bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term pelvic fracture and overall mortality risk after pelvic cancer and pelvic radiation
Authors: Nelson Rebecca A , Blakely Andrew M , Larson Joseph C , Chlebowski Rowan T , Chen Yi-Jen , Cauley Jane A , Shadyab Aladdin H , Lai Lily L
Published: October 2022

Background

The association of pelvic radiation with pelvic fracture risk has not been examined in prospective cohort settings with comprehensive fracture risk assessment, cancer-free comparison populations, and long-term follow-up. Our objective is to better characterize pelvic fracture and overall mortality risks in postmenopausal women participating in the Women’s Health Initiative.

Methods

A total of 135 743 Women’s Health Initiative participants aged 50 to 79 years enrolled from 40 US clinical centers from 1993 to 1998 who had entry Fracture Risk Assessment Tool scores were eligible. Outcomes included pelvic cancer diagnosis, pelvic fracture occurrence, and mortality. Cox proportional hazards regression models were used to examine associations of pelvic cancer and pelvic radiation with pelvic fracture and mortality risk.

Results

After 17.7 years (median) follow-up, 4451 pelvic cancers, 10 139 pelvic fractures, and 33 040 deaths occurred. In multivariable analyses, women with incident pelvic cancer, compared with women who remained pelvic cancer free, had higher pelvic fracture risk (hazard ratio [HR] = 1.26, 95% confidence interval [CI] = 1.11 to 1.43) and higher overall mortality risk (HR = 2.91, 95% CI = 2.77 to 3.05). Women with pelvic cancer treated with pelvic radiation, compared with women with pelvic cancer not treated with pelvic radiation, had higher pelvic fracture risk (HR = 1.98, 95% CI = 1.41 to 2.78) and higher overall mortality after pelvic cancer (HR = 1.32, 95% CI = 1.15 to 1.52).

Conclusions

Postmenopausal women with pelvic cancer, especially those receiving pelvic radiation, are at higher pelvic fracture risk and higher overall mortality risk. As therapeutic advances have reduced cancer mortality, attention to and interventions for pelvic fracture prevention may be important in pelvic cancer survivors.
Outbreak of tuberculosis in internet cafes amongst young internal migrants without fixed abode in Shanghai, China, 2018–2019
Authors: Lu Liping , Li Meng , Chen Caiping , Li Jin , Zou Jinyan , Li Yong , Guo Xiaoqin , Gao Qian
Published: October 2022

We reported an outbreak of tuberculosis in internet cafes amongst young migrants without fixed abode in Shanghai. Our results implied these populations of young migrants who get lost in the internet cafes of the big cities were at high risk for TB transmission and need more attention from health-care system.
The locoweed endophyteAlternaria oxytropisaffects root development in Arabidopsisin vitrothrough auxin signaling and polar transport
Authors: Guan Huirui , Liu Xin , Fu Yanping , Han Xiaomin , Wang Yanli , Li Qing , Guo Liang , Mur Luis A J , Wei Yahui , He Wei
Published: October 2022

Locoweeds are leguminous forbs known for their toxicity to livestock caused by the endophytic fungi Alternaria sect. Undifilum. Unlike the defensive mutualisms reported in many toxin-producing endophytes and their plant hosts, the benefits that A. sect. Undifilum can confer to it host plants remains unclear. Here, we conducted physiological and genetic analyses to show that A. (sect. Undifilum) oxytropis influences growth, especially root development, in its locoweed host Oxytropis ochrocephala and Arabidopsis. The presence of A. oxytropis significantly decreased primary root length while increasing the numbers of lateral roots and root hairs, and increasing plant leaf area and fresh weight. The fungus also increased the concentrations of plant endogenous auxin, and the expression of key genes for auxin biosynthesis, signaling, and transport. These effects on root development were abolished in mutants deficient in auxin signaling and polar transport. Alternaria oxytropis down-regulated expression of PIN1 but increased expression of PIN2, PIN7, and AUX1, which might reflect alterations in the spatial accumulation of auxin responsible for the changes in root architecture. Plant growth was insensitive to A. oxytropis when naphthylphthalamic acid was applied. Our findings indicate a function of A. oxytropis in promoting the growth and development of Arabidopsis via the regulation of auxin, which in turn suggests a possible role in benefiting its locoweed hosts via a process independent of its toxin production.
R-loops: emerging key regulators in plants
Authors: Zheng Dongyang , Li Mengqi , Yang Ying , Huang Ranran , Zhang Wenli
Published: October 2022

The biological implications of R-loops are increasingly receiving attention in plant biology. Compared with recent progresses in humans, the studies of R-loops in plants are lagging behind. Massive efforts must be invested by the plant community to better harness the possible regulatory functions of R-loops. Pioneering studies indicate that R-loops might act as key regulators of plant growth and development, and stress responses. This review thus timely updates the biological implications of R-loops and proposes a series of future lines of investigations to further decipher R-loop biology in plants. The following three aspects are included: the interplay between R-loops and epigenetic modifications at DNA, RNA, and chromatin levels; their regulatory roles in genome integrity, centromere functions, and DNA replication; and how they likely control plant growth and development as well as stress responses and RNA processing. Altogether, the wealth of information provided here portrays R-loop biology in plants accurately, and makes these new regulators interesting genetic levers in developing plants with new and beneficial agronomical traits.
Adult EEG
Authors: Sirven Joseph I.
Published: October 2022

The use of electroencephalography (EEG), particularly long-term bedside EEG in the hospital and intensive care unit, has grown dramatically over the past several years. The purpose of these studies has been to identify occult seizures and nonconvulsive status epilepticus. Often, the EEG in these circumstances reveals a spectrum of abnormal nonepileptiform activity. This chapter explores these abnormal nonepileptiform patterns inclusive of focal and diffuse slowing, named findings such as frontal intermittent rhythmic delta or triphasic waves and rhythmic periodic abnormalities that often reside on the border between epileptiform and nonepileptiform discharges. The chapter addresses specific patterns often seen in common neuropathologies and then discusses the use of EEG in prognostication and brain death.
Quantitative EEG Analysis, EEG Mapping, and Magnetoencephalography
Authors: Brinkmann Benjamin H. , Lundstrom Brian Nils , Worrell Gregory A. , Lagerlund Terrence D.
Published: October 2022

Quantitative EEG Analysis, EEG Mapping, and Magnetoencephalography reviews quantitative methods that facilitate interpretation of multichannel electroencephalographic (EEG) recordings and extract information not readily obtainable with visual analysis alone. Fourier analysis assesses dominant background frequencies, looks for trends over long periods, and can be applied to epileptic seizures. Pattern recognition can automatically detect epileptiform discharges, seizures, and high-frequency oscillations. Montage reformatting allows the same EEG segment to be viewed using different montages, including the Laplacian montage. Cross-correlation and cross-spectral analysis quantifies time relationships between channels. Interpolation techniques and topographical displays help visualize spatial distributions of cortical activity. Multivariate statistical methods find independent components of a multichannel EEG recording and can be used for artifact removal. Machine learning approaches can facilitate identification of seizures and interictal features. Cortical projection and source localization techniques attempt to resolve underlying generators of EEG activity. Magnetic source imaging finds underlying generators of the magnetoencephalogram.
Sensory Nerve Conduction Studies and Sensory Nerve Action Potentials
Authors: Sorenson Eric J.
Published: October 2022

Sensory nerve action potentials are a valuable component of any neurophysiological assessment of the peripheral nerves. In the proper clinical environment these potentials can be invaluable in localizing lesions either proximal or distal to the dorsal root ganglia. They are among the most sensitive measures of peripheral nerve dysfunction and are more sensitive than motor conduction studies in most forms of peripheral neuropathy. Additionally, the responses may be able to provide some information about the pathophysiology of the neuropathy, suggesting demyelination or axonal loss in some cases. Because sensory nerve action potentials are much smaller than compound muscle action potentials (being microvolts in size, compared to millivolts of the compound muscle action potential), they are technically more difficult to perform and require greater expertise and caution. Temperature will have a greater impact on sensory potentials than motor potentials, with cooler limb temperatures leading to longer latencies, slower conduction velocities, and larger amplitudes. Background electrical interference may be a problem when recording sensory nerve action potentials. As a result, responses are commonly averaged three to five times to minimize the effect of the background noise on the waveforms. Distance from the electrical generator and interelectrode distance will also impact the appearance and size of the nerve potential waveform. All of these variables should be standardized wherever possible.
Late Responses
Authors: Laughlin Ruple S.
Published: October 2022

Late responses are a group of responses occurring after the compound muscle action potential (M-wave) in motor nerve conduction studies (NCSs) and include F-waves, H-reflexes, and axon reflexes. These responses can be useful in assessing various disease processes as they serve as an indirect measure of the proximal segment of the nerve that are not obtained with routine motor NCS techniques. This chapter discusses the method of eliciting the late responses as well as their clinical applications. The focus of the chapter is F-waves and H-reflexes, as these entities have clinical implications, with a brief discussion of the axon reflex to allow discernment from the F-wave.
Repetitive Nerve Stimulation Studies
Authors: Kennelly Kathleen D.
Published: October 2022

The neuromuscular junction is a cholinergic synapse between the motor nerve terminal and the muscle fiber. If there is a deficit in neuromuscular transmission, patients can exhibit variable weakness. The electrophysiological techniques of repetitive stimulation are important components in evaluation of these patients. These techniques can unmask abnormalities in the neuromuscular junction by depleting the immediate acetylcholine stores at the nerve terminal with low-frequency repetitive stimulation or with brief exercise can facilitate the presynaptic calcium levels, thereby revealing a presynaptic neuromuscular junction abnormality. These procedures require knowledge of the physiology of neuromuscular transmission to be performed properly and to understand the pattern of abnormalities seen. This chapter describes the techniques that are used and how the tests should be individualized depending on the clinical symptoms. It also reviews the major disorders that can be evaluated with repetitive stimulation.
Electrodiagnostic Assessment of Mononeuropathies
Authors: Khoury Julie A.
Published: October 2022

Electrodiagnostic testing plays an important role in the evaluation of mononeuropathies. In patients presenting with symptoms in a localized distribution in a limb, electrodiagnostic testing is used to differentiate a mononeuropathy from other localizations. Despite advancement of imaging modalities, nerve conduction studies and needle examination remain the principal modalities for diagnosing neuropathy. The clinical features should generate a differential diagnosis that informs the specific electrodiagnostic studies that should be performed. Electromyography (EMG) can confirm not only the suspected diagnosis but also the location and severity of the nerve injury. EMG is also important to exclude alternative diagnoses and more diffuse nerve injury. This chapter reviews the electrodiagnostic approaches and findings of upper and lower limb mononeuropathies.
Assessment of Plexopathies
Authors: Dimberg Elliot L.
Published: October 2022

Electrodiagnostic studies are essential to the evaluation of both brachial and lumbosacral plexus neuropathies. They not only can confirm a suspected diagnosis but also exclude alternative or additional possibilities, such as radiculopathy or mononeuropathy. They are beneficial to assist with localization to specific areas within a plexus (including root or specific peripheral nerve involvement additionally), specify involvement that is not clinically evident, assess severity and degree of reinnervation, and potentially provide information regarding an etiology. Electrodiagnostic studies for the assessment of plexus abnormalities are frequently extensive, may require comparison to an unaffected limb, and may require nerve conduction studies and needle examination of less commonly studied nerves and muscles. This chapter presents plexus anatomy and the electrodiagnostic approach to brachial and lumbosacral plexus neuropathies.
Movement-Related Cortical Potentials and Event-Related Potentials
Authors: Utianski Rene L. , Caviness John N.
Published: October 2022

Movement-related cortical potentials (MRCPs) are electroencephalographic (EEG) potentials that occur around the time of movement. They are recorded using surface scalp electrodes and analyzed with EEG back averaging. MCRPs and contingent negative variation are observed before a voluntary movement occurs. Similarly, other special EEG averaging techniques may be used to study the cortical processes underlying cognition. The P300, N400, and other event-related potentials provide electrophysiological correlates of attention and auditory processing. These potentials have been important in understanding the cortical activity underlying normal and abnormal movements and higher-level cognitive processes; however, their current clinical application is limited.
Long Latency Reflexes and the Silent Period
Authors: Hassan Anhar , Caviness John N.
Published: October 2022

Long latency reflexes (LLRs) and the silent period are normal electromyographic (EMG) phenomena recorded from muscles following a stimulus. LLRs are defined as involuntary responses, which follow the short latency response and precede the voluntary response. They can be elicited irrespective of whether the stimulus is muscle stretch, electrical stimulation of nerve (mixed nerve or cutaneous), or a more complex stimulus. LLRs help compensate for mechanical perturbations in different body parts in order to ensure goal success. They may be absent, delayed or enhanced in different disease states. The silent period can be evoked by strong shocks to either a mixed nerve or cutaneous nerve and reflects transient suppression of EMG activity. This is considered a protective reflex and may be shortened or absent in disease states. Together, LLRs and the silent period reflect the complex interplay of spinal cord, brainstem, and cortical influences in motor control.
Abnormal Sleep and Sleep Disorders
Authors: Louis Erik K. St. , Junna Mithri R.
Published: October 2022

Sleep disorders are a common source of major morbidity and impaired quality of life, with sleep-disordered breathing a risk to cardiovascular and brain health. Sleep disorders include insomnia (difficulty initiating and maintaining sleep with poor sleep quality), sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders. Evaluation should first include an appropriately tailored history and examination, aided by evaluation with extensions of the clinical method, including polysomnography or home sleep apnea testing, multiple sleep latency testing, and actigraphy monitoring, when appropriate. Therapy is tailored toward the specific sleep disorder(s). Insomnia is most often treated with cognitive behavioral therapy. Obstructive sleep apnea may be effectively treated with positive airway pressure therapy or other alternatives, while narcolepsy and the central disorders of hypersomnolence most often require stimulant and wake-promoting pharmacotherapies. Circadian rhythm sleep-wake disorders are addressed by counseling with appropriately timed bright light, light restriction, and melatonin therapies. The sleep-related movement disorder of restless legs syndrome should be investigated for iron deficiency with iron replacement therapy offered as a first-line therapeutic measure if appropriate and consideration of alpha-2 delta ligand calcium channel blockers, dopaminergic agonists, or opioids if necessary for symptomatic treatments. Timely diagnosis and treatment of sleep disorders benefits patients greatly and improves their functioning, health, and quality of life.
Spinal Cord and Root Monitoring
Authors: Hoffman E. Matthew
Published: October 2022

Intraoperative neurophysiological monitoring (IONM) is the application of neurophysiologic tests as a surrogate for neurologic function during surgery wherein loss of neurophysiologic potentials indicates likely neurologic injury. Spinal cord IONM during vertebral column surgery is the most prevalent situation where these techniques are applied. This chapter discusses common electrophysiological modalities useful for spinal cord and spinal nerve root monitoring, including somatosensory evoked potentials, motor evoked potentials, D-waves, and electromyography. Spinal cord and nerve root injury can be detected by multimodality IONM. The selection of which modalities and which nerve/muscle combinations to use needs to be tailored to the each surgery. Given the variety of practice models, intraoperative monitoring physicians must strive to maintain excellent communication with and situational awareness of the operating rooms they are working in, even when working remotely.
Small bowel obstruction
Authors: Sakata Shinichiro , Moran Brendan J.
Published: October 2022

Small bowel obstruction (SBO) is a surgical emergency that results in morbidity and mortality in a substantial number of patients. SBO is characterized by failure of the normal passage of intestinal contents and its features include colicky abdominal pain, nausea, vomiting, abdominal distension, and absolute constipation. In developed nations, the most common cause of SBO in adults is postoperative adhesions. Other causes include abdominal wall hernias, malignancy, Crohn’s disease, volvulus, and obstructing lesions distal to the small bowel. In contrast, SBO in adults from developing countries, including rural regions of the Indian subcontinent, may be a result of parasitic infections, abdominal wall hernias, and postoperative adhesions. Laboratory tests are used to assess the presence and severity of hypovolaemia, leucocytosis, and metabolic abnormalities such as hyponatraemia and hypokalaemia. Although supine and erect plain abdominal X-rays are helpful initial investigations, computed tomography is the preferred imaging technique for SBO as it identifies the location of the site of obstruction, differentiates between partial and complete SBO, and determines the cause of the obstruction by identifying hernias, masses, and strictures. Non-operative management involves intravenous resuscitation combined with nasogastric decompression. This so-called drip-and-suck strategy should be attempted in all patients with SBO unless there are signs of strangulation. Laboratory tests and imaging are not adequately sensitive in ruling out strangulated SBO. A patient with bowel obstruction, obvious septic physiology, and peritonitis should be considered for urgent surgical exploration, irrespective of reassuring laboratory or imaging results. Laparoscopy can be considered in selected cases of SBO provided an experienced laparoscopic surgeon, team, and equipment are available. An early conversion to laparotomy should not be considered a failure as patient safety is paramount.
Radiation enteritis
Authors: Rentea Rebecca M. , Otterson Mary F.
Published: October 2022

Significant radiation exposure of the gastrointestinal tract produces early and late consequences. Therapeutic interventions are largely anecdotal, but there appear to be multiple mechanisms. The mechanism of injury and predisposing factors have been partially worked out in animal and cellular models. Clinical manifestations of chronic radiation enteritis vary and can be vague and difficult to characterize. Surgical intervention is required in 30% of patients with chronic radiation injury. A structured approach to assessing patients with GI symptoms after radiotherapy is useful as the therapeutic modality aimed at alleviating a specific symptom will clearly depend on the underlying pathology. Important information to gather at the time of presentation includes the history of the primary neoplasm, surgery performed, as well as an understanding of the duration and location of radiotherapy treatment, dosing regimen, target fields, and complications during treatment. Surgery may alleviate symptoms but is of greater risk than procedures on normal tissues.
Crohn’s disease of the duodenum and small bowel
Authors: Barton Jeffrey S. , Davis Kurt G.
Published: October 2022

Crohn’s disease of the duodenum and small intestine can be a highly variable disease. Symptoms vary according to the anatomical location, the severity of inflammation, the temporal phenotype, as well as the presence of any fibrosis or fistulae. Evaluation centres on endoscopic evaluation of the patient with direct visualization, and cross-sectional imaging. Medical management continues to be the mainstay of therapy for these patients, but surgery remains a common and often necessary treatment. Intestinal resection should be performed with bowel-sparing modalities such as strictureplasty when possible as these patients cannot be cured of their disease with surgery, but surgery often occupies an important component of their therapy.
Neuroendocrine tumours of the duodenum and small bowel
Authors: Andreasi Valentina , Partelli Stefano , Muffatti Francesca , Falconi Massimo
Published: October 2022

The incidence of duodenal (dNENs) and small bowel neuroendocrine neoplasms (SB-NENs) is growing. While dNENs are often discovered incidentally during upper gastrointestinal endoscopy, SB-NENs are frequently diagnosed in patients with carcinoid syndrome. The diagnostic workup for dNENs includes upper gastrointestinal endoscopy with biopsy, endoscopic ultrasound, and somatostatin receptor imaging, along with high-quality radiological examinations (computed tomography and/or magnetic resonance imaging) with contrast medium, that are also important for diagnosis and staging of SB-NENs. According to tumour size, depth of invasion, tumour location, and presence of nodal involvement, the management of localized dNENs ranges from conservative treatment (active surveillance or endoscopic resection) to surgical resection. In contrast, SB-NENs should be always treated with surgical resection of the primary tumour associated with lymphadenectomy, when technically feasible. If liver metastases are present and resectable, it is recommended to remove them as well. The overall prognosis of both dNENs and SB-NENs is good, with 5-year survival rates around 90% for localized dNENs and approximately 100% for stage I–II SB-NENs.
Techniques of duodenal surgery
Authors: Macutkiewicz Christian , Baltatzis Minas , Siriwardena Ajith K.
Published: October 2022

This chapter provides a concise overview of the broad topic of duodenal surgery. Relevant aspects of the anatomy and relations of the duodenum are reviewed. There are also sections on the management of the common indications for duodenal surgery such as perforation and bleeding. The technique of pyloric exclusion for dealing with large (giant) duodenal perforation is addressed. There is a discussion of pancreas-preserving surgery for duodenal polyposis. This procedure is a specialized intervention. Older surgical procedures such as sphincteroplasty and ampullectomy are described here and may still retain a place in practice. Pancreatoduodenectomy is not covered in this chapter as it is addressed elsewhere.
The Prevalence, Incidence, and Risk of Tourette Syndrome
Authors: Scahill Lawrence , Thorsteinsson Erla , Dalsgaard Søren
Published: October 2022

This chapter summarizes the results and discusses the methodological issues related to prevalence studies on Tourette syndrome (TS) conducted during the past two decades. The best estimate for the prevalence of TS in school-age children is between 5 and 7 cases per 1,000. The prevalence of chronic motor tic disorder appears to range from 3 to 8 per 1,000, whereas estimates of prevalence for chronic vocal tic disorder in school-age children are less stable and await further study. Children with chronic tic disorders, even those with mild conditions, have a higher likelihood of other problems, such as attention-deficit/hyperactivity disorder, disruptive behavior, and obsessive–compulsive disorder. The classic two-stage design seems to be an acceptable approach for prevalence studies of TS and related tic disorders; however, this requires sample sizes greater than 5,000 to ensure relatively narrow confidence intervals. From a public health perspective, chronic tics may serve as a marker of neurodevelopmental vulnerability. Community-based studies that improve case finding and register-based studies may also improve our comprehension of the public health impact of tic disorders in children.
Perinatal Adversities and Tourette Syndrome
Authors: Hoekstra Pieter J. , Dietrich Andrea
Published: October 2022

This chapter provides a literature review and critical commentary on studies evaluating the association between pregnancy-related and birth-related adversities in Tourette syndrome. Perinatal risk factors for the development of Tourette syndrome include low birth weight and the simultaneous presence of multiple pregnancy, delivery, and/or neonatal adversities. Risk factors for more severe tics may include older paternal age, maternal psychosocial stress during pregnancy, maternal severe nausea and/or vomiting during the first trimester, maternal smoking during pregnancy, maternal medication use during pregnancy, low birth weight, and delivery complications. These factors have not been replicated across studies, however. Maternal smoking during pregnancy and low birth weight are risk factors for the presence of comorbid obsessive–compulsive disorder and/or attention-deficit/hyperactivity disorder in individuals with a tic disorder.
Infections and Tic Disorders
Authors: Martino Davide , Escobar Alex Medina , Malik Osman , Hedderly Tammy
Published: October 2022

Several associations between patients with infections, particularly group A streptococcal (GAS) infections, and subsequent tics and obsessive–compulsive symptoms have been established in population-based studies, suggesting at least a nonspecific role of infections in a subgroup of patients with tics. Expanding the clinical entity of pediatric autoimmune neuropsychiatric disorders associated with streptococcus, a broader spectrum named pediatric acute-onset neuropsychiatric syndromes (PANS) has been proposed, which encompasses phenotypes dominated by obsessive–compulsive symptoms or eating behavior abnormalities and includes tics as accompanying features. PANS are defined by the temporal course but are not limited to post-infectious etiologies. In chronic tic disorders, GAS infections do not seem to be a major determinant of tic exacerbations, although a potential interactive effect with psychosocial stress cannot be excluded. The role of other pathogens in influencing course and onset of tic disorders remains uncertain. The complex interaction of patient-specific attributes (neurochemical and immune vulnerability genes leading to maladaptive neuropsychiatric or immune function) with environmental attributes (psychosocial stress, injuries, substance exposures, and pathogen-specific properties) creates an interesting and ongoing research challenge.
Neuroimmunoendocrinology of Tourette Syndrome
Authors: Martino Davide , Johnson Isaac N. S. , Escobar Alex Medina , Leckman James F.
Published: October 2022

Cellular and molecular mechanisms involving immune-competent cells can modulate normal brain development, influencing the genesis, refinement, and maintenance of neural circuits. There is increasing evidence in support of the contribution of an early immune priming to the abnormal trajectories of maturation of cortico-subcortical circuits associated with the generation of tics. During postnatal life, the hyperreactivity of systemic immune pathways and neuroinflammation may contribute to natural fluctuations of the behavioral features manifesting in Tourette syndrome and related disorders. Moreover, abnormalities in the parallel development of neural and immune systems, as well as in stress responses, are reflected in the higher risk of autoimmune and allergic illnesses in people with these neurodevelopmental disorders. There is still limited knowledge regarding the efficacy of direct and indirect immune-modulatory interventions in the treatment of these disorders. There are also limitations in knowledge of the key molecular pathways associated with gut dysbiosis that can influence neuroimmune interactions in these disorders. This chapter provides an up-to-date summary of the existing knowledge around these themes, highlighting existing gaps that need to be addressed by future research in order to develop breakthrough, disease-modifying, immunological, hormonal, and microbiota-based therapeutic interventions.
Animal Models of Tic Disorders
Authors: Bortolato Marco , Cadeddu Roberto
Published: October 2022

Animal models of Tourette syndrome (TS) and other tic disorders are powerful research tools to advance our knowledge of the neurodevelopmental and molecular foundations of these disorders. Assessing the reliability and translational validity of an animal model of TS is a particularly intricate task due to the heterogeneous presentation, multifactorial ontogeny, and neurobiological complexity of this disorder. Even with these limits, recent advances in understanding the semiology and ontogeny of tics and their accompanying phenotypes are paving the way for new refinements in the characterization and validation of animal models. In addition, the development of novel models reflecting the impact of genetic and environmental vulnerability factors is greatly expanding knowledge on the causes of TS and providing a rich source of molecular mechanisms to account for the neurobiological dysregulations associated with this disorder. This chapter recapitulates the current state of the art in animal modeling of tic disorders and highlights how each model allows for the analysis of complementary aspects of phenomenology, pathophysiology, etiology, and therapy of TS. The chapter also outlines several methodological and conceptual directions for the future development of new animal models and the refinement of available ones. The implementation of these translational strategies will be critical to further improve knowledge of the biological foundation of TS and expand the therapeutic arsenal for tic disorders and comorbid symptoms.
The Differential Diagnosis of Tic Disorders
Authors: Kurlan Roger
Published: October 2022

Tics need to be distinguished from other neurological movement disorders (chorea, myoclonus, and dystonia). Tics also need to be distinguished from movement disorders associated with psychiatric conditions (compulsions, stereotypies, mannerisms, and habits). Tourette syndrome (TS) is part of a family of primary tic disorders that include chronic motor or vocal tic disorder and transient tic disorder. Tics can occur secondary to a number of conditions, including neurological disorders, medications, and as a functional manifestation. This chapter discusses the differential diagnosis of tic disorders at two levels. First is a discussion about how to distinguish tics from other types of body movements and sounds. This is followed by a discussion about the various etiologic entities that can cause tics.
Social and Adaptive Functioning in Tourette Syndrome
Authors: Sukhodolsky Denis G. , Kalvin Carla , Artukoğlu Bekir B. , Eicher Virginia W. , Leckman James F.
Published: October 2022

Many children, adolescents, and adults with Tourette syndrome have impairments across various domains of social and adaptive functioning, both as a result of the severity and particular features of tics and as a result of co-occurring disorders such as attention-deficit/hyperactivity disorder and anxiety. The relative contribution of tics and comorbid disorders to these impairments is an area of active investigation. A thorough clinical assessment should also include standardized ratings of adaptive functioning. Psychosocial interventions for tics and associated behavioral disorders are constantly improving and show the potential to reduce symptom severity and associated impairment as well as to improve quality of life and adaptive functioning.
Psychoeducational Interventions
Authors: Lebowitz Eli R. , Artukoğlu Bekir B.
Published: October 2022

This chapter both reviews research about the role of psychoeducation in coping with and treating Tourette syndrome and serves as a psychoeducational resource, summarizing key information about the disorder. Providing patients and families with accurate, nuanced, and up-to-date knowledge about Tourette syndrome is important to promoting better coping, helping them become informed consumers of resources and supports, and combating negative stigma that can be attached to the disorder. This chapter examines many of the features of Tourette syndrome that contribute to its complexity and discusses psychoeducational interventions for patients and families. Parents of children with tics and other commonly comorbid psychiatric problems face practical and emotional challenges, and addressing these challenges is another important objective of psychoeducation. Children with tics also face educational and social difficulties in school and are often targets of peer victimization. Psychoeducation for school staff as well as peers may alleviate these difficulties. Advocacy organizations can offer helpful and informative resources to individuals and families living with tics and can provide a forum for social support. Finally, adults with tics often face discrimination and social victimization in the workplace and tend to be underemployed. Psychoeducation for employers and colleagues about tics as well as about the legal obligations toward individuals with disabilities may mitigate such discrimination.
Surgical Treatment of Tourette Syndrome
Authors: Servello Domenico , Deeb Wissam , Galbiati Tommaso F. , Porta Mauro
Published: October 2022

This chapter presents an overview of the existing literature on the functional surgery therapeutic approach in Tourette syndrome (TS) and summarizes the current recommendations for the application of this type of treatment. A special focus is provided with respect to the pending issues concerning this invasive treatment that will need to be addressed in future research. Some technical notes are also given. Deep brain stimulation (DBS) for TS is not curative, and in some cases it does not improve tics. Drugs for TS are prescribed according to the different symptomatology exhibited by the individual patient: Although the same tailored approach is conceivable in choosing the best target for DBS, evidence is still insufficient to provide a sound clinical guidance to target selection. Ongoing technological advances in the surgical procedure (e.g., the introduction of the O-arm and other imaging modalities) have the potential to improve its safety and applicability in routine clinical practice. A patient selection and target selection algorithm, based on evidence from randomized controlled trials and multidisciplinary experiences from tertiary referral centers, is currently under development.
Inhibitory Control and Tic Generation
Authors: Kurvits Lille , Ganos Christos
Published: October 2022

Tic disorders are characterized by a surplus of brief movements and sounds that share some of the characteristics of voluntary actions but occur repetitively and are inapposite to discernable context. Tics are most commonly observed in primary tic disorders, and are often accompanied by additional neuropsychiatric features, including impulsive and socially disruptive behaviors. This lends support to the hypothesis of a core inhibitory deficit at different organization levels of brain structure and function. This chapter dissects evidence supporting the disinhibition model, starting from neuronal composition aberrations within the cortico-basal-ganglia-thalamo-cortical loops to their putative consequences in behavioral output. Specifically, it provides an overview of the neuropathological and functional neuroanatomic changes of different cell populations within the basal ganglia, with a focus in GABA-ergic and cholinergic interneurons, dopaminergic neurotransmission, and the glutamate–glutamine-GABA cycle. Evidence from animal models of tic disorders, alongside studies of cortical neurophysiology are also discussed. Finally, an account of behavioral studies related both to control of voluntary actions and tics is provided, and knowledge gaps are listed to motivate future studies in the field.
Basic Physics
Authors: Johnson Evan M. , Misulis Karl E.
Published: October 2022

This chapter introduces basic physics. It explores the structure of atoms, which are known to be the smallest unit of matter. Atoms, such as hydrogen and oxygen, are frequently represented in a periodic table of elements. Additionally, bonds are considered either covalent or ionic depending on the sharing of atoms. While the atomic theory is vital for understanding electronics, atomic decay is essential for understanding laboratory techniques. The chapter also highlights charge movement as a critical aspect of physics, especially neurology. Atoms have either positive or negative charges that could help them share electrons. Then, the chapter discusses neurohydrodynamics covering fluid dynamics, movement of gasses and the motion of liquids.
Computers, Applications, and Artificial Intelligence
Authors: Misulis Karl E. , Doyle Eamon
Published: October 2022

This chapter discusses the development of computers, applications, and artificial intelligence (AI). The value of technology primarily focuses on keeping track of knowledge such as medical care. Additionally, the chapter looks into the functions and components of a computer such as the CPU. Signal processing starts on the analog signal before the ADC. Thus, neurophysiologists are concerned about the calculations performed on the digitized data. Moreover, cognitive physicians are highly dependent on computers for their ability to handle electronic health records (EHR) and extensive diagnostic equipment. The functions of EHR range between communication with patients and providers, decision support, and patient list management.
Physics of Neurophysiology
Authors: Johnson Evan M. , Misulis Karl E.
Published: October 2022

This chapter focuses on neurophysiology, which is dependent on the physics and chemistry of excitable tissues. It parallels the traveling signals between the nervous system and electrical wirings wherein biophysics allows the conduction of electronic signals in living creatures. Additionally, the polarization of the membrane is dependent on selective permeability or conductance to specific ions, especially since ions are affected by chemical and electrical gradients. Then, an action potential is produced when the depolarization of the postsynaptic membrane resulted in a regenerative increase in sodium conductance. The chapter also expounds on the physics of neurologic dysfunction affecting neuron bodies, axons, and/or the myelin sheath.
History of Technology in Neurology
Authors: Misulis Karl E. , Johnson Evan M.
Published: October 2022

This chapter explores the history of neurology technology. It highlights how the scientific method revolutionized the advancement of knowledge with a hypothesis, observation, and experiments. Before, people were used to death and their methods to relieve suffering are mostly ineffective and harmful. The chapter lists bloodletting, electrical stimulation, and trephination as examples of harmful pain-relieving methods. Thus, part of scientific methods, data, and decisions are continuously evaluated and revised since not all technologies could stand the test of time. An example of technology with uncertain implications is therapeutic hypothermia due to the differences in critical care and results amidst the complex studies that are conducted.
Nuclear Imaging
Authors: Johnson Evan M.
Published: October 2022

This chapter tackles the features of nuclear imaging. The two forms of radio-isotope based imaging modality are positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Compared to other imaging modalities, nuclear imaging is more tailored for assessing functional information or tissue-specific localization. Radioisotopes used for diagnostic purposes could also deliver therapeutic localized radiation. The limit of the possible tracers for PET and SPECT that can carry a positron emitter is largely dependent on the imagination and capability of chemists and biochemists. Modern PET scanners can benefit from the patient’s internalized source of radiation by using a fixed 360-degree ring array of detectors.
Neurologic Therapeutics
Authors: Johnson Evan M. , Misulis Karl E.
Published: October 2022

This chapter focuses on neurologic therapeutics. Trephination and electric shocks are the earliest neurologic technique used to help people through their neurological issues. Neurostimulation techniques are commonly used to treat epilepsy and movement disorders. Deep brain stimulation (DBS) is a method of targeted neurostimulation through electrical impulse generation. DBS also allows access to deeper structures in an effort to provide optimal relief of symptoms without any side effects. Thus, DBS is commonly used to treat epilepsy, dystonia, Parkinson’s disease, and obsessive compulsive disorder (OCD). The chapter also tackles transcranial magnetic stimulation (TMS) which is mostly used to alleviate psychiatric disorders, while electroconvulsive therapy is often utilized for refractory psychiatric conditions.
Crossing Over
Authors: Barnard David , Towers Anna , Boston Patricia , Lambrinidou Yanna
Published: October 2022

The revised edition of Crossing Over is a book of stories—narratives of giving and receiving palliative care in the context of end of life. It is not a textbook that portrays ideal palliative care or that prescribes specific management techniques. Instead, it presents stories of actual patients and families who have experienced terminal illness with the support of hospice or palliative care teams. The narratives are derived from a three-year, qualitative, ethnographic study of the experiences of patients, families, and caregivers. Since the first edition of Crossing Over appeared, changes have occurred in healthcare and in society at large that have altered the environment in which people give and receive palliative care, including effects of the COVID-19 pandemic, the opioid crisis, changes in social welfare policy, the rise of the internet, the evolution of palliative care as a field, increased emphasis on advance care planning, and, in some jurisdictions (including all of Canada), legalization of medical aid in dying. The Authors’ Comments following each narrative pinpoint specific decisions and choices of patients, families, and clinicians where today’s changed context may be particularly relevant.
Prelude—Palliative Care in the Time of Pandemic
Authors: Towers Anna
Published: October 2022

This narrative is based on the author’s experience working as a palliative care physician during the first year of the COVID-19 crisis in Quebec. She offers it to feature the role, the dilemmas, and the impact on herself as a physician and a person, as well as to express sympathy for those who have suffered the most all over the world. She and her co-authors also offer it as a Prelude to this Revised Edition of Crossing Over. Of the myriad ways the world has changed since this book first appeared in 2000, perhaps none has been so radical as the changes in consciousness and self-understanding forced upon us by the pandemic. As clinicians, we have had to reckon with the fragility of our systems of care in the face of surging demand. We have had to question the capabilities of our institutions, our governments, and our leaders to respond equitably and efficiently to a fast-moving but entirely predictable global threat. And, while we celebrate the resilience and courage of our colleagues and the unprecedented achievements in vaccine development, we are shaken and humbled by these failures.
Stanley Gray
Authors: Lambrinidou Yanna
Published: October 2022

When Stanley Gray was admitted to the home care program of hospice, he appeared to be dying from congestive heart failure (CHF) and end-stage chronic obstructive pulmonary disease (COPD). To everyone’s surprise, his condition improved. Although dependent on oxygen, morphine, and eight bronchodilator treatments a day, Mr. Gray started to lead a relatively independent and deeply religious life. A year and a half after his admission to hospice, his social worker believed he was no longer “terminal.” His nurse, on the other hand, argued that although he was functional, he could die at any time. Mr. Gray was the only patient in our study who was still alive when we completed the writing of this book. His case demonstrates the unpredictability of diseases like CHF and COPD and the challenge they present to the current system of hospice care in the United States. It unfolds on the borderland between palliative and long-term care, even as it illustrates the immense personal and relational transformations that can take place near the end of life. It is also a portrait of a certain type of religious faith. Though Mr. Gray’s consuming relationship with God made some members of his hospice team uncomfortable, and the nurse and chaplain even suspected that it compromised his health, Mr. Gray was convinced that it was God who had caused him to outlive his terminal prognosis.
Susan Mulroney
Authors: Boston Patricia
Published: October 2022

Susan Mulroney had always considered herself a very private person. She had many friends and a caring family, but all her life she prided herself on being very independent and in control of her own affairs. She never liked to burden family or friends with her problems. When she was diagnosed with advanced cervical cancer at the age of 47, she did not talk much about it to anyone. During the next few months, she remained stoic in the face of her illness and tried to continue with her life normally, as though nothing eventful had taken place. But chemotherapy did not work, and she felt increasingly tired, physically weak, and unable to cope on her own.

Not wishing to burden family members, Susan chose to be admitted to the Palliative Care Unit, where her condition rapidly became worse. Her physical symptoms were controlled, and she seemed comfortable. But no one could tell how she was coping emotionally with the knowledge that she would soon die. When people tried to talk with her, she usually found them intrusive. Ten days following her admission to the Palliative Care Unit, she died. Except for one close friend, no one knew much about how she had felt or what the last few months of her life had been like.