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Gastric motility disorders remain a complex clinical challenge, and inflict a substantial burden of cost and suffering on society. Gastric contractions are coordinated by an underlying electrical activity, and gastric dysrhythmias are implicated in the pathophysiology of several motility disorders. However, the significance of dysrhythmias remains uncertain, and there are few elective therapies, because current tools to investigate dysrhythmias have low reliability owing to their lack of spatial resolution. This thesis aimed to develop an improved foundation for the investigation and management of gastric dysrhythmia, by advancing and translating high-resolution (HR; multi-electrode) spatiotemporal mapping. The research is a cross-disciplinary program of bioengineering, and basic and clinical electrophysiology. A range of HR mapping devices are first developed and validated for intra-operative gastric mapping, including at open and laparoscopic surgery. Automated signal processing tools are next validated for the efficient, reliable marking, grouping, and mapping of slow wave events, and these tools are integrated into an intuitive software platform. These methodological advances are then applied in a series of experimental studies. The origin and propagation of porcine gastric slow wave activity is defined, followed by clinical translation with the first spatiotemporal analysis of normal human gastric slow wave propagation. The methods are then applied to define new patterns and mechanisms of gastric dysrhythmia, initially in a porcine model, including the first demonstration of how rapid, high-amplitude circumferential propagation emerges during dysrhythmias. The first clinical study applying HR electrical mapping is then presented, performed on a cohort of patients with diabetic and idiopathic gastroparesis, revealing new patterns of human dysrhythmia. A new classification scheme for abnormalities of human gastric slow wave initiation and conduction is proposed. Finally, the evidence for high-frequency gastric electrical stimulation is reviewed, prior to the presentation of a new 'entrainment mapping' method for better assessing gastric pacing protocols. In total, this work constitutes a coordinated series of advances that offer a strengthened foundation for investigating and managing gastric electrical abnormalities. It is hoped that these new methods and findings will translate into future clinical advances, to improve the diagnosis and treatment of these complex patient populations.
Scores of talented and dedicated people serve the forensic science community, performing vitally important work. However, they are often constrained by lack of adequate resources, sound policies, and national support. It is clear that change and advancements, both systematic and scientific, are needed in a number of forensic science disciplines to ensure the reliability of work, establish enforceable standards, and promote best practices with consistent application. Strengthening Forensic Science in the United States: A Path Forward provides a detailed plan for addressing these needs and suggests the creation of a new government entity, the National Institute of Forensic Science, to establish and enforce standards within the forensic science community. The benefits of improving and regulating the forensic science disciplines are clear: assisting law enforcement officials, enhancing homeland security, and reducing the risk of wrongful conviction and exoneration. Strengthening Forensic Science in the United States gives a full account of what is needed to advance the forensic science disciplines, including upgrading of systems and organizational structures, better training, widespread adoption of uniform and enforceable best practices, and mandatory certification and accreditation programs. While this book provides an essential call-to-action for congress and policy makers, it also serves as a vital tool for law enforcement agencies, criminal prosecutors and attorneys, and forensic science educators.
Continuous Renal Replacement Therapy provides concise, evidence-based, bedside guidance for the management of critically ill patients with acute renal failure, offering quick reference answers to clinicians' questions about treatments and situations encountered in daily practice.
As the number of patients with diabetes increases annually, it is not surprising that the number of patients with diabetes who are admitted to the hospital also increases. Once in the hospital, patients with diabetes or hyperglycemia may be admitted to the Intensive Care Unit, require urgent or elective surgery, enteral or parenteral nutrition, intravenous insulin infusion, or therapies that significantly impact glycemic control (e.g., steroids). Because many clinical outcomes are influenced by the degree of glycemic control, knowledge of the best practices in inpatient diabetes management is extremely important. The field of inpatient management of diabetes and hyperglycemia has grown substantially in the last several years. This body of knowledge is summarized in this book, so it can reach the audience of hospitalists, endocrinologists, nurses and other team members who take care of hospitalized patients with diabetes and hyperglycemia.
Patients with Parkinson's disease (PD) are known to suffer from motor symptoms of the disease, but they also experience non-motor symptoms (NMS) that are often present before diagnosis or that inevitably emerge with disease progression. The motor symptoms of Parkinson's disease have been extensively researched, and effective clinical tools for their assessment and treatment have been developed and are readily available. In contrast, researchers have only recently begun to focus on the NMS of Parkinson's Disease, which are poorly recognized and inadequately treated by clinicians. The NMS of PD have a significant impact on patient quality of life and mortality and include neuropsychiatric, sleep-related, autonomic, gastrointestinal, and sensory symptoms. While some NMS can be improved with currently available treatments, others may be more refractory and will require research into novel (non-dopaminergic) drug therapies for the future. Edited by members of the UK Parkinson's Disease Non-Motor Group (PD-NMG) and with contributions from international experts, this new edition summarizes the current understanding of NMS symptoms in Parkinson's disease and points the way towards future research.
Diet and Health examines the many complex issues concerning diet and its role in increasing or decreasing the risk of chronic disease. It proposes dietary recommendations for reducing the risk of the major diseases and causes of death today: atherosclerotic cardiovascular diseases (including heart attack and stroke), cancer, high blood pressure, obesity, osteoporosis, diabetes mellitus, liver disease, and dental caries.
This book delineates the state of the art of the diagnosis and treatment of J wave syndromes, as well as where future research needs to be directed. It covers basic science, translational and clinical aspects of these syndromes. The authors are leading experts in their respective fields, who have contributed prominently to the literature concerning these topics. J wave syndromes are one of the hottest topics in cardiology today. Cardiac arrhythmias associated with Brugada syndrome (BrS) or an early repolarization (ER) pattern in the inferior or infero-lateral ECG leads are thought to be mechanistically linked to accentuation of transient outward current (Ito)-mediated J waves. Although BrS and ER syndrome (ERS) differ with respect to magnitude and lead location of abnormal J waves, they are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. ERS is divided into three subtypes with the most severe, Type 3, displaying an ER pattern globally in the inferior, lateral and right precordial leads. BrS has been linked to mutations in 19 different genes, whereas ERS has been associated with mutations in 7 different genes. There is a great deal of confusion as to how to properly diagnose and treat the J wave syndromes as well as confusion about the underlying mechanisms. The demonstration of successful epicardial ablation of BrS has provided new therapeutic options for the management of this syndrome for which treatment alternatives are currently very limited, particularly in the case of electrical storms caused by otherwise uncontrollable recurrent VT/VF. An early repolarization pattern is observed in 2-5% of the US population. While it is clear that the vast majority of individuals exhibiting an ER pattern are not at risk for sudden cardiac death, the challenge moving forward is to identify those individuals who truly are at risk and to design safe and effective treatments.
This volume covers aspects of sudden infant and early childhood death, ranging from issues with parental grief, to the most recent theories of brainstem neurotransmitters. It also deals with the changes that have occurred over time with the definitions of SIDS (sudden infant death syndrome), SUDI (sudden unexpected death in infancy) and SUDIC (sudden unexpected death in childhood). The text will be indispensable for SIDS researchers, SIDS organisations, paediatric pathologists, forensic pathologists, paediatricians and families, in addition to residents in training programs that involve paediatrics. It will also be of use to other physicians, lawyers and law enforcement officials who deal with these cases, and should be a useful addition to all medical examiner/forensic, paediatric and pathology departments, hospital and university libraries on a global scale. Given the marked changes that have occurred in the epidemiology and understanding of SIDS and sudden death in the very young over the past decade, a text such as this is very timely and is also urgently needed.
In the years since the third edition of this indispensable reference was published, a great deal has been learned about the nutritional requirements of common laboratory species: rat, mouse, guinea pig, hamster, gerbil, and vole. The Fourth Revised Edition presents the current expert understanding of the lipid, carbohydrate, protein, mineral, vitamin, and other nutritional needs of these animals. The extensive use of tables provides easy access to a wealth of comprehensive data and resource information. The volume also provides an expanded background discussion of general dietary considerations. In addition to a more user-friendly organization, new features in this edition include: A significantly expanded section on dietary requirements for rats, reporting substantial new findings. A new section on nutrients that are not required but that may produce beneficial results. New information on growth and reproductive performance among the most commonly used strains of rats and mice and on several hamster species. An expanded discussion of diet formulation and preparationâ€"including sample diets of both purified and natural ingredients. New information on mineral deficiency and toxicity, including warning signs. This authoritative resource will be important to researchers, laboratory technicians, and manufacturers of laboratory animal feed.