bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term retention of the pedicled thymic flap after bronchial stump coverage
Authors: Karasaki Takahiro , Fujimori Sakashi , Suzuki Souichiro , Kikunaga Shinichiro , Ito Kazuki , Hamada Yosuke , Mihara Shusei
Published: January 2025

This study aimed to assess the feasibility and retention rates of pedicled thymic flaps to enhance understanding of bronchial stump coverage. A retrospective analysis of 22 consecutive patients who underwent anatomical lung resection followed by bronchial stump coverage with pedicled thymic flaps between January 2017 and December 2022 was conducted. The procedure was performed using a minimally invasive three-port video-assisted thoracoscopic surgery technique for all patients with no complications related to graft harvest or fixation. Postoperative retention of the engrafted flaps was evaluated in the 16 patients who underwent thin-slice computed tomography at least once after surgery. The majority of the postoperative computed tomography examinations were performed for surveillance of lung cancer recurrence. The retention rates of pedicled thymic flaps were 100% at 60 days, 87% at 180 days and 70% at 1 year post-surgery. Pedicled thymic flaps can be safely harvested using a minimally invasive approach, and the majority of engrafted flaps remain adjacent to the bronchial stump for more than 1 year. This technique may be a viable option for patients at high risk of a delayed bronchopulmonary fistula.
Defining Personas for Assistive Technology Development: Improving the Cognitive Support of Older Adults on the Dementia Continuum
Authors: Spalla Guillaume , Gouin-Vallerand Charles , Yaddaden Amel , Gagnon-Roy Mireille , Bottari Carolina , Bier Nathalie
Published: January 2025

Executive function operations (Formulate a Goal, Plan, Carry out the task and Verify goal attainment) are important for supporting independence, and are often impacted early in dementia, yet are seldom considered in the design of assistive technologies for cognition for older adults with dementia. This article introduces personas, i.e., fictitious, specific, concrete representations of target users, to support the design of assistive technologies for cognition from the perspective of executive dysfunction. We first categorized the assistance most appropriate to provide, based on a quantitative secondary analysis of annotated videos of 16 older adults who received assistance during a functional assessment. The annotations of the videos classified the assistance required for task completion into categories. We then designed the personas based on this quantitative secondary analysis. A persona was designed for each of the first three executive function operations: Formulate a goal, Plan and Carry out the task. No persona was designed for Verify goal attainment because assistance was seldom provided for this operation. Stimulate the thought process and clarification of instructions were the categories of assistance most frequently identified overall. Each persona is illustrated with examples of assistance. Stimulate the thought process was the category of assistance most frequently provided for goal formulation and plan, and motivational assistance for carry out the task. We defined several design recommendations to support the design of assistive technologies for cognition for older adults on the dementia continuum, including 1) stimulate the person to reason and act by themselves first; 2) design context-aware assistive technologies; 3) consider “goal formulation” and “plan” executive operation dysfunctions; 4) personalize assistive technologies to the specific needs of each individual; 5) do not rely only on personas to take individual needs into account. Personas created from real situations can serve as a tool to better understand the assistance this population requires in order to develop assistive technologies for cognition.
Efficacy of ground herb-based and essential oil-based phytobiotics on the intestinal health and performance of nursery pigs challenged with F18+ Escherichia coli
Authors: Garavito-Duarte Yesid , Duarte Marcos Elias , Kim Sung Woo
Published: January 2025

This study aimed to evaluate the efficacy of using ground herb-based phytobiotics and essential oil-based phytobiotics in pig diets on intestinal health and growth performance (GP) of nursery pigs challenged with F18+  Escherichia coli (E. coli). Forty nursery pigs (6.4 ± 0.1 kg) at 21 d of age were individually housed and assigned to 4 dietary treatments in a randomized complete block design, with body weight (BW) and sex as blocking factor. Basal diets were fed to pigs for 28 d in 3 phases. Treatments were NC: basal diet, non-challenged; PC: basal diet, challenged with F18+  E. coli; HP: PC + 1% ground herb-based phytobiotics (Salcochek Pro, Ayurvet Limited, Kaushambi, India); EP: PC + 1% essential oil-based phytobiotics (Liq-biotic, Ayurvet Limited, Kaushambi, India). The GP was recorded for each phase and fecal score (FS) was measured daily. On d 7 post-weaning, the challenged groups were orally inoculated with F18+  E. coli (2.0 × 1010 CFU), the NC treatment received sterile saline solution. On d 28, pigs were euthanized to collect jejunal samples to evaluate intestinal health and relative abundance (RA) of jejunal mucosa-associated microbiota. Data were analyzed using the MIXED procedure on SAS 9.4. The PC increased (P < 0.05) the RA of Prevotellaceae, Lachnospiraceae, and Ruminococcaceae when compared to NC. The HP reduced (P < 0.05) the RA of Veillonellaceae, Prevotellaceae, and Lachnospiraceae when compared to PC. The EP tended to reduce the RA of Streptococcaceae (P = 0.073) and Corynebacteriaceae (P = 0.074) when compared to PC. The PC increased (P < 0.05) occludin and tended to increase (P = 0.096) toll like-receptor-4 (TLR4) when compared to NC. The PC decreased (P < 0.05) average daily gain and average daily feed intake when compared to NC in d 7 to d 28. The PC increased FS (P < 0.05) compared to the HP and EP d 7 to d 11. The HP and EP decreased (P < 0.05) FS when compared to PC during d 7 to d 11 and d 7 to d 18. In conclusion, F18+  E. coli challenge disrupted the jejunal mucosa-associated microbiota, increased TLR4 expression and FS, consequently reduced GP. Both HP and EP phytobiotics supported intestinal morphology during the challenge to F18+  E. coli by supporting enterocyte maturation. The HP and EP treatments exhibited antimicrobial-like effects by altering the jejunal mucosa-associated microbiota and reduced FS during the first two weeks post-challenge. The HP treatment showed potential antioxidant effects.
Prolactin and Heat Stress; focus on Domestic Ruminants
Authors: Clarke Iain J , Dunshea Frank R , Chauhan Surinder S
Published: January 2025

Prolactin has traditionally been associated with milk production, but recent studies identify prolactin as having many other functions. These include a role in pelage growth, sweating, immune function, metabolism and water/electrolyte balance. A signature of HS is a rise in prolactin concentrations so the question arises as to whether this hormone has a particular function in relation to response to or mitigation of HS. Thus, prolactin plays a multifaceted role in the physiological and behavioral responses of livestock to HS, contributing to their ability to cope with warmer temperatures and maintain homeostasis. A major advance in recent years is the identification of the SLICK gene in cattle, being a mutation in the prolactin receptor. It is responsible for a phenotype of short, shiny coat. SLICK confers heat resilience and offers a realistic means of mitigating HS by introgression into cattle without the mutation. The purpose of this article is to ascertain what functions prolactin may have in the response to HS. It appears that prolactin may be involved in many of the physiological processes that are affected by HS, but it is clear that definitive evidence of cause/effect are yet to be discerned.
Evaluating trapping methods to increase earwig capture in temperate tree fruit crops
Authors: Hanel Aldo , Nottingham Louis B , Orpet Robert J , Hilton Richard , Northfield Tobin D , Schmidt-Jeffris Rebecca
Published: January 2025

The European earwig, Forficula auricularia L. (sensu lato), has a dual role in temperate tree fruit crops—a pest of stone fruit and a predator of key pests in pome fruit. Some growers trap earwigs in crops where they are pests, subsequently releasing them in pome fruit as an augmentative biological control strategy. Effective earwig monitoring and trapping are critical for understanding their biological control potential in orchards. Traps made of rolled, corrugated cardboard have long been used for earwig monitoring; however, no standardized studies have investigated improvements to them. In a series of trials, we explore options to improve traps by testing different trap materials, sizes, positioning on the tree, and time in the field, in addition to the lures and baits. We found that cardboard traps had higher earwig catch than black or translucent plastic traps. There were diminishing returns in earwig capture for increased trap length, plateauing at ~30 cm. Traps placed on the main trunk captured more earwigs than traps on the base or near the end of branches. Lures and baits mostly did not increase trap efficacy, except fish sauce which inconsistently increased earwig captures. The use of plastic bottles to contain the cardboard traps greatly reduced trap catch. Finally, we found evidence that traps left in the field for longer periods of time can increase earwig capture, possibly due to the accumulation of earwig aggregation pheromone. Overall, the standard unbaited corrugated cardboard trap was the most effective and practical earwig monitoring trap.
Genetic structure of the northern house mosquito (Diptera: Culicidae) in a WNV-susceptible area
Authors: Alvial Ingrid E , Rojas‑Hernández Noemi , Guerra Nicolas , Véliz David , González Christian R , Pérez Laura M , Benítez Hugo A
Published: January 2025

Mosquitoes from the Culex pipiens complex are found worldwide and have been the focus of numerous studies due to their role as vectors of human pathogens. We investigated the population genetic structure of Cx. pipiens s.l. by analyzing SNPs and the COI gene, focusing on the genetic grouping signals of the ecotypes pipiens and molestus. Our analysis revealed no genetic association between the ecotypes and the SNPs, suggesting that the classification is based on ecological traits rather than genetic factors. Using data from 2,641 SNPs and 164 genotypes, our Bayesian clustering analysis categorized the populations into six distinct genetic groups, distinguishing the Rapa Nui island population from those on the American mainland. The estimated effective migration rates (EEMR) showed low levels of migration between island and continental populations, with significant migration occurring only among populations between 29° S and 33° S. Genetic differentiation between Rapa Nui island and the American continent was observed. In contrast, no significant differentiation was noted in other regions. The haplotype network suggests a possible migration pathway from that area of the South Pacific. Additionally, demographic history analysis indicates a relatively recent founder effect of Cx. pipiens s.l. on the island. Geographic isolation and variations in genetic makeup can limit the spread of pathogens regionally and globally. However, these same factors can also promote specialization and enhance adaptation to new ecological niches, thereby improving the ability of pathogens to function as effective vectors in isolated environments.
A polarized multicomponent foundation upholds ciliary central microtubules
Authors: Chen Qingxia , Zhao Huijie , Pan Xinwen , Fang Chuyu , Qiu Benhua , Guo Jingting , Yan Xiumin , Zhu Xueliang
Published: January 2025

Cilia's back-and-forth beat pattern requires a central pair (CP) of microtubules. However, the mechanism by which the CP is upheld above the transition zone (TZ) remains unclear. Here, we showed that a rod-like substructure marked by Cep131 and ciliary Centrin serves as a polarized CP-supporting foundation. This CP-foundation (CPF) was assembled independently of the CP during ciliogenesis in mouse ependymal cells. It protruded from the distal end of the basal body out of the TZ to enwrap the proximal end of the CP. Through proximity labeling, we identified 26 potential CPF components, among which Ccdc148 specifically localized at the proximal region of Centrin-decorated CPF and was complementary to the Cep131-enriched distal region. Cep131 deficiency abolished the CPF, resulting in CP penetration into the TZ. Consequently, cilia became prone to ultrastructural abnormality and paralysis, and Cep131-deficient mice were susceptible to late-onset hydrocephalus. In addition to Centrin, phylogenetic analysis also indicated conservations of Ccdc131 and Ccdc148 from protists to mammals, suggesting that the CPF is an evolutionarily conserved multicomponent CP-supporting platform in cilia.
Perioperative Medicine
Authors: Richman Deborah C. , Pulley Debra D. , Oprea Adriana D.
Published: January 2025

Perioperative Medicine: A Problem-Based Learning Approach provides a unique learning opportunity for the busy perioperative clinician who wants to read how others approach a case and for clinicians in training who need to learn the basics. Each chapter starts with a stem case, followed by a comprehensive, up-to-date discussion on the topic to make evidence-based decisions, and multiple choice questions for self-assessment.

The subject matter covered within the forty-eight chapter book has been chosen to cover a broad array of conundrums encountered in clinical perioperative medicine. A majority of the chapters focus on preoperative optimization of patients with different comorbidities, such as, coronary artery disease, heart failure, chronic obstructive pulmonary disease, obstructive sleep apnea, diabetes mellitus, cirrhosis, substance use disorder, and anemia. Choosing preoperative tests and medication management are also discussed. There is a section on immediate postoperative complications such as confusion and arrhythmia.

Highlighted is a section on ethical issues. Not as straight-forward as optimization or treatment of diseases, these topics address aspects of care that are more patient-centered such as informed consent, DNR, or how to discuss uncomfortable topics with a patient. Since all practices are different, there is a chapter on different models of the preoperative process and a discussion of continuity of care across the perioperative period.

Overall, this book provides an up-to-date compendium of topics commonly presenting in daily practice.
My 79-Year-Old Patient for Right Inguinal Hernia Repair Has No Labs on File
Authors: Ackermann Wiebke , Rogers Barbara
Published: January 2025

Inguinal hernia repair is one of the most common surgeries performed. This type of hernia may cause pain, discomfort, and decreased quality of life. As the population in general is aging, more elderly people are seeking elective repair of these hernias. There are concerns about which surgery and anesthesia techniques are best for an older patient, as well as which preoperative testing is appropriate in light of this population’s increased chance of comorbidities. This chapter reviews the signs and symptoms of inguinal hernia, the various options for corrective procedures, the contraindications for surgery, the preoperative testing required, and the perioperative evaluation and care.
COVID-19
Authors: Fong Robert
Published: January 2025

While hospitals have largely adapted their processes to safely resume operations and surgical volumes in many healthcare systems have returned to pre-pandemic levels, increasing numbers of surgical candidates who are either newly infected with or have had a history of COVID-19 infection present a new challenge to the field of perioperative medicine. It has been well documented that undergoing surgery in the context of active infection with SARS-CoV-2 is a risky proposition, with significantly increased perioperative morbidity and mortality, as well as engendering risk of exposure to perioperative providers and staff. Additionally, many in the recovery phase of COVID-19 illness have been shown to have lasting effects and disability months after initial infection, with potential implications for long-term perioperative risk. This chapter reviews the assessment of perioperative risk in both acute and convalescent phases of COVID-19 infection, surgical timing, preoperative assessment, and intraoperative management of actively infected patients.
Patient Has Seizures and Needs “Clearance”
Authors: Kang Ramanjot S. , Mathew Ashley , Avraham Shirley
Published: January 2025

Patients with neurological and seizure disorders pose a particular challenge to perioperative management. In the anesthetic management of these patients, perioperative evaluation plays an important role. In patients with seizure disorder undergoing surgical procedures under anesthesia, there may be increased frequency of seizures in the perioperative period, which may be attributed to missed antiepileptic drug (AED) doses, epileptogenic anesthetic agents, hypoxia, metabolic derangement, or poor drug absorption due to postoperative ileus. Additional concerns for the anesthesiologist in the management of patients with epilepsy are the side effects of AEDs, AED interaction with anesthetics, the potential of anesthetics to modulate seizure activity, and the presence of concomitant medical problems associated with epilepsy, such as nutritional deficiencies, cardiorespiratory deficits, and occult learning disabilities.
Restrictive Lung Disease from Parkinson’s Disease Rigidity
Authors: Rao Shilpa
Published: January 2025

Parkinson’s disease (PD) is a slowly progressive neurodegenerative disorder chiefly involving the central nervous system. Although the exact etiology is unknown, it is postulated that genetic and environmental factors play a role in the development of PD. It is caused by a progressive deficit of dopamine-producing cells of the substantia nigra causing an imbalance between acetylcholine and dopamine. Signs and symptoms include a variable combination of bradykinesia, masked facies, resting tremor, rigidity, sleep problems, and depression. Restrictive lung disease may be seen in a few patients with PD. Medical treatment involves optimizing and/or replacing dopamine levels through various therapeutic agents.
Avoiding Exacerbation of Chronic Kidney Disease
Authors: Xue Emily Y. , Moore David , Arriaga Alexander F.
Published: January 2025

Chronic kidney disease (CKD) afflicts millions of patients in the United States and has a high association with other chronic conditions. It can range from asymptomatic and well-controlled to life-threatening. Patients with CKD require effective outpatient care to prevent disease progression and manage comorbid conditions. Likewise, management of perioperative patients with this disease requires careful consideration and a tailored anesthetic plan. Surgical patients are at risk for acute kidney injury (AKI), and techniques should be employed to minimize this risk. CKD contributes to a multitude of other perioperative risks affecting multiple organ systems. Medical optimization and careful preoperative evaluation of their comorbidities allow the anesthesiologist to most effectively manage these patients intraoperatively.
Older Primigravida with Twin Pregnancy for Elective Cesarean Delivery
Authors: Jin Evan , Kumaraswami Sangeeta , Weber Garret
Published: January 2025

The perioperative management of a woman with advanced maternal age and twin pregnancy who is scheduled for an elective cesarean delivery can prove to be very complex. The presentation may include preexisting conditions like hypertension, diabetes, obesity, obstructive sleep apnea, and substance use disorder. Furthermore, pregnancy-specific conditions including preeclampsia, gestational diabetes, peripartum cardiomyopathy, and placental abnormalities indicative of placenta accreta spectrum disorder may arise, and management may prove to be extremely challenging. The patient may refuse blood products, and the clinician may encounter racial and ethnic disparities which could impact the patient’s perianesthetic care. Although all these issues are unlikely to occur in a single patient, it is important to be prepared for them, starting with the preoperative assessment and continuing through the postoperative course.
Minimally Invasive Surgery and Other Elements of Enhanced Recovery Protocols
Authors: Bennici Lesley , Factor Morgane , Singh Sunitha M. , Costa Ana
Published: January 2025

Robotic surgeries present specific challenges to the anesthesia team. Included in these challenges are positioning issues, lack of access to the patient, and intraperitoneal insufflation with carbon dioxide. Robotic hysterectomies necessitate lithotomy and steep Trendelenburg positioning, which could lead to mechanical ventilation problems, potential nerve injuries, and hemodynamic instability. Many patients who undergo robotic hysterectomies are at a higher risk for postoperative nausea and vomiting, and considerations should be made to minimize this risk. In addition, some patients undergoing a robotic hysterectomy are discharged home the day of surgery. Therefore, the anesthesiology team should apply enhanced recovery after surgery principles to maximize analgesia and minimize any potential complications postoperatively.
Being a doctor
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter explores what is involved in being a doctor. It introduces the reader to the Foundation Programme, covers starting as an F1, communication skills, quality and ethics, medical errors, complaints, incident reporting, pay and contracts, and career progression in the medical field after the Foundation Programme.
Life on the wards
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter discusses life on the wards. It covers interactions with the medical and multidisciplinary teams, ward rounds, and anatomical terms and planes. The chapter moves on to include discussion of medical forms such as fitness to work notes and referrals, common issues that may come up when working on the wards. Being on-call and night shifts are discussed. Finally, the chapter covers surgery, including pre-op and post-op assessments, surgical terminology, wound management, and stomas.
Pharmacopoeia
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter covers specifications for the most commonly used pharmaceutical drugs.
Fluids and renal
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter covers diseases related to fluids and renal function. The chapter discusses acute kidney injury, chronic kidney disease, haematuria, proteinuria, glomerular disease, urological disorders, low urine output, IV fluids, potassium emergencies, and electrolyte imbalance.
Emergency department
Authors: Raine Tim , Collins George , Brown Fraser , Howarth Sophie
Published: January 2025

This chapter sets out what Foundation doctors can expect from working in the emergency department. It includes discussion of emergency procedures when it comes to acute limb pain, burns, anaphylaxis in adults, hypotension, and overdose. The chapter also covers trauma, head injury, neck injury, falls and collapse, acute limb pain, burns, hypotension (systolic blood pressure <100mmHg), hypotension emergency, shock, pyrexia, overdose and deliberate self-harm, and emergencies in obstetrics and gynaecology.
Application of Stem Cells to Understanding Psychiatric Disorders
Authors: Birtele Marcella , Quadrato Giorgia , Brennand Kristen J.
Published: January 2025

Although much has been learned through clinical postmortem and neuroimaging studies of patients and/or animal models of autism spectrum disorder, bipolar disorder, and schizophrenia, these classical approaches have yet to fully elucidate the interaction of complex genetic risk factors on disorder predisposition. The derivation of human-induced pluripotent stem cells (hiPSCs) from patients with psychiatric disorders permits the study of the full complement of risk variants (known and unknown) that underlie disease predisposition, precisely in the cell types relevant to disease. A better mechanistic understanding of mental illness will not only enable the development of new therapeutic approaches but also help affirm that these disorders are the consequence of specific neural pathology and dysregulation of discrete neural processes. This chapter discusses work to date regarding the advancements in the use of hiPSCs to model psychiatric disorders.
Positron Emission Tomography Brain Imaging Methodologies
Authors: Hillmer Ansel T. , Cosgrove Kelly P. , Carson Richard E.
Published: January 2025

Positron emission tomography (PET) brain imaging provides a powerful noninvasive tool for quantitative and pharmacologically specific clinical research. PET imaging provides quantitative measurements of pharmacologically specific phenomena including blood flow, glucose metabolism, synaptic density, receptor–ligand binding phenomena, neurotransmitter synthesis, transporters, and other enzymatic processes in living people. This chapter describes basic methodological considerations for PET brain imaging studies. First, the physiological interpretation of common outcome measures of binding potential (BPND) and volume of distribution (VT) are described. Next, aspects of acquisition of PET imaging data and blood measurements for analysis are discussed, followed by a summary of standard data analysis techniques. Finally, various applications for the study of mental illness, including group differences, measurements of drug occupancy, and assay of acute neurotransmitter release, are discussed.
Neuroimaging and Circuit Mechanisms of Schizophrenia
Authors: Woodward Neil D. , Heckers Stephan , Ongur Dost , Sheffield Julia M.
Published: January 2025

Neuroimaging’s unique capability at capturing pathology in brain images has transformed the understanding of schizophrenia. Numerous abnormalities in brain structure have been identified, including ventricular enlargement, smaller subcortical and hippocampal volumes, and widespread cortical thinning. Functional neuroimaging has informed the mechanisms of psychosis phenotypes and cognitive impairment. Connectivity based methods have helped develop and test neural models of schizophrenia, including network models emphasizing dysconnectivity in cortical, thalamocortical, and hippocampal circuits. Magnetic resonance spectroscopy has revealed abnormalities in glutamatergic and GABAergic neurotransmission. Studies of unaffected family members and genetic syndromes associated with elevated risk for psychosis have informed genetic mechanisms. These discoveries helped redefine schizophrenia as a brain disorder. Nevertheless, neuroimaging has yet to fundamentally alter the clinical management of individuals with schizophrenia. Greater emphasis on longitudinal and intervention studies, optimizing psychometric properties (e.g., reliability) of neuroimaging variables, and dimensional assessments of psychopathology will help reach this goal.
Neurotrophic Mechanisms of Depression and Antidepressant Action in Animal and Human Studies
Authors: Monteggia Lisa M.
Published: January 2025

Neurotrophic factors are required for the proliferation, maturation, and guidance of neurons during development, but they also play critical roles in the adult brain. The disruption of neurotrophic factor expression and signaling by stress has been hypothesized to contribute to an individual’s vulnerability to depression. Conversely, neurotrophic factors have been shown to be critical for antidepressant effects, including the rapid action of ketamine and scopolamine. This chapter provides an overview of neurotrophic factors, with a focus on brain-derived neurotrophic factor (BDNF), in depression and the complexity of recent findings. It also discusses the essential role of BDNF in antidepressant action, including rapid antidepressant effects of ketamine and scopolamine.
Current Treatments for Depression
Authors: Fava Maurizio , Krystal John H.
Published: January 2025

Major depressive disorder (MDD) is a highly prevalent and disabling medical condition, with such prevalence having markedly increased during the COVID-19 pandemic. Depression may be a predictor of later medical disease and, in the presence of comorbid medical illness, is associated with poorer medical outcomes. It is critical to provide adequate treatment of MDD. This chapter reviews the pharmacological approaches to the treatment of patients with MDD, ranging from the monoamine-based pharmacotherapies to the more recently introduced glutamatergic and GABAergic antidepressants. It also reviews the pharmacological actions of these agents and their relevance to both efficacy and tolerability, as well as the results of the STAR*D study, the largest trial ever conducted in MDD. The chapter describes the most common approaches to MDD patients who do not respond adequately to antidepressants and, in particular, the most common augmentation strategies. The roles of psychotherapy and of brain stimulation strategies are discussed.
Current Treatments for Anxiety and Trauma-Related Disorders
Authors: Szuhany Kristin L. , Feldman Benjamin , Malgaroli Matteo , Simon Naomi M.
Published: January 2025

Abstract: Anxiety and trauma-related disorders are some of the most commonly occurring mental health conditions and have a significant impact on quality of life and/or functioning. This chapter highlights evidence-based pharmacotherapy, psychotherapy, and integrative health interventions for common anxiety and trauma-related disorders, including generalized anxiety disorder, social anxiety disorder, panic disorder, and post-traumatic stress disorder. First-line interventions generally include selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors, as well as cognitive–behavioral therapy approaches. However, patient preference, resources, access, and clinical presentation factors such as comorbidity must be considered when selecting treatment. Digital interventions also offer alternatives to increase access and scalability of evidence-based interventions. Future directions include emphasis on processes of change and mechanisms of action, including for novel interventions and augmentation strategies, to further optimize and personalize interventions for anxiety and trauma-related disorders.
The Lewy Body Dementias
Authors: Galvin James E. , Bras Jose Tomas
Published: January 2025

Lewy body dementia (LBD) is the second most common form of neurocognitive disorder after Alzheimer’s disease and covers two related diagnoses: dementia with Lewy Bodies and Parkinson’s disease dementia. Despite being a common disorder, diagnosis outside expert academic centers remains a significant challenge. The core pathological feature of LBD is the cortical Lewy body; however, many cases will have coexistent Alzheimer’s disease pathology. Genetic risk factors for LBD include mutations in genes for apolipoprotein E (APOE), α-synuclein (SNCA), and galactocerebrosidase (GBA). Dopamine transporter imaging remains the most sensitive, but platforms for measuring α-synuclein are being developed. Current therapies focus on symptomatic relief, but experimental cell and animal models are providing new insights for the development of disease-modifying therapeutics.
Novel Approaches for Treating Alzheimer’s Disease and Other Dementias
Authors: Silva M. Catarina , Butler David C. , Temple Sally , Haggarty Stephen J.
Published: January 2025

Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) are associated with memory and reasoning impairment caused by progressive brain cell death. A common disease feature is the accumulation of pathological aggregating proteins in neurons and glia of the affected brain regions, such as extracellular deposition of amyloid plaques and intracellular tau neurofibrillary tangles. Despite substantial research and investment efforts, there are no effective disease-modifying or preventative therapeutics for AD/ADRD. Challenges include insufficient understanding of pathogenic mechanisms, poor target validation/binding, poor drug delivery to the brain, and weak drug-modifier effects. Repeated AD/ADRD clinical trial failures underscore the need for innovative human cellular and preclinical animal models, novel therapeutic modalities, and new ways to stratify patient populations. In this chapter, progress toward these goals is reviewed, including innovations in small molecules, biologics, immunotherapies, and gene therapies that target protein–protein interactions and aggregation, promote protein degradation, lessen neuroinflammation, and improve blood–brain barrier accessibility.
Neuroimaging in Pediatric Psychiatric Disorders
Authors: Roberts Timothy P. L. , Bloy Luke
Published: January 2025

Noninvasive imaging and electrophysiological techniques have been developed to probe specific aspects of brain function and dysfunction, providing spatial maps of functional centers and temporal activity characteristics. These techniques have evolved from single-modality methods identifying functional localization, specialization, and segregation, through real-time measures of neuronal activity, toward multimodality integration of structural, functional, and spectrotemporal approaches. While imaging makes an immediate impact in neurologic conditions where physical brain lesions are clearly evident, to make a commensurate contribution within neuropsychiatry is substantially more complex; nonetheless by combining concepts of morphology, neurochemistry, neural signal propagation, and regional connectivity, there appears to be ample opportunity to contribute not only to the diagnosis of patients with mental illness but also to the stratification and subtyping across behavioral phenotypes and, ultimately, to patient management. This chapter present an overview of the most common noninvasive neuroimaging methodologies, as well as their applications to pediatric neurodevelopmental disorders.
Neurobiology of Tic Disorders and Obsessive–Compulsive Disorder
Authors: Pittenger Christopher
Published: January 2025

Obsessive–compulsive disorder (OCD) and Tourette syndrome (TS), along with other tic disorders, involve pathophysiological alterations in the corticostriatal circuitry. Both are neurodevelopmental conditions, although OCD can also have adult onset. They are frequently comorbid and often run together in families. Genetic studies suggest shared risk factors, especially in the case of early onset OCD. Because of these shared characteristics, they are treated together in this chapter. Structural and functional neuroimaging studies are refining understanding of the abnormalities in corticostriatal connectivity that accompany symptomatology. Advances in animal models that may capture aspects of pathophysiology have allowed testing of specific etiological hypotheses and have established several systems in which more precise mechanistic studies of pathophysiology are proceeding. Finally, growing evidence suggests that immune dysregulation may contribute to a subset of cases.
Digital Therapies of Psychiatric Disorders
Authors: Biagianti Bruno , Nahum Mor , Yitzhak Neta , Vinogradov Sophia
Published: January 2025

The field of digital mental health is rapidly expanding. This chapter focuses on digital interventions for depression, emphasizing that only a limited number of adequately powered and rigorously designed randomized clinical trials have investigated their efficacy in well-defined participant groups. Digital cognitive–behavioral theory (dCBT) is the most commonly used scientific paradigm studied to date, and the data indicate that for mild depression, self-guided dCBT interventions are efficacious, whereas for moderate or severe symptoms, assisted dCBT and blended treatments are preferable. Digital behavioral activation and cognitive training programs have also been explored. In the near future, it is likely that multiple aspects of digital technology will be able to be harnessed to create precision phenotyping and to deliver and monitor individualized digital interventions in real time via closed-loop systems. Digital mental health formularies are already available and being further developed to support clinicians in understanding patient engagement, efficacy, and safety.
Quo Vadis
Authors: Lawrence Ryan E. , Lieberman Jeffrey A.
Published: January 2025

In the course of its history, psychiatry has faced many challenges and controversies, including an ongoing search for biomarkers, a need for more effective treatments, difficulties in enabling access to care, questions surrounding the appropriateness of involuntary treatment, and ongoing stigma. These challenges are not unique to the present age. Each has historical precedent and exists in a historical context that has profoundly shaped how psychiatry has evolved over decades and sometimes over centuries. Understanding this historical context provides perspective on how these challenges developed into their current shape and offers hints of the future. This chapter provides a historical review of the field of psychiatry.
Discrimination, Bias, and Their Effects on Professionalism Standards for Underrepresented Groups
Authors: Chawla Vanika , Alexander Amy
Published: January 2025

This chapter explores unique considerations of the applications of professionalism for those underrepresented in medicine groups, including first-generation physicians, international medical graduates, LGBTQ+ physicians, physicians with disabilities, Asian medical trainees, and physicians and racial and ethnic minorities (e.g., Black, Latinx, and Native American) medical students and physicians. Bias is reviewed in the constructs and applications of professionalism that may negatively disadvantage these groups, and the importance of identifying, acknowledging, and challenging these notions to operationalize professionalism is discussed in a manner that is inclusive and encourages diversity. This chapter explores research with a focus on qualitative studies and narratives to illustrate the experiences of diverse physicians and their experiences with professionalism.
Low-Dose Neuroleptics for Treating Delirium
Authors: Araya Deborah
Published: January 2025

“A Double-Blind Trial of Haloperidol, Chlorpromazine, and Lorazepam in the Treatment of Delirium in Hospitalized AIDS Patients” compares the efficacy and side effects of 3 drugs commonly used to treat delirium. The researchers gained consent from 244 nondelirious hospitalized patients with AIDS. Thirty patients subsequently developed delirium while in the hospital setting and were randomized to 1 of 3 treatment arms. The results were measured using the Delirium Rating Scale, Mini-Mental State scores, and the Extrapyramidal Symptoms Rating Scale. Both haloperidol and chlorpromazine were found effective in low doses with minimal side effects. Lorazepam worsened delirium symptoms and had treatment-limiting side effects.
The Use of Very Low-Dose Methadone for Palliative Pain Control
Authors: Davis Mellar P.
Published: January 2025

Methadone is a unique opioid analgesic with high-efficacy binding to mu receptors. In a study by Salpeter and colleagues, patients on potent opioids were placed on a loading dose (2.5–15 mg/day) depending on whether opioid naïve or tolerant and then the potent opioid in the opioid-tolerant patient was tapered. Haloperidol was used as an adjuvant. The median pain intensity score on methadone was 0 (range 0–6), similar in cancer and noncancer patients. Haloperidol was used in 40% of those receiving methadone and 70% of those who converted from long-acting opioids to methadone. The median dose of haloperidol was 3 mg (interquartile range 2–6 mg).
Lorazepam and Haloperidol Versus Haloperidol Monotherapy for the Treatment of Agitated Delirium
Authors: Juba Katherine M. , Svengsouk Jefferson S.
Published: January 2025

Agitated delirium is a common symptom in patients with a limited life expectancy. The objective of this single-center, double-blind, randomized controlled trial was to assess the efficacy of 3 mg intravenous (IV) lorazepam + 2 mg IV haloperidol versus placebo + 2 mg IV haloperidol for the treatment of agitated delirium in adult patients with advanced cancer. Ninety patients were enrolled, and 52 patients completed the study (n = 26 lorazepam and n = 26 placebo). Patients who received lorazepam + haloperidol had a greater decrease in agitation (Richmond Agitation-Sedation Scale [RASS] = –4.1 points) than haloperidol alone (RASS = –2.3 points) (P < .001). This study suggests that the addition of 3 mg IV lorazepam to IV haloperidol versus haloperidol alone resulted in a significantly greater reduction in agitation at 30 minutes and at 8 hours with a lower risk of hyperactivity.
Treatment of Cancer-Related Fatigue With Dexamethasone
Authors: Mis Lydia , Kamal Arif
Published: January 2025

Clinicians frequently prescribe corticosteroids to patients with advanced cancer for the management of cancer-related fatigue (CRF), pain, nausea, and anorexia/cachexia based on small randomized trials that have shown benefit. This trial was undertaken to examine the benefit of short-term dexamethasone (14 days) versus placebo on CRF and other symptoms using validated, patient assessment instruments. At the conclusion of the trial period (day 15), there was a significant improvement in CRF and other patient-related symptom scores except for overall symptom distress or psychological distress scores. There was no difference in the frequency of adverse effects between the 2 groups. More studies are needed to evaluate the safety and efficacy of corticosteroids for CRF for longer durations of time as many patients are living many months with advanced cancer.
Efficacy of Levetiracetam, Fosphenytoin, and Valproate for Established Status Epilepticus by Age Group (ESETT)
Authors: Yeh Angela , Martin Emily J.
Published: January 2025

In this multicenter, double-blind, response-adaptive, randomized controlled trial, investigators found that levetiracetam, fosphenytoin, and valproate were equally effective and safe in the treatment of benzodiazepine-refractory status epilepticus among children (< 18 years), adults (18–65 years), and older adults (> 65 years).
Treatment of Malodorous Tumors With Topical Metronidazole
Authors: Mis Lydia
Published: January 2025

Malodorous tumors cause emotional distress due to the appearance of fungating wounds, exudate, pain, constant bleeding risk, low self-esteem, social isolation, and low quality of life (QOL). Family and caregivers may avoid such patients. This study showed that once- to twice-daily application of metronidazole (MTZ) 0.75% gel successfully decreased odor (measured on a scale of 0 to 5) by day 14 to a score of 0 to 1 in 95.5% of patients and that 71.4% of patients were satisfied with results. Treatment was well tolerated except for 2 cases of tumoral bleeding (1 each of mild and moderate). The use of MTZ 0.75% gel should be considered as part of fungating wound care management protocols.
The Effect of Cannabis on Appetite and Quality of Life in Patients With Cancer-Related Anorexia-Cachexia Syndrome
Authors: Natarajan Balakrishnan , Bhagavat Bavna
Published: January 2025

“Comparison of Orally Administered Cannabis Extract and Delta-9-Tetrahydrocannabinol in Treating Patients With Cancer-Related Anorexia-Cachexia Syndrome: A Multicenter, Phase III, Randomized, Double-Blind, Placebo-Controlled Clinical Trial From the Cannabis-In-Cachexia-Study-Group,” is a randomized controlled trial which studied 243 patients with cancer-related anorexia-cachexia syndrome (CACS) over a 6 week period. This trial investigated the effects of cannabis extract (CE), THC (delta-9-tetrahydrocannabinol), and placebo on appetite and quality of life (QOL). Results revealed no significant differences between the CE, THC, and placebo arms in QOL, appetite, nausea, mood, and cannabinoid-related toxicity. There was early closure of the trial due to insufficient differences between study arms. Increase in appetite was noted in other studies3, however THC dosing was variable. No strong recommendation of cannabinoids for palliation of appetite and QOL can be made on the basis of this study. Further studies on larger sample sizes are needed to characterize the palliative and adverse effects of cannabinoids.
Role of Paracetamol (Acetaminophen) for Cancer Pain Requiring High-Dose Opioids
Authors: Pandey Shila
Published: January 2025

Cancer pain is a common symptom managed by palliative care clinicians that may require high-dose opioids. The use of paracetamol (acetaminophen) as an adjuvant to an opioid regimen was studied in this randomized, controlled, crossover trial. Thirty-one patients received paracetamol and placebo for 5 days. The primary outcome was effect on pain and number of breakthrough medications used. Secondary outcomes included adverse effects and overall well-being. There were no statistically significant differences in any of these variables. Palliative care providers should question the role of paracetamol as an adjuvant to an opioid regimen > 200 mg/day.
Treatment of Painful Wounds With Topical Morphine
Authors: Protus Bridget McCrate , Brinker Joni
Published: January 2025

Opioid receptors are present on peripheral nerve terminals and are believed to play a role in pain modulation at the site of pressure injuries, malignant lesions, and other wound types. The authors present a case series to illustrate treatment of painful wounds with application of a compounded morphine-hydrogel topical wound dressing. All but 1 of the patients obtained pain relief after topical morphine applications. Additional research is needed to determine definitive benefit of topical opioid application for painful wounds. Based on subjective patient reporting of pain control, topical morphine appears to be effective at reducing pain in open wounds.
Efficacy and Safety of Valproic Acid Versus Haloperidol in Patients With Acute Agitation
Authors: Vanston Vincent Jay , Langi Alyssa
Published: January 2025

The objective was to compare the efficacy of valproate versus haloperidol in decreasing agitation in affected patients in the emergency department. A total of 160 acutely agitated patients were assigned to receive intravenous sodium valproate (20 mg/kg) or intramuscular haloperidol (5 mg/1 mL). Agitation was measured at baseline and 30 minutes after the first injection using 3 agitation scales. A larger proportion of patients in the haloperidol group experienced intense sedation and extrapyramidal symptoms compared with the valproate group. Findings suggest that in the clinical practice setting of emergency psychiatry, intravenous valproate is as effective as haloperidol in reducing agitation, with a better safety profile.
Migraine in women
Authors: Macgreggor Anne
Published: January 2025

Around 4 of every 10 women will experience migraine at some point during their lives, with most having their first attack by age 35 years. This chapter deals with the influence of the hormonal effects of menstruation and menopause and the implications for contraception and pregnancy. It covers pathophysiology, diagnosis and management options full these areas of Women’s Health.