bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship of smoking cessation period with the incidence of complications in lung cancer surgery
Authors: Kadomatsu Yuka , Sugiyama Tomoshi , Sato Keiyu , Nakanishi Keita , Ueno Harushi , Goto Masaki , Ozeki Naoki , Nakamura Shota , Fukumoto Koichi , Chen-Yoshikawa Toyofumi Fengshi
Published: February 2022

OBJECTIVES

The incidence of postoperative complications is relatively high in smokers. Although 4-week smoking cessation before surgery is generally recommended, it has not been sufficiently studied in lung cancer surgery. This study investigated whether smoking cessation for a short period of time significantly reduced complications after lung cancer surgery.

METHODS

This was a retrospective, observational study that investigated the relationship between the smoking cessation period and the incidence of complications in lung cancer surgery. Patients who underwent curative-intent surgery for lung cancer at our institution between January 2014 and December 2017 were included. The smokers were classified into the following 4 categories of smoking cessation period before surgery: current (<4 weeks), recent (4 weeks to 12 months), distant (12 months to 5 years) and ex-smokers (>5 years).

RESULTS

A total of 911 patients were included in this study. The incidence of pulmonary complications was 5 times higher in the smoker group than in the never smoker group (12.9% vs 2.5%, P < 0.001). On multivariable analysis in both models, the odds ratio for complications was significantly higher in distant smokers than in recent smokers and never smokers. Across all models, low lung function significantly predicted the development of postoperative complications.

CONCLUSIONS

The evidence-based smoking cessation duration that reduces the incidence of complications after thoracic surgery remains unclear. The incidence of postoperative complications was more strongly affected by low pulmonary function than by the duration of preoperative smoking cessation. For patients with marginal indications for surgery, postponing surgery to accommodate a smoking cessation period seemed unnecessary.
Pacemaker implantation after sutureless or stented valve: results from a controlled randomized trial
Authors: Lorusso Roberto , Ravaux Justine M , Pollari Francesco , Folliguet Thierry A , Kappert Utz , Meuris Bart , Shrestha Malakh L , Roselli Eric E , Bonaros Nikolaos , Fabre Olivier , Corbi Pierre , Troise Giovanni , Andreas Martin , Pinaud Frederic , Pfeiffer Steffen , Kueri Sami , Tan Erwin , Voisine Pierre , Girdauskas Evaldas , Rega Filip , Garcia-Puente Julio , Fischlein Theodor ,   on behalf the PERSIST-AVR Investigators, Fischlein Theodor , Lorusso Roberto , Folliguet Thierry , Shrestha Malakh , Meuris Bart , Roselli Eric , Kappetein Arie Pieter , Gaggianesi Sara
Published: February 2022

OBJECTIVES

Sutureless aortic valves demonstrated non-inferiority to standard stented valves for major cardiovascular and cerebral events at 1 year after aortic valve replacement. We aim to assess the factors correlating with permanent pacemaker implantation (PPI) in both cohorts.

METHODS

PERSIST-AVR is a prospective, randomized, open-label trial. Patients undergoing aortic valve replacement were randomized to receive a sutureless aortic valve replacement (Su-AVR) or stented sutured bioprosthesis (SAVR). Multivariable analysis was performed to identify possible independent risk factors associated with PPI. A logistic regression analysis was performed to estimate the risk of PPI associated to different valve size.

RESULTS

The 2 groups (Su-AVR; n = 450, SAVR n = 446) were well balanced in terms of preoperative risk factors. Early PPI rates were 10.4% in the Su-AVR group and 3.1% in the SAVR. PPI prevalence correlated with valve size XL (P = 0.0119) and preoperative conduction disturbances (P = 0.0079) in the Su-AVR group. No predictors were found in the SAVR cohort. Logistic regression analysis showed a significantly higher risk for PPI with size XL compared to each individual sutureless valve sizes [odds ratio (OR) 0.272 vs size S (95%confidence interval 0.07–0.95), 0.334 vs size M (95% CI 0,16–0; 68), 0.408 vs size L (95% CI 0,21–0.81)] but equivalent risk of PPI rates for all other combination of valve sizes.

CONCLUSIONS

Su-AVR is associated with higher PPI rate as compared to SAVR. However, the increased PPI rate appears to be size-dependent with significant higher rate only for size XL. The combination of preoperative conduction disorder and a size XL can lead to a higher probability of early PPI in Su-AVR.

Clinical trial registration number

NCT02673697.
Comparison of a full sternotomy with a minimally invasive approach for concomitant mitral and tricuspid valve surgery
Authors: Paparella Domenico , Margari Vito , Santarpino Giuseppe , Moscarelli Marco , Guida Pietro , Fattouch Khalil , Albertini Alberto , Martinelli Luigi , Mikus Elisa , Gregorini Renato , Speziale Giuseppe
Published: February 2022

OBJECTIVES

The need for concomitant tricuspid surgery in patients who need mitral valve surgery casts doubt on its feasibility via a minimally invasive approach. Our goal was to evaluate the short-term outcomes of patients undergoing concomitant mitral and tricuspid valve surgery either with a standard full sternotomy (full-MTS) or a minimally invasive approach (mini-MTS).

METHODS

The outcomes of patients who had combined mitral and tricuspid valve surgery in 11 centres were retrospectively evaluated. The primary outcome was the incidence of 30-day mortality. A propensity score matched cohort was selected to create 2 comparable groups stratified by surgery (valve replacement or repair).

RESULTS

During the study period, 1048 consecutive patients had combined mitral and tricuspid valve surgery (730 full-MTS, 318 mini-MTS). The matching procedure paired 192 full-MTS to 192 mini-MTS procedures. After matching, mini-MTS was associated with longer cardiopulmonary bypass [123 min, standard deviation (SD) 46, vs 102 min, SD 36, P = 0.001] and cross-clamping times (89 min, SD 34, vs 78 min, SD 29, P = 0.003). Although the hospital length of stay was shorter (8 days, interquartile range 7-12 vs 9 days, interquartile range 7–14, P = 0.034) with mini-MTS before matching, this difference disappeared after matching. No differences in other major complications or in 30-day mortality were observed: 48 deaths (4.6%), 36 of which (4.9%) occurred in patients who had a full-MTS and 12 (3.8%), in patients who had a mini-MTS (4.7% in both approaches paired by propensity).

CONCLUSIONS

The mini-MTS approach proved to be safe and effective in patients requiring concomitant mitral and tricuspid surgery. We could not demonstrate any difference in short-term outcomes between the 2 surgical approaches, indicating that there is not a preferred surgical approach.
Cardiac ablation with pulsed electric fields: principles and biophysics
Authors: Sugrue Alan , Maor Elad , Del-Carpio Munoz Freddy , Killu Ammar M , Asirvatham Samuel J
Published: February 2022

Pulsed electric fields (PEFs) have emerged as an ideal cardiac ablation modality. At present numerous clinical trials in humans are exploring PEF as an ablation strategy for both atrial and ventricular arrhythmias, with early data showing significant promise. As this is a relatively new technology there is limited understanding of its principles and biophysics. Importantly, PEF biophysics and principles are starkly different to current energy modalities (radiofrequency and cryoballoon). Given the relatively novel nature of PEFs, this review aims to provide an understanding of the principles and biophysics of PEF ablation. The goal is to enhance academic research and ultimately enable optimization of ablation parameters to maximize procedure success and minimize risk.
Rewiring host–microbe interactions and barrier function during gastrointestinal inflammation
Authors: Jensen Sune K , Pærregaard Simone I , Brandum Emma P , Jørgensen Astrid S , Hjortø Gertrud M , Jensen Benjamin A H
Published: February 2022

Organismal survival depends on a well-balanced immune system and maintenance of host–microbe mutualism. The fine-tuned relationship between the gut microbiota and host immunity is constantly challenged by opportunistic bacteria testing the integrity of gastrointestinal (GI) barrier defenses. Barrier dysfunction reduces immunological tolerance towards otherwise innocuous microbes; it is a process that may instigate chronic inflammation. Paradoxically, sustained inflammation further diminishes barrier function, enabling bacterial translocation to extra-intestinal tissues. Once translocated, these bacteria stimulate systemic inflammation, thereby compromising organ function. While genetic risk alleles associate with barrier dysfunction, environmental stressors are key triggers of GI inflammation and associated breakdown in immune tolerance towards resident gut microbes. As dietary components dictate substrate availability, they also orchestrate microbiota composition and function, including migratory and pro-inflammatory potential, thus holding the capacity to fuel both GI and extra-intestinal inflammation. Additionally, Western diet consumption may weaken barrier defenses via curbed Paneth cell function and diminished host-defense peptide secretion. This review focuses on intervenable niches of host–microbe interactions and mucosal immunity with the ambition to provide a framework of plausible strategies to improve barrier function and regain tolerance in the inflamed mucosa via nutritional intervention.
How Sequence Context-Dependent Mutability Drives Mutation Rate Variation in the Genome
Authors: Oman Madeleine , Alam Aqsa , Ness Rob W
Published: February 2022

The rate of mutations varies >100-fold across the genome, altering the rate of evolution, and susceptibility to genetic diseases. The strongest predictor of mutation rate is the sequence itself, varying 75-fold between trinucleotides. The fact that DNA sequence drives its own mutation rate raises a simple but important prediction; highly mutable sequences will mutate more frequently and eliminate themselves in favor of sequences with lower mutability, leading to a lower equilibrium mutation rate. However, purifying selection constrains changes in mutable sequences, causing higher rates of mutation. We conduct a simulation using real human mutation data to test if 1) DNA evolves to a low equilibrium mutation rate and 2) purifying selection causes a higher equilibrium mutation rate in the genome’s most important regions. We explore how this simple process affects sequence evolution in the genome, and discuss the implications for modeling evolution and susceptibility to DNA damage.
The ‘becomings’: singing and songwriting with mothers and midwives at South-East Queensland
Authors: Mani Charulatha
Published: February 2022

Plain language summary

 

How can songwriting show us the meaning of music and language for health and wellbeing in culturally and linguistically diverse mothers? This article examines the artistic processes in music-cum-health workshops involving new and expectant mothers and their midwives. The voices of the mothers of colour have been silenced historically and systemically. To give them social justice in a health context, singing is a powerful tool and songwriting links this tool to useful health messages. Through this article, the formation of a song on the placenta, a key part of the womb in childbearing, is traced through the stories of a music facilitator, a mother and a midwife. The storying highlights the importance of artistic processes for understanding the person within and their cultural identity. The article argues that cultural understanding of the participants in such arts-in-health programmes is important for socially just models of health care for those at the margins.

From being instrumentalized as interventions that are ‘administered’ with an aim to garner health outcomes, art-based participatory approaches are now recognized as capable of activating culturally founded wellbeing in individuals. Through this article, I propose that as the focus shifts from what art does for health to what art means for a healthy life, the cultural vitality inherent in individuals and societies can be better championed in arts-in-health discourses. I discuss the artistic processes in singing and songwriting in a perinatal context involving mothers from culturally and linguistically diverse backgrounds and their midwives. I argue for lenses to better understand the role of cultural practices in health research involving migrant and refugee communities. Using narrative inquiry, I trace intersecting trajectories wherein the storied life of a coloured mother is intercepted by that of a midwife, and of myself, a coloured female mother-researcher and facilitator. At the intersection emerges a song, as a process and product. This article advances that it is when artmaking processes are centred that the voices from the margins become heard, and it is when their voices are amplified that health research design becomes equitable and ethically sound.
Lower Impact of Disease on Daily Life and Less Fatigue in Patients With Inflammatory Bowel Disease Following a Lifestyle Intervention
Authors: Lamers Carlijn R , de Roos Nicole M , Heerink Henrike H , van de Worp-Kalter Linda A , Witteman Ben J M
Published: February 2022

Background

Despite the potential benefits of diet and physical activity, evidence for beneficial effects of a combined lifestyle intervention is lacking in patients with inflammatory bowel disease (IBD). Therefore, we assessed its effects on impact of disease on daily life, clinical disease activity, fatigue, and health-related quality of life (HRQoL) in patients with IBD.

Methods

A 6-month single-arm intervention study was performed in adult IBD patients in remission or with mildly active disease. Participants received personal dietary and physical activity advice from a dietician and a physiotherapist in 6 consults. At baseline and over time, questionnaires on diet quality, physical activity, and disease-related outcomes were completed and fecal calprotectin was determined. Data were analyzed by linear mixed models.

Results

During the intervention, diet quality significantly increased (P < .001), but the level of physical activity remained the same. Over time, impact of the disease on daily life reduced (P = .009) and fatigue decreased (P = .001), while clinical disease activity, HRQoL, and fecal calprotectin did not change. Improvement in diet quality was significantly associated with a lower impact of disease on daily life (β = 0.09; 95% confidence interval [CI], 0.03 to 0.15; P = .003) and less fatigue (β = -0.13; 95% CI, -0.20 to -0.07; P < .001) but not with clinical disease activity, HRQoL, and fecal calprotectin. No associations were found with physical activity.

Conclusions

This combined lifestyle intervention significantly improved diet quality, and this improvement was associated with a reduction in the impact of disease on daily life and fatigue in patients with IBD in remission or with mildly active disease.
Normal Sperm DNA Integrity in Patients With Inflammatory Bowel Disease on Ustekinumab Maintenance Therapy
Authors: Grosen Anne , Bellaguarda Emanuelle , Liljeqvist-Soltic Ingela , Mejlby Hansen Mette , Skytte Anne-Bine , Julsgaard Mette , Hanauer Stephen B , Kelsen Jens
Published: February 2022

Lay Summary

We demonstrate that ustekinumab does not adversely affect semen quality or sex hormones in male patients. Ustekinumab is not detectable in semen and poses no risk to partners. Our observations support a recommendation to continue ustekinumab therapy in patients wishing to conceive.
Impact of transit-time flow measurement on early postoperative outcomes in total arterial coronary revascularization with internal thoracic arteries: a propensity score analysis on 910 patients
Authors: Laali Mojgan , Nardone Nathalie , Demondion Pierre , D'Alessandro Cosimo , Guedeney Paul , Barreda Eleodoro , Lebreton Guillaume , Leprince Pascal
Published: February 2022

OBJECTIVES

The aim of this study was to evaluate the impact of transit-time flow measurement (TTFM) on early postoperative outcomes in total arterial coronary revascularization.

METHODS

A single-centre retrospective analysis was conducted on 910 patients undergoing isolated total arterial coronary artery bypass grafting with internal thoracic arteries (ITAs) at our institution, between January 2017 and February 2020. Complete arterial revascularization with bilateral ITAs with a Y-configuration, or single ITA, was planned for all patients. According to the surgeon preference, TTFM was assessed in 430 patients (TTFM group). They were compared with 480 patients without TTFM assessment (no TTFM group). Primary end point was the occurrence of in-hospital major cardiac adverse events (MACE). A propensity score analysis with an inverse probability weighting approach was performed to control for selection bias.

RESULTS

TTFM was associated with longer cardiopulmonary bypass times (76.0 [62.0; 91.2] vs 79.0 [65.0; 94.0] min, P = 0.042). Six (1.4%) patients in the TTFM group versus no patient in the no TTFM group underwent intraoperative graft revision because of unsatisfying flow values (P = 0.011). MACE were significantly lower in the TTFM group (14, 3.3%) than in the no TTFM group (33, 6.9%, P = 0.014). At crude regression, TTFM was protective against MACE occurrence (odds ratios 0.46, 95% confidence interval 0.23–0.85, P = 0.016). Inverse probability weighting adjustment did not significantly displace P-values and odds ratios for MACE occurrence in the TTFM group 0.44, 95% confidence interval 0.28–0.69, P < 0.001.

CONCLUSIONS

Even if associated with longer cardiopulmonary bypass times, intraoperative graft flow measurement with TTFM reduces MACE occurrence and it should be recommended for graft evaluation in arterial coronary artery bypass grafting surgery.
Informing training needs for the revised certified clinical data manager (CCDMTM) exam: analysis of results from the previous exam
Authors: Williams Tremaine Brueon , Schmidtke Carsten , Roessger Kevin , Dieffenderfer Vicki , Garza Maryam , Zozus Meredith
Published: February 2022

Objective

To inform training needs for the revised Certified Clinical Data Manager (CCDMTM) Exam.

Introduction

Clinical data managers hold the responsibility for processing the data on which research conclusions and regulatory decisions are based, highlighting the importance of applying effective data management practices. The use of practice standards such as the Good Clinical Data Management Practices increases confidence in data, emphasizing that the study conclusions likely hold much more weight when utilizing standard practices.

Methods

A quantitative, descriptive study, and application of classic test theory was undertaken to analyze past data from the CCDMTM Exam to identify potential training needs. Data across 952 sequential exam attempts were pooled for analysis.

Results

Competency domain-level analysis identified training needs in 4 areas: design tasks; data processing tasks; programming tasks; and coordination and management tasks.

Conclusions

Analysis of past CCDMTM Exam results using classic test theory identified training needs reflective of exam takers. Training in the identified areas could benefit CCDMTM Exam takers and improve their ability to apply effective data management practices. While this may not be reflective of individual or organizational needs, recommendations for assessing individual and organizational training needs are provided.
Retracted: Increased feed supply and dietary fiber from sugar beet pulp improved energy retention in gestating sows
Authors: Wisbech Sigrid J , Bruun Thomas S , Theil Peter K
Published: February 2022

The aim of the study was to investigate whether increased inclusion of sugar beet pulp (SBP) alters retention of fat, protein, and energy when backfat (BF) is restored in early- and mid-gestation. In total, 46 sows were fed one of four treatments with increasing inclusion of SBP with dietary fiber (DF) levels of 119, 152, 185, and 217 g/kg; sows were assigned to one of three feeding strategies (FS; high, medium, and low) depending on BF thickness at mating and again at day 30 for the following month. On days 0, 30, 60, and 108, body weight (BW) and BF thickness were measured, and body pools of protein and fat were estimated using the deuterium technique. On days 30 and 60, urine, feces, and blood samples were collected to quantify metabolites, energy, and N balances. On days 15 and 45, heart rates were recorded to estimate the heat production. At farrowing, total born and weight of the litter were recorded. In early gestation, BW gain (P < 0.01) and body protein retention increased (P < 0.05) with increasing fiber inclusion, while body fat retention increased numerically by 59%. Increase in BF was the greatest for sows fed the high FS, intermediate when fed the medium strategy, and negligible for sows fed the lowest FS. N intake, N loss in feces, and N balance increased linearly, whereas N loss in urine tended to decrease with increasing inclusion of fibers in early gestation. Concomitantly, fecal energy output and energy lost as methane increased linearly (P < 0.001), while energy output in urine declined linearly, and total metabolizable energy intake, therefore, increased from 40.5 MJ ME/d in the low-fiber group to 43.5 mega joule (MJ) metabolizable energy (ME)/d in the high-fiber group (P < 0.001). Changing the metabolizable energy toward more ketogenic energy was expected to favor fat retention rather than protein retention. However, due to increased intake of metabolizable energy and increased N efficiency with increasing fiber inclusion, the sows gained more weight and protein with increasing fiber inclusion. In conclusion, increased feed intake improved both fat and protein retention, whereas increased DF concentration increased protein retention.
Maternal Body Mass Index, Diabetes, and Gestational Weight Gain and Risk for Pediatric Cancer in Offspring: A Systematic Review and Meta-Analysis
Authors: Marley Andrew R , Domingues Allison , Ghosh Taumoha , Turcotte Lucie M , Spector Logan G
Published: February 2022

Background

Pediatric cancer incidence has steadily increased concurrent with rising adult obesity, but associations between maternal obesity and associated comorbidities and pediatric cancer risk remain understudied. We aimed to quantitatively characterize associations of pediatric cancer risk with maternal prepregnancy body mass index (BMI), gestational weight gain, and maternal diabetes.

Methods

We performed a comprehensive and systematic literature search in Ovid and EMBASE from their inception to March 15, 2021. Eligible studies reported risk estimates and sample sizes and provided sufficient description of outcome and exposure ascertainment. Random effects models were used to estimate pooled effects.

Results

Thirty-four studies were included in the analysis. Prepregnancy BMI was positively associated with leukemia risk in offspring (odds ratio [OR] per 5-unit BMI increase =1.07, 95% confidence intervals [CI] = 1.04 to 1.11; I2 = 0.0%). Any maternal diabetes was positively associated with acute lymphoblastic leukemia risk (OR = 1.46, 95% CI = 1.28 to 1.67; I2 = 0.0%), even after restricting to birthweight-adjusted analyses (OR = 1.74, 95% CI = 1.29 to 2.34; I2 = 0.0%), and inversely associated with risk of central nervous system tumors (OR = 0.73, 95% CI = 0.55 to 0.97; I2 = 0.0%). Pregestational diabetes (OR = 1.57, 95% CI = 1.11 to 2.24; I2 = 26.8%) and gestational diabetes (OR = 1.40, 95% CI = 1.12 to 1.75; I2 = 0.0%) were also positively associated with acute lymphoblastic leukemia risk. No statistically significant associations were observed for gestational weight gain.

Conclusions

Maternal obesity and diabetes may be etiologically linked to pediatric cancer, particularly leukemia and central nervous system tumors. Our findings support weight management and glycemic control as important components of maternal and offspring health. Further validation is warranted.
N limitation increases along a temperate forest succession: evidences from leaf stoichiometry and nutrient resorption
Authors: Zhang Peng , Lü Xiao-Tao , Li Mai-He , Wu Tonggui , Jin Guangze
Published: February 2022

Forest productivity and carbon (C) sequestration largely depend on soil N and P availability. To date, however, the temporal variation of nutrient limitation along forest succession is still under debate. Leaf stoichiometry and nutrient resorption are important indicators for predicting nutrient limitation of plant growth. Here, we measured nitrogen (N) and phosphorus (P) concentrations in green leaves and leaf litter for all woody species at four stages of temperate forest succession, and analyzed how abiotic and biotic factors affect leaf stoichiometry and nutrient resorption along forest succession. At the individual scale, leaf N and P concentrations had a significant increase at the end of the succession, while no change in leaf N:P ratio was detected. Nitrogen resorption efficiency (NRE) increased significantly with succession, but P resorption efficiency (PRE) first increased and then decreased. Significant increases in NRE:PRE ratios only occurred at the end of the succession. Moreover, plant N cycling was less responsive to soil nutrient than P cycling. At the community scale, we found that leaf N and P concentrations first decreased and then increased along forest succession, which were mainly affected by Shannon–Wiener index and species richness. Leaf N:P ratio significantly varied with succession and was mainly determined by community-weighted mean diameter at breast height (DBH). NRE increased and was significantly influenced by species richness and DBH, while PRE was relatively stable along forest succession. Thus, the NRE:PRE ratios significantly increased, indicating that N limitation is exacerbated with the temperate forest succession. These results might reflect the intense interspecific competition for limiting resource in a higher biodiversity community. In conclusion, our findings highlight the importance of biotic factors in driving forest ecosystem nutrient cycling and provide valuable information for sustainable fertilizer management practices in China’s temperate and boreal forests.
Adapted agency: how connected (Dutch) police professionals rework their professional capabilities
Authors: Meurs Teun , Noordegraaf Mirko
Published: February 2022

Increasingly, public professionals deal with complex issues, stakeholders, and publics. The so-called protective notions of professionalism no longer seem sufficient; they are reconfigured into more ‘connective’ forms. This involves dealing with tensions, dilemmas, and contradictions, calling for abilities to tackle these. Professionals will have to work on how they work, on their standards, routines, and practices. On the basis of an action-oriented research project, aimed at understanding the rise and results of new forms of police professionalism, we analyze what Dutch police professionals actually do when they perform connective work. We focus on policing, as this field experiences a transition from practice-based to knowledge-intensive forms of professionalism, relating police actions to societal stakeholders and issues. Based on observations of work practices of higher educated police professionals as well as interviews and educational interventions, we conclude that police professionals cannot simply ‘apply’ knowledge and competencies to practice, in order to solve societal problems. Rather, they gradually ‘develop’ capabilities (i.e., situational, analytical, and normative capabilities), in order to combine different forms of professional knowledge in real-life situations. Our research shows this is complicated. They ‘mess with’ how police professionalism ‘normally’ works. Police professionals are adapting their agency; they are performing ‘agency work’. They try to get a sense of the situation, explore multiple viewpoints, and demonstrate their added value. We argue that our conclusions are relevant for other professional fields.
NaCl affects photosynthetic and stomatal dynamics by osmotic effects and reduces photosynthetic capacity by ionic effects in tomato
Authors: Zhang Yuqi , Kaiser Elias , Li Tao , Marcelis Leo F M
Published: February 2022

NaCl stress affects stomatal behavior and photosynthesis by a combination of osmotic and ionic components, but it is unknown how these components affect stomatal and photosynthetic dynamics. Tomato (Solanum lycopersicum) plants were grown in a reference nutrient solution [control; electrical conductivity (EC)=2.3 dS m–1], a solution containing additional macronutrients (osmotic effect; EC=12.6 dS m–1), or a solution with additional 100 mM NaCl (osmotic and ionic effects; EC=12.8 dS m–1). Steady-state and dynamic photosynthesis, and leaf biochemistry, were characterized throughout leaf development. The osmotic effect decreased steady-state stomatal conductance while speeding up stomatal responses to light intensity shifts. After 19 d of treatment, photosynthetic induction was reduced by the osmotic effect, which was attributable to lower initial stomatal conductance due to faster stomatal closing under low light. Ionic effects of NaCl were barely observed in dynamic stomatal and photosynthetic behavior, but led to a reduction in leaf photosynthetic capacity, CO2 carboxylation rate, and stomatal conductance in old leaves after 26 d of treatment. With increasing leaf age, rates of light-triggered stomatal movement and photosynthetic induction decreased across treatments. We conclude that NaCl impacts dynamic stomatal and photosynthetic kinetics by osmotic effects and reduces photosynthetic capacity by ionic effects.
The Decision to Discontinue Antidepressants
Authors: Fava Giovanni A.
Published: February 2022

Discontinuation of antidepressant medications is a complex medical decision that should consider the detailed clinical history of the patient and is essentially based on clinical judgment. It should take into account a number of specific clinical situations, such as the presence of side effects from treatment, insufficient response to the antidepressant drug, and manifestations of behavioral toxicity. The physician’s clinical judgment, and particularly the notion that each therapeutic act has advantages and disadvantages, is the ideal ground for sharing decisions with the patient, who has then the opportunity of expressing opinions and preferences.
Prevention of Dependence and Withdrawal Symptomatology Caused by Antidepressant Medications
Authors: Fava Giovanni A.
Published: February 2022

The problems and difficulties that patients encounter in discontinuing antidepressant medications, and the increasing awareness of their long-term complications, alert us to the need of preventing the occurrence of dependence, with its ensuing problems of withdrawal symptomatology. Prevention of the dependence and withdrawal caused by antidepressants basically depends on their rational use. Antidepressant medications are life-saving drugs, but clinicians need to target their application only to the most severe and persistent cases of depression, limiting their use to the shortest possible time, and reducing their utilization in anxiety disorders, unless a major depressive disorder is present or other treatments have been ineffective. The importance of a psychotherapeutic approach for addressing symptoms with enduring effects is emphasized in this chapter.
Guidance for Caregivers
Authors: McQuellon Richard P. , Cowan Michael A.
Published: February 2022

Professional, family, and friend caregivers have a crucial role for cancer patients in mortal time. They are companions who experience both rewards and risks on the cancer journey. One risk is that the caregiver can be in a different place than the patient with regard to accepting or denying their mortality. The caregiver may be holding on to ordinary time while their loved one is letting go. This can create incongruent communication. Other challenges include complex family dynamics that can make for difficult interactions. Competent caregivers bring important virtues to the relationship, which give life to the process of companioning. These virtues include compassion, genuineness, courage, respect, humor, and awareness of limitations. A significant risk to professional and family caregivers is “empathy shift,” in which the caregiver companion begins to have less tolerance for minor illnesses (colds and flu) in others. Being a caregiver in mortal time requires resilience, the ability to absorb suffering, and the capacity to share the darkness, to share the sadness that is the partner of loss foretold by mortality. These activities can literally help mend the patient and help repair the world in the manner of the Jewish concept of tikkun olam. Professional caregivers are commonly asked, “How can you do this anyway . . . work with cancer patients?” Answers vary widely but often include the fact that although cancer care is a challenge, it is also an opportunity to discover courage in the face of life-threatening illness.
Exploring Thalamocortical Interactions
Authors: Sherman S. Murray , Usrey W. Martin
Published: February 2022

The thalamus and cerebral cortex are active and necessary partners in the processing of signals essential for sensory, motor, and cognitive functions. This partnership is absolute, as neither the thalamus nor the cortex can be understood in any meaningful way in isolation from the other. This book provides readers with fundamental knowledge about the cells and circuits that mediate thalamocortical interactions and then explores new ideas that often challenge conventional understanding. Some of the major themes emphasized throughout the book include the need for a proper classification of thalamocortical and corticothalamic circuits, the role of spike timing for thalamocortical and corticothalamic communication and the mechanisms for modulating spike timing, the organization and function of corticothalamic feedback projections, the role of higher order thalamic nuclei in cortico-cortical communication and cortical functioning, attentional modulation of thalamocortical interactions, and a rethinking of efference copies and distinguishing neural signals as sensory versus motor. Importantly, to encourage readers to think beyond the material and views provided throughout the book, each chapter closes with a section on “Some Outstanding Questions” to stimulate creative approaches to increase our understanding of thalamocortical interactions.
Introduction
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

This monograph provides new views of the relationships between thalamus and cortex and, in doing so, challenges the overall conventional understanding of the subject. The first four chapters of the book review some basic cellular and circuit aspects of thalamus and cortex. It then describes two relatively recent changes in the way we interpret thalamocortical relationships: Chapter 5 describes how the underlying glutamatergic pathways can be identified as either driver (i.e., information bearing) or modulator (i.e., affecting the way in which driver inputs are processed); and Chapter 6 shows that, based on driver inputs—from a subcortical source or layer 5 of cortex—thalamic relays can be respectively identified as first order or higher order. The next chapters delve further into thalamic (Chapter 7) and cortical (Chapter 8) circuitry. Chapter 9 explores the variability in thalamocortical and corticothalamic organizational motifs. Chapters 10-13 offer speculation on the significance of the cell and circuit properties outlined in previous chapters. Finally, Chapter 14 finishes with speculations regarding new ideas of the functional organization of thalamocortical and corticothalamic circuitry.
Intrinsic Membrane Properties
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

This chapter summarizes basic membrane properties of thalamic and cortical neurons, starting with a consideration of current flow within these cells based on modeling of the somadendritic tree as a series of branched cables with leaky membranes. This assumes passive membrane properties and provides some useful first approximations of neuronal functioning, but these neurons have a number of active ionic conductances that are also described and play important roles in neuronal activity. These involve various ligand-, voltage-, and time-dependent ion channels. The ubiquitous voltage- and time-dependent Na+ channel underlying the action potential is the best known example of such channels, and these are found virtually in all thalamic and cortical neurons. Another important voltage- and time-dependent channel is the T-type Ca2+ channel, and thalamic neurons are relatively unique in having these channels distributed so densely in their somadendritic membranes that, when evoked, they can produce all-or-none Ca2+ spikes that propagate through the soma and dendrites; these spikes, in turn, evoke a burst of conventional action potentials. Some cortical cells show similar burst firing based on a different voltage- and time-dependent Ca2+ channel. Details of these processes and speculation of their functional significance are discussed.
Glutamatergic Drivers and Modulators
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

Brain circuits are often analyzed based largely on the transmitter systems involved. Thus, glutamatergic inputs have been thought to be the chief substrate for information transfer; GABAergic inputs are thought mainly to act locally to limit activity in circuits, thereby preventing runaway activity; and classical modulator inputs (e.g., from ACh, NA, 5-HT, etc., afferents) work to affect how glutamatergic inputs are processed. Here, however, we show how glutamatergic inputs in thalamus and cortex can be further divided into two clear classes: one, called “driver,” seems to be the main conduit of information transfer, and the other, called “modulator,” acts synaptically like classical modulators but with much more topographic precision and involving cognitive content not seen in classical modulatory systems.
First and Higher Order Thalamic Relays
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

A major aspect of the function of a thalamic relay is the nature of information being relayed. Thus, the function of the lateral geniculate nucleus can largely be described a relaying retinal information to cortex. That is, identification of the driver (i.e., information bearing) input to a thalamic relay largely defines that relay’s function. Identification of driving inputs to many thalamic nuclei reveal that there are two types: one that emanates from a subcortical source (e.g., retinal input to the lateral geniculate nucleus) and another that emanates from layer 5 of cortex (e.g., much or most of the pulvinar). The lateral geniculate nucleus is an exemplar of a first order thalamic relay, because it represents the first relay of a type of information (e.g., visual) to cortex, whereas the pulvinar is a higher order thalamic relay because it relays information already in cortex between cortical areas. We refer to the latter circuit as transthalamic. Examples of first order relays are the lateral geniculate nucleus (for vision), the ventral posterior nucleus (for somatosensation), and the ventral division of the medial geniculate nucleus (for hearing); the respective higher order relays are the pulvinar, posterior medial nucleus, and dorsal division of the medial geniculate nucleus. Other first and higher order thalamic relays are described, and the significance of the newly appreciated transthalamic pathways is discussed.
Brief Overview of Cortical Organization
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

The cerebral cortex is a laminated sheet of cells that surrounds much of the brain. Historically, distinctions in the cellular and laminar morphology across this sheet provided a basis for parcellating the cortex into distinct areas. Much of this parcellation has held up with more advanced investigation, and it provides a framework for our current understanding of cortical organization. In general, there are six layers within each cortical area, and neurons within these layers have specific patterns of connectivity with each other as well as with other cortical and subcortical areas. This chapter explores the areal organization of the cerebral cortex and its laminar patterns of inputs, intrinsic circuits, and outputs, with an emphasis on the relationship with the thalamus.
Spike Timing and Thalamocortical Interactions
Authors: Martin Usrey W. , Murray Sherman S.
Published: February 2022

Although thalamic relay cells have spatial receptive fields that are quite similar to the neurons that provide their driving input, the temporal properties of their responses often differ substantially. This chapter explores the role of spike timing in thalamic processing and thalamocortical interactions. In the visual pathway, temporal summation plays a key role in generating suprathreshold responses from retinal inputs to target neurons in the lateral geniculate nucleus, and the branching of retinal axons provides a substrate for tight synchrony between lateral geniculate neurons that receive common input from retinal ganglion cells. Temporal summation also enhances thalamocortical communication, particularly for spikes that arrive synchronously from multiple relay cells. Relay cells produce tonic spikes and bursts of spikes depending on their membrane potential history. Importantly, both categories of spikes can carry sensory information, although there are significant differences between them in the details of what they convey and in their efficacy for driving cortical responses. Temporal features of relay cell responses are also affected by modulatory sources of input, which includes corticothalamic feedback. Taken together, it is clear that thalamic relay cells do far more than simply pass the baton of signals en route to cortex.
Mayo Clinic Illustrated Textbook of Neurogastroenterology
Authors: Camilleri Michael
Published: February 2022

Mayo Clinic Illustrated Textbook of Neurogastroenterology reflects experience covering the spectrum and maturation of the field of gastrointestinal motility— from studies of exotic patterns of myoelectric recordings in research laboratories to a clinical discipline with major advances in the clinical management of thousands of patients seen by gastroenterologists, primary care physicians, surgeons, or neurologists. Development of the specialty has been characterized by advances in imaging, developments of methods to measure diverse motor and sensory functions from the stomach to the anorectum, introduction of genetic testing, and a plethora of novel pharmacologic and interventional therapies that have revolutionized its practice. The book covers the spectrum of neurogastroenterologic disorders: from those that are associated with genetic and molecular disorders, through disturbances of the extrinsic neural control or the enteric neuromuscular apparatus, to dysfunction associated with disorders of the gut-brain axis; it reflects a desire to pass on clinical and mechanistic insights and advances in therapies that are relevant to a diverse spectrum of clinicians or clinicians in training who care for the estimated 40% of patients presenting to gastroenterologists with symptoms suggestive of disorders of stomach, intestinal, colonic, or anorectal function.
Measurement of Gastrointestinal and Colonic Motility in Clinical Practice
Authors: Camilleri Michael
Published: February 2022

The motor functions of the gastrointestinal (GI) tract are complex, and their measurements are crucial to understanding mechanisms, achieving diagnosis, and planning treatment of diverse digestive diseases. Unlike the heart, which has a more rhythmic and patterned electrical and contractile function, the GI tract has diverse motor functions, necessitating the development, validation, and standardization of a vast repertoire of tests of GI motor functions. Measurements of motility functions have been validated and standardized and can be delivered at the point of care.
Case Discussions: Nausea and Vomiting
Authors: Camilleri Michael
Published: February 2022

The gastrointestinal causes of nausea and vomiting include delayed gastric emptying (GE), such as chronic gastroparesis and chronic intestinal pseudo-obstruction; impaired gastric accommodation; rumination syndrome; colonic motor dysfunction or rectal evacuation disorder manifesting as associated constipation; and, extremely rarely, brainstem tumor.
Primary bone sarcomas
Authors: Begum Gulshad , Prewett Sarah , Horan Gail , Gerety Emma-Louise
Published: February 2022

Bone sarcomas are rare and require a multidisciplinary approach. Typically patients present with pain or swelling and are usually initially imaged by radiograph, with CT and MRI used for further assessment. CT provides information as to the type of calcification and ossification associated with the lesion, whereas MRI provides information about the soft tissue component and extent of bone marrow involvement. Biopsy is usually required for definitive histological diagnosis and should be performed at a specialist bone sarcoma centre to avoid compromising the surgical field. The most common primary bone sarcomas are osteosarcoma, Ewing’s sarcoma, and chondrosarcoma. We discuss the role of different imaging modalities in the diagnosis, staging, and response to therapy.
Chronic cancer pain syndromes
Authors: Cherny Nathan I.
Published: February 2022

Cancer pain syndromes are defined by the association of particular pain characteristics and physical signs with specific consequences of the underlying disease or its treatment. The recognition of cancer pain syndromes and the ability to distinguish between them is a critical skill for palliative care clinicians since syndromes are associated with distinct aetiologies and pathophysiologies, and they often have important prognostic and therapeutic implications. Most chronic cancer-related pains are caused directly by the tumour. Bone pain and compression of neural structures are the two most common causes. Adverse consequences of cancer therapy, including surgery, chemotherapy, and radiation therapy, account for 15–25% of chronic cancer pain problems, and a small proportion of the chronic pains experienced by cancer patients are caused by pathology unrelated to either the cancer or the cancer therapy. This chapter reviews chronic cancer pain syndromes and their distinguishing clinical features.
Coping and resilience in palliative medicine
Authors: Cohen Tzeela , Wein Simon
Published: February 2022

Coping and resilience aim to define the ways by which individuals handle stress and adversity in their life. Most would agree that a good outcome of coping would maintain quality of life and minimize distress and translate into resilience. In palliative care there is much stress, therefore it is common to see coping and resilience. Over the years the study of these concepts led to many insights into the cognitive processes involved and offered avenues to promote coping and resilience. After decades of zooming in on these concepts, it looks as if we can take a few steps back and look at the big picture and see it for what it is: a dynamic, colourful picture that is constantly evolving. Self-efficiency, social support, spirituality, and faith enhance coping and resilience, help in finding hope and meaning, minimize stress, and maintain quality of life.