bluuebunny/crossref_metadata_2025 huggingface dataset:
Refined Approach to Preservation of the Inferior Alveolar Nerve during Resection and Primary Reconstruction of the Mandible
Authors: Tereshchuk Sergey , Sukharev Vladimir
Published: March 2018

Sacrifice of the inferior alveolar nerve (IAN) during resection of the mandible is taken as a rule. In 1987, Jensen and Nock described a technique that permitted placement of dental implants in the atrophied mandibular alveolar ridge that lacked sufficient vertical height superior to the mandibular canal. This technique was used by some authors to preserve continuity of the IAN during resection of the mandible in patients with benign tumors. The described techniques are traumatic, time-consuming, and not precise. We propose a new refined technique of preservation of IAN with use of a guide to approach mandibular canal, cutting guides with a slot for a relocated IAN, and a new approach to positioning of the fixating screws. We assessed the effectiveness of this new technique with use of an electro-odontometer. In 21 cases, we demonstrated a refined approach to preservation of the IAN. In 7 patients (33%), the IAN was preserved on one side and in 14 patients (67%), on both sides. Sensation in the lower lip was restored in 18 patients (86%). These patients generally recovered sensation within 22 days postoperatively. This proposed technique makes preservation of IAN easier, faster, less traumatic, and more predictable. In this article, we describe criteria for the patients with cancer of oral mucosa to be admitted for this procedure. Restored sensation in the lower lip of the patients who have undergone resection of the mandible significantly improves their quality of life.
Traum und Gesundheit in der antiken Traumdeutung
Authors: Walde Christine
Published: March 2018

In den meisten Kulturen hat sich eine enge Verbindung zwischen den Träumen und dem körperlichen Befinden – Gesundheit wie Krankheit – etabliert. Aus den vielstimmigen Diskursen über Traum und Traumdeutung in der griechisch-römischen Antike werden die Formen von professioneller Traumnutzung/-deutung näher betrachtet, in denen der Gesundheitszustand der Träumer/innen im Zentrum des Interesses stand.
Traumerleben und Wacherleben
Authors: Schredl Michael
Published: March 2018

Die Kontinuitätshypothese des Träumens besagt, dass Träume das Wachleben widerspiegeln. Die empirische Forschung belegt diesen Zusammenhang eindrucksvoll. Spannend ist die Untersuchung von Einflussfaktoren auf die Kontinuität, z. B. emotionale Intensität, Bevorzugung von sozialen Themen, weil diese einen Hinweis auf die mögliche Funktion des Träumens geben können.
Hypothenar hammer syndrome
Authors: Juscafresa Laura Calsina , Grochowicz Lukasz
Published: March 2018

Introduction

In 1934 von Rosen first described a posttraumatic thrombosis of the distal ulnar artery resulting from blunt a trauma to the hypothenar region. But it was Conn in
1970 who named it the “hypothenar hammer syndrome (HHS)” 1–2.
Das Enthesitis-Konzept – ein Paradigmenwechsel in der radiologischen Diagnostik seronegativer Spondyloarthritiden
Authors: Freyschmidt Jürgen , Freyschmidt Pia
Published: March 2018

Das Enthesitis-Konzept hat zum Ziel, sog. seronegative Spondyloarthritiden schon in frühen klinischen Stadien radiologisch sicherer zu erkennen, denn diese Entitätengruppe spielt sich im Wesentlichen an den Enthesen ab. In diesem Artikel werden das anatomische und funktionelle Wesen von Enthesen und ihrer Erkrankungen erläutert und die typische klinische und radiologische Symptomatik in der MRT und der CT dargestellt.
5. Internationale Konferenz zu Verhaltenssüchten in Köln –Eine einmalige Gelegenheit zum wissenschaftlichen Austausch über substanzungebundene Abhängigkeitserkrankungen
Authors: Müller Astrid , Brand Matthias
Published: March 2018

Unter dem Begriff Verhaltenssüchte werden Verhaltensweisen subsumiert, die suchtartig und exzessiv betrieben zum Problem für die davon Betroffenen und ihre Angehörigen werden. Dazu zählen das pathologische Glücksspielen, die Mediensucht bzw. Internetbezogene Störungen und pathologisches Kaufen. Als weitere Vertreter dieser Störungsgruppe werden zudem Sexsucht, Sportsucht 1 und „Food Addiction“ diskutiert 2. Typisch für die genannten Störungsbilder ist, dass infolge eines unwiderstehlichen Verlangens, das nur schwer oder gar nicht kontrolliert werden kann, ein bestimmtes – kurzfristig mit Belohnung assoziiertes – Verhalten immer wieder ausgeführt wird, obwohl die Betroffenen selbst oder ihr Umfeld längerfristig negative Konsequenzen des Verhaltens erleben (z. B. soziale Probleme, familiäre Konflikte, Verschuldung, Leistungsversagen, Arbeitsplatzverlust, psychische und somatische Erkrankungen, Straffälligkeit). In Analogie zu den substanzgebundenen Abhängigkeitserkrankungen werden auch bei den Verhaltenssüchten Phänomene wie Cue-Reactivity und Craving beobachtet 3
4. Die exzessive Ausübung des Verhaltens aktiviert offenbar dieselben Belohnungszentren im Gehirn wie bei substanzgebundenen Abhängigkeiten, was in Kontrollverlust, Toleranzeffekten und durchaus auch Entzugserscheinungen (z. B. ängstliche oder deprimierte Stimmung, Dysphorie, Gereiztheit) resultiert 5.
Empfehlungen zur Diagnostik und Therapie bei krebskranken Kindern mit Fieber und Neutropenie – Vergleich zweier aktueller Leitlinien
Authors: Lehrnbecher Thomas , Groll Andreas , Agyeman Philipp , Ammann Roland , Attarbaschi Andishe , Behrends Uta , Berger Christoph , Hamprecht Axel , Hufnagel Markus , Laws Hans-Jürgen , Scheler Max , Temme Christian , Vieth Simon , Simon Arne
Published: March 2018

Krebskranke Kinder und Jugendliche haben aufgrund der Beeinträchtigung ihres Immunsystems ein erhöhtes Risiko für Infektionen. Die Neutropenie ist der wichtigste Risikofaktor für infektiöse Komplikationen, und Fieber in der Neutropenie stellt einen pädiatrischen Notfall dar. Während für Erwachsene mit Fieber in der Neutropenie bereits seit langem Leitlinien existieren, finden sich eigene Leitlinien für Kinder und Jugendliche erst seit wenigen Jahren. Sie sind von Bedeutung, da pädiatrische Patienten sich von Erwachsenen in vielen Punkten wie Grunderkrankung, Komorbidität sowie verfügbare Arzneimittel unterscheiden. Im vorliegenden Artikel werden die wichtigsten Gemeinsamkeiten und Unterschiede der jüngst erschienenen interdisziplinären Leitlinie der Deutschen Gesellschaft für Pädiatrische Infektiologie (DGPI) und Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH) sowie einer Leitlinie eines internationalen Expertenpanels für Kinder mit Fieber und Neutropenie herausgearbeitet und diskutiert.
IT Leadership and ERP: A Challenging Day for a New Leader
Authors: Carton Robert , Richmond William
Published: March 2018

This case is a set of leadership role-plays that address several critical IT issues including understanding (1) differing objectives of critical project stakeholders; (2) concepts of change management and their importance and process; (3) escalation issues of when and how to do it; and (4) issues arising from client/customer communication. The case combines role-plays with traditional case discussion. The scenario is an IT manager of a large university leading an ERP implementation that must satisfy differing stakeholders including academic, administrative, and curriculum leadership. The case highlights problems of objective alignment, execution, and communication.
Hole-alleviated trap transport in dielectrics
Authors: Novikov Yu. N.
Published: March 2018

At present, the nature of ionic conductivity in dielectrics remains unclear. It is believed that the ionic transport is due to local Joule heating. In this paper, another ionic conductivity mechanism is proposed and considered. Taking into account the two-band conductivity, the diffusion and drift of traps in a dielectric are studied after the holes are captured on them. It is assumed that capturing holes onto traps leads to a significant decrease in their activation energy, which, in turn, leads to an increase in ionic conductivity in dielectrics. Considering the drift and diffusion of traps with captured holes, it was possible to describe the high conductivity in thin Si3N4 films.
Numerical study of MHD micropolar carreau nanofluid in the presence of induced magnetic field
Authors: Atif S. M. , Hussain S. , Sagheer M.
Published: March 2018

The heat and mass transfer of a magnetohydrodynamic micropolar Carreau nanofluid on a stretching sheet has been analyzed in the presence of induced magnetic field. An internal heating, thermal radiation, Ohmic and viscous dissipation effects are also considered. The system of the governing partial differential equations is converted into the ordinary differential equations by means of the suitable similarity transformation. The resulting ordinary differential equations are then solved by the well known shooting technique. The impact of emerging physical parameters on the velocity, angular velocity, temperature and concentration profiles are analyzed graphically. The dimensionless velocity is enhanced for the Weissenberg number and the power law index while reverse situation is studied in the thermal and the concentration profile.
An examination of funding for terrestrial vertebrate fauna research from Australian federal government sources
Authors: Howell Lachlan G. , Rodger John C.
Published: March 2018

Funding for research towards more effective conservation of Australian fauna is widely believed to be low. Publically available data were examined to determine the spread of wildlife projects supported for the period 2005–15 by Federal Government agencies responsible for research and/or environmental management funding and funding aimed at delivering innovation across relevant sectors. A word search method was used and projects categorised according to their relevance to conservation goals. Of the AU$7.2 billion invested by the Australian Research Council, 0.9% (AU$67.8 million) was in areas relevant to conservation. However, of this relatively modest funding, 40% of conservation projects addressed questions classified as highly relevant, and 11.4% dealt with Australia’s threatened terrestrial vertebrate fauna. Of the AU$2.5 billion grant investment by the Department of the Environment, 7.9% (AU$196.3 million) was relevant to fauna conservation but mainly for on-ground management (62.5%). However, 32.9% of projects were research highly relevant to conservation practice, and 18.8% dealt with Australia’s threatened terrestrial vertebrate fauna. The Cooperative Research Centres Program is a well funded system that has supported applied research relevant to wildlife conservation. However, the Program’s recent focus has been on commercial outcomes rather than the public good. The study provides support for the argument that greater investment by the Federal Government is needed if innovation in wildlife management is to have a solid evidence base.
Synergistic activity of cosecreted natural products from amoebae-associated bacteria
Authors: Arp Johannes , Götze Sebastian , Mukherji Ruchira , Mattern Derek J. , García-Altares María , Klapper Martin , Brock Debra A. , Brakhage Axel A. , Strassmann Joan E. , Queller David C. , Bardl Bettina , Willing Karsten , Peschel Gundela , Stallforth Pierre
Published: March 2018

Significance

Bacterially produced small molecules are indispensable leads in the development of antibiotics, anticancer therapeutics, or immunomodulators. To unveil novel aspects in the biosynthetic potential of bacteria, a consideration of the ecological context in which the adapted producers thrive is extremely insightful. Here, we describe two natural products produced by
Pseudomonas
sp. QS1027, a bacterium that resides in the vicinity of the bacterial predator
Dictyostelium discoideum
. The two metabolites are jessenipeptin, a nonribosomal cyclic lipopeptide, and mupirocin, a known polyketide antibiotic. Both compounds are quorum-sensing regulated and display potent synergistic inhibitory activity against clinically relevant methicillin-resistant
Staphylococcus aureus
(MRSA).
Olive leaf extract prevents cartilage degeneration in osteoarthritis of STR/ort mice
Authors: Takuma Maruyama , Haruka Kamihama , Mutsuto Watanabe , Toshiki Matsuo , Kenshiro Matsuda , Akane Tanaka , Hiroshi Matsuda , Yoshihiro Nomura
Published: March 2018

The chondroprotective effect of olive leaf extract (OLE) on knee osteoarthritis (OA) was studied with STR/ort mice (n = 5). OLE was administrated with a dosage of 100 mg/kg for 8 weeks and the OA severity score of hind limb knee joints was then measured. The Mankin scores of the knee joints of the non-OA control group, OA control group and OLE-treated group were 3.50, 11.13 and 7.20, respectively. This suggests that oral OLE supplements help prevent cartilage degeneration in STR/ort mice. In vitro, the synthesis of high molecular weight hyaluronan in synovial cells (HIG-82) was increased by OLE stimulation. This suggests that OLE modulates hyaluronan metabolism in synovial cells and improves OA symptoms. Our findings indicate that OLE intake inhibits cartilage destruction by increasing high molecular weight hyaluronan and thus preventing OA progress.
Two approaches to 14,15-secoergostane intermediates for the synthesis of strophasterols
Authors: Fukuda Yuki , Sato Shuntaro , Ogura Yusuke , Kuwahara Shigefumi
Published: March 2018

Two protected 14,15-secoergostane derivatives suitable as pivotal intermediates for the synthesis of strophasterols A and B, anti-MRSA and neuronal cell-protecting natural products bearing a recently discovered strophastane skeleton, have been synthesized by two different routes. The first approach employed an oxidative cleavage of an α-hydroxy ketone intermediate with the Jones reagent as the key step to reach the targeted secoergostane from ergosterol in ten steps. In the second approach, an unprecedented reaction cascade composed of four reactions enabled us to obtain the secoergostane more efficiently in six steps.
There is no Diophantine quintuple
Authors: He Bo , Togbé Alain , Ziegler Volker
Published: March 2018

A set of

m
m

positive integers

{

a
1

,

a
2

,
…
,

a
m

}

\{a_1, a_2, \ldots , a_m\}

is called a Diophantine

m
m

-tuple if

a
i

a
j

+
1

a_i a_j + 1

is a perfect square for all

1
≤
i
>
j
≤
m

1 \le i > j \le m

. Dujella proved that there is no Diophantine sextuple and that there are at most finitely many Diophantine quintuples. In particular, a folklore conjecture concerning Diophantine

m
m

-tuples states that no Diophantine quintuple exists at all. We prove this conjecture.
Control of Annual Bluegrass Weevil With Pyrethroids, 1995
Authors: Swier Stanley R. , Rollins Alan
Published: March 2018

Fourteen treatments were applied 28 Jul for control of second generation ABW at the Rutland Country Club, Rutland, VT. The target life stage was adults and young larvae. Plots were 3.5 X 6 ft separated by a 1 ft buffer. Sprays were applied with a CO2 boom sprayer, 8004 nozzles, at 40 PSI, in 2 gal water per 1000 ft2. Granules were applied with a salt shaker. Plots were rated 22 Aug by removing 3 (0.1 ft2) plugs per plot and counting live larvae and pupae in the laboratory. Counts were converted to larvae per ft2. Conditions at the time of treatment were: air temperature 79.2°F; wind, calm; sky, haze; soil temperature 77.1°F; thatch depth, 0.5 inch; soil pH, 5.4; slope, 2%; soil texture, sandy loam, sand 67%, silt 30%, clay 3%; soil moisture, 24.9%; post treatment precipitation, 0.2 inch, daily irrigation.
AGORA: organellar genome annotation from the amino acid and nucleotide references
Authors: Jung Jaehee , Kim Jong Im , Jeong Young-Sik , Yi Gangman
Published: March 2018

Next-generation sequencing (NGS) technologies have led to the accumulation of high-throughput sequence data from various organisms in biology. To apply gene annotation of organellar genomes for various organisms, more optimized tools for functional gene annotation are required. Almost all gene annotation tools are mainly focused on the chloroplast genome of land plants or the mitochondrial genome of animals. We have developed a web application AGORA for the fast, user-friendly and improved annotations of organellar genomes. Annotator for Genes of Organelle from the Reference sequence Analysis (AGORA) annotates genes based on a basic local alignment search tool (BLAST)-based homology search and clustering with selected reference sequences from the NCBI database or user-defined uploaded data. AGORA can annotate the functional genes in almost all mitochondrion and plastid genomes of eukaryotes. The gene annotation of a genome with an exon–intron structure within a gene or inverted repeat region is also available. It provides information of start and end positions of each gene, BLAST results compared with the reference sequence and visualization of gene map by OGDRAW.

Availability and implementation

Users can freely use the software, and the accessible URL is https://bigdata.dongguk.edu/gene_project/AGORA/. The main module of the tool is implemented by the python and php, and the web page is built by the HTML and CSS to support all browsers.

Supplementary information

Supplementary data are available at Bioinformatics online.
Length of Local Cohomology in Positive Characteristic and Ordinarity
Authors: Bitoun Thomas
Published: March 2018

Let D be the ring of Grothendieck differential operators of the ring R of polynomials in d ≥ 3 variables with coefficients in a perfect field of characteristic p. We compute the D-module length of the 1st local cohomology module ${H^{1}_{f}}(R)$ with respect to a polynomial f with an isolated singularity, for p large enough. The expression we give is in terms of the Frobenius action on the top coherent cohomology of the exceptional fibre of a resolution of the singularity. Our proof rests on a tight closure computation of Hara. Since the above length is quite different from that of the corresponding local cohomology module in characteristic zero, we also consider a characteristic zero D-module whose length is expected to equal that above, for ordinary primes.
Automatic recognition of self-acknowledged limitations in clinical research literature
Authors: Kilicoglu Halil , Rosemblat Graciela , Malički Mario , ter Riet Gerben
Published: March 2018

Objective

To automatically recognize self-acknowledged limitations in clinical research publications to support efforts in improving research transparency.

Methods

To develop our recognition methods, we used a set of 8431 sentences from 1197 PubMed Central articles. A subset of these sentences was manually annotated for training/testing, and inter-annotator agreement was calculated. We cast the recognition problem as a binary classification task, in which we determine whether a given sentence from a publication discusses self-acknowledged limitations or not. We experimented with three methods: a rule-based approach based on document structure, supervised machine learning, and a semi-supervised method that uses self-training to expand the training set in order to improve classification performance. The machine learning algorithms used were logistic regression (LR) and support vector machines (SVM).

Results

Annotators had good agreement in labeling limitation sentences (Krippendorff’s α = 0.781). Of the three methods used, the rule-based method yielded the best performance with 91.5% accuracy (95% CI [90.1-92.9]), while self-training with SVM led to a small improvement over fully supervised learning (89.9%, 95% CI [88.4-91.4] vs 89.6%, 95% CI [88.1-91.1]).

Conclusions

The approach presented can be incorporated into the workflows of stakeholders focusing on research transparency to improve reporting of limitations in clinical studies.
The heart as a pump: governing principles
Authors: Kovács Sándor J.
Published: March 2018

The pumping attributes of the heart remain active topics of investigation and mastery of how the heart functions as a pump is part of the fund of knowledge of physiologists and cardiologists. The advent of high-resolution, real-time imaging (computed tomography, magnetic resonance imaging cardiac catheterization, two- and three-dimensional echocardiography) has continued to advance our understanding of how the four-chambered heart (left heart, right heart) works as it fills and as it empties. The insights that have evolved emanate from a conceptual framework based on motion (kinematics) of selected phases and portions of the four-chambered heart and the contents of the pericardial sac. Concepts include pressure pumping, volume pumping, constant-volume pumping, the relationship between atrial and ventricular function and atrial and ventricular indexes, the role of the heart as a suction pump, laws that govern isovolumic relaxation, and the relationship of intraventricular fluid mechanics to diastolic function and wall motion. Accordingly, by asking such questions as ‘What is the ejection fraction of the pericardial sack, and why does it have the numerical value it has?’ or ‘Why does the left atrium fill in two phases—one in systole and one in diastole?’ or ‘How is atrial conduit volume related to diastolic wall motion?’ one can gain new insights into pumping function. This chapter presents a simple, useful, yet powerful conceptual framework that can be used descriptively or mathematically to addresses these and other clinically important themes.
Cardiovascular response to exercise
Authors: Arena Ross , Popovic Dejana , Guazzi Marco , McNeil Amy , Sagner Michael
Published: March 2018

The body’s response to an exertional stimulus, if performed adequately to meet the imposed demand, is an orchestrated response predominantly among the cardiovascular, pulmonary, and skeletal systems. These physiological systems work together to ensure that up-titrated energy and force production demands are met. The magnitude of the exertional stimulus these systems are able to respond to, when an individual is in a true state of physiological health, is influenced by multiple factors including age, sex, biomechanics, genomics, and exercise training history. When one or more of these systems suffers from dysfunction, as is the case when an individual is at risk for (i.e. unhealthy lifestyle history) or diagnosed with a chronic disease, the response to a physical stimulus ultimately fails and exertional capacity is limited. There is a clear and well-established clinical relevance to the cardiovascular response to an exertional stimulus, commonly assessed through a graded aerobic exercise test on a treadmill or cycle ergometer. In fact, aerobic capacity has been referred to a key vital sign. We are also gaining an appreciation of how communication and presentation of information between health professionals and individuals receiving care significantly impacts comprehension and adherence to a plan of care. This chapter addresses these areas, beginning with a brief granular description of exertional cardiovascular physiology, transitioning to practical clinical implications of this information for health professionals, and ending with how the individuals seeking healthcare receive, process, and comprehend this information with the ultimate goal being real-world application and improved health outcomes.
Cardiovascular response to mental stress
Authors: Barthelmes Jens , Sudano Isabella
Published: March 2018

Mental stress, intrinsically subjective, lacks clear operationalization by any universally accepted gauge in routine clinical practice. There is not even an accepted single conceptualization of mental stress as opposed to the classic risk factors measured by, for example, resting blood pressure or low-density lipoprotein cholesterol among others. Yet, the link between psychosocial stress and cardiovascular events is a century-old intuition substantiated by many studies. Likely, mental stress affects cardiovascular health over the whole course of at-risk-stage up to cardiovascular events. This chapter discusses the major pathophysiologic effects of mental stress on cardiovascular pathogenesis.
The cardiovascular system during sleep
Authors: Covassin Naima , Somers Virend K.
Published: March 2018

The majority of molecular, physiological, and behavioural processes undergo substantial variations across a 24 h period. The health implications of such fluctuations, whether they are expressions of an intrinsic circadian rhythmicity or are secondary to changes in physical activity, posture, and/or sleep, are increasingly recognized. Similar to other biological functions, the cardiovascular system exhibits a prominent day–night profile, with profound haemodynamic, autonomic, and hormonal oscillations occurring during the sleep period. These time-dependent and sleep stage-dependent patterns of function have important clinical significance. The cardiovascular downregulation achieved throughout the night while asleep may be restorative and protective against adverse events, while the morning physiological activation coincident with awakening facilitates resumption of daytime activities. Nevertheless, rather than beneficial, these activity configurations may be pathogenic in individuals with a vulnerable substrate and may favour onset and progression of cardiovascular diseases. Cardiovascular complications may also arise as a consequence of abnormal day–night periodicity and disturbed sleep quantity and quality. Hence, consideration of the diurnal pattern of cardiovascular activity is critical in the clinical setting.
Fibrinolytic therapy
Authors: Verheugt Freek W. A.
Published: March 2018

Fibrinolytic agents are able to reopen blood vessels that are occluded by a fresh thrombus. Urokinase, streptokinase, and streptokinase derivatives were the first effective agents. Recombinant plasminogen activators became available and they are specific for thrombus-bound fibrin. Significant bleeding is the major side effect of fibrinolysis, a major hurdle for its use. The current era of mechanical reperfusion has made fibrinolytic therapy a niche treatment for acute arterial thrombosis such as ST elevation myocardial infarction and stroke. Only for pulmonary embolism with haemodynamic consequences and mechanical heart valve thrombosis may lytic therapy have a place in selected patients.
Drug–drug interactions
Authors: Aronson Jeffrey K.
Published: March 2018

A drug interaction occurs when the effects of a drug are altered by the effects of another drug, a vaccine, herb, foodstuff, or device. In drug–drug interactions, a precipitant drug increases or reduces the effects of an object drug by pharmaceutical, pharmacokinetic, or pharmacodynamic mechanisms. Pharmaceutical interactions occur during intravenous drug infusion; they are avoidable by infusing drugs separately. Pharmacokinetic interactions can arise from altered absorption, protein binding, cellular distribution, metabolism, or excretion of an object drug. The last two mechanisms are the most important. Pharmacodynamic interactions can be direct (antagonism or synergism at the same site of action, or summation or synergism of similar effects at different sites) or indirect (when an outcome of an action of a precipitant drug alters the effects of an object drug). Some drug–drug interactions are beneficial, through combining drugs with different beneficial mechanisms of action or using drugs to reverse or prevent adverse reactions.
Epidemiology and global burden of peripheral arterial disease and aortic aneurysms
Authors: Reinecke Holger
Published: March 2018

Peripheral artery disease (PAD) and aortic aneurysms are common diseases which show an increasing prevalence and incidence. From community-based trials assessing ankle–brachial indices, 2–4% of the general population have been shown to be affected by PAD, which increases up to 15% in those above 70 years of age. About 30–40% of the in-hospital cases with PAD have critical limb ischaemia and suffer from a 1-year mortality of 20–40%. Abdominal aortic aneurysms (AAAs) also show a relatively high prevalence of about 1–2% in the general population as found by large-scale, systematic duplex screening. Of these, about 5% come to hospital admittance with a ruptured AAA which is still associated with an in-hospital mortality of up to 50%. The prevalence of thoracic aortic aneurysms (TAAs) was reported to be at about 0.16–0.34% in selected subgroups of the general population. The incident cases of TAAs have risen from 10/100,000 cases in the late 1980s up to about 17/100,000 cases in the first decade of this millennium. It is noteworthy that PAD and aortic aneurysms as well as their associated co-morbidities remain in many cases underdiagnosed and undertreated. This leads to a high cardiovascular morbidity and mortality which could not be obviously markedly reduced in the recent decades. Since nearly all vascular disorders are systemic diseases, not only the specific vessel bed which leads to a presentation should be assessed but also all other possible vascular manifestations should be thoroughly examined to reduce adverse events.
Cardiomyopathies
Authors: Friedrich Matthias , aus dem Siepen Fabian
Published: March 2018

Cardiovascular magnetic resonance (CMR) is generally recognized as the most powerful imaging technology for assessing patients with non-ischaemic cardiomyopathies. Its specific capability to provide information on myocardial tissue characteristics allows for the detection, localization, and spatial quantification of myocardial oedema, fibrosis, and infiltration. This not only provides an accurate discrimination of non-ischaemic from ischaemic disease, but also has led to very specific diagnostic criteria for certain cardiomyopathies (e.g. those caused by cardiac amyloidosis, myocardial iron overload, stress-induced cardiomyopathy (Takotsubo), or Fabry’s disease). Furthermore, CMR provides criteria for acute versus remote injury and, depending on the clinical context, evidence for myocardial inflammation such as in viral myocarditis. The chapter presents and discusses the important aspects of the clinical application of CMR in non-ischaemic cardiomyopathies with a focus on useful scan protocols, typical findings, added diagnostic value, and limitations. New approaches such as cardiac T1 mapping and T2 mapping are included. Key references on the current state-of-the-art use of CMR are provided and discussed.
Basic principles and technological state of the art: hybrid imaging
Authors: Buechel Ronny R. , Pazhenkottil Aju P.
Published: March 2018

The core principle of hybrid imaging is based on the fact that it provides information beyond that achievable with either data set alone. This is attained through the combination and fusion of two datasets by which both modalities synergistically contribute to image information. Hybrid imaging is, thus, more powerful than the sum of its parts, yielding improved sensitivity and specificity. While datasets for integration may be obtained by a variety of imaging modalities, its merits are intuitively best exploited when combining anatomical and functional imaging, particularly in the setting of evaluation of coronary artery disease (CAD) as this combination allows a comprehensive assessment with regard to presence or absence of coronary atherosclerosis, the extent and severity of coronary plaques, and the haemodynamic relevance of stenosis. In clinical practice, the combination of CT coronary angiography (CCTA) with myocardial perfusion studies obtained by single-photon emission computed tomography (SPECT) and by positron emission tomography (PET) has been well established. Recent literature also reports on the feasibility of combining CCTA with cardiac magnetic resonance imaging. Finally, recent advances in CCTA and SPECT imaging have led to a substantial reduction of radiation exposure, now allowing for comprehensive morphological and functional diagnostic work-up by cardiac hybrid SPECT/CCTA imaging at low radiation dose exposures ranging below 5 mSv.
Primary prevention of sudden cardiac death - b) in ischemic cardiomyopathy
Authors: Di Biase Luigi , Romero Jorge , Natale Andrea , Avendano Ricardo , Garcia Mario
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Monogenic and oligogenic cardiovascular diseases: genetics of arrhythmias—catecholaminergic polymorphic ventricular tachycardia
Authors: Schwartz Peter J. , Crotti Lia
Published: March 2018

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited disorder associated with syncope and sudden death manifesting in the young during sympathetic activation. The electrocardiogram is normal and the heart is structurally normal. The diagnosis is usually made with an exercise stress test that shows a typical pattern of onset and offset of adrenergically induced ventricular arrhythmias. Molecular screening of RyR2, the major CPVT gene, is recommended whenever the suspicion of CPVT is high. If a disease-causing mutation is identified, cascade screening allows pre-symptomatic diagnosis among family members. All affected subjects should be treated with beta blockers (nadolol or propranolol). Preliminary data support the association of beta blockers with flecainide. After a cardiac arrest, an implantable cardioverter defibrillator (ICD) should be implanted, but it is accompanied by a disquietingly high incidence of adverse effects. After syncope on beta blocker therapy, left cardiac sympathetic denervation is most effective, preserves quality of life, and does not preclude a subsequent ICD implantation.
Structural diseases of the heart: genetics of congenital heart diseases
Authors: Barge-Schaapveld Daniela Q. C. M. , DeRuiter Marco C. , van Munsteren Conny C. , Jongbloed Monique R. M.
Published: March 2018

Congenital heart defects are the most common congenital defects. As a substantial number of patients with congenital heart disease (CHD) now reach reproductive age, the cardiologist dealing with grown-up patients with CHD is confronted with questions from patients regarding the impact of their CHD on pregnancy and offspring, and genetic counselling is becoming more relevant to clinical practice. Developments in the field of clinical genetics do not always facilitate clinicians’ knowledge and reasoning. Interpretation of the often large DNA datasets is challenging, especially in the light of phenotypic heterogeneity and incomplete penetrance, and requires specific expertise. In this chapter, the genetics of CHD are addressed. An overview of ‘causative’ genes is provided, that is, genes with a high likelihood to be involved in the development of human CHD and found so far to harbour (likely) pathogenic mutations in patients. In addition, the challenges and limitations in determining such genes are addressed and pitfalls in interpreting DNA variants in these genes discussed. The fact that single genes may in some instances be associated with different forms of CHD, may be explained by the broad range of cellular contributions during embryology, which will be briefly addressed. Finally, practical recommendations in addressing the genetics of CHD are provided.
Echocardiography
Authors: Marek Jan , Meijboom Folkert
Published: March 2018

Echocardiographic techniques have revolutionized the practice of congenital cardiology over the last three decades. Due to its non-invasive nature and high temporal resolution, echocardiography enables cardiac structures to be imaged as early as the 14th gestational week and it remains the superior diagnostic modality in small children. While transoesophageal (TOE) two-dimensional echocardiography has become an integral part of almost all cardiac interventions, real-time three-dimensional TOE used in older children and adults may help surgeons to understand dynamic spatial relationships of intracardiac structures, enabling them to achieve the best result of an operation. Post bypass, two- and three-dimensional TOE studies significantly reduce the number of reoperations, unnecessary bypass procedures, and general anaesthetics. A developing technique known as tissue deformation imaging enables the assessment of global and regional myocardial systolic and diastolic function even in small hearts. Although mainly used for research, in some specific situations these techniques may modify further diagnostic management, optimize medication, or even change clinical management. Despite its known limitations, echocardiography remains a routine imaging modality for all patients with congenital heart disease, being a definitive imaging modality prior to intervention for many children and screening imaging for older children and adults with congenital heart disease.
Long-term outcomes
Authors: Mulder Barbara , Bouma Berton , Winter Michiel
Published: March 2018

Due to tremendous improvements in corrective surgery, and medical therapy, survival of patients with congenital heart disease has improved dramatically over the past decades, with an estimated 95% of such patients in the Western world currently reaching adulthood. Nonetheless, patients with congenital heart disease have decreased long-term outcomes in terms of morbidity and mortality compared to their healthy counterparts.
Aortic stenosis and left ventricular outflow tract obstruction
Authors: Anderson David
Published: March 2018

Left ventricular outflow tract obstruction can occur at subvalvar, valvar, and supravalvar levels. Severity and progression can be evaluated by echocardiography. Aortic valve stenosis can usually be relieved by balloon valvotomy, but some patients require surgery, either with valvotomy, valve replacement, or the Ross procedure. Sub- and supravalvar aortic stenosis require surgical management. Long-term follow-up of all patients is required.
The wider psychosocial context
Authors: Denollet Johan
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Clinical implications and future perspectives
Authors: Smolderen Kim
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Conclusions
Authors: Pedersen Susanne
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Personal perspective
Authors: Pedersen Susanne
Published: March 2018

This is a forthcoming chapter in ESC CardioMed. Please check back later for the full chapter.
Cardiovascular risk estimation at the individual level
Authors: Smulders Yvo M. , Cooney Marie-Therese , Graham Ian
Published: March 2018

The absolute benefit of any measure to prevent cardiovascular disease, be it lifestyle improvement or pharmacological therapy, depends on the baseline cardiovascular risk. This risk cannot be assessed exactly, but only be estimated because many known risk determinants cannot be accounted for in existing risk scoring systems, and because the occurrence of cardiovascular disease is likely to depend not just on pre-existing risk factors, but also on chance. Several cardiovascular risk estimation methods are available, and the European Society of Cardiology has favoured the European-based Systematic COronary Risk Evaluation (SCORE) system as a basis for their cardiovascular disease prevention guidelines. SCORE estimates absolute 10-year cardiovascular mortality risk. In specific circumstances, estimation of relative risk, risk age, or lifetime risk may be considered. High- and very-high-risk population are defined by SCORE risks greater than 5% and greater than 10%, respectively, or by clinical conditions conferring high risk, such as existing cardiovascular disease or chronic kidney disease. The role of additional risk information on top of the information entered in SCORE is generally limited. In particular, markers of early cardiovascular damage should be collected and interpreted with caution. Absolute cardiovascular risks in young and elderly individuals are almost always low or very high, respectively, and the options for appropriate interpretation of these risks are discussed.
Risk factor management at the level of the individual using lifestyle changes
Authors: Backer Guy De , Sutter Johan De , Graham Ian M.
Published: March 2018

Lifestyle changes related to dietary habits, tobacco smoking, physical activity pattern, avoidance of overweight, and to some psychosocial issues are very important for the prevention of atherothrombotic cardiovascular disease both at the level of the individual and as part of population strategies. The potential for cardiovascular disease prevention is strongly dependent on the adherence to healthy lifestyles. Therefore the advice on how to reach and to maintain healthy habits should be given by professionals, taking into account the preparedness and ability of the individual to change as well as local sociocultural aspects. Lifestyle changes are also the first steps to take for the management and control of cardiovascular disease risk factors such as arterial hypertension, dyslipidaemias, and dysglycaemias.
Diabetes and heart failure
Authors: Swedberg Karl
Published: March 2018

Type 2 diabetes is an important and common co-morbidity in chronic heart failure. It makes the prognosis of heart failure worse and chronic heart failure impacts the choice of treatment for type 2 diabetes.
Epidemiology and chronic kidney disease as a cardiovascular risk factor
Authors: Segerer Stephan , Seeger Harald
Published: March 2018

Chronic kidney disease defined by an estimated glomerular filtration rate of less than 60 mL/min or the presence of albuminuria is present in about 10% of the European populations. The risk increases with age, arterial hypertension, and diabetes. Both aspects—reduced estimated glomerular filtration rate, and albuminuria—are major factors associated with the progression of renal failure, cardiovascular events, and all-cause mortality. Patients on dialysis have a 10- to 20-fold increase in the cardiovascular event rate. Furthermore, heart failure and sudden cardiac death are associated with the severity of renal failure.
Surveillance for cardiotoxicity in patients receiving potentially cardiotoxic chemotherapy
Authors: McCarthy Cian P. , Osborne Michael T. , Neilan Tomas G.
Published: March 2018

As cancer survival has improved, some of the focus of care has shifted to minimizing the long-term complications of cancer therapy. Cardiovascular disease is a leading long-term cause of morbidity and mortality in patients who survive cancer. This chapter focuses on current clinical imaging and non-imaging techniques that are used to detect the cardiovascular consequences of chemotherapy. Overall, the detection and quantification of chemotherapy-induced myocardial injury, dysfunction, and heart failure is challenging due to intrinsic limitations of the available imaging techniques coupled with the latency period that can occur between injury and clinical presentation with heart failure.
Pericarditis and myopericarditis in HIV
Authors: Perumal Rubeshan , Magula Nombulelo P.
Published: March 2018

Pericardial and myopericardial diseases are common cardiac presentations in people living with HIV, and may occur at all stages of HIV disease. There are a vast number of aetiologies, the relative likelihood of which is dependent on host, pathogenic, and environmental factors. The convergence of HIV and tuberculosis in many settings has resulted in an increased prevalence of tuberculous pericardial disease with significant morbidity and mortality. While the introduction of antiretroviral therapy has resulted in a reduced incidence of viral, bacterial, neoplastic, and idiopathic pericarditis in people living with HIV, tuberculous pericarditis remains a challenge. The clinical presentation of the disease may reflect the extent of cardiac involvement, and further investigation should be guided by risk stratification. There is limited evidence to guide the treatment of myopericarditis; however, the principles of treatment are now well established in guidelines. A high index of suspicion for tuberculous pericarditis in high tuberculosis-HIV burdened settings, and the appropriate use of empiric tuberculosis treatment may be warranted. While tuberculous pericardial disease continues to confer a high risk of mortality, most other causes of pericardial and myopericardial diseases bear a good prognosis.
Hypertrophic cardiomyopathy: genetics
Authors: Akhtar Mohammed Majid , Lopes Luis Rocha
Published: March 2018

Hypertrophic cardiomyopathy is most commonly transmitted as an autosomal dominant trait, caused by mutations in genes encoding cardiac sarcomere and associated proteins. Knowledge of the genetic pathophysiology of the disease has advanced significantly since the initial identification of a point mutation in the beta-myosin heavy chain (MYH7) gene in 1990. Other genetic causes of the disease include mutations in genes coding for proteins implicated in calcium handling or which form part of the cytoskeleton. The recent emergence of next-generation sequencing allows quicker and less expensive identification of causative mutations. However, a causative mutation is not identified in up to 50% of probands. At present, the primary clinical role of genetic testing in hypertrophic cardiomyopathy is in the context of familial screening, allowing the identification of those at risk of developing the condition. Genetic testing can also be used to exclude genocopies, particularly in the presence of certain diagnostic ‘red flag’ features, where lysosomal, glycogen storage, neuromuscular or Ras-MAPK pathway disorders may be suspected. The role of individual mutations in predicting prognosis is limited at present. However, the higher incidence of sudden cardiac death in the presence of a family history of such, suggests that genetics play a significant role in determining outcome. With an increased understanding of the impact of these mutations on a cellular level and on longer-term clinical outcomes, the aim in future for gene and mutation specific prognosis or potential disease-modifying therapy is closer.
Arrhythmogenic right ventricular cardiomyopathy: genetics
Authors: Syrris Petros , Protonotarios Alexandros
Published: March 2018

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder of the heart muscle which is typically inherited in an autosomal dominant manner. It is believed to be familial in over 50% of cases. A recessive mode of inheritance has also been reported in syndromic cases with cardiocutaneous features. The classic form of the disorder is considered to be ‘a disease of the desmosome’ as pathogenic variants have been identified in five genes encoding key desmosomal proteins: plakoglobin, desmoplakin, plakophilin-2, desmoglein-2, and desmocollin-2. Mutations in these genes account for 30–50% of ARVC cases. A further eight non-desmosomal genes have also been implicated in the pathogenesis of the disorder but only account for rare cases. Studies of patients with ARVC-associated gene mutations have revealed marked genetic heterogeneity and very limited genotype–phenotype correlation. Disease expression often varies significantly amongst individuals carrying the same mutation. It has been proposed that the presence of more than one sequence variant is required to determine overt clinical disease and patients with multiple variants have a more severe phenotype compared to single variant carriers. Identification of a potentially pathogenic variant comprises a major criterion in the diagnosis of ARVC but informative integration of genetic testing into clinical practice remains challenging. Gene testing should be used to identify asymptomatic family members at risk and only aids diagnosis in cases of high suspicion for ARVC, along with other evident features of the disease already present. However, genetic findings should be used with caution in clinical practice and their interpretation must be performed in expert centres.