bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in organization of care are associated with mortality, severe complication and failure to rescue in emergency colon cancer surgery
Authors: Huijts Daniëlle D , Dekker Jan willem T , van bodegom-vos Leti , van groningen Julia T , Bastiaannet Esther , Marang-van de mheen Perla J
Published: March 2021

Background

Emergency colon cancer surgery is associated with increased mortality and complication risk, which can be due to differences in the organization of hospital care. This study aimed.

Objective

To explore which structural factors in the preoperative, perioperative and postoperative periods influence outcomes after emergency colon cancer surgery.

Methods

An observational study was performed in 30 Dutch hospitals. Medical records from 1738 patients operated in the period 2012 till 2015 were reviewed on the type of referral, intensive care unit (ICU) level, surgeon specialization and experience, duration of surgery and operating room time, blood loss, stay on specialized postoperative ward, complication occurrence, reintervention and day of surgery and linked to case-mix data available in the Dutch Colorectal Audit. Multivariate logistic regression analysis was used to estimate the influence of these factors on 30-day mortality, severe complication and failure to rescue (FTR), after adjustment for case-mix.

Results

Patients operated by a non-Gastro intestinal/oncology specialized surgeon have significantly increased mortality (Odds Ratio (OR) 2.28 [95% confidence interval (95% CI) 1.23–4.23]) and severe complication risk (OR 1.61 [95% CI 1.08–2.39]). Also, duration of stay in the operating room was significantly associated with increased risk on severe complication (OR 1.03 [95% CI 1.01–1.06]). Patients admitted to a non-specialized ward have significantly increased mortality (OR 2.25 [95% CI 1.46–3.47]) and FTR risk (OR 2.39 [95% CI 1.52–3.75]). A low ICU level (basic ICU) was associated with a lower severe complication risk (OR 0.72 [95% CI 0.52–1.00]). Surgery on Tuesday was associated with a higher mortality risk (OR 2.82 [95% CI 1.24–6.40]) and a severe complication risk (OR 1.77, [95% CI 1.19–2.65]).

Conclusion

This study identified a non-specialized surgeon and ward, operating room, time and day of surgery to be risk factors for worse outcomes in emergency colon cancer surgery.
What Causes Primary Psychotic Disorders Like Schizophrenia?
Authors: Broussard Beth , Compton Michael T.
Published: March 2021

It is believed that a combination of certain genes and a number of early life risk factors probably leads to subtle abnormalities in brain development, which set the stage for the later development of psychosis. It is unlikely that only one gene can cause psychosis. Instead, a number of genes each play a small role in a person’s risk for developing psychosis. The abnormal brain development that happens early in life among people who later develop psychosis is very subtle and usually remains undetected and quiet. School difficulties and social problems may develop during childhood and adolescence. In addition to the subtle abnormalities in early brain development, additional subtle abnormalities may also happen during the important period of adolescent brain maturation. Research suggests that adolescent drug use, especially marijuana use, increases one’s risk of developing psychosis.
The Initial Evaluation of Psychosis
Authors: Broussard Beth , Compton Michael T.
Published: March 2021

For a young person with psychosis, the evaluation process can provide the start of a path toward effective treatment and recovery. Although the initial evaluation can be done in inpatient or outpatient settings, treatment of early psychosis often begins with a short stay in the hospital or related inpatient setting. In some instances, mental health professionals may be able to start treatment in the outpatient setting if there are no immediate safety concerns. The evaluation may include gathering additional information from sources other than the young person experiencing psychosis. Individuals experiencing psychosis often receive a physical exam, labs, and other tests to look for any medical problems that can cause symptoms. Understanding the evaluation process and providing mental health professionals with all available information can help in making a diagnosis and planning for the best treatment that will help the young person move toward recovery.
Psychosocial Treatments for Early Psychosis
Authors: Broussard Beth , Compton Michael T.
Published: March 2021

This chapter discusses the importance of psychosocial treatments for psychosis. The recovery process focuses as much on resuming school, work, relationships, and recreation/leisure activities as it does on treating symptoms. The purpose of psychosocial treatments is to help young people with psychosis overcome common challenges in these areas and resume a full life. Group therapy can help young people to feel less alone and give them a chance to talk to others who are going through similar difficulties and discover what’s working for them. Family interventions help families to cope with stress, improve their social supports, and reduce the effects of stigma. Supported employment aims to move young people toward successful paid employment. Social skills training focuses on teaching people how to approach and navigate personal and professional social situations through a combination of learning new techniques and practicing these skills in various settings.
Staying Healthy
Authors: Broussard Beth , Compton Michael T.
Published: March 2021

To move toward recovery after a first episode of psychosis, young people must focus on both their mental and physical health. Staying away from tobacco products, alcohol, and marijuana and other drugs; having a healthy diet; getting plenty of exercise; sleeping well; and having social support from family and friends are all necessary parts of a healthy lifestyle. Even those who have already begun to use substances can quit, and though difficult, in the end quitting will improve their mind and body. Even if the young person is not ready to quit completely, reducing substance use is always helpful. One way to introduce new healthy behaviors is by setting achievable weekly goals and tracking progress along the way to keep motivated.
Embracing Recovery
Authors: Broussard Beth , Compton Michael T.
Published: March 2021

Recovery is a broad concept, pertaining to one’s life goals, rather than to just getting symptoms under control. It means successfully living with a mental illness by not being confined by it; embracing hope, empowerment, and self-determination; and focusing on one’s personal life goals and roles in society. The goal of the recovery model of mental health treatment is to empower individuals to achieve their full potential in life. Individuals themselves decide on their personal goals for treatment and recovery instead of mental health professionals deciding for them. Recovery requires learning, support, courage, and patience. People who are successfully living with psychosis, including peer specialists (also called peer counselors or peer navigators), can help support others with similar experiences because they have had their own journey in recovery.
Early Detection of Prostate Cancer
Authors: Dahm Philipp
Published: March 2021

This chapter describes the design, main findings, relevance, and limitations of the European Randomized Study of Screening for Prostate Cancer (ERSPC), which compared screening based on prostate-specific antigen (PSA) to no screening. ERSPC indicated that screened patients may derive a small survival benefit in terms of prostate cancer–specific mortality but not all-cause mortality. Such a benefit is most likely realized in men with an extended life expectancy of 15 years or greater. The potential harms of PSA-based prostate cancer screening include a high rate of false-positive tests, biopsy-related complications, the unnecessary diagnosis of low-risk prostate cancer unlikely to affect a man during his lifetime (overdiagnosis) in some, and treatment sequelae both in men who may benefit from treatment and those who will not (overtreatment).
Radical Prostatectomy Versus Observation for Localized Prostate Cancer
Authors: Dahm Philipp
Published: March 2021

This chapter provides a summary of the landmark PIVOT trial that randomized men with clinically localized prostate cancer from the early prostate-specific antigen (PSA) era to radical prostatectomy versus watchful waiting. Based on long-term follow-up, the study found that surgery provided only small reductions in disease-specific survival but caused substantial side effects. It suggested that many men with clinically localized prostate cancer fare well with watchful waiting.
Enzalutamide in Metastatic Prostate Cancer Before Chemotherapy
Authors: Zabell Joseph
Published: March 2021

This chapter summarizes the findings of the landmark PREVAIL trial conducted in men with castrate-resistant prostate cancer who had received prior chemotherapy comparing enzalutamide to placebo. It demonstrated improved overall survival, radiographic progression-free survival, and time to cytotoxic chemotherapy.
Sunitinib Versus Interferon Alfa in Metastatic Renal Cell Carcinoma
Authors: Weight Christopher
Published: March 2021

This chapter summarizes the findings of one of the earliest trials of targeted therapy with a protein kinase inhibitor in patients with previously untreated, metastatic renal cell carcinoma who received either systemic sunitinib or interferon alfa. The study found better progression-free survival and overall survival in patients who received sunitinib. Diarrhea was the most common adverse event in the sunitinib group and was much more frequent compared to the interferon alfa group
Neoadjuvant Chemotherapy Plus Cystectomy Compared With Cystectomy Alone for Locally Advanced Bladder Cancer
Authors: Narayan Vikram M.
Published: March 2021

This study summarizes a landmark study on the role of neoadjuvant chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC) in patients with muscle-invasive bladder cancer. This randomized study of M-VAC plus cystectomy versus cystectomy alone suggested improved overall survival in patients receiving neoadjuvant therapy. Severe granulocytopenia was a common adverse effect in the chemotherapy group, but no deaths were attributed to chemotherapy.
Radiotherapy With or Without Chemotherapy in Muscle-Invasive Bladder Cancer
Authors: Narayan Vikram M.
Published: March 2021

This randomized study assessed the role of synchronous chemotherapy with intravenous 5-fluorouracil and mitomycin in patients with muscle-invasive bladder cancer undergoing radiotherapy compared to radiotherapy only. This study demonstrated improved 2-year locoregional recurrence-free survival and also suggested improved overall survival favoring combination therapy. High-grade, primarily gastrointestinal toxic events were increased with combination therapy, while cystectomy rates were decreased.
Shock Wave Lithotripsy Versus Ureteroscopy for Lower-Pole Caliceal Calculi 1 cm or Less
Authors: Bird Vincent G. , Borofsky Michael S.
Published: March 2021

This chapter reviews the findings of an important randomized controlled trial of ureteroscopy versus shock wave lithotripsy in adult patients with isolated lower pole stones 1 cm or less in size in whom treatment was indicated. The type of ureteroscope and shock wave lithotripter, the power settings used, and the number of shocks administered were left to the discretion of the treating physician. The study suggested that there is little to no difference in stone-free rates between the two modalities for the treatment of small lower pole renal calculi.
Treatment of Men With Erectile Dysfunction With Transurethral Alprostadil
Authors: Bodie Joshua
Published: March 2021

This chapter summarizes the results of an important trial comparing transurethral alprostadil to placebo in men with erectile dysfunction. Sexual intercourse was reported as having occurred more often in the alprostadil group, and more men in the group experienced orgasm. Penile pain was reported by approximately one-third of men during clinic testing. This study described the initial experience with transurethral alprostadil and identified the effectiveness of patient-specific doses.
The Efficacy of Terazosin, Finasteride, or Both in Benign Prostatic Hyperplasia
Authors: Jung Jae Hung
Published: March 2021

This chapter summarizes the landmark Veterans Affairs Cooperative Benign Prostatic Hyperplasia Study in patients with lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH) that randomized men to receive terazosin, the 5-alpha reductase inhibitor (5-ARI) finasteride, their combination, or placebo. This study demonstrated the benefit of alpha-blocker therapy for men with BPH symptoms but did not demonstrate an added benefit of combination alpha-blocker and 5-ARI therapy.
Chlorhexidine–Alcohol Versus Povidone–Iodine for Surgical-Site Antisepsis
Authors: Dahm Philipp
Published: March 2021

This chapter summarizes the landmark trial that examined, in patients undergoing clean-contaminated surgery, how chlorhexidine–alcohol scrub compared to povidone–iodine scrub and paint in terms of infection rates. The trial included patients who were undergoing colorectal, small intestinal, gastroesophageal, biliary, thoracic, gynecologic, or urologic operations without substantial spillage or unusual contamination. Chlorhexidine reduced the rate of any surgical infection as well as that of superficial incisional infection, but no difference was observed for deep incisional infections, organ space infection, and sepsis from surgical-site infection.
Introduction
Authors: Robinson Terry , Scullion Jane
Published: March 2021

Respiratory diseases are one of the most common forms of ill-health, affecting about 12.5 million in the United Kingdom (UK); approximately one in five people. Globally the UK is in the top 20 countries for lung cancer and COPD deaths, with prevalence being highest in the North-West and South-West of England. More women than men have a diagnosed lung disease, mainly due to higher pneumonia incidence; most other lung conditions are more common in men. This chapter begins with an overview of respiratory disease, and outlines some of the common causes that impact on lung health. The mortality and morbidity of various respiratory diseases is covered, and the costs of consultations and drug treatments are discussed.
Pharmacology
Authors: Robinson Terry , Scullion Jane
Published: March 2021

Pharmacology is the study of the actions, mechanisms, uses, and adverse effects of a drug. A drug is any natural or synthetic substance that changes the physiological state of a living organism. In respiratory medicine drugs are used for the prevention, diagnosis, and treatment of a disease. This chapter begins by outlining basic pharmacology and pharmacokinetics, absorption, distribution, metabolism, and excretion. It then covers pharmacodynamics and adverse drug reactions (ADRs). It then begins to look at β‎2 agonists for asthma and COPD, oral bronchodilators, anticholinergic bronchodilators, theophyllines, and corticosteroids. Combinations of different drug therapies for respiratory conditions are described. Monoclonal antibody therapies are described, including dosing regimens, administration, side effects, and interactions. Different inhaler devices are covered. Patient engagement and placebo devices are included.
Pulmonary embolism
Authors: Robinson Terry , Scullion Jane
Published: March 2021

A pulmonary embolism (PE) is a clinically significant obstruction occurring in part of or the entire pulmonary vascular tree. The most common cause is a thrombus from a distant site such as the leg. Most pulmonary emboli originate from detached portions of venous thrombi that have formed in the deep veins of the lower limbs. Other sites where they form include the right side of the heart and the pelvis.

Non-thrombotic emboli, mainly fat, air, and amniotic fluid, may also occur but these are rarer. This chapter provides an overview of incidence and aetiology, and tabulates the risk factors for PE. The clinical features and assessment are covered, and six different investigations are explained. Management—anticoagulants, thrombolysis, and high-flow oxygen—are also included, along with nurse involvement at different points of PE.
Tuberculosis (TB)
Authors: Robinson Terry , Scullion Jane
Published: March 2021

This chapter covers the key facts about tuberculosis (TB), then goes on to describe the epidemiology and pathophysiology of the disease. Risk factors, and signs and symptoms, and investigations are all covered. The treatment phase and standard drug therapies are shown, and directly observed therapy for the patient with an increased risk of poor adherence is described. Mono-resistant, multidrug-resistant, and extensively drug-resistant types are included in this chapter, as well as contact tracing in line with NICE clinical guidelines. Mycobacterium Tuberculosis (MTB) is part of a family of mycobacterium which includes Mycobacterium bovis. M. bovis is uncommon in humans, although it frequently affects cattle and badgers. MTB can affect any organ in the body; this chapter will concentrate on the diagnosis, treatment, and prevention of pulmonary MTB in adults in the UK.
Palliative care
Authors: Robinson Terry , Scullion Jane
Published: March 2021

Although there are respiratory diseases that are acute and respond well to treatments, many end in what could be viewed as an essentially palliative or terminal phase. Many respiratory disease processes are essentially chronic in nature and some patients should be considered palliative from diagnosis. There is increasing evidence that patients with end-stage lung disease experience declining heath, anxiety, depression, fatigue, coping difficulties, and somatic preoccupation, and if this is unrecognized then there is a potential for basic needs to remain unmet. This chapter describes the management of breathlessness, chest clearance, and relaxation during the palliative phase of care, methods for managing anxiety, depression, and pain, and the nurse’s role in care during end-of-life care.
Sex, sexuality, and breathlessness
Authors: Robinson Terry , Scullion Jane
Published: March 2021

This chapter looks at sex and sexuality as an integral part of human relationships, and discusses the difficulties that can come with having a chronic respiratory disease and how these can be mitigated. These can range from infertility issues for male patients with cystic fibrosis, contraceptive issues for patients on antituberculosis medication, disease-modifying antirheumatic drugs such as methotrexate, and a range of problems for other patients experiencing symptoms and adapting to their disease processes. Here the text addresses stereotypes that may exist, such as ageism and not seeing people with long-term conditions as sexually active. It then goes on to describe the nurse’s role in sexual assessment, sexual expression in the respiratory patient, adverse effects of medication, and key points to remember when discussing these issues with a patient.
Terrorism, Violent Radicalisation, and Mental Health
Authors: Bhui Kamaldeep , Bhugra Dinesh
Published: March 2021

Terrorism, Violent Radicalization, and Mental Health brings together distinct disciplinary and ideological narratives on the political, social, economic, and cultural aspects of radicalization and terrorism today. Specifically, adopting methodologies and concepts from cultural psychiatry, and a range of other disciplines, across 18 chapters, we assesses a wide range of groups and types of extremism and terrorism from around the world. There are key topics such as technology, social and international policies, ethics and cultural competency, and the role that psychiatrists and mental health professionals play in treatment, management, and prevention. There are implications for counter-terrorism policy and practice, as well as wider social and public health and immigration policies. We thank the authors for their commitment to this challenging area of work, yet one which is much needed, to create social and global cohesion and improve public health, enabling all to flouris.
A discourse for the prevention of radicalization in the Netherlands: Curbing the radical inflow
Authors: Steinmetz Carl H.D.
Published: March 2021

This chapter is arranged around a theory about egocentric and sociocentric individuals and cultures. The theory outlines different experiences and trajectories of individualists and communities when it comes to sympathizing with radicalization, the emergence of violent protest, carrying out attacks on civilians and general populations, and travelling to war zones. The present chapter highlights a discourse that might place the prevention of radicalization higher on the national agenda. We do this in order to prevent the recruitment of ‘radicals’ at different levels. We illustrate that the British example—of few resources and efforts for the prevention of radicalization as a response to fear and panic after certain attacks—is not followed by the Netherlands, where there the focus is on investment, interventions, and community policing. Themes for intervention to prevent radicalization are described.
Acute dyspnoea in the emergency department
Authors: Michou Eleni , Kozhuharov Nikola , Martin Jasmin , Mueller Christian
Published: March 2021

Acute dyspnoea is a very common symptom in the acute cardiac care setting. In contrast to current beliefs, acute dyspnoea, as the leading symptom, is associated with about twice the mortality risk, compared to acute chest pain. Rapid and accurate identification of the cause of dyspnoea is critical to the initiation of specific and effective treatment. In most patients, a rapid and accurate diagnosis in the emergency department can be achieved by a combination of vital signs, including pulse oximetry, detailed patient history, physical examination, blood tests including B-type natriuretic peptide or N-terminal pro-B type natriuretic peptide, venous blood gases, and C-reactive protein in all patients, and D-dimers in selected patients, electrocardiograms, chest X-ray and pleural and/or lung ultrasound. It is key to remember that the prevalence of acute heart failure in unselected patients with acute dyspnoea is about 50%. Therefore, a high awareness for the presence of acute heart failure is mandatory. Acute heart failure, pneumonia, obstructive pulmonary diseases (chronic obstructive pulmonary disease and asthma), pulmonary embolism, and anxiety disorders represent more than 90% of all cases with acute dyspnoea in the emergency department. In about 10-15%, two acute causes (e.g. acute heart failure and pneumonia) may be present and require combined treatment. Transthoracic echocardiography should be immediately performed in all patients with acute dyspnoea and shock, and in those patients in whom the diagnosis remains uncertain, even after initial work-up
Monitoring of the kidneys, liver, and other vital organs
Authors: Werdan Karl , Patel Brijesh , Girndt Matthias , Ebelt Henning , Schröder Jochen , Nuding Sebastian
Published: March 2021

The prognosis of critically ill cardiac patients in the critical care unit and intensive cardiac care unit depends not only on the underlying cardiac disease, but also on the development of secondary organ complications and failures. Therefore, close monitoring of vital organs is mandatory in all critically ill cardiac patients to detect the development of non-cardiac organ failure as early as possible.
Echocardiography and thoracic ultrasound
Authors: Flachskampf Frank A , Myrianthefs Pavlos , Beyer Ruxandra
Published: March 2021

For the emergency management of cardiovascular disorders, echocardiography and thoracic ultrasound are indispensable imaging techniques at the bedside. In the intensive care environment, crucial questions, such as left and right ventricular function, valvular heart disease, volume status, aortic disease, cardiac infection, pleural effusion, pulmonary oedema, pneumothorax, and many others, can be sufficiently and reliably answered by using these techniques; in fact, it is almost impossible to manage patients with acute severe haemodynamic impairment reasonably well without prompt and repeated access to echocardiography. This is confirmed by the prominent place that echocardiography has in the guideline-based diagnosis and treatment of all major cardiovascular emergencies, from acute heart failure to acute coronary syndrome to pulmonary embolism, etc. Moreover, it is the ideal tool to follow up the patient, since repeat examinations pose no risk to the patient and demand relatively little logistics and resources. To benefit from the wealth of information that echocardiography and thoracic ultrasound can provide, modern equipment (including a transoesophageal probe) and systematic training of echocardiographers must be ensured. The availability of prompt and experienced echocardiography and thoracic ultrasound services at all times is fundamental for sound contemporary cardiovascular intensive care.
Ultrasound-guided vascular access in intensive/acute cardiac care
Authors: Paul Richard
Published: March 2021

Acid-base homeostasis is vital for the maintenance of normal tissue and organ function, as both acidosis and alkalosis can have harmful and potentially life-threatening effects on the human body. Arterial blood gas analysis, combined with routine clinical history and examination, can provide useful information for the management of the critically ill cardiac patient. Most acid-base derangements are reversed by treatment of the underlying disease process, rather than simple correction of the abnormal pH, and prognosis is determined by the nature of the underlying disease, rather than the extent of pH value deviation. Within this chapter, an approach is presented for prompt and accurate acid-base interpretation. Water and electrolyte disorders are common in the intensive cardiac care unit, particularly in patients with cardiac failure. Prompt recognition and treatment is required to prevent cardiovascular and neurological compromise. Therapeutic strategies range from simple electrolyte substitution and fluid management to extracorporeal filtration of excess fluid and electrolytes. These are discussed within this chapter.
Pericardiocentesis
Authors: Carlini Caterina C De , Maggiolini Stefano
Published: March 2021

Pericardiocentesis, the percutaneous drainage of the pericardial effusion, is the technique of choice for the treatment of cardiac tamponade. In addition, it could be useful for diagnostic purposes in specific situations. The pericardial puncture could be associated to serious complications and as it could be performed in a wide variety of clinical settings, from an emergency to a programmed diagnostic procedure, it is mandatory for the clinician to know how to plan and how to safely perform the procedure. This chapter will deal with indications, contraindications, different approaches, complications and periprocedural management of the pericardiocentesis procedure.
Biomarkers of coagulation and thrombosis
Authors: Hvas Anne-Mette , Grove Erik L , Kristensen Steen Dalby
Published: March 2021

Coagulation is evaluated by conventional coagulation analyses, often supplemented by point-of-care tests. A number of point-of-care tests for evaluation of platelet function and the efficacy of antiplatelet therapy have been investigated. Thrombophilia contributes to the risk of thrombosis, and a battery of complex assays is required to identify thrombophilias. Disseminated intravascular coagulation is characterized by microthrombosis and clinical bleeding. A scoring system for overt disseminated intravascular coagulation provides a five-step diagnostic algorithm. The cornerstone of the managing disseminated intravascular coagulation is treatment of the underlying triggering condition. Heparin-induced thrombocytopenia is an adverse immunological effect of heparin therapy. Besides thrombocytopenia, the major clinical consequence of heparin-induced thrombocytopenia is an increased risk of thrombosis. The diagnosis is based on clinical symptoms and detection of platelet-activating heparin-induced thrombocytopenia antibodies. When heparin-induced thrombocytopenia is strongly suspected, it is recommended to stop heparin treatment, investigate for heparin-induced thrombocytopenia antibodies, and initiate non-heparin anticoagulant treatment.
Biomarkers of renal and hepatic failure
Authors: Plebani Mario , Mion Monica Maria , Zaninotto Martina
Published: March 2021

In the last years, major advances have been achieved in the understanding of the molecular and pathophysiological mechanisms which underlie the complex interactions between the heart and the kidney, as well as between the heart and the liver. According to these new insights, innovative biomarkers have been proposed for better evaluating and monitoring patients affected by cardiovascular diseases. In addition, some biomarkers should be used as risk factors and for an early identification and treatment of these severe diseases. This chapter reviews the most important biomarkers for evaluating the 'cardiorenal syndrome', in particular, the measurement of serum creatinine and its use for calculating the glomerular filtration rate which, with the new and more efficient equation, namely Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), still remains the most widely used biomarker. The role of newer biomarkers will be explored. The measurement of cystatin C, representing additional information, particularly in paediatric age groups and in the early phase of kidney disease, plays an increasing role. Neutrophil gelatinase-associated lipocalin (NGAL) is a recently developed but largely used biomarker for the early diagnosis of acute kidney injury, while the well-known albumin/creatinine ratio has been re-evaluated as a simple and useful tool for an early identification of kidney disease. Regarding liver diseases, a growing body of evidence demonstrates the usefulness of non-invasive makers of hepatic fibrosis that may avoid the need for a liver biopsy in most patients. A promising field of research is represented by the role of non-alcoholic fatty liver disease in the pathogenesis of cardiovascular disease.
Coronary artery bypass graft surgery
Authors: Davierwala Piroze M , Borger Michael A
Published: March 2021

The surgical management of acute coronary syndrome still remains a challenge for the cardiac surgeon. Although most patients can be managed by percutaneous coronary intervention, for patients with complex multivessel or left main coronary artery disease (high SYNTAX score), in whom percutaneous coronary intervention is not possible or is unsuccessful, urgent or emergent coronary artery bypass graft surgery is the only available option. It is very important for surgeons to determine the optimum timing of surgical intervention, which is usually based on the clinical presentation, coronary anatomy, and biomarkers. Surgeons should be conversant with the different operative techniques, whether off- or on-pump coronary artery bypass graft surgery, that would help in achieving the best possible outcomes in such situations. Early and late survival of patients depends not only on an efficiently executed operation, but also on the competency of the post-operative care delivered. Modern perioperative management is reinforced by the availability of a variety of mechanical cardiopulmonary assist devices, like the intra-aortic balloon pump, the extracorporeal membrane oxygenation, and an array of ventricular assist devices, which aid us in managing very sick patients presenting with cardiogenic shock. The results of coronary artery bypass graft surgery for acute coronary syndrome, as published in the literature, vary significantly, because of the heterogeneity of patient populations, operative timing, and haemodynamic status, making a comparison of surgical outcomes almost impossible. Only one randomized trial has been conducted to that effect, to date. A heart team approach, involving an interventional cardiologist and a cardiac surgeon, is mandatory to determine the best treatment strategy and achieve the best possible outcomes in patients with acute coronary syndrome.
Sex considerations in acute coronary syndromes
Authors: Swahn Eva , Alfredsson Joakim , Lawesson Sofia Sederholm
Published: March 2021

It is a very important issue to enlighten on gender differences and similarities regarding the management of patients with acute coronary syndromes. It is a fact that women have not been included in clinical trials in numbers equal to men, for whatever reason. In the future, it will be necessary to individualize, as much as possible, the management of patients, regardless of gender. To get there, it is necessary to have sufficient numbers of patients from both genders included in trials, or otherwise it is not possible to draw proper conclusions. Until now, most results regarding women and acute coronary syndromes have been based on substudy analyses with inadequate statistical power. If gender differences have become evident in studies with gender-mixed populations, it seems obvious that the calculated power to show significant differences is also inadequate for men. There is an urgent need of more research in this area, in order not to harm our patients with our treatment because of a paucity of knowledge. It is also as important not to withdraw proper treatment from certain individuals when they can benefit from it.
Palliative care in the intensive cardiovascular care unit
Authors: Wood Jayne
Published: March 2021

Specialist palliative care services originally focused on improving the quality of life for patients with a diagnosis of cancer in the terminal phase of their illness. However, organizations, such as the World Health Organization, supported by national strategies, such as the End of Life Care Strategy (United Kingdom, 2008), promote the early integration of specialist palliative care into the management of patients with incurable disease, irrespective of the diagnosis. The primary goal of the intensive cardiac care unit is to help patients survive acute threats to their lives. However, the suddenness and severity of illness, particularly when associated with an underlying cardiological diagnosis, often means that the provision of optimal specialist palliative care is challenging. This chapter addresses key issues relating to the provision of specialist palliative care in the challenging and complex environment of the intensive cardiac care unit, including symptom control, end of life care, decision making, and communication. The benefits of multidisciplinary working for effective quality improvement in patient care and best support for patients, families/carers, and staff are also addressed. The importance of interdisciplinary working is highlighted, and, by embedding the principles of holistic care into daily practice, the intensive cardiac care unit can ensure that patients and their families/carers receive the support they need in a timely manner from individuals who are well supported in what is often considered to be one of the most challenging medical environments.
Atrial fibrillation and supraventricular arrhythmias
Authors: Katritsis Demosthenes G , Camm A John
Published: March 2021

The term supraventricular tachycardia (SVT) refers to atrial arrhythmias, including atrial fibrillation, atrioventricular nodal reentry, and atrioventricular reentry due to accessory pathway(s). In clinical practice, SVT may present as narrow- or wide-QRS tachycardias, and with the potential exception of atrial fibrillation, most of them are usually, although not invariably, manifest as regular rhythms. They are usually intrusive, symptomatic, and anxiety provoking but not dangerous. However, depending on their cycle length and the patient's background, they could also be, rarely, life-threatening conditions. In the acute setting, consideration of epidemiology data, clinical presentation, and the 12 lead ECG can provide diagnostic clues for differential diagnosis between SVT and ventricular arrhythmias, and guide appropriate therapy.
Myocarditis and pericarditis
Authors: Imazio Massimo , Heymans Stephane
Published: March 2021

Myocarditis is an inflammatory disease of the myocardium diagnosed using established histologic and immunohistochemical criteria. Pericarditis is the most common pericardial syndrome that is encountered in clinical practice. It is an inflammatory pericardial syndrome with or without pericardial effusion. As acute pericarditis and myocarditis frequently co-occur, we will describe their presentation, diagnosis and treatment together.
Acute valve disease and endocarditis
Authors: Ducrocq Gregory , Thuny Franck , Iung Bernard , Vahanian Alec
Published: March 2021

The management of patients with acute valve disease is now a rare, but challenging, event, as valvular patients are often elderly with severe comorbidities. Furthermore, a proportion of previously operated patients present with acute valve dysfunction. The aim, in this situation, is to establish a rapid diagnosis, based on clinical examination and echocardiography, followed by early intervention. The primary treatment remains surgical valve replacement but more conservative surgical approaches have been developed More recently, percutaneous interventional techniques have been introduced. However, every effort should be made to avoid performing interventions in an acute situation, as it is always at high risk.
Pulmonary embolism
Authors: Konstantinides Stavros , Kurzyna Marcin , Torbicki Adam
Published: March 2021

Pulmonary embolism is usually a consequence of deep vein thrombosis, and together the two conditions are known as venous thromboembolism. Non-thromboembolic causes of pulmonary embolism are rare. Pulmonary thromboembolism is a potentially life-threatening disease, if left untreated. This is due to a natural tendency towards early recurrence of pulmonary emboli which may lead to fatal right ventricular failure. In more severe cases, secondary right ventricular failure may result from myocardial ischaemia and injury caused by systemic hypotension and adrenergic overstimulation. Clinical presentation of pulmonary embolism is non-specific and may include dyspnoea, chest pain, haemoptysis, syncope, hypotension, and shock. Patients with suggestive history, symptoms, and signs require an immediate triage which determines further management strategy. Computerized tomographic angiography has become the mainstay of diagnosis. However, depending on the clinical presentation, treatment decisions may also be made based on results of other tests. In particular, in high-risk patients with persistent hypotension or shock, bedside echocardiography may be the only available test to identify patients in need of primary thrombolysis, surgical embolectomy, or percutaneous intervention which will stabilize the systemic cardiac output. For most normotensive patients, anticoagulation is sufficient as initial treatment. However, in the presence of signs of right ventricular dysfunction and myocardial injury monitoring is recommended to allow prompt rescue reperfusion therapy in case of haemodynamic decompensation.
Infection, sepsis, and multiorgan dysfunction syndrome
Authors: Vincent Jean-Louis
Published: March 2021

Sepsis is the main cause of multiple organ failure and remains a concern because of the associated high morbidity and mortality. In recent years, important advances have been made in the understanding of the pathophysiology of sepsis. Sepsis and septic shock are the end result of complex interactions between infecting organisms and various elements of the host response. A key feature of the common sequence of organ failure is dysfunction of the cardiovascular system, including microcirculatory elements. Outcome improvement in sepsis is based on recognizing the process early and instituting effective therapies. The time window for intervention is relatively short, and treatment must promptly control the source of infection, restore haemodynamic homoeostasis, and support failing organ systems.
Delirium in the intensive cardiovascular care unit
Authors: Keane Stephen , Clarkson Kevin , McEvoy John W
Published: March 2021

Approximately 10 to 20% of cardiac intensive care unit (CICU) patients are delirious when formally evaluated. However, cardiologists often fail to recognize the signs and symptoms of delirium, frequently missing the diagnosis as a consequence. The CICU has a number of unique predisposing and precipitating factors for delirium, which should be recognized by treating cardiologists. These include; medications (e.g. benzodiazepines, anti-arrhythmics), procedures which are often supplemented by sedatives (e.g. coronary interventions, electrophysiological procedures, structural interventions), mechanical support devices and temporary transvenous pacing (both resulting in immobilization), heart failure, targeted temperature management, and extremes of age related in part to the expanding use of transcutaneous aortic valve replacement (TAVR). In this chapter, we provide a comprehensive update on the etiology, epidemiology, prevention, and treatment of delirium in the CICU patient and provide future directions for the management of this unique and high-risk cohort.
Deep extragalactic visible legacy survey (DEVILS): stellar mass growth by morphological type since z = 1
Authors: Hashemizadeh Abdolhosein , Driver Simon P , Davies Luke J M , Robotham Aaron S G , Bellstedt Sabine , Windhorst Rogier A , Bremer Malcolm , Phillipps Steven , Jarvis Matt , Holwerda Benne W , Lagos Claudia del P , Koushan Soheil , Siudek Malgorzata , Maddox Natasha , Thorne Jessica E , Elahi Pascal
Published: March 2021

Using high-resolution Hubble Space Telescope imaging data, we perform a visual morphological classification of ∼36 000 galaxies at z < 1 in the deep extragalactic visible legacy survey/cosmological evolution survey region. As the main goal of this study, we derive the stellar mass function (SMF) and stellar mass density (SMD) sub-divided by morphological types. We find that visual morphological classification using optical imaging is increasingly difficult at z > 1 as the fraction of irregular galaxies and merger systems (when observed at rest-frame UV/blue wavelengths) dramatically increases. We determine that roughly two-thirds of the total stellar mass of the Universe today was in place by z ∼ 1. Double-component galaxies dominate the SMD at all epochs and increase in their contribution to the stellar mass budget to the present day. Elliptical galaxies are the second most dominant morphological type and increase their SMD by ∼2.5 times, while by contrast, the pure-disc population significantly decreases by $\sim 85{{\ \rm per\ cent}}$. According to the evolution of both high- and low-mass ends of the SMF, we find that mergers and in situ evolution in discs are both present at z < 1, and conclude that double-component galaxies are predominantly being built by the in situ evolution in discs (apparent as the growth of the low-mass end with time), while mergers are likely responsible for the growth of ellipticals (apparent as the increase of intermediate/high-mass end).
Vortex pinning in the superfluid core of relativistic neutron stars
Authors: Sourie Aurélien , Chamel Nicolas
Published: March 2021

Our recent Newtonian treatment of the smooth-averaged mutual-friction force acting on the neutron superfluid and locally induced by the pinning of quantized neutron vortices to proton fluxoids in the outer core of superfluid neutron stars is here adapted to the general-relativistic framework. We show how the local non-relativistic motion of individual vortices can be matched to the global dynamics of the star using the fully 4D covariant Newtonian formalism of Carter & Chamel. We derive all the necessary dynamical equations for carrying out realistic simulations of superfluid rotating neutron stars in full general relativity, as required for the interpretation of pulsar frequency glitches. The role of vortex pinning on the global dynamics appears to be non-trivial.
OMC-1 dust polarization in ALMA Band 7: diagnosing grain alignment mechanisms in the vicinity of Orion Source I
Authors: Pattle Kate , Lai Shih-Ping , Wright Melvyn , Coudé Simon , Plambeck Richard , Hoang Thiem , Tang Ya-Wen , Bastien Pierre , Eswaraiah Chakali , Furuya Ray S , Hwang Jihye , Inutsuka Shu-ichiro , Kim Kee-Tae , Kirchschlager Florian , Kwon Woojin , Lee Chang Won , Liu Sheng-Yuan , Lyo Aran , Ohashi Nagayoshi , Rawlings Mark G , Tahani Mehrnoosh , Tamura Motohide , Soam Archana , Wang Jia-Wei , Ward-Thompson Derek
Published: March 2021

We present ALMA Band 7 polarization observations of the OMC-1 region of the Orion molecular cloud. We find that the polarization pattern observed in the region is likely to have been significantly altered by the radiation field of the >104 L⊙ high-mass protostar Orion Source I. In the protostar’s optically thick disc, polarization is likely to arise from dust self-scattering. In material to the south of Source I – previously identified as a region of ‘anomalous’ polarization emission – we observe a polarization geometry concentric around Source I. We demonstrate that Source I’s extreme luminosity may be sufficient to make the radiative precession time-scale shorter than the Larmor time-scale for moderately large grains ($\gt 0.005\!-\!0.1\, \mu$m), causing them to precess around the radiation anisotropy vector (k-RATs) rather than the magnetic field direction (B-RATs). This requires relatively unobscured emission from Source I, supporting the hypothesis that emission in this region arises from the cavity wall of the Source I outflow. This is one of the first times that evidence for k-RAT alignment has been found outside of a protostellar disc or AGB star envelope. Alternatively, the grains may remain aligned by B-RATs and trace gas infall on to the Main Ridge. Elsewhere, we largely find the magnetic field geometry to be radial around the BN/KL explosion centre, consistent with previous observations. However, in the Main Ridge, the magnetic field geometry appears to remain consistent with the larger-scale magnetic field, perhaps indicative of the ability of the dense Ridge to resist disruption by the BN/KL explosion.
Space observations of AA Doradus provide consistent mass determinations. New HW-Vir systems observed with TESS
Authors: Baran A S , Østensen R H , Heber U , Irrgang A , Sanjayan S , Telting J H , Reed M D , Ostrowski J
Published: March 2021

We present an overview of eclipsing systems of the HW-Virginis (HW-Vir) type, based on space observations from the Transiting Exoplanet Survey Satellite (TESS) mission. We perform a detailed analysis of the properties of AA Doradus (AA Dor), which was monitored for almost a full year. This excellent time series data set permitted us to search for both stellar pulsations and eclipse timing variations. In addition, we used the high-precision trigonometric parallax from Gaia Early Data Release 3 to make an independent determination of the fundamental stellar parameters. No convincing pulsations were detected down to a limit of 76 parts per million; however, we detected one peak with false alarm probability of 0.2 per cent. 20 s cadences being collected during Year 3 should confirm or reject our detection. From eclipse timing measurements we were able to confirm that the orbital period is stable, with an upper limit to any period change of 5.75 × 10−13 s s−1. The apparent offset of the secondary eclipse is consistent with the predicted Rømer delay when the primary mass is that of a canonical extended horizontal branch star. Using parallax and a spectral energy distribution corroborates that the mass of the primary in AA Dor is canonical, and its radius and luminosity are consistent with an evolutionary state beyond core helium burning. The mass of the secondary is found to be at the limit of hydrogen burning.