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162. Male Sexual Dysfunction

of recommendations. Bmj, 2008. 336: 924. 23. Phillips, B. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated by Jeremy Howick March 2009. 1998. 24. Guyatt, G.H., et al. Going from evidence to recommendations. Bmj, 2008. 336: 1049. 25. Van den Broeck T, et al. What are the benefits and harms of testosterone treatment for male sexual dysfunction? PROSPERO: International prospective register of systematic reviews, 2015. 26. Gratzke, C., et al. Anatomy, physiology, and pathophysiology of erectile (...) -onset hypogonadism in males: ISA, ISSAM, EAU, EAA, and ASA recommendations. Eur Urol, 2009. 55: 121. 147. Khera, M., et al. A new era of testosterone and prostate cancer: from physiology to clinical implications. Eur Urol, 2014. 65: 115. 148. Corona, G., et al. Cardiovascular risk associated with testosterone-boosting medications: a systematic review and meta-analysis. Expert Opin Drug Saf, 2014. 13: 1327. 149. Baillargeon, J., et al. Risk of Myocardial Infarction in Older Men Receiving Testosterone

2018 European Association of Urology

166. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

balance between arousing and sleep-inducing physiological systems. Current research suggests that arousal and wakefulness are promoted by parallel neurotransmitter systems whose cell bodies are located in brainstem or midbrain centres, with projections to the thalamus and forebrain. These activating neurotransmittersarenoradrenaline,serotonin,acetylcholine, dopamine and histamine. In addition the newly discovered orexin system with cell bodies in the hypothalamus promotes wakefulness through (...) (Raskind et al., 2007). Trazodone is commonly used to promote sleep and has blocking actions at noradrenaline, 5HT and histamine receptors; this multiple action probably explains why it is widely used, although there are few controlled clinical trials. Other drugs such as sedating antidepressants and antipsy- chotics probably promote sleep in a similar fashion. The promotion of sleep is regulated by a number of other neurotransmitters (see Table 2); primary amongst these is gamma-aminobutyric acid

2019 British Association for Psychopharmacology

168. Nicotine stimulates pancreatic cancer xenografts by systemic increase in stress neurotransmitters and suppression of the inhibitory neurotransmitter γ-aminobutyric acid (PubMed)

the hypothesis that nicotine stimulates the growth of PDAC xenografts in nude mice by increasing the systemic levels of the stress neurotransmitters adrenaline and noradrenaline, which are the physiological agonists for beta-adrenoreceptors and that inhibition by gamma-aminobutyric acid (GABA) of the adenylyl cyclase-dependent pathway downstream of adrenoreceptors blocks this effect. The size of xenografts from PDAC cell line Panc-1 was determined 30 days after inoculation of the cancer cells. Stress (...) Nicotine stimulates pancreatic cancer xenografts by systemic increase in stress neurotransmitters and suppression of the inhibitory neurotransmitter γ-aminobutyric acid Pancreatic ductal adenocarcinoma (PDAC) is a leading cause of cancer mortality in Western countries. We have shown previously that four representative human PDAC cell lines were regulated by beta-adrenoreceptors via cyclic adenosine 3',5'-monophosphate (cAMP)-dependent signaling. In the current study, we have tested

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2009 Carcinogenesis

169. CRACKCast E111 – Mood Disorders

was an increase from 5% in 2000. This increase is nearly double what would have been expected by population growth alone. Up to 50% of Americans will meet the criteria for a DSM-5 disorder sometime in their life, with an estimated 21% having a mood disorder.” [1] List the 3 neurotransmitters implicated in depression. Low levels of these in the synapse: Serotonin Norepinephrine Dopamine Other neurotransmitter systems implicated: Low levels of Glutamate γ-aminobutyric acid [2] List the DSM V criteria for Major (...) of worthlessness, or excessive or inappropriate guilt Diminished ability to think or concentrate, or indecisiveness Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation, or a suicide plan or attempt. B. Symptoms cause clinically significant distress or impairment in social, occupational, or other functioning. C. Symptoms are not caused by direct physiologic effects of a substance (eg, drug of abuse, medication) or a general medical condition (eg, hypothyroidism). D. Symptoms

2017 CandiEM

170. National Research Agenda on the Health Impacts of Non-Medical Cannabis Use

by the endocannabinoid system (ECS).7 In the past 10 to 15 years a large amount of research has been conducted on the ECS and there is now extensive knowledge about its constituent parts; their location in different regions of the brain and in other organs and tissues elsewhere in the body; their role in retrograde signaling in synapses using glutamate, serotonin, GABA, endogenous opioids and a variety of other neurotransmitters and neuromodulators; and their roles in neurogenesis, angiogenesis, synaptic plasticity (...) , nervous system maturation, inflammation and numerous other physiological and pathological processes. Much of this research has been motivated by the search for potential therapeutic agents, but increasing interest has been shown in the effects of altered ECS function in the production of the adverse effects of cannabis and other agents on health. Gene variants of different elements of the ECS, including the CB1 receptor and the enzymes that synthesize and degrade the endocannabinoids themselves, have

2017 Canadian Centre on Substance Abuse

171. CRACKCast E041 – Head Injury

with a serious TBI Principles of disease ANATOMY AND PHYSIOLOGY Scalp and cranium : “SCALP MAP” Scalp components: Dermis: thick layer of skin (skin) Subcutaneous tissue : hair follicles, and BLOOD supply (cutaneous) Galea : tough fascia (aponeurosis) Loose areolar tissue : loose tissue, where subgaleal hematomas form Pericranium : firmly attached to the skull Skull: Frontal, ethmoid, sphenoid, occipital, and TWO parietal + temporal bones Temporal bones are the thinnest Must consider contrecoup injuries (...) pressure of CSF is 6-20 cm H20 Blood in the ventricles can cause traumatic hydrocephalus Blood brain barrier When intact it serves to balance ion and neurotransmitters. Post-traumatic cerebral edema affects the permeability of the BBB which can last for hours. This can lead to vasogenic edema Brain cellular damage and death – Primary and Secondary Brain Injuries Primary: Mechanical damage occurring at the time of head injury Brain lacerations, hemorrhages, contusions, tissue avulsions. Permanent

2016 CandiEM

172. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

to the nicotinic receptor, muscarinic acetylcholine receptors on the presynaptic side of the neuromuscular junction, when stimulated by acetylcholine molecules, inhibit the release of more neurotransmitter ( ). | Neurophysiology of the Neuromuscular Junction. When the vesicles fuse to the membrane of the nerve terminal, the amount of acetylcholine released into the cleft is several times greater than the amount required to activate nicotinic receptors on the myofibril ( ). The nicotinic receptor in adults (...) are competitive antagonists at nicotinic receptors, binding to the receptor for a longer period of time and preventing acetylcholine from binding to the receptor, which results in prolonged neuromuscular blockade ( ). The two classes of nondepolarizing NMBAs—the benzylisoquinolinium and the aminosteroid compounds—have one or more positively charged quaternary ammonium groups in their chemical structure, resulting in an ionized water-soluble drug at physiologic pH. These NMBAs are lipophobic; thus

2016 Society of Critical Care Medicine

173. Salt Sensitivity of Blood Pressure

and on behalf of the American Heart Association Professional and Public Education Committee of the Council on Hypertension; Council on Functional Genomics and Translational Biology; and Stroke Council Originally published 21 Jul 2016 Hypertension. 2016;68:e7–e46 You are viewing the most recent version of this article. Previous versions: Introduction The simplest definition of salt sensitivity of blood pressure (SSBP) states that it is a physiological trait present in rodents and other mammals, including (...) could be selected by inbreeding made it clear that hypertension had a genetic component. The gaussian distribution of population BP is probably the result of a random mixture of prohypertensive and antihypertensive genes and genetic variants in a heterogeneous population interacting with environmental factors (eg, diet), physiological characteristics (eg, aging), and clinical features (eg, renal function). Analogously, there were indirect clues suggesting genetic determination of SSBP: The trait

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2016 American Heart Association

174. Perinatal substance use: maternal

Aggression o Feelings of rejection o Disruptive/inattentive behaviour including Attention deficit hyperactivity disorder (ADHD) o Poor neurodevelopment Queensland Clinical Guideline: Perinatal substance use: maternal Refer to online version, destroy printed copies after use Page 10 of 29 1.4 Psychostimulants exposure Stimulants, also known as psychostimulants, act to increase neurotransmitters dopamine, noradrenaline and serotonin. They produce euphoria, wellbeing, energy, wakefulness and alertness (...) not require medication • Use close to birth may cause baby to be agitated and overactive • Neurobehavioural effects: decreased arousal, increased stress and poor quality of movement (dose-response relationship) 32 • May be dose-response relationship resulting in neurotoxic effects • Heavy use related to lower arousal, more lethargy and increased physiological stress observed as difficulty maintaining normal, regular respirations 14,22,37,38 • Impaired bonding and emotional dysregulation 39 • Compromised

2016 Queensland Health

175. Depression

but occurring on a cyclical basis related to ambient light deprivation during winter months. Both phototherapy and medications are frequently used. Mood disorder associated with a general medical condition. A form of depression with features similar to MDD but is part of the physiological sequelae of a major medical condition such as cancer, stroke, myocardial infarction, major trauma, or neurodegenerative disorders such as Alzheimer’s disease. Perimenopausal mood disorder is addressed in Table 8 (following (...) is involved. Depression can interfere with effective treatment of the other conditions, delaying recovery and significantly increasing morbidity. Depressed patients are three times more likely to be non-adherent with medical recommendations. Depression is a more powerful predictor of mortality from myocardial infarction than physiological measures such as cardiac ejection fraction. Depression is prevalent in patients with heart failure and is associated with a poorer short-term prognosis. Major depressive

2016 University of Michigan Health System

176. Management of Concussion-mild Traumatic Brain Injury (mTBI)

Injury February 2016 Page 6 of 133 II. Background A traumatic brain injury (TBI) is defined as a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force and is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event:[2,3] • Any period of loss of or a decreased level of consciousness • Any loss of memory for events immediately before or after the injury (posttraumatic amnesia (...) . Conceptually, a confirmatory objective test that could provide a definitive diagnosis of mTBI that could be used to direct treatment and/or predict outcomes would be desirable. Unfortunately, at this time, evidence does not support the use of any laboratory, imaging, or physiological test for these purposes. There are several studies that evaluate the use of computerized tomography (CT) scan or magnetic resonance imaging (MRI) within the first week after the concussive incident.[16,17] These studies fall

2016 VA/DoD Clinical Practice Guidelines

177. Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids ? An Update

countries in the 1960s was related principally to its nonmedical use by young people to produce euphoria and facilitate social interaction (the “high”). However, as scientific interest revived, the exploration of its potential therapeutic uses was renewed, and has increased greatly since the discovery of the endocannabinoid system and its widespread physiological activity in many different body organs and tissues, described later in this report. Cannabinoids The major pharmacologically active

2016 Canadian Centre on Substance Abuse

178. Age and the anaesthetist

and political models of the NHS in England Scotland, Wales and Northern Ireland. Andrew Hartle President, AAGBI Liam Brennan President, RCoA 1.0: Executive Summary 04 2.0: Introduction – what is the problem? 05 3.0: Societal changes and financial issues 06 3.1: Life expectancy 06 3.2: Financial provision for retirement 07 3.3: The current conflicted situation 09 4.0: Age, physiological changes and comorbidities 10 4.1: The ageing process and its impact on organ function 10 4.2: The role of comorbidity 12 (...) on pension income could be considerable. 6 Data from the Pensions Advisory Service. http://www.pensionsadvisoryservice.org.uk10 Anaesthesia News August 2016 • Issue 349 Anaesthesia News August 2016 • Issue 349 11 homeostenosis and frailty Age related physiological changes (adapted from Chester & Rudolph [32]) 4.0: Age, physiological changes and comorbidities Anaesthesia News August 2016 • Issue 349 11 4.1: The ageing process and its impact on organ function The ageing process Ageing is a complex

2016 Association of Anaesthetists of GB and Ireland

179. Premenstrual syndrome

include reduced cognitive ability and aggression. A diagnosis of PMS is supported by the timing (rather than the types) of symptoms and the degree of impact on daily activity. To differentiate PMS from physiological premenstrual symptoms (experienced by 80–90% of women), it must be demonstrated that symptoms cause significant impairment to the woman during the luteal phase of the menstrual cycle. Premenstrual dysphoric disorder (PMDD) is a severe form of PMS defined in the Diagnostic and Statistical (...) by the timing (rather than the types) of symptoms and the degree of impact on daily activity. To differentiate PMS from physiological premenstrual symptoms (experienced by 80–90% of women) [ ; ; ], it must be demonstrated that symptoms cause significant personal, interpersonal, and/or functional impairment to the woman during the luteal phase of the menstrual cycle. Women who experience minor, transient premenstrual symptoms (such as abdominal bloating [most common], breast tenderness, headache, acne

2019 NICE Clinical Knowledge Summaries

180. Eating disorders

with an eating disorder are female. Neurobiological factors: Eating disorders have been associated with abnormal neurotransmitter activity (including serotonin and dopamine) and satiety-related hormones (including adiponectin and ghrelin). It is not known if these are involved in the development of an eating disorder or are the result of physiological alterations due to malnutrition. Psychosocial factors such as: Anxiety, depression, perfectionism, low self-esteem, body dissatisfaction and overestimation (...) such as bradycardia, tachycardia, orthostatic hypotension, syncope or pre-syncope are associated with increased risk of sudden unexpected cardiovascular death in this group [ ]. The presence of oedema is usually multifactorial and reflects hypoalbuminaemia, nutritional deficiency, congestive cardiac failure or refeeding syndrome [ ]. Be aware that normal and cut-off physiological parameters such as blood pressure vary with age, and danger thresholds differ significantly for children and adults [ ]. Collateral

2019 NICE Clinical Knowledge Summaries

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