bluuebunny/crossref_metadata_2025 huggingface dataset:
Flecainide toxicity associated with the use of goji berries: a case report
Authors: Guzmán Carlos E , Guzmán-Moreno Carla Gabriela , Assad-Morell José Luis , Carrizales-Sepúlveda Edgar Francisco
Published: June 2021

Background

Goji berries (GB), usually marketed as a ‘superfruit’, are a widely used herbal supplement. As with other herbal remedies, the use of GB might be associated with herb–drug interactions, increasing plasma levels of other drugs and causing adverse events. Here, we present the case of a patient that developed flecainide toxicity secondary to an herb–drug interaction, associated with the use of GB to prevent COVID-19.

Case summary

A 75-year-old female presented to the emergency department with fainting. She was taking flecainide for the treatment of atrial extrasystoles diagnosed 2 years previously, and she was using a tea of GB for the prevention of COVID-19. The admission electrocardiogram showed a wide complex polymorphic tachycardia that was considered and treated as flecainide toxicity. The patient had a favourable evolution and was discharged 48 h after admission.

Discussion

Flecainide toxicity is uncommon and needs timely recognition and treatment; it is usually secondary to overdose and renal or hepatic failure. In our case, toxicity was associated with GB use, probably by inhibition of CYP2D6 which is the main enzyme associated with the metabolism of flecainide. Clinicians need to be aware of the possible interactions between herbal remedies (in this case used for the prevention of COVID-19) and cardiovascular drugs that are used to treat chronic cardiovascular diseases.
Three-dimensional passive-source anisotropic reverse time migration for imaging lithospheric discontinuities
Authors: Zou Peng , Cheng Jiubing
Published: June 2021

The scattered teleseismic body waves have been used intensively to characterize the receiver-side lithospheric structures. The routinely used ray-theory-based methods have limitations to image complex structures and tackle strong heterogeneities. The newly developed wave-equation based, passive-source reverse time migration (RTM) approach can overcome such limitations. To date, passive-source RTM has been developed only for isotropic media. However, at least to the first-order, most lithospheric structures possess effective transverse isotropy with spatially variable symmetry directions. It is important to know the magnitudes of imaging errors that may be introduced by passive-source RTM when seismic anisotropy is treated in an incorrect way. In this paper, we investigate the influence of elastic anisotropy on teleseismic P-to-S conversions at the lithospheric discontinuities and explain why an isotropic RTM may fail to focus the converted wavefields from the perspective of relative arrival time variations with backazimuth and shear wave splitting. Accordingly, we extend the passive-source RTM approach for imaging 3-D lithospheric targets possessing transverse isotropy from the following two aspects: First, the teleseismic recordings with direct P and converted S phases are reverse-time extrapolated using rotated staggered grid (RSG) pseudospectral method, which can tackle strong heterogeneity and transverse isotropies with symmetry axes in arbitrary direction; Secondly, the backward elastic wavefields are efficiently decomposed into vector anisotropic P and S modes to support accurate imaging.
Community research collaboration to develop a promotores-based hereditary breast cancer education program for Spanish-speaking Latinas
Authors: Almeida Rebeca , Lopez-Macha Alejandra , Dugatkin Tania , Joseph Galen , Duron Ysabel , Hurtado de Mendoza Alejandra , D. Graves Kristi , Fejerman Laura
Published: June 2021

Breast cancer (BC) is the most common cancer in Latinas and the leading cause of cancer death. Latinas tend to be diagnosed at later stages, receive poorer quality care and have a higher risk of mortality than non-Latina White (NLW) women. Among women with a genetic predisposition to hereditary BC, genetic counseling can be beneficial. Latinas participate in genetic counseling at lower rates than NLW women. The goal of this study was to develop comprehensive, culturally appropriate materials for community health educators (promotores)-led hereditary BC education program for Spanish-speaking Latinas. We developed the curriculum through feedback from 7 focus groups, with a total of 68 participants (35 promotores and 33 community members). We used a mixed-methods approach that relied on quantitative analysis of survey questions and qualitative content analysis of the focus groups transcripts. Pre and post promotores’ training survey responses suggested improvement in the promotores’ cancer-related knowledge. Themes that emerged from the qualitative analyses were (i) barriers to health education and/or care; (ii) importance of educating the Latino community about BC and genetics and (iii) role of the promotores. Future research will further evaluate the impact of the program in promotores’ knowledge and community members’ screening behaviors.
What is dementia?
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Dementia is the term used to describe progressive impairment of thinking and memory that interferes with daily function. Dementia is not a specific disorder; rather, it is a condition with many causes. Alzheimer’s disease is the most common cause of dementia. Other common causes of dementia include vascular dementia, dementia with Lewy bodies, primary progressive aphasia which comes in the logopenic, semantic, and nonfluent/agrammatic variants, behavioral variant frontotemporal dementia, and normal pressure hydrocephalus. Primary care providers are able to diagnose most straightforward cases of dementia, whereas specialists such as neuropsychologists, neurologists, psychiatrists, and geriatricians may be needed when the diagnosis is not straightforward.
How do you build your care team?
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

No one person can manage the demands of dementia alone. Building a strong care team early following a diagnosis is critical to your wellbeing and to providing your loved one with the best care. By reaching out to family, friends, neighbors, and professional caregivers, you can limit your burden, reduce your feelings of isolation, and create a healthier environment for you and your loved one. Your loved one’s doctor should be a source of help as well. Support groups can provide you with information and important skills in addition to emotional support. Whether as a day program or overnight stay, respite care may be an invaluable resource for you. National organizations dedicated to Alzheimer’s disease and dementia can also be an invaluable resource.
How to plan for the end and beyond
Authors: Budson Andrew E. , O’Connor Maureen K.
Published: June 2021

Although discussing the death of your loved one may be uncomfortable, we believe it is best to be prepared. Have conversations with your loved one about the end of their life. Consider hospice and palliative care, the death itself, the ceremony, and what should be done with their body and brain. Think about whether you wish to be present at the death. Managing grief and preparing for your future after your loved one has died are important. Find the resources you need to cope with the many emotions you may feel during the grieving process. Build a life for yourself after caregiving.
Managing Cancer and Living Meaningfully
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This text outlines the empirical research, theoretical underpinnings, and clinical application of a novel supportive-expressive psychotherapy for patients with metastatic cancer and their caregivers. Managing Cancer and Living Meaningfully, known by its acronym of CALM, provides a framework for therapists with diverse backgrounds and training to help patients and their caregivers to address the practical and profound challenges of advanced cancer and to live their lives as meaningfully as possible. CALM provides reflective space for them to consider treatment decisions and communication with their health care providers, disruptions in identity, attachment security and the sense of meaning in their life, and to address fears, hopes, and concerns related to the end of life. Particular attention is paid in CALM to the regulation of affect, to the renegotiation of attachment relationships and to helping patients and their caregivers to sustain “double awareness” of the possibilities for living, while also managing their disease and planning for the end of life. Such an approach not only helps to prevent depression and death anxiety, but also helps to reclaim the loss of the imaginative possibilities for living in the context of all-consuming cancer care. The universal dimensions of advanced cancer and the semi-structured nature of CALM permit it to be delivered in the language and cultural idiom of cancer treatment settings in virtually all parts of the world. This text provides the most comprehensive and up-to-date description of the evidence base for CALM, its theoretical foundations and a manualized guide to its clinical application, filled with rich clinical illustrations.
CALM and the Desire for Death
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter considers the loss of the will to live, the desire for hastened death, and suicidality in patients with advanced disease. The challenge of distinguishing the loss of the will to live as a manifestation of depression from nonpathological death acceptance is explored and the clinical implications of such distinctions are examined. The quantitative findings from our longitudinal research regarding the prevalence, trajectory, and correlates of the desire for death in patients with advanced cancer are presented. The qualitative findings from this research revealed three distinct dimensions of the desire for death, only one of which reflects the literal wish to end life. The role of Managing Cancer and Living Meaningfully (CALM) in alleviating death anxiety, in examining the desire for death, in enhancing death preparation, and in improving communication with healthcare providers is considered here.
Measuring Process and Outcome in CALM
Authors: Rodin Gary , Hales Sarah
Published: June 2021

This chapter considers the qualitative and quantitative evidence base for Managing Cancer and Living Meaningfully (CALM) and the role of relevant, validated measures in substantiating its effectiveness and informing its clinical practice. The early qualitative evidence for the benefit of CALM is reviewed and the challenges inherent in generating meaningful quantitative results in an advanced cancer population are described. An important component of the early work on CALM included the development and validation of measures to assess relevant outcomes in this population. This resulted in development of new measures of distress related to death and dying and of perceived clinical benefit from CALM, and of modified measures for attachment security, quality of life, and treatment integrity. The results of a large randomized controlled trial (RCT) demonstrating the effectiveness of CALM are presented and the unique value of measures of treatment process and treatment integrity are described. Finally, the clinical utility of outcome and process measures in terms of guiding CALM therapy is considered.
Military Medical Research and Experimentation
Authors: Gross Michael L.
Published: June 2021

Medicine is often unprepared for the physical and psychological wounds of modern war. Military medicine requires urgent research to treat traumatic brain injury, develop resuscitation techniques, upgrade surgical procedures, and acquire effective drugs. Retrospective, observational, and survey studies dominate the literature. However, clinically controlled experimental studies, the gold standard of medical research, are rare in military medicine. Stringent informed consent requirements to protect service members from coercion and undue influence make it difficult to enlist them for in-theater clinical studies. When a research subject is unconscious and his representative is unavailable to give consent, investigators can request waivers. But due to concerns about patient vulnerability, waivers are rarely granted to allow researchers to recruit injured soldiers in the field. Easing informed consent requirements to match those of civilian medical research, and intensifying efforts to recruit civilian research subjects during war will improve the prospects of clinical research.
Warfighter Enhancement: Research and Technology
Authors: Gross Michael L.
Published: June 2021

To improve warfighter performance, medical science seeks pharmacological, surgical, genetic, and neurological technologies to make soldiers smarter, faster, stronger, and more alert. The sought after soldier is a gladiator or Jedi knight. Scientific research, however, is unwarranted if superfluous, and there are grave doubts about the usefulness of super soldiers in modern warfare where warfighters need language and cultural skills rather than strength and endurance. Beneficial enhancement research, therefore, focuses on learning, information analysis, and organizational efficiency that do not require invasive, irreversible, or surgical interventions. Utilizing noninvasive technologies such as wearables or neuroplasticity training carry few risks and enable research subjects to give fully informed consent. Nevertheless, medical scientists are not conducting therapeutic research to ameliorate pain and suffering. They are building weapons of war. As a result, enhancement researchers and providers jeopardize their immunity on the battlefield and leave themselves liable to defensive killing in war.
Perspectives on Integrative Sleep Medicine
Authors: Lum Esther
Published: June 2021

Sleep, like nutrition and physical activity, has been found to affect nearly all aspects of health, both individual and societal. Despite this, it has long been neglected in the medical literature until relatively recent times, and, despite its importance, sleep deprivation and impaired sleep are pervasive in modern life. In this chapter, different perspectives on sleep are discussed, including historical views of sleep and alternative sleep patterns. The development of sleep as a medical specialty is described, as are limitations to the conventional medical approach to sleep. The foundations of a truly integrative approach to sleep are enumerated.
Normal Sleep in Childhood
Authors: Artinian Hovig K. , Anne Tablizo Mary , Witmans Manisha
Published: June 2021

Sleep is a critical process in children in that it influences all aspects of physiological functioning, development, and behavior. The two types of sleep, rapid eye movement (REM) sleep and non–rapid eye movement (NREM) sleep, are inherent throughout life; however, the sleep architecture and sleep duration changes over time as the brain changes from the newborn period to adulthood. There are hallmarks related to sleep architectural changes that are specific and unique to the different age ranges. Although the process and neuromodulation of sleep is similar across the life span, there are attributes that are different in children compared to adults. There are also physiological differences in the brain waves and changes in respiratory parameters. This chapter highlights normal sleep in children.
Sleep Duration, Timing, and Napping as Components of Healthy Sleep
Authors: Dautovich Natalie D. , Imel Janna L. , Dzierzewski Joseph M.
Published: June 2021

Although optimal sleep is essential for overall health and well-being, questions exist regarding the sufficient duration of sleep, appropriate timing of sleep, and whether or not naps are helpful or harmful. Generally speaking, for optimal sleep health, adults should aim to obtain between 7 and 9 hours of sleep per day. The optimal timing of this daily sleep is during the nocturnal hours. In regards to napping, evidence is mixed regarding whether napping represents a detriment to optimal sleep behavior. For those who engage in napping, characteristics of napping such as the duration, timing, regularity, and environment are important factors to consider.
Physical Activity, Sleep, and Sleep Disorders
Authors: O’Connor Patrick J. , Wender Carly L. A.
Published: June 2021

Science-based knowledge about the influence of physical activity on sleep has grown during the past 5 years. The available evidence reviewed in this chapter shows that clinicians can safely recommend the adoption and maintenance of regular physical activity as an adjunctive therapy for patients with insomnia and obstructive sleep apnea. Specific conclusions are that healthy people who engage in a single bout of physical activity show small sleep benefits compared to a day in which no physical activity was performed; healthy sedentary people who adopt a program of regular physical activity show improvements in sleep after exercise training, especially in perceived sleep quality; (physical activity and cardiorespiratory fitness are associated with reduced sleep complaints and a small number of randomized trials with insomnia patients supports that regular physical activity can improve their sleep; regular physical activity reduces the severity of obstructive sleep apnea and improves daytime sleepiness in these patients; exercise reduces symptoms of restless legs syndrome in patients with kidney disease but the evidence is uncertain whether physical activity improves restless legs syndrome in other patient groups; physical activity has the potential to treat circadian rhythm sleep–wake disorders because a single bout of appropriately timed exercise can cause circadian phase shifts and it is uncertain if physical activity impacts the sleep of patients with narcolepsy or parasomnias.
Spirituality, Religion, and Sleep
Authors: Craigie Frederic C.
Published: June 2021

Spirituality is a vital element of integrative health and well-being. Research is demonstrating that spiritual and religious beliefs and practices are associated with sleep quality, as they are for many aspects of waking life. This chapter examines literature and clinical approaches to explore questions about the definition of spirituality and religion, how spirituality influences health, how spirituality influences sleep, what can be gleaned from current descriptive and interventional research, and what mechanisms might underlie associations of spirituality with sleep. The authors then present material on approaches to working with spirituality in the practice of integrative medicine and care, touching on the personal groundedness and well-being of clinicians, clinical approaches to supporting meaningful living in patients, and organizational approaches to creating affirming, empowering, and satisfying work environments. The authors also include a short section on spirituality and dreams.
Dietary and Herbal Supplements for Sleep
Authors: Kiefer David
Published: June 2021

Dietary supplements, including vitamins, minerals, and herbal medicines, are used for many common conditions, including insomnia. An example is valerian, one of the top-selling botanicals in the United States. Other dietary supplements used for sleep are the hormone melatonin, the mineral magnesium, and the herbal medicines chamomile, hops, kava kava, lavender, lemon balm, and passionflower. There are both mechanistic studies and clinical trials of varying methodological quality exploring the efficacy of these products in affecting sleep quantity and quality. An additional factor with the use of any dietary supplement is assuring safety, by understanding both possible adverse effects and any supplement-pharmaceutical interactions.
Aromatherapy for Sleep
Authors: Cacho Valerie , Green Mindy
Published: June 2021

Aromatherapy is defined as using the essential (volatile) oil extracted from an aromatic plant to improve health and well-being. The naturally occurring chemical constituents in essential oils cross the blood–brain barrier and interact with neurons of the autonomic nervous system. Specific essential oils can be used to treat insomnia via the parasympathetic nervous system by reducing anxiety, improving relaxation, and promoting sleep. They can also be used to treat hypersomnia by increasing alertness through stimulation of the sympathetic nervous system. Essential oils are simple to use and have a low side-effect profile. Essential oils can be blended to create a personliazed aromatic therapy to support relaxation or promote alertness.
Functional Medicine and Sleep
Authors: Colón José
Published: June 2021

Functional medicine recognizes that illness does not occur in isolation. Similarly, sleep disorders do not occur in a vacuum because clinical imbalances that lead to illnesses may subsequently affect sleep, and sleep disruption and circadian dysregulation affect chronic disease. As a way of organizing clinical imbalances the Functional Medicine Matrix helps clinicians to examine the body systems, symptoms, and risk factors associated with a specific condition. The matrix provides an outline for the clinician to organize the patient’s clinical imbalances in biological systems, called nodes: these are defense and repair, energy, biotransformation and elimination, transport, communication, structural integrity, and assimilation. The Functional Medicine Matrix assists the clinician in organizing and prioritizing each patient’s health issues, including sleep disorders, as elicited by a thorough personal, family, social, and medical history. The matrix is a tool for organizing what seem to be disparate issues into a complete story to help the clinician gain a comprehensive perspective of the patient and subsequently facilitate discussion of complex health issues, including chronic disease and sleep disorders.
Hypnosis and Guided Imagery
Authors: Lewis-Croswell Jaclyn L.
Published: June 2021

This chapter overviews hypnosis and guided imagery, describing similarities and differences in their application to sleep disorders. It includes an introduction to hypnosis, and provides a definition and, history of the method, as well as a, guide to using hypnosis interventions and their utility and applications for sleep disorders. Some of the sleep disorders found to be effectively treated by hypnosis include nightmares, sleep walking, night terrors, and parasomnia overlap disorder. The chapter also overviews guided imagery and, provides an example and various uses for guided imagery in sleep disorders. The chapter concludes by reviewing the various differences and uses of hypnosis and guided imagery, including the greater research and wider use of guided imagery in its application to sleep disorders.
Pharmaceutical Sleep Medications and Medications That Affect Sleep
Authors: Beshir Michael , Cook Kayla
Published: June 2021

While sleep medications can improve sleep for those suffering from insomnia, other medications, particularly antidepressants and antipsychotics, can significantly reduce sleep quality. The mechanism by which this occurs is often indirect and variable, and it is not entirely understood. In this chapter, the authors examine how these drugs affect various sleep parameters as evidenced by polysomnography and which phase of the sleep cycle is most impacted as a result of their actions. This chapter also discusses the risks and downsides associated with long-term use of prescription and nonprescription insomnia agents, as well as important age considerations with their use.
Integrative Sleep Medicine and Chronic Pain Management
Authors: Mehta Ashwin
Published: June 2021

Widespread opioid dependency has spurred growing interest in nonpharmacologic methods of addressing chronic pain. Timely research has established a reciprocal and bidirectional relationship between physical discomfort and sleep disturbances. Thus, comprehensive management of chronic pain necessitates a thorough sleep evaluation because underlying sleep concerns can often thwart otherwise effective treatment strategies. Interventions such as cognitive-behavioral therapy are useful to loosen the psychologic association patients commonly form between chronic pain and nonrestorative sleep. Exercise and mindfulness are among those modalities with the best evidence to simultaneously address both sleep loss and chronic pain. Acupuncture, yoga, and tai chi, as well as certain herbs, can be used to stem the inflammatory cascade that frequently hinders successful treatment. Integrative approaches that promote restful sleep are of increasing importance in the context of managing chronic pain.
Sleep and Mental Health Disorders
Authors: Dube Sutapa , Wheeler Claire E. , Ranjbar Noshene
Published: June 2021

Sleep health is crucial to well-being, resiliency, and optimal function. Similar to the relationship between stress and sleep, the relationship between sleep and psychiatric disorders is bidirectional. Given the associations between sleep and mental health, patients should be assessed and treated for sleep disturbances as part of their psychiatric care. In most cases, addressing sleep problems will help with the mental health condition, and sleep treatment should be part of the course of care from the beginning. To successfully address mental health issues, sleep disorders need to be tackled, and treating sleep disorders in many psychiatric patients necessitates addressing mental health issues. The relationships between sleep disturbances and common psychiatric illnesses including depressive, bipolar, anxiety, obsessive compulsive, posttraumatic stress, psychotic, and attention deficit hyperactivity disorders are explored in this chapter.
Sleep and Women
Authors: Finley Nicola
Published: June 2021

There are features of sleep that are unique to women, and these gender differences can be observed over the life span of a woman. Changes in sleep patterns can be observed during a woman’s menstrual cycle, during pregnancy, and during menopause. For example, sleep disorders in pregnancy adversely impact maternal and fetal outcomes. And older postmenopausal women may have sleep disturbances beyond having hot flashes at night. An ideal tactic to manage sleep disorders in women is an integrative medicine approach that allows for a holistic viewpoint of mind, body, and spirit. This chapter explores the topics of insomnia, sleep apnea, and restless leg syndrome in women, as well as sleep gender differences in women.
Circadian Sleep Disorders
Authors: Rahman Shadab A. , Klerman Elizabeth B.
Published: June 2021

This chapter discusses circadian rhythm sleep wake disorders (CRSWDs) as defined by the International Classification of Sleep Disorders (3rd ed.), including the etiology, clinical characteristics, diagnostic methods, and treatment options for both “intrinsic” (delayed and advanced sleep–wake phase disorders, non–24-hour sleep–wake rhythm disorder, and irregular sleep–wake rhythm disorder) and “extrinsic” (shift work and jet lag disorders) types of CRSWDs. Cognitive and psychiatric comorbidities commonly associated with these disorders are also highlighted. The chapter reviews the current gaps in our understanding of the pathophysiology and treatment options of these disorders and discusses the need for considering an integrative approach, one combining complementary and conventional medicine, to treat these disorders. Recommendations are also presented for future research that may improve diagnosis and treatment.
Restless Legs Syndrome and Sleep-Related Movement Disorders
Authors: Duntley Stephen Paul
Published: June 2021

Normal sleep is characterized by a relative lack of body movements. In a variety of sleep disorders, abnormal movements may result from pathological arousals, whereas in sleep-related movement disorders the movement itself is the pathological event. Sleep-related movement disorders are typically characterized by simple, often repetitive and stereotyped movements that occur at sleep onset or during sleep and may disrupt sleep. These include restless legs syndrome, periodic limb movements, sleep-related bruxism, sleep-related leg cramps, and sleep starts. These are common disorders that may be barely noticed or, as in the case of severe restless legs syndrome, can be life-altering. Proper diagnosis is essential because effective treatments are usually available.
The Future of Sleep (and Dream) Medicine
Authors: Naiman Rubin
Published: June 2021

Envisioning the future of sleep medicine begins with an examination of the limitations imposed by our presumptions about sleep itself. Damaged by the overarching sociocultural forces of denaturation, industrialization, and medicalization, the tenets of integrative medicine provide a foundation for imagining a radically transformed sense of sleep and more effective approaches to managing sleep loss. With a greater recognition that we cannot separate what supports healthy sleep and dreams from what supports our general health, the future will emphasize sleep health promotion and prevention. The future of sleep medicine will be integrative in the broadest sense of the term. Beyond the integration of conventional with complementary and alternative medicine, it will likely encourage a richer integration of objectivity and phenomenology, the individual and the natural world, and waking consciousness with sleep and dreams.
Transradial Access Techniques
Authors: Luther Evan , Chen Stephanie H. , Jabbour Pascal M. , Peterson Eric C.
Published: June 2021

The room set-up and patient positioning of the transradial approach (TRA) are different from that of the transfemoral approach (TFA). This is critical to the success of transitioning a medical practice. The most important areas are keeping the hand tight on the patient’s hip, minimal hand supination, and building up the space next to the knee to provide a platform for the catheters to lie during a transradial procedure. The initial patient positioning, room set-up, access techniques, and medications are reviewed, including cocktail, puncture techniques and sheath placement, as well as setup and hand positioning for left radial access procedures.
Transradial Interventional Procedures
Authors: Snelling Brian , Chen Stephanie H. , Jabbour Pascal M. , Peterson Eric C.
Published: June 2021

The majority of neurointerventions can be performed via the radial approach, even with the femoral catheters. The specific case set-up depends on the goals of the intervention. If using the femoral catheters, one is limited to the 6F and 8F systems. The former offers the protection of a radial sheath, the latter must be performed sheathlessly. The size of the radial artery and difficulty and support demands of the case dictate the preferred setup. With minimal experience, once diagnostic angiography is mastered, interventions can easily be learned. The technical pearls and nuances of performing complex neurointervention via the radial approach are reviewed.
Aneurysm Treatment
Authors: Storey Christopher , Lebovitz Jonathon , Peterson Eric C. , Jabbour Pascal M.
Published: June 2021

The transradial approach offers safer access than the transfemoral approach based on the cardiac literature. The dual-antiplatelet requirements of many interventions and the high prevalence of patients on anticoagulation have made the transradial approach the access of choice for elective interventions. For ruptured cases, the benefit provides quicker extubation to reduce risk of pneumonia. All treatment modalities up to 6F triaxial systems can be used for embolization as one would from the femoral approach. All current neurointerventional therapies can be performed from a transradial approach. One needs to realize that, with new technologies, transradial neurointervention will become simpler, more efficient, and reliable.
Treatment of Arteriovenous Fistulas and Arteriovenous Malformations
Authors: Mouchtouris Nikolaos , Khanna Omaditya , Peterson Eric C. , Jabbour Pascal M.
Published: June 2021

The transradial approach has been increasingly utilized for the diagnosis and treatment of arteriovenous fistulas (AVFs) and arteriovenous malformations (AVMs) with great success. The proximity of the radial artery catheterization site to the cerebrum has allowed for navigation of the fragile vasculature of AVFs and AVMs with ease and plenty of support. Intraoperative angiography has tremendously benefitted from transradial catheterization due to the ease of radial access regardless of the intricate patient positioning required for microsurgical resection. This chapter provides a detailed account of the technical details of the transradial approach for the treatment of AVF/AVMs.
Use of Long Radial Sheaths for Radial Artery Spasm in Neurointerventions
Authors: Luther Evan , Jabbour Pascal M. , Peterson Eric C.
Published: June 2021

One of the challenges of the radial approach is radial artery spasm. Because of the smaller caliber, the guide catheters can cause significant spasm that can complicate the procedure or even preclude it. One of the most effective ways to avoid radial artery spasm and stuck catheters is to employ the use of a protective sheath. Recently special long radial sheaths have been developed that completely cover the radial artery, thus precluding the possibility of spasm. In addition, the protection results in less trauma to the innovation of long radial sheaths has dramatically decreased the issues surrounding radial artery spasm. The nuances of the long radial sheaths and a protocol for their use are described.
Pediatric Transradial Approach
Authors: Hafazalla Karim , Saiegh Fadi Al , Peterson Eric C. , Jabbour Pascal M.
Published: June 2021

Neuroendovascular surgery has become an indispensable domain in the treatment of cerebrovascular disease with a slew of treatment options for numerous pathologies. The field experienced a movement toward a transradial approach for diagnostic and interventional procedures. Advantages of the transradial approach include lower risk for complications, which can be fatal using the transfemoral route, higher patient satisfaction, and shorter hospital stays. Those advantages are not unique to the adult population but are, in fact, even more pronounced in pediatrics. They include early mobilization of patients since flat bed rest is not required as it is with transfemoral puncture for hemostasis at the groin. This also obviates the need for continuous intravenous sedatives, which is fraught with its own risks. Early reports have demonstrated the feasibility of transradial cerebral angiography in children. Others have also shown that the transradial approach can be safely used to administer intra-arterial chemotherapy in children with retinoblastoma. A standardized protocol is imperative to maximize the success rate of the transradial approach in pediatrics and includes the routine use of ultrasound as well as a “radial cocktail” to avoid vasospasm. While transfemoral may be the conventional route, transradial offers a plethora of advantages, particularly in children. As more experience in transradial is gained in adults, it is likely that this will translate into more transradial procedures in children as well.
How to Start Your Radial Practice
Authors: Luther Evan , Peterson Eric C.
Published: June 2021

Once committed to converting your practice to the radial approach, there are several tips and tricks that the authors suggest to improve your journey. Radial access is not difficult, but there are several strategies that are counterintuitive that can make the difference between building a successful radial practice and going back to femoral access. Understanding the learning journey having traveled it ourselves, the audience can receive the benefit of us having already tread the path and defined the optimal way to convert your practice to a radial first practice. The nuances of setting up a radial neurointerventional practice are reviewed.
Training and competence in cardiovascular imaging
Authors: Fox Kevin , Di Carli Marcelo F.
Published: June 2021

The provision of safe and effective cardiovascular imaging requires a competent trained workforce practising within a quality assured service. Training has evolved and nowadays organized training programmes with objective assessments of competence are the norm across the cardiovascular imaging modalities. The European Association of Cardiovascular Imaging (EACVI) has been instrumental in many of the progressive improvements in training and competence assessment in the last decade. Typically training programmes require acquisition of knowledge, skill, and professionalism assessed by exams, logbooks, and workplace-based assessments. E-learning and simulation are increasingly used as tools to enhance knowledge acquisition and practical skill development. Effective clinical performance, which is the ultimate aim, requires competent individuals to work in a quality assured environment. The future challenge will be to transition from a unimodality model to a multimodality approach.
Three-dimensional echocardiography
Authors: Gianstefani Silvia , Monaghan Mark J.
Published: June 2021

Despite the fact that three-dimensional echocardiography (3DE) has been available for many years, its utilization on a routine clinical basis has been rather limited. However, recent improvements in image quality, semi-automated quantification, better workflow, and other developments such as fusion imaging, have now accelerated the integration of 3D imaging into routine echo practice. In this chapter, we have reviewed the standard and well established applications of the technique such as volumetric chamber analysis and 3D evaluation of valvular pathology, as well as highlighting some of the exciting new developments such as the use of artificial intelligence and photo-realistic visualization. these newer techniques will undoubtedly help ensure that 3D echocardiography plays a pivotal role in contemporary cardiac imaging leading and cutting edge patient care.
Contrast echocardiography
Authors: Senior Roxy , Becher Harald , Pinto Fausto J. , Khattar Rajdeep S.
Published: June 2021

Contrast echocardiography has become an established technique to enhance endocardial border definition in those with suboptimal images. This has been enabled by newer intravenously administered ultrasound contrast agents that can traverse the pulmonary circulation intact, coupled with ultrasound imaging techniques designed specifically to allow good visualization of these agents in the left ventricular cavity and myocardium. Contrast echocardiography improves the evaluation of left ventricular function providing more accurate and reproducible measurements of volumes and ejection fraction. Contrast use in stress echocardiography improves the feasibility, diagnostic accuracy, and reader confidence in the test. Consequently, contrast agents enhance decision-making, shorten time to diagnosis, and reduce downstream costs in those with difficult acoustic windows. The technique is particularly useful in delineating apical pathology, and may be used to assess cardiac masses and aortic diseases. Myocardial perfusion may also be assessed during resting and stress echocardiography, improving the evaluation of coronary artery disease.
Aortic valve stenosis
Authors: Pibarot Philippe , Baumgartner Helmut , Clavel Marie-Annick , Côté Nancy , Orwat Stefan
Published: June 2021

Aortic valve stenosis (AS) is the most prevalent valvular heart disease and is increasingly diagnosed in high-income countries due to an ageing population but also to more widely available diagnostic tools. The prevalence of AS is estimated at ~0.5% in the general population, ~2–3% in the population over 65 years old. This disease starts with mild fibrosis and calcification and thickening of the aortic valve leaflets without obstruction of blood flow, which is termed aortic sclerosis, and evolves over the years to severe calcification with impaired leaflet mobility and significant obstruction to blood flow, i.e. AS. The clinical presentation includes the spectrum from asymptomatic patients with different grades (mild, moderate, severe) of AS severity to symptomatic patients with severe AS who may present with preserved or already depressed left ventricular (LV) function and/or reduced transvalvular flow. Accurate assessment of the AS anatomic and haemodynamic severity as well as the extent of cardiac damage associated with AS are crucial for the therapeutic management of patients with AS. Doppler-echocardiography is the method of choice providing a comprehensive non-invasive diagnostic work-up of these patients.
Imaging-guided transseptal puncture and transcatheter closure of patent foramen ovale/atrial septal defect, ventricular septal defect, and paravalvular leaks
Authors: Kronzon Itzhak , Monteagudo Juan Manuel , Faletra Francesco F. , Mehla Priti , Saric Muhamed
Published: June 2021

Repairing structural heart diseases without surgery has been a major challenge. The title ‘The Father of Interventional Cardiology’ belongs to William J. Rushkind (1922–1986) who performed atrial balloon septostomy in newborn babies with D-transposition as early as 1968. He also designed devices for the transcatheter closure of atrial defects and of patent ductus arteriosus. The introduction of better devices and skilled operators led to successful procedures which are less traumatic, shorter, and in many cases significantly less expensive. The various modalities of cardiac imaging have become a crucial ingredient of the preprocedural diagnosis, procedural guidance, and the assessment of procedural results and follow-up. This chapter will demonstrate and discuss the role of imaging in several catheter-based procedures that are now commonly practised by the current generation of interventional cardiologists who are involved in structural heart disease.
Imaging for electrophysiological procedures
Authors: O’Neill Louisa , Sim Iain , Whitaker John , Williams Steven , Chubb Henry , Maurovich-Horvat Pál , O’Neill Mark , Razavi Reza
Published: June 2021

Electrophysiology is one of the most rapidly growing area of cardiology. Currently >50,000 catheter ablations are performed in Europe every year and >200,000 patients receive a device for arrhythmia treatment, sudden death prevention, or cardiac resynchronization. The advantages and limitations of fluoroscopy are well known. The rapid development of implantable cardiac devices therapies and ablation procedures all depend on accurate and reliable imaging modalities for preprocedural assessments, intraprocedural guidance, detection of complications, and post-procedural assessment for the longitudinal follow-up of patients. Therefore, over the last decades, imaging become an integral part of electrophysiological procedures.
CMR and detection of coronary artery disease
Authors: Nagel Eike , Schwitter Juerg , Plein Sven
Published: June 2021

Cardiovascular magnetic resonance (CMR) imaging plays a major role in the diagnosis and assessment of coronary artery disease (CAD). This chapter will focus on the diagnosis of ischaemia by CMR with brief reference to viability assessment, which is covered in detail elsewhere. Perfusion-CMR has matured to a reliable technique for the assessment of CAD. It detects and excludes CAD with a high diagnostic performance. There is also increasing evidence from single-centre studies and the European CMR registry for the high prognostic value of ischaemia detection by perfusion-CMR and a normal CMR study in patients with or without known CAD predicts a rate for MACE of 0.3–1%/year. Coronary angiography by CMR will not be discussed in this chapter, however, as it is only recommended for delineation of the course of coronary artery anomalies.
Hypertrophic cardiomyopathy
Authors: Cardim Nuno , Toste Alexandra , Nijveldt Robin
Published: June 2021

Imaging plays a major role in the evaluation of hypertrophic cardiomyopathy (HCM) patients, offering answers to clinical questions. Imaging techniques provide a broad spectrum of information, including morphological data, functional information, and ischaemia assessment, useful in many clinical settings of HCM. The clinical diagnosis of HCM is based on unexplained left ventricular hypertrophy (LVH) by imaging, though the role of genetic diagnosis has increased. A multimodality imaging (MMI) approach is encouraged in HCM. Each technique must be selected to provide solutions to the specific problems, avoiding duplicated data, and taking into account its technical characteristics, availability, benefits, risks, and costs.
Constrictive pericarditis
Authors: Caforio Alida L.P. , Galderisi Maurizio , Imazio Massimo , Marcolongo Renzo , Adler Yehuda , Santoro Ciro
Published: June 2021

Constrictive pericarditis is a pericardial syndrome where the pericardium becomes relatively rigid and inelastic, may be thickened and calcified or not, and impairs mid to late diastolic filling. Constrictive pericarditis is the final pathway of several different diseases or causes, usually starting from pericarditis and pericardial effusion, and progressing towards pericardial fibrosis and calcification. Constrictive pericarditis is commonly the final evolution of any type of pericarditis and pericardial effusion. The risk of developing such evolution is especially related to the aetiology. The risk of progression is especially related to the aetiology: low (<1%) in viral and idiopathic pericarditis, intermediate (2–5%) in immune-mediated pericarditis and neoplastic pericardial diseases, and high (20–30%) in bacterial pericarditis, especially purulent pericarditis. It is important to recognize transient (subacute) constrictive pericarditis early on in the process versus calcific chronic constrictive pericarditis.
The role of echocardiography
Authors: Evangelista Arturo , Teixidó-Turà Gisela
Published: June 2021

Echocardiography plays an important role in the diagnosis and follow-up of aortic diseases. Evaluation of the aorta is a routine part of the echocardiographic examination. Transthoracic echocardiography (TTE) is an excellent modality for imaging the aortic proximal ascending aorta, which is important in the diagnosis and follow-up of aorta aneurysms. Transoesophageal echocardiography (TEE) overcomes the limitations of TTE in thoracic aorta assessment. Although TEE is the technique of choice in the diagnosis of aortic dissection, TTE may be used as the initial modality in the emergency setting. Intimal flap in proximal ascending aorta, pericardial effusion/tamponade, and left ventricular function can be easily visualized by TTE. However, a negative TTE does not rule out aortic dissection and other imaging techniques must be considered. TEE should define entry tear size and location, mechanisms and severity of aortic regurgitation, and true lumen compression. TEE is essential in selecting and monitoring surgical and endovascular treatment and in detecting possible complications.
Towards a psychoanalytic migration studies: A son, a brother, a father, an American, and his house in a Cameroonian village
Authors: Page Ben
Published: June 2021

Around the world, migrants are building houses in their countries-of-origin. For the women and men who create them, these houses are unambiguously significant. Yet, in academic migration studies, they are often seen as peripheral—interesting rather than important. This article follows recent work that aims to show why these houses really do matter. These houses are where migrants can seek to process the trauma of the disconnection that is inherent in migration and are how they repress the anxieties that arise from transnationalism. Migrants’ emotions are externalised onto the house. Based on ethnographic fieldwork in Cameroon between 2013 and 2018, this article develops a case study about one transnational migrant, his family, and his house. It uses the example to develop two arguments: first that these houses sit within transnational networks, but the networks are subject-centred so a theory of the subject is needed to analyse them. Secondly, that human subjects make a deal when they exchange infantile egocentrism for collective inter-subjectivity, which is similar to the deal made between transnational migrants and their ancestral home when they receive permission to leave in exchange for continuing to connect—a link that is materialised in the house. Both these arguments combine to support an underlying claim that migration studies in general, and studies of migrant housing in particular would benefit from building further on existing work that draws on psychoanalytical approaches.