particularly maximal oxygen uptake ( V · O 2 max), that are associated with endurance performance.4 This chapter will focus on the latter consideration and will examine the effect of aerobic training in apparently healthy children and adolescents.
8
Wade, Carlson. Carlson Wade's New Fact/Book on Bee Pollen and Your Health. Keats Publishing, 1994.
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9
illustrator, Standeford Brian, ed. What's it like in space?: Stories from astronauts who've been there. 2016.
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10
Williams, Scot N. Assessing the phosphorus status of growing beef heifers. 1988.
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11
(US), National Research Council. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII – Phase 2 (Beir). National Academies Press, 2006.
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12
A, Mizrahi, Lensky Yaacov, and International Conference on Bee Products: Properties, Applications, and Apitherapy (1996 : Tel Aviv, Israel), eds. Bee products: Properties, applications, and apitherapy. New York: Plenum Press, 1997.
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13
(Editor), Avshalom Mizrahi, and Yaacov Lensky (Editor), eds. Bee Products: Properties, Applications and Apitherapy. Springer, 1997.
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14
Health Effects Of Exposure To Radon Beir Vi Committee On Health Risks Of Exposure To Radonbeir Vi Board On Radiation Effects Research Commission On Life Sciences National Research Council. National Academies Press, 1999.
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15
Neibergs, Holly Louise. Serum luteinizing hormone and testosterone concentrations after administration of LHRH analog microcapsules in pony stallions and synchronization of estrus in yearling beef heifers with melengestrol acetate and prostaglandin F₂Ü. 1988.
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16
National Research Council (U.S.). Committee to Assess Health Risks from Exposure to Low Level of Ionizing Radiation, ed. Health risks from exposure to low levels of ionizing radiation : BEIR VII Phase 2. Washington, D.C: National Academies Press, 2006.
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17
Aloia, Lindsey S., Amanda Denes, and John P. Crowley, eds. The Oxford Handbook of the Physiology of Interpersonal Communication. Oxford University Press, 2020. http://dx.doi.org/10.1093/oxfordhb/9780190679446.001.0001.
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In the past decade, there has been an increased focus on the role of physiology in interpersonal interactions, resulting in a surge of research exploring topics related to communication in close relationships. This growing line of research has explored topics such as affectionate communication, forgiveness, communication apprehension, and social support. Contributing to the increase in physiological research on communication processes is a greater recognition of the bidirectional nature of the associations among communication and the body. Researchers studied both the physiological outcomes of communication episodes (e.g., stress responses to conflict conversations) and the effects of physiology on the communication process (e.g., the influence of hormones on postsex communication). The Oxford Handbook of the Physiology of Interpersonal Communication offers a comprehensive review of the most prolific areas of research investigating both the physiological outcomes of interpersonal communication and the effects of physiology on interpersonal interactions. This edited volume serves as a resource for both researchers and students interested in investigating the mutual influence of physiology and communication in close relationships.
18
Moore, Charles, and Sarah S. Mosko. The Plastic Age. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190490911.003.0002.
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We describe the environmental and physiologic consequences of our toxic love affair with synthetic polymers in the Anthropocene epoch’s plastic age. It took only three generations for man-made polymers to attain ubiquity. The masses of synthetic polymers invading billions of lives and every part of the globe have created wealth and convenience, but their use also has generated surprising and unwanted outcomes such as intractable pollution problems and adverse health effects for humans and animals. Plastic often is perceived as an inert and physiologically harmless, because most polymers have little taste or smell, but numerous chemicals attach to and leach from polymeric materials. Many are bioactive and have been implicated as etiologic agents in diverse pathologies. The ocean is downhill from nearly everywhere on earth and receives plastic waste from far inland as well as from coastal areas. Ocean currents gather the floating fraction in enormous eddies known as gyres.
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Taccone, Paolo, and Davide Chiumello. Prone positioning in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0099.
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Prone positioning (also known as ‘proning’, ‘prone manoeuvre’ or ‘prone ventilation’) refers to mechanical ventilation with patients positioned in prone position in contrast of standard supine (flat or semi-recumbent) position. The use of the prone positioning was proposed over 30 years ago as a means to improve arterial oxygenation in patients with acute respiratory distress syndrome (ARDS). Since then, extensive physiological research has been conducted to explore the possible mechanisms underlying the observed improvement in gas exchange, which involve changes in the distribution of both ventilation and pulmonary blood flow. Furthermore, it has been shown that, independently of gas exchange, prone positioning may reduce the harm of mechanical ventilation, which is known to adversely impact patient survival. In this chapter we will summarize the physiological effect of prone positioning, as well as the clinical evidences supporting its use to reduce mortality in patients with ARDS.
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Classen, Joseph, and Katja Stefan. Changes in TMS Measures induced by repetitive TMS. Edited by Charles M. Epstein, Eric M. Wassermann, and Ulf Ziemann. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780198568926.013.0016.
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This article reviews several protocols of repetitive transcranial magnetic stimulation (rTMS)-induced plasticity. rTMS, when applied to the motor cortex or other cortical regions of the brain, may induce effects that outlast the stimulation period. The neural plasticity, which emerges as a result of such interventions, has been studied to gain insight into plasticity mechanisms of the brain. In two protocols the structure of rTMS trains is modified, informed by the knowledge of the physiological properties of the corticospinal system. Pulse configuration, stimulus frequency, stimulus intensity, the duration of the application period, and the total number of stimuli are some variables that have to be taken into account when reviewing the physiological effects of rTMS. This article also introduces the concept of patterned rTMS pulses and rTMS with ischemic nerve block. In addition, rTMS has raised considerable interest because of its therapeutic potential; however, much needs to be done in this field.
21
Wenzel, Amy. Perinatal Psychology. Edited by Amy Wenzel. Oxford University Press, 2015. http://dx.doi.org/10.1093/oxfordhb/9780199778072.013.33.
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Most adults undergo the transition to parenthood, yet there is a great deal of mystery and uncertainty inherent in this period of time. Because the perinatal period is of great interest to scholars and laypeople alike, much research has been dedicated to the psychological, behavioral, physiological, and neurochemical experiences associated with pregnancy and lactation. This chapter identifies key themes in the perinatal literature and future directions for research. An abundance of research has characterized and described the changes that women undergo during the transition to parenthood, the effects of adjustment problems on women and their infants, and interventions to assist women who are experiencing or are at risk for adjustment problems. Future interdisciplinary research is necessary to capture the complex interactions among psychological, behavioral, physiological, neurochemical, and environmental variables that can explain good and poor outcomes associated with pregnancy, childbirth, and postpartum adjustment.
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Perkins, Elizabeth C., Shaun P. Brothers, and Charles B. Nemeroff. Animal Models for Post-Traumatic Stress Disorder. Edited by Charles B. Nemeroff and Charles R. Marmar. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190259440.003.0024.
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Animal models of post-traumatic stress disorder (PTSD) provide a wellspring of biological information about this complex condition by providing the opportunity to manipulate trauma exposure and measure biological outcomes in a systematic manner that is not possible in clinical studies. Symptoms of PTSD may be induced in animals by physical (immobilization, foot shock, underwater stress) and psychological stressors (exposure to predator, social defeat, early life trauma) or a combination of both. In addition, genetic, epigenetic and transgenic models have been created by breeding animals with a behavioral propensity for maladaptive stress response or by directly manipulating genes that have been implicated in PTSD. The effect of stressors in animals is measured by a variety of means, including observation of behavior, measurement of structural alterations in the brain and of physiological markers such as HPA axis activity and altered gene expression of central nervous system neurotransmitter system components including receptors. By comparing changes observed in stress exposed animals to humans with PTSD and by comparing animal response to treatments that are effective in humans, we can determine the validity of PTSD animal models. The identification of a reliable physiological marker of maladaptive stress response in animals as well as standard use of behavioral cutoff criteria are critical to the development of a valid animal model of PTSD.
23
Fancourt, Daisy. The theoretical background to arts in health. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198792079.003.0002.
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This chapter explores how definitions of health have shifted over the past 200 years. It charts the rise of the biomedical model, considering its position in relation to other fields of work, including public health, psychosomatic medicine, and behavioural medicine. It examines the theories of psychiatrist George Engel and his proposition of the biopsychosocial model, and the steady increase in theory and research around mental health, positive psychology, and wellbeing. Research into the health benefits of the arts are then explored in relation to these theoretical frameworks to illustrate the wide-ranging biological, physiological, psychological, and social effects of the arts that have been identified.
24
Morris, Craig Eric, Melanie L. Beaussart, Chris Reiber, and Linda S. Krajewski. Intrasexual Mate Competition and Breakups. Edited by Maryanne L. Fisher. Oxford University Press, 2016. http://dx.doi.org/10.1093/oxfordhb/9780199376377.013.19.
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Female competition for male attention is multifaceted. Typically psychological and relational in nature, this competition may be no less damaging than physical violence more commonly used between males. Research on female–female mate competition has examined short-term effects, yet how women cope with long-term effects of romantic relationship dissolution has been little explored. If negative emotions exist because they provide an evolutionary advantage (attuning physiological processes, thoughts, and behaviors to deal with situations that have frequently incurred high fitness costs), then emotions arising from the loss of a mate to a sexual rival may potentially motivate actions that could make one avoid this scenario in the future. This essay argues that there are consequences of female intrasexual mate competition that may be both evolutionarily adaptive and also beneficial in terms of personal growth and that may expand beyond mating and into other realms of personal development.
25
Newberg, Andrew B., and David B. Yaden. The Neurobiology of Meditation and Stress Reduction. Edited by Anthony J. Bazzan and Daniel A. Monti. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190690557.003.0004.
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Meditation is a complex mental process that involves changes in cognition, sensory perception, emotions, hormones, and autonomic activity. Several brain regions are involved in these practices, particularly as they relate to improvements in brain function and psychological parameters, including the thalamus, frontal lobes, limbic system, and parietal lobes. Additionally, many different neurotransmitter systems are likely affected by meditation practices. Meditation programs have become widely used, either alone or combined with other therapies, for stress reduction depression, anxiety, and posttraumatic stress disorder. There has been an increasing understanding of the overall biological mechanism of meditation practices in terms of their effects on both the brain and body. Recent studies using clinical tools and functional neuroimaging have substantially augmented the knowledge of the biology of meditative practices. This chapter reviews current understanding regarding the physiological and neurophysiological effects of meditation practices as they pertain to brain health.
26
Troisi, Alfonso. Nepotism. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199393404.003.0014.
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Nepotism is a social habit that is commonly condemned because it threatens our confidence in meritocracy and offends our sense of fair play. Yet, nepotism has been a common practice in different cultures throughout ancient, modern, and contemporary history. This chapter explores the biological bases of this powerful human inclination to help one’s own and to introduce the reader to those evolutionary theories that account for nepotistic behaviors: kin selection and reciprocal altruism. The chapter briefly reviews the physiological and psychological mechanisms that allow kin recognition and the cultural means that have been developed by human societies to expand the definition of kinship to include nongenetic relatives. The concluding reflection of the chapter is that nepotism was a driving force in human evolution but, in contemporary large-scale societies, its practice can have disrupting effects because it is incompatible with individual rights.
27
Wójcik-Gładysz, Anna. Ghrelin – hormone with many faces. Central regulation and therapy. The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, 2020. http://dx.doi.org/10.22358/mono_awg_2020.
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Discovered in 1999, ghrelin, is one of the peptides co-creating the hypothalamicgastrointestinal axis, otherwise known as the brain-gut axis. Ghrelin participates in many physiological processes and spectrum of its activity is still being discovered. This 28 amino acid peptide ‒ a product of the ghrl gene, was found in all vertebrates and is synthesized and secreted mainly from enteroendocrine X/A cells located in the gastric mucosa of the stomach. Expression of the ghrelin receptor has been found in many nuclei of the hypothalamus involved in appetite regulation. Therefore it’s presumed that ghrelin is one of the crucial hormones deciphering the energy status required for the maintenance of organism homeostasis. Ghrelin acts as a signal of starvation or energy insufficiency and its level in plasma is reduced after the meal. Neuropeptide Y (NPY) and agouti-related peptide (AgRP; NPY/AgRP) neurons located in the arcuate nucleus (ARC) area are the main target of ghrelin in the hypothalamus. This subpopulation of neurons is indispensable for inducing orexigenic action of ghrelin. Moreover ghrelin acting as a neurohormone, mainly in the hypothalamus area, plays an important role in the regulation of growth and reproduction processes. Indeed, ghrelin action on reproductive processes has been observed in the systemic effects exerted at both hypothalamus-pituitary and gonadal levels. Similarly the GH-releasing ghrelin action was observed both on the hypothalamus level and directly on the somatotrophic cells in the pituitary and this dose-related GH releasing activity was found in in vitro as well as in in vivo experiments. In recent years, numerous studies revealed that ghrelin potentially takes part in the treatment of diseases associated with serious disturbances in the organism energy balance and/or functioning of the gastrointestinal tract. It was underlined that ghrelin may be a hormone with a broad spectrum of therapeutic effect on obesity and anorexia nervosa, as well as may also have protective effect on neurodegenerative diseases, inflammatory disorders or functional changes in the body caused by cancers. In overall, ghrelin treatment has been tested in over 100 preclinical studies with healthy volunteers as well as patients with various types of cancer, eating disorders such as anorexia nervosa and bulimia nervosa. It was observed that ghrelin has an excellent clinical safety profile and emerging side effects occurred only in 3–10% of patients and did not constitute a sufficient premise to discontinue the therapy. In general, it can be concluded that ghrelin may be sufficiently used as a prescription drug.
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Karan, Lori D. Pain and Addiction in Patients Who Smoke Cigarettes (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0029.
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Through a discussion of the effects of cigarette smoking on both pain perception and other substance use, this chapter outlines the presentation of the benefits to the patient and reviews smoking cessation strategies. It begins with an epidemiological review of the higher prevalence of smoking among those with chronic pain syndromes, such as fibromyalgia, headache, and low back pain. The many adverse consequences of cigarette smoking for general health are identified, from enhanced osteoporosis to prolonged wound repair. Most strikingly, smoking is demonstrated to both exacerbate the experience of pain and lead to a heightened requirement for opioid analgesia. Its overlap with other substance use disorders has long been recognized, including an association with higher relapse rates to alcohol and other drugs. A table is provided detailing the physiological improvements seen upon smoking cessation.
29
Sommer, Martin, and Walter Paulus. TMS waveform and current direction. Edited by Charles M. Epstein, Eric M. Wassermann, and Ulf Ziemann. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780198568926.013.0002.
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This article introduces the difference between biphasic and monophasic transcranial magnetic stimulation (TMS). Waveform and current direction determine the effectiveness of TMS in humans. The alternating use of mono and biphasic pulses as conditioning or test pulse has so far not been possible. Since pulses of different waveform or orientation cannot be applied through the same coil at an interval in the millisecond range, using two different coils could be a feasible approach. This article brings in the concept of repetitive TMS (rTMS). Although clinical relevance is lacking, there is plenty of interesting data available for rTMS. Both pulse configuration and current direction affect the modulation of corticospinal excitability induced by rTMS. The effects during rTMS may differ from those outlasting rTMS. Further studies are needed to confirm the histological and physiological basis for these differences, and to clarify their clinical relevance.
30
Awan, Kanwal, and Martin Steinberg. Medical Conditions That May Cause Cognitive Impairment and Depression. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199959549.003.0005.
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Ruling out medical conditions that can cause depression or cognitive impairment is essential in effectively caring for elderly patients. Case examples illustrate how these may present. Diabetes can cause confusion due to either hyper- or hypoglycemia. Congestive heart failure and chronic obstructive lung disease can cause hypoxia and resulting confusion. Sleep apnea can present with amnesia, apathy, and depression. Physiological changes make elderly patients especially susceptible to adverse drug effects, including hyponatremia and anticholinergic symptoms. Depression and cognitive changes have been associated with both hyper- and hypothyroidism, as well as with hyperparathyroidism. Elderly patients are at risk for developing subdural hematomas which can present with cognitive deficits and blunting of mood, and some patients may not have taken notice of the traumatic incident. Vitamin B12 deficiency can present with neurological symptoms including dementia, and cancer may present with fatigue and weight loss, which may be interpreted as depression.
31
Yang, James. Endocrine Disorders: Integrative Treatments of Hypothyroidism, Diabetes, and Adrenal Dysfunction. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190466268.003.0014.
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Thyroid function, glucose metabolism, and an adaptive hypothalamic–pituitary–adrenal (HPA) axis are critical determinants of health and wellness. This chapter highlights the integrative physiology and interactions between these three systems and an integrative medicine approach to these conditions. Integrative medicine expands the evaluation of endocrine dysfunction through a person-centered approach. Patients’ overall symptoms and physiological function should be taken into account in evaluating thyroid function and planning treatment. Our approach to diabetes focuses on the importance of lifestyle changes and nutrition. Our perspective of the effects of chronic stress has been informed by current perspectives on neurobiology and neuroplasticity; chronic stress leaves its mark on the brain through changes in structure as well as its function in adapting to further stress. We present an integrative approach to manage and improve these three endocrine systems to address disease and improve patients’ energy and health.
32
McLean, Peter D., and Sheila R. Woody. Anxiety Disorders in Adults. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780195116250.001.0001.
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In this title, the authors review psychosocial treatments for anxiety disorders, focusing on the scientific basis and demonstrated outcomes of the treatments. Cognitive-behavioral therapies are highlighted, as they have been the most frequently investigated approaches to treating anxiety disorders. Individual chapters feature specific phobias: social phobia, panic disorder, and generalized anxiety disorder. The book is rich in clinical material and integrates science and clinical practice in an effort to help practitioners to improve the effectiveness of their work with anxious clients. Recently developed psychosocial treatments for anxiety disorders reflect the systematic influence of scientifically generated knowledge, and these new treatments yield strong results. Research in such areas as information processing, cognition, behavioral avoidance, and the physiological components of anxious arousal has increased our knowledge of mediators that cause and maintain anxiety disorders.
33
Price, Susanna, Brian F. Keogh, and Lorna Swan. Congenital heart disease in adults. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199687039.003.0060.
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The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
34
Price, Susanna, Brian F. Keogh, and Lorna Swan. Congenital heart disease in adults. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199687039.003.0060_update_001.
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The number of patients with congenital heart disease surviving to adulthood is increasing, with many requiring ongoing medical attention. Although recommendations are that these patients should be cared for in specialist centres, the clinical state of the acutely unwell patient may preclude transfer prior to the instigation of lifesaving treatment. Although the principles of resuscitation in this patient population differ little from those with acquired heart disease, the acutely unwell adult congenital heart disease patient presents a challenge, with potential pitfalls in examination, assessment/monitoring, and intervention. Keys to avoiding errors include: knowledge of the primary pathophysiology, any interventions that have been undertaken, residual lesions present (static or dynamic), and the normal physiological status for that patient-to determine the precise cause for the acute deterioration and to appreciate the effects (detrimental or otherwise) that any supportive and/or therapeutic interventions might have. Expert advice should be sought at the earliest opportunity.
35
Chakera, Aron, William G. Herrington, and Christopher A. O’Callaghan. Disorders of acid–base balance. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0178.
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Normal metabolism results in a net acid production of approximately 1 mmol/kg day−1. Physiological pH is regulated by excretion of this acid load (as carbon dioxide) by the kidneys and the lungs. A series of buffers in the body reduces the effects of metabolic acids on body and urine pH. For acid–base disorders to occur, there must be excessive intake (or loss) of acid (or base) or, alternatively, an inability to excrete acid. For these changes to result in a substantially abnormal pH, the various buffer systems must been overwhelmed. The pH scale is logarithmic, so relatively small changes in pH signify large differences in hydrogen ion concentration. Most minor perturbations in acid–base balance are asymptomatic, as small changes in acid or base levels are rapidly controlled through consumption of buffers or through changes in respiratory rate. Alterations in renal acid excretion take some time to occur. Only when these compensatory mechanisms are overwhelmed do symptoms related to changes in pH develop. This chapter reviews the causes and consequences of acid–base disorders.
36
Burton, Derek, and Margaret Burton. Integration and control: the nervous system. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780198785552.003.0011.
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The complexity of fish behaviour and information processing indicates high levels of neural, anatomical and functional organization. Neural cells are conducting neurons and neuroglia with putative support and physiological roles. Neuronal conduction, synaptic transmission, reflexes and neuropils are factors in integrative activity and information processing. Fish nervous systems are organized into central (brain and spinal cord) and peripheral (including autonomic) components. Interestingly the structure and function of the fish optic tectum have been considered comparable to those of the tetrapod cerebral cortex. Also of interest are the bilaterally paired large Mauthner fibres in the teleost central nervous system, which mediate startle responses. The autonomic nervous system in fish occupies a pivotal position amongst vertebrates, including uncertainty about the existence of a posterior parasympathetic component. The trend is to regard it in terms of spinal autonomic (sympathetic) cranial autonomic (parasympathetic) and enteric systems. Accounts of the autonomic control of individual effector systems are included.
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Thomas, Dafydd, and Katy Beard. Blood conservation and transfusion in anaesthesia. Edited by Michel M. R. F. Struys. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0051.
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Over the last three decades, avoidance of allogeneic transfusion in order to decrease adverse events within the recipient has become a part of clinical care. Although the main driver was an avoidance of transfusion-transmitted disease, other immunological consequences have been noted, and it is widely regarded as desirable to avoid the use of allogeneic component transfusion unless there is an essential physiological need. Of course this attempt at decreasing allogeneic blood component use has a potentially beneficial effect of blood component supply, leading to decreased use within the surgical specialties, while allowing increased use in clinical cases where there is currently no alternative to the transfusion of allogeneic components, such as those cases who have received chemotherapy and marrow suppression. The development of an array of techniques and treatments to decrease dependence of blood component transfusion has led to a care pathway that attempts to treat preoperative anaemia, minimize operative blood loss, and withhold allogeneic transfusion in the postoperative period according to clinical need. Many questions remain about the appropriate level of haemoglobin depending upon the comorbidities suffered by the patient, which is why patient blood management has gained popularity, as each patient deserves an individual care plan according to need.
38
Lewis, Keir. Smoking. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0338.
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The UK government, in its White Paper in 1998, declared that ‘smoking is the greatest single cause of preventable illness and premature death in the UK’. Cigarette smoke is inhaled because it contains nicotine, which is highly addictive. Nicotine itself has some adverse physiological effects but it is mainly the 4000+ chemicals (including acetone, arsenic, paint stripper, pesticides, and over 60 known carcinogens), added to make the cigarette such an extremely potent nicotine delivery device, that cause so much damage.A smoker dies on average 8–10 years before a non-smoker does. The commonest causes of premature death in smokers are cardiovascular disease, lung cancer, and COPD. However, smoking also leads to much morbidity, causing or worsening many illnesses and affecting every system of the body. In addition, it is associated with a number of cancers, including lung cancer, nasopharyngeal cancer, laryngeal cancer, oesophageal cancer, stomach cancer, pancreatic cancer, colonic cancer, kidney cancer, bladder cancer, cervical cancer, and acute myeloid leukaemia. Stopping smoking at any age has been shown to improve health and increase life expectancy. Even with advanced smoking-related diseases, observational studies show clinically meaningful benefits in stopping smoking.
39
Dahl, Vegard, and Ulrich J. Spreng. Anaesthesia for non-obstetric surgery. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198713333.003.0010.
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Anaesthesia for non-obstetric reasons is performed in 1–2% of all pregnant women. Although the chances of complications like miscarriage, preterm labour, and abortion are higher when surgery is performed during gestation, careful evaluation, preparation, and a multidisciplinary approach will minimize these risks. There are no methods of anaesthesia that are preferable to others during pregnancy. The most important preventive measure is to maintain maternal haemodynamic stability and normoventilation in order to ensure fetal well-being. Extensive knowledge of the profound anatomical and physiological changes that a pregnancy induces is mandatory for the team when operating on a pregnant woman. Short time exposure to anaesthetic agents in clinically relevant doses during surgery has never been demonstrated to have teratogenic effects. Lately, focus has been made on the possible behavioural teratogenic properties of anaesthesia, especially on the use of NMDA receptor antagonists and GABA receptor agonists. Emergency diagnostic imaging during pregnancy is considered safe and should be performed if necessary. Electroconvulsive therapy for the treatment of serious psychiatric disorders during pregnancy is a possibility that should be considered if necessary. Electric cardioversion seems safe for the fetus if life-threatening arrhythmias occur during pregnancy. Trauma is one of the leading non-obstetric causes of maternal mortality and morbidity. When treating a traumatized pregnant woman one should initially focus on the mother’s safety and haemodynamic stability.
40
Sabri, Omar, and Martin Bircher. Management of limb and pelvic injuries. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0336.
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Pelvic ring injuries can be life and limb threatening. The mechanism of injury can often be a good indicator of the type of injury; the Young & Burgess classification deploys that concept to full effect. Early identification based on mechanism of injury and improved prehospital care can play a major role in the outcome following such injuries. Pelvic ring injuries can lead to significant haemorrhage. Mechanical measures to stabilize the pelvis, in addition to modern concepts of damage control resuscitation (DCR), have been shown to be effective in early management of potentially life-threatening haemorrhage. Emphasis is now entirely on protecting the primary clot following a pelvic ring injury. Mechanical disturbance by log rolling the patient or springing of the pelvis are strongly discouraged. Early radiological clearance of the pelvis is encouraged. The lethal triad of coagulopathy, acidosis, and hypothermia should be corrected simultaneously to improve outcome. A traffic light system for monitoring venous lactate as an indicator of the patients’ physiological state can help the intensive care practitioner and the surgeon identify optimum timing for surgery. Pelvic ring injuries are associated with significant concomitant injuries. Limb trauma can also be life or limb threatening. Early identification, splinting, and resuscitation follow the same guidelines as pelvic ring injuries. Open long bone fractures should be managed by senior orthopaedic and plastic surgeons.
41
Peppin, John, Joseph V. Pergolizzi, Robert B. Raffa, and Steven L. Wright, eds. The Benzodiazepines Crisis. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780197517277.001.0001.
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When properly prescribed, benzodiazepines and related “Z” drugs, are usually safe and effective. However, some patients experience lack of efficacy, severe adverse effects, and/or protracted withdrawal symptoms. Unfortunately, there is no reliable way to predict outcome prior to treatment. Use has dramatically expanded, to the point where some experts suggest a disconnect with actual medical need. With increased and longer prescribing there has been a corresponding increase in the “down-side” of these drugs. Benzodiazepines, as all drugs, produce some degree of normal physiologic tolerance and physical dependence. But for some patients withdrawal can result in a bewildering array of symptoms, that can persist for protracted time periods, difficult to understand and live with. Although there is currently no clear mechanistic explanation, some potentials include alterations of receptor number, promoters of receptor protein synthesis or degradation, absorption, distribution, metabolism, and elimination, GABAA-receptor function or subtype-distribution, or involvement of peripheral benzodiazepine binding/receptor sites. This book attempts to bring benzodiazepine use under a more rational paradigm and reduce the incidence of side-effects and drug–drug interactions (DDI). It is the first devoted to take on this responsibility. Use, overuse/misuse, side-effects, DDI, physiology, and withdrawal are reviewed by expert clinicians and basic scientists in-depth. The book challenges the medical community to take seriously the use of this class of drug and to ameliorate prescribing behavior. The case is made for limiting initiation and duration (2–4 weeks) of use, and careful, supported discontinuation. We laud and suggest increased research into this class of drug and it’s “down-side.”
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Sidhu, Kulraj S., Mfonobong Essiet, and Maxime Cannesson. Cardiac and vascular physiology in anaesthetic practice. Edited by Jonathan G. Hardman. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0001.
Full textAbstract:
This chapter discusses key components of cardiovascular physiology applicable to clinical practice in the field of anaesthesiology. From theory development to ground-breaking innovations, the history of cardiac and vascular anatomy, as well as physiology, is presented. Utilizing knowledge of structure and function, parameters created have allowed adequate patient clinical assessment and guided interventions. A review of concepts reveals the impact of multiple physiological variables on a patient’s haemodynamic state and the need for more accurate and efficient measurements. In particular, it is noted that a more reliable index of ventricular contractility is the end-systolic elastance rather than the ejection fraction. Constant direct preload assessment has not yet been achieved but continues to be determined through surrogate variables, and continuous cardiac output monitoring for oxygen delivery, although advancing, has limitations. Considering the effect of compound factors perioperatively, especially heart failure, modifies the goals and interventions of anaesthetists to achieve improved outcomes. Therefore, medical management prior to surgery and complete assessment through history, physical examination, and diagnostic tests are a priority. This chapter also details the expectations following volume expansion to augment haemodynamics during surgery, the concept of functional haemodynamic monitoring, and limitations to the parameters applied in assessing fluid responsiveness. Challenging the accuracy of conventional indices to predict volume status led to the use of goal-directed therapy, reducing morbidity and minimizing length of hospital stay. The mainstay of this chapter is to reinforce the relevance of advances in haemodynamic monitoring and homeostasis optimization by anaesthetists during surgery, using fundamental concepts of cardiovascular physiology.
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Gutiérrez, Orlando M. Fibroblast growth factor 23, Klotho, and phosphorus metabolism in chronic kidney disease. Edited by David J. Goldsmith. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0119.
Full textAbstract:
Fibroblast growth factor 23 (FGF23) and Klotho have emerged as major hormonal regulators of phosphorus (P) and vitamin D metabolism. FGF23 is secreted by bone cells and acts in the kidneys to increase urinary P excretion and inhibit the synthesis of 1,25 dihydroxyvitamin D (1,25(OH)2D) and in the parathyroid glands to inhibit the synthesis and secretion of parathyroid hormone. Phosphorus excess stimulates FGF23 secretion, likely as an appropriate physiological adaptation to maintain normal P homeostasis by enhancing urinary P excretion and diminishing intestinal P absorption via lower 1,25(OH)2D. The FGF23 concentrations are elevated early in the course of chronic kidney disease (CKD) and may be a primary initiating factor for the development of secondary hyperparathyroidism in this setting. Klotho exists in two forms: a transmembrane form and a secreted form, each with distinct functions. The transmembrane form acts as the key co-factor needed for FGF23 to bind to and activate its cognate receptor in the kidneys and the parathyroid glands. The secreted form of Klotho has FGF23-independent effects on renal P and calcium handling, insulin sensitivity, and endothelial function. Disturbances in the expression of Klotho may play a role in the development of altered bone and mineral metabolism in early CKD. In addition, abnormal circulating concentrations of both FGF23 and Klotho have been linked to excess cardiovascular disease, suggesting that both play an important role in maintaining cardiovascular health.
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Trivedi, Madhukar H., and Steven M. Strakowski, eds. Depression. Oxford University Press, 2019. http://dx.doi.org/10.1093/med/9780190929565.001.0001.
Full textAbstract:
Major depressive disorder is a serious, debilitating, life-shortening illness that affects many persons of all ages and backgrounds. The point prevalence is high (2.3%–3.2% in men, 4.5%–9.3% in women) and the lifetime risk is 7% to 12% for men and 20% to 25% for women. Major depression is a disabling disorder that costs the United States over $200 billion per year in direct and indirect costs. Depression also has detrimental effects on all aspects of social functioning, such as self-care, social role, and family life, including household, marital, kinship, and parental roles. While there have been several treatments that are efficacious, many individuals suffering from depression experience life-long challenges due to the often chronic and episodic nature of the disease. Identifying strategies to find the right treatments for the right patients is critical. Ongoing research has explored the importance of examining physiologic biomarkers as well as clinical characteristics to gain a better understanding of subtypes of depression, which will lead to improved treatments and better outcomes. This book provides an introduction to the etiology and pathophysiology of depression, common comorbidities and differential diagnoses, pharmacotherapy strategies, psychotherapeutic and neuromodulation interventions, novel and nontraditional treatment strategies, and considerations in special populations.
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Gill, Steven J., and Michael H. Nathanson. Central nervous system pathologies and anaesthesia. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0081.
Full textAbstract:
Anaesthesia induces changes in many organ systems within the body, though clearly none more so than the central nervous system. The physiology of the normal central nervous system is complex and the addition of chronic pathology and polypharmacy creates a significant challenge for the anaesthetist. This chapter demonstrates a common approach for the anaesthetist and specific considerations for a wide range of neurological conditions. Detailed preoperative assessment is essential to gain understanding of the current symptomatology and neurological deficit, including at times restrictions on movement and position. Some conditions may pose challenges relating to communication, capacity, and consent. As part of the consent process, patients may worry that an anaesthetic may aggravate or worsen their neurological disease. There is little evidence to support this understandable concern; however, the risks and benefits must be considered on an individual patient basis. The conduct of anaesthesia may involve a preference for general or regional anaesthesia and requires careful consideration of the pharmacological and physiological impact on the patient and their disease. Interactions between regular medications and anaesthetic drugs are common. Chronically denervated muscle may induce hyperkalaemia after administration of succinylcholine. Other patients may have an altered response to non-depolarizing agents, such as those suffering from myasthenia gravis. The most common neurological condition encountered is epilepsy. This requires consideration of the patient’s antiepileptic drugs, often relating to hepatic enzyme induction or less commonly inhibition and competition for protein binding, and the effect of the anaesthetic technique and drugs on the patient’s seizure risk. Postoperative care may need to take place in a high dependency unit, especially in those with limited preoperative reserve or markers of frailty, and where the gastrointestinal tract has been compromised, alternative routes of drug delivery need to be considered. Overall, patients with chronic neurological conditions require careful assessment and preparation, a considered technique with attention to detail, and often higher levels of care during their immediate postoperative period.
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Office, General Accounting. Air pollution: Sulfur dioxide emissions from nonferrous smelters have been reduced : report to the chairman, Subcommittee on Oversight and Investigations, Committee on Energy and Commerce, House of Representatives. Washington, D.C: GAO, 1986.
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