bluuebunny/crossref_metadata_2025 huggingface dataset:
Rare complication of subacute renal artery intramural haematoma after renal artery stenting: a case report
Authors: Chen Yang , Dong Hui , Jiang Xiongjing , Che Wuqiang
Published: April 2019

Background

Renal artery intramural haematoma (IMH) is a rare cause of renal artery obstruction after stenting. Diagnosis and treatment are difficult as there are only a few cases reported.

Case summary

We present the case of sudden-onset abdominal pain and non-functional kidney 3 days after renal artery stent implantation. Subacute luminal narrowing of the renal artery was initially diagnosed using computed tomography angiography and renal artery angiography, and a final diagnosis of subacute renal artery IMH was made using intravascular ultrasound (IVUS). Subsequently, the patient was treated with percutaneous transluminal angioplasty from far to near and another stent implantation. At the third month follow-up, blood pressure and renal function were normal.

Discussion

This case suggests that IVUS could be useful for qualifying and treating the subacute renal artery IMH.
Sociodemographic factors associated with secondhand smoke exposure and smoking rules in homes with children
Authors: Arechavala Teresa , Continente Xavier , Pérez-Ríos Mónica , Schiaffino Anna , Fernández Esteve , López María José
Published: April 2019

Background

This study aims to identify sociodemographic characteristics associated with secondhand smoke (SHS) exposure and the adoption of smoking bans in homes with children in Spain

Methods

We performed, in 2016, a cross-sectional study to a representative sample of Spanish households with children under 12 years old. We administered a telephone survey to the parents asking about smoking patterns at home, children’s SHS exposure and sociodemographic characteristics. Poisson regression models with robust variance were built to assess sociodemographic characteristics associated with household SHS exposure and the adoption of smoking rules.

Results

In this study participated 2411 families, 25.8% of which reported exposure at home and 84.4% implemented smoking bans. SHS exposure was associated with having one (aPR = 2.09; 95% CI: 1.43–3.04) or two Spanish parents (aPR = 1.71; 95% CI: 1.24–2.36), lower educational attainment (primary: aPR = 1.74; 95% CI: 1.45–2.10; secondary: aPR = 1.37; 95% CI: 1.17–1.60 compared with university studies), a family structure different from two-parent family (aPR = 1.38; 95% CI: 1.14–1.67) and parents between 31 and 40 years (aPR = 0.75; 95% CI: 0.57–0.99) and 41–50 years (aPR = 0.62; 95% CI: 0.47–0.81) compared with 18- to 30-year-old parents. The adoption of smoking bans was associated with two-parent family (aPR = 1.09; 95% CI: 1.01–1.17), living with non-smokers (aPR = 1.46; 95% CI: 1.31–1.62), parents of foreign origin (aPR = 1.09; 95% CI: 1.04–1.14) and younger children (0–3 years: aPR = 1.05; 95% CI: 1.01–1.09) compared with the oldest children (8–11 years).

Conclusion

The parent’s origin and the family structure were associated with SHS exposure and the adoption of smoking bans at home. Moreover, the number of smokers living at home was relevant for the adoption of smoking bans, and the educational attainment for SHS exposure. These factors should be taken into consideration when designing or implementing smoke-free home programmes.
Emergent surgical treatment for acute thrombosis caused by pulmonary artery kinking after left upper sleeve lobectomy
Authors: Nakajima Daisuke , Oda Hiromi , Chen-Yoshikawa Toyofumi F , Date Hiroshi
Published: April 2019

This is a report on the pulmonary arterioplasty for mechanical stenosis post-left upper sleeve lobectomy. A 64-year-old man had a tumour protruding into the left upper bronchus with a diagnosis of squamous cell carcinoma (cT1cN1M0). Left upper bronchial sleeve lobectomy was performed through posterolateral thoracotomy. On postoperative day 1, he received veno-arterial extracorporeal membrane oxygen support due to sudden pulseless electrical activity. We detected left pulmonary artery (PA) kinking with an impaired blood flow by using pulmonary angiography and immediately performed PA thrombectomy and arterioplasty using rethoracotomy. Following the en bloc removal of a thrombus that had completely occluded the left PA, the redundant PA was resected, and PA reconstruction was performed by direct end-to-end anastomosis. A postoperative contrast-enhanced computed tomography scan showed no signs of PA kinking and no residual thrombus formation. When PA bending and mechanical stenosis are detected after bronchial sleeve lobectomy, resection of the redundant PA is also required to prevent PA thrombosis.
Violent crime among Swedish military veterans after deployment to Afghanistan: a population-based matched cohort study
Authors: Pethrus Carl-Martin , Frisell Thomas , Reutfors Johan , Johansson Kari , Neovius Kristian , Söderling Jonas K , Bruze Gustaf , Neovius Martin
Published: April 2019

Objective

To investigate the incidence of violent crime conviction among Swedish military veterans after deployment to Afghanistan versus non-deployed comparators. The main outcome was first conviction of a violent crime, retrieved from the Swedish National Council for Crime Prevention Register until December 31, 2013.

Methods

This was a cohort study of military veterans identified through personnel registers regarding deployment to Afghanistan between 2002 and 2013 (n = 5894). To each military veteran, up to five non-deployed comparators identified via the Military Service Conscription Register were matched by age, sex, conscription year, cognitive ability, psychological assessment, self-reported mental health, body mass index, antidepressants/anxiolytics prescriptions and self-harm (fully matched comparators; n = 28 895). Multivariable adjustment was made for substance abuse and previous health care visits with psychiatric diagnoses. An additional comparator group matched only for age, sex and conscription year was also used (age-sex-matched comparators; n = 29 410).

Results

During 21 898 person-years of follow-up (median = 3.6 years) there were 26 events among deployed military veterans compared with 98 in non-deployed fully matched comparators [12 vs 9 per 10 000 person-years, adjusted hazard ratio (aHR) 1.36; 95% confidence interval (CI) 0.88–2.10]. Among non-deployed age-sex-matched comparators there were 170 violent crime convictions (16 per 10 000 person-years; aHR 0.85; 95% CI 0.56–1.29). Factors associated with greater risk of violent crime convictions were younger age, lower scores on cognitive ability tests and psychological assessment, and convictions preceding deployment.

Conclusion

The violent crime conviction rate after returning from military deployment to Afghanistan was not different compared with non-deployed comparators in individuals without history of violent crime convictions.
Necrotizing Soft Tissue Infection Staphylococcus aureus but not S. pyogenes Isolates Display High Rates of Internalization and Cytotoxicity Toward Human Myoblasts
Authors: Baude Jessica , Bastien Sylvère , Gillet Yves , Leblanc Pascal , Itzek Andreas , Tristan Anne , Bes Michèle , Duguez Stephanie , Moreau Karen , Diep Binh An , Norrby-Teglund Anna , Henry Thomas , Vandenesch François ,   INFECT Study Group, Arnell Per , Bergey Francois , Martins Dos Santos Vitor A P , Hyldegaard Ole , Nekludov Michael , Norrby-Teglund Anna , Pieper Dietmar , Skrede Steinar , Svensson Mattias , Vandenesch Francois
Published: April 2019

Background

Necrotizing soft tissue infections (NSTIs) caused by group A Streptococcus (GAS) and occasionally by Staphylococcus aureus (SA) frequently involve the deep fascia and often lead to muscle necrosis.

Methods

To assess the pathogenicity of GAS and S. aureus for muscles in comparison to keratinocytes, adhesion and invasion of NSTI-GAS and NSTI-SA isolates were assessed in these cells. Bloodstream infections (BSI-SA) and noninvasive coagulase-negative staphylococci (CNS) isolates were used as controls.

Results

NSTI-SA and BSI-SA exhibited stronger internalization into human keratinocytes and myoblasts than NSTI-GAS or CNS. S. aureus internalization reached over 30% in human myoblasts due to a higher percentage of infected myoblasts (>11%) as compared to keratinocytes (<3%). Higher cytotoxicity for myoblasts of NSTI-SA as compared to BSI-SA was attributed to higher levels of psmα and RNAIII transcripts in NSTI-SA. However, the 2 groups were not discriminated at the genomic level. The cellular basis of high internalization rate in myoblasts was attributed to higher expression of α5β1 integrin in myoblasts. Major contribution of FnbpAB-integrin α5β1 pathway to internalization was confirmed by isogenic mutants.

Conclusions

Our findings suggest a factor in NSTI-SA severity is the strong invasiveness of S. aureus in muscle cells, a property not shared by NSTI-GAS isolates.
Neodermis Formation in Full Thickness Wounds Using an Esterified Hyaluronic Acid Matrix
Authors: Aballay Ariel , Hermans Michel H E
Published: April 2019

The role of the dermis is essential for the proper orchestration of all phases of the normal wound healing process. Wounds with seriously damaged or even absent dermis consistently show seriously impaired wound healing and/or long-term complications such as hypertrophic scarring. Replacing a damaged dermis requires a dermal matrix that is compatible with, or even stimulates, the process of wound healing. Hyaluronic acid (HA), in an esterified form, is among the many matrices that are available. HA has been used in a number of indications, such as ulcers (ie, diabetic foot ulcers and venous leg ulcers), trauma, including burns, and for the repair of contractures and hypertrophic scars. The shorter healing time and the decrease of recurring hypertrophy demonstrate the efficiency of HA-derived matrices. Biopsies, taken up to 12 months post-reconstruction show a neodermis that histologically is largely comparable to normal skin, which probably is a function of HA playing such a pivotal role in normal, unwounded skin, as well as in the process of healing.
Featured Article: Behavior Interventions Addressing Obesity in Rural Settings: The E-FLIP for Kids Trial
Authors: Janicke David M , Lim Crystal S , Perri Michael G , Mathews Anne E , Bobroff Linda B , Gurka Matthew J , Parish Alice , Brumback Babette A , Dumont-Driscoll Marilyn , Silverstein Janet H
Published: April 2019

Objective

To assess the effectiveness of behavioral parent-only (PO) and family-based (FB) interventions on child weight, dietary intake, glycated hemoglobin, and quality of life in rural settings.

Methods

This study was a three-armed, randomized controlled trial. Participants were children (age 8–12 years) with overweight or obesity and their parents. A FB (n = 88), a PO (n = 78) and a health education condition (HEC) (n = 83) each included 20 group contacts over 1 year. Assessment and treatment contacts occurred at Cooperative Extension Service offices. The main outcome was change in child body mass index z-score (BMIz) from baseline to year 2.

Results

Parents in all conditions reported high treatment satisfaction (mean of 3.5 or higher on a 4-point scale). A linear mixed model analysis of change in child BMIz from baseline to year 1 and year 2 found that there were no significant group by time differences in child BMIz (year 2 change in BMIz for FB = −0.03 [−0.1, 0.04], PO = −0.01 [−0.08, 0.06], and HEC = −0.09 [−0.15, −0.02]). While mean attendance across conditions was satisfactory during months 1–4 (69%), it dropped during the maintenance phase (42%). High attendance for the PO intervention was related to greater changes in child BMIz (p < .02). Numerous barriers to participation were reported.

Conclusion

Many barriers exist that inhibit regular attendance at in-person contacts for many families. Innovative delivery strategies are needed that balance treatment intensity with feasibility and acceptability to families and providers to facilitate broad dissemination in underserved rural settings.

ClinicalTrials.gov Identifier: NCT01820338.
Cytokinin inhibits cotton fiber initiation by disrupting PIN3a-mediated asymmetric accumulation of auxin in the ovule epidermis
Authors: Zeng Jianyan , Zhang Mi , Hou Lei , Bai Wenqin , Yan Xingying , Hou Nan , Wang Hongxing , Huang Juan , Zhao Juan , Pei Yan
Published: April 2019

Auxin-dependent cell expansion is crucial for initiation of fiber cells in cotton (Gossypium hirsutum), which ultimately determines fiber yield and quality. However, the regulation of this process is far from being well understood. In this study, we demonstrate an antagonistic effect between cytokinin (CK) and auxin on cotton fiber initiation. In vitro and in planta experiments indicate that enhanced CK levels can reduce auxin accumulation in the ovule integument, which may account for the defects in the fiberless mutant xu142fl. In turn, supplementation with auxin can recover fiber growth of CK-treated ovules and mutant ovules. We further found that GhPIN3a is a key auxin transporter for fiber-cell initiation and is polarly localized to the plasma membranes of non-fiber cells, but not to those of fiber cells. This polar localization allows auxin to be transported within the ovule integument while specifically accumulating in fiber cells. We show that CKs antagonize the promotive effect of auxin on fiber cell initiation by undermining asymmetric accumulation of auxin in the ovule epidermis through down-regulation of GhPIN3a and disturbance of the polar localization of the protein.
Defence gene expression and phloem quality contribute to mesophyll and phloem resistance to aphids in wild barley
Authors: Leybourne Daniel J , Valentine Tracy A , Robertson Jean A H , Pérez-Fernández Estefania , Main Angela M , Karley Alison J , Bos Jorunn I B
Published: April 2019

Aphids, including the bird cherry-oat aphid (Rhopalosiphum padi), are significant agricultural pests. The wild relative of barley, Hordeum spontaneum 5 (Hsp5), has been described to be partially resistant to R. padi, with this resistance proposed to involve higher thionin and lipoxygenase gene expression. However, the specificity of this resistance to aphids and its underlying mechanistic processes are unknown. In this study, we assessed the specificity of Hsp5 resistance to aphids and analysed differences in aphid probing and feeding behaviour on Hsp5 and a susceptible barley cultivar (Concerto). We found that partial resistance in Hsp5 to R. padi extends to two other aphid pests of grasses. Using the electrical penetration graph technique, we show that partial resistance is mediated by phloem- and mesophyll-based resistance factors that limit aphid phloem ingestion. To gain insight into plant traits responsible for partial resistance, we compared non-glandular trichome density, defence gene expression, and phloem composition of Hsp5 with those of the susceptible barley cultivar Concerto. We show that Hsp5 partial resistance involves elevated basal expression of thionin and phytohormone signalling genes, and a reduction in phloem quality. This study highlights plant traits that may contribute to broad-spectrum partial resistance to aphids in barley.
How water flow, geometry, and material properties drive plant movements
Authors: Morris Richard J , Blyth Mark
Published: April 2019

Plants are dynamic. They adjust their shape for feeding, defence, and reproduction. Such plant movements are critical for their survival. We present selected examples covering a range of movements from single cell to tissue level and over a range of time scales. We focus on reversible turgor-driven shape changes. Recent insights into the mechanisms of stomata, bladderwort, the waterwheel, and the Venus flytrap are presented. The underlying physical principles (turgor, osmosis, membrane permeability, wall stress, snap buckling, and elastic instability) are highlighted, and advances in our understanding of these processes are summarized.
Linkage mapping and genome-wide association reveal candidate genes conferring thermotolerance of seed-set in maize
Authors: Gao Jingyang , Wang Songfeng , Zhou Zijian , Wang Shiwei , Dong Chaopei , Mu Cong , Song Yunxia , Ma Peipei , Li Chengcheng , Wang Zhao , He Kewei , Han Chunyan , Chen Jiafa , Yu Haidong , Wu Jianyu
Published: April 2019

It is predicted that high-temperature stress will increasingly affect crop yields worldwide as a result of climate change. In order to determine the genetic basis of thermotolerance of seed-set in maize under field conditions, we performed mapping of quantitative trait loci (QTLs) in a recombinant inbred line (RIL) population using a collection of 8329 specifically developed high-density single-nucleotide polymorphism (SNP) markers, combined with a genome-wide association study (GWAS) of 261 diverse maize lines using 259 973 SNPs. In total, four QTLs and 17 genes associated with 42 SNPs related to thermotolerance of seed-set were identified. Among them, four candidate genes were found in both linkage mapping and GWAS. Thermotolerance of seed-set was increased significantly in near-isogenic lines (NILs) that incorporated the four candidate genes in a susceptible parent background. The expression profiles of two of the four genes showed that they were induced by high temperatures in the maize tassel in a tolerant parent background. Our results indicate that thermotolerance of maize seed-set is regulated by multiple genes each of which has minor effects, with calcium signaling playing a central role. The genes identified may be exploited in breeding programs to improve seed-set and yield of maize under heat stress.
Sieve element biology provides leads for research on phytoplasma lifestyle in plant hosts
Authors: van Bel Aart J E , Musetti Rita
Published: April 2019

Phytoplasmas reside exclusively in sieve tubes, tubular arrays of sieve element–companion cell complexes. Hence, the cell biology of sieve elements may reveal (ultra)structural and functional conditions that are of significance for survival, propagation, colonization, and effector spread of phytoplasmas. Electron microscopic images suggest that sieve elements offer facilities for mobile and stationary stages in phytoplasma movement. Stationary stages may enable phytoplasmas to interact closely with diverse sieve element compartments. The unique, reduced sieve element outfit requires permanent support by companion cells. This notion implies a future focus on the molecular biology of companion cells to understand the sieve element–phytoplasma inter-relationship. Supply of macromolecules by companion cells is channelled via specialized symplasmic connections. Ca2+-mediated gating of symplasmic corridors is decisive for the communication within and beyond the sieve element–companion cell complex and for the dissemination of phytoplasma effectors. Thus, Ca2+ homeostasis, which affects sieve element Ca2+ signatures and induces a range of modifications, is a key issue during phytoplasma infection. The exceptional physical and chemical environment in sieve elements seems an essential, though not the only factor for phytoplasma survival.
Teaching Sociocultural Psychiatry Throughout the Lifespan
Authors: Sehgal Priya , Nauphal Maya , Chen Justin A.
Published: April 2019

In response to persistent and growing health disparities among racial and ethnic minority groups in the United States, health care institutions have started to enhance cultural competency education and training in both health care organizations and medical education. This effort to integrate culture into professional guidelines and training curricula has been consistent among the psychiatric workforce over the last few decades. While these efforts to address mental health disparities among racial and ethnic minority groups are welcomed, much more work is needed to integrate sociocultural education into medical training. This chapter describes the evolution of sociocultural medical education from teaching cultural competence to cultural humility, with its opportunities and challenges. Using a case-based approach, the authors propose general principles from existing curricula that can help psychiatric faculty design and teach sociocultural curricula for psychiatry trainees in diverse settings.
Case 3: Syncope Without Hyperventilation
Authors: Novak Peter
Published: April 2019

This case presents syncope, neurally mediated, and mixed. Small fiber neuropathy (SFN) presented as sensory and length-dependent, and the typical hyperventilatory response with a decline of end tidal CO2 just before the syncope was absent.
Case 4: Syncope, Vasodepressor
Authors: Novak Peter
Published: April 2019

The autonomic testing revealed vasodepressor syncope. The decline in blood pressure while the heart rate remains unchanged is characteristic for vasodepressor syncope. Treatment consists of volume expansion with high fluid and high salt intake.
Case 15: Postural Tachycardia Syndrome with Hyperventilation and Presyncope
Authors: Novak Peter
Published: April 2019

Postural tachycardia syndrome (POTS) without evidence of autoimmunity or neuropathy has a good prognosis. Early blood pressure decline at the beginning of tilt may provide early warning of impending syncope or other abnormalities during the tilt. Hypocapnic hyperventilation is a common occurrence in POTS.
Case 28: Postural Tachycardia Syndrome with Reverse Tilt Test
Authors: Novak Peter
Published: April 2019

Autonomic testing is useful to differentiate between postural tachycardia syndrome and inappropriate sinus tachycardia (IST) using reverse tilt.
Case 43: Multiple System Atrophy and Vitamin B12 Deficiency
Authors: Novak Peter
Published: April 2019

This patient showed severe generalized autonomic failure associated with compensated orthostatic hypotension, which is consistent with multiple system atrophy (MSA). Cerebral autoregulatory failure was associated with low supine cerebral blood flow velocity, which remained stable during the tilt. Small fiber neuropathy, biopsy-proven, mixed, was affecting both sensory and autonomic fibers.
Case 62: Small Fiber Neuropathy with Symptomatic Improvement on Immune Globulins
Authors: Novak Peter
Published: April 2019

Autonomic testing revealed length-dependent small fiber neuropathy affecting sensory fibers. Repeated titer of acetylcholine ganglionic antibody was negative, but repeated epidermal nerve fiber density testing showed progressive deterioration. Symptoms improved with intravenous immune globulin therapy.
Case 63: Small Fiber Sensory Neuropathy with Elevated Ganglionic Acetylcholine Receptor Antibody Responding to Immunoglobulins
Authors: Novak Peter
Published: April 2019

This case demonstrates inflammatory small fiber neuropathy, sensory, length-dependent. Autonomic functions were essentially normal. Patient tested positive for ganglionic acetylcholine receptor antibody and improved on intravenous immune globulin therapy.
Case 65: Ehlers-Danlos Syndrome with Postural Tachycardia Syndrome, Presyncope, and Anxiety
Authors: Novak Peter
Published: April 2019

The tilt test showed a combination of anxiety, postural tachycardia syndrome (POTS), and presyncope. The POTS in this patient was mild, but anxiety may exacerbate symptoms.
Case 67: Ehlers-Danlos Syndrome with Postural Tachycardia Syndrome and Psychogenic Pseudosyncope
Authors: Novak Peter
Published: April 2019

Patient became unresponsive during the first minute of the tilt; she was tachycardic but the blood pressure and cerebral blood flow were stable. Psychogenic pseudosyncope can be superimposed on postural tachycardia syndrome (POTS). Pseudosyncope, small fiber neuropathy, and POTS can be associated with hypermobile Ehlers-Danlos syndrome.
Case 78: Small Fiber Neuropathy in Wilson Disease
Authors: Novak Peter
Published: April 2019

The tilt test provoked characteristic syncope, mixed form, with simultaneous decline in heart rate and blood pressure. Small fiber neuropathy, severe, length-dependent, mixed, affecting both sensory and autonomic fiber was diagnosed. This patient had several potential causes of small fiber neuropathy, including metabolic derangement after bariatric surgery, Wilson disease, and chronic therapy with penicillamine.
Case 80: Vitamin B12 Deficiency
Authors: Novak Peter
Published: April 2019

Fatigue and small fiber neuropathy can be associated with a vitamin B12 deficiency.
Case 81: Hypovolemia in Valsalva Maneuver
Authors: Novak Peter
Published: April 2019

Dizziness can be associated with cerebral autoregulatory failure and hypovolemia, which can be detected by pulse pressure collapse during the Valsalva maneuver.
Case 87: Intermittent Supine Hypotension
Authors: Novak Peter
Published: April 2019

Autonomic testing may reveal an intermittent decline in blood pressure and cerebral blood flow associated with dizziness even in the supine position. Paroxysmal dysautonomia can be associated with blood pressure and cerebral blood flow instability.
Case 89: Periodic Apnea
Authors: Novak Peter
Published: April 2019

Autonomic testing may reveal, apneusis which can be associated with dizzy spells.
Case 94: Anxiety and Postural Tachycardia Syndrome
Authors: Novak Peter
Published: April 2019

Severe anxiety and severe postural tachycardia syndrome (POTS) may coexist, and both require adequate therapy. Autonomic testing can be useful in the evaluation of dizziness in anxious patients.
Natural History and Classification
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

Classification of the natural history of untreated HIV infection into discrete disease stages helped to optimize the treatment approach to those infected with HIV. Due to the advancements in antiretroviral treatment and current treatment recommendations some of the subdivisions of chronic HIV infection are now seemingly more of historical than clinical value, but the clinically important stages are discussed in further detail in this chapter. It is important to note that although antiretroviral therapy has completely changed the disease course of HIV and altered the relevance of some of the disease stages there remains a gap in the life expectancy of treated HIV-infected individuals compared to uninfected controls in the general population. This chapter defines the various stages of HIV, beginning with primary HIV infection before moving onto chronic HIV infection and its complications. The diagnosis and staging of HIV is also discussed in detail, allowing it to be looked at from both clinical and research perspectives.
Antiretroviral Therapy
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

Abstract: This chapter is about antiretroviral therapy (ART). It includes the goals of antiretroviral therapy (according to the 2018 Department of Health and Human Services [DHHH] guidelines), and it covers recommendations for antiretroviral therapy, special co-factor considerations, and what antiretroviral regimen to start. The chapter includes a detailed discussion on the selection of the initial third ART drug, individualized selection of the initial regimen, initiating ART in a patient with HIV-associated complications, treatment of HIV-2 infection, factors that influence the probability of prolonged viral suppression and regimen tolerability, the rapidity of virologic response, clinical failure, treatment strategies in selected situations, and treatment strategies in the setting of immunologic failure. The chapter concludes with a summary of pivotal antiretroviral trials.
Infection Management
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

Abstract: This chapter is about management of infections in HIV-infected persons and covers aspergillosis, bartonellosis, mucocutaneous candidiasis, esophageal candidiasis, cytomegalovirus, Cryptococcus neoformans, cryptosporidiosis, herpes simplex virus, microsporidiosis, progressive multifocal leukoencephalopathy, Mycobacterium avium complex infection, Mycobacterium tuberculosis, toxoplasmosis, and herpes zoster. Although the advent of highly active antiretroviral therapy (HAART) has somewhat ameliorated some opportunistic infections that carried a dire prognosis in patients with advanced HIV infection, infection remains a serious threat to those living with HIV. Prompt assessment, testing, diagnosis, and treatment are essential to maintaining the health of those with compromised immune systems.
Malan Syndrome
Authors: Priolo Manuela , Zenker Martin , Hennekam Raoul C.
Published: April 2019

The chapter discusses the clinical phenotype and the molecular abnormalities in Malan syndrome, an overgrowth condition caused by mutations in the NFIX gene. Overgrowth in Malan syndrome can be present at birth, especially in terms of large head circumference, and it continues after birth, although statural growth velocity decreases with age. The syndrome is also characterized by dysmorphic facial traits, skeletal abnormalities, intellectual disability, visual problems, and advanced bone age. This condition is allelic to another overgrowth disorder, Marshall-Smith syndrome, with which it shares several clinical features and should be considered in the differential diagnosis. The causative gene for both conditions, NFIX, encodes the nuclear factor one X-type transcription factor, which regulates the growth of several types of connective tissues.
Focused ultrasound
Authors: Peck Marcus , MacNaughton Pete
Published: April 2019

This chapter will define focused ultrasound, outline its scope, and explain why it is so important in contemporary intensive care practice.
Image optimization
Authors: Corredor Carlos , Fletcher Nick
Published: April 2019

This chapter will describe how you can optimize the environment, probe selection, depth, gain, compression, focus, sector width, and zoom to obtain the best images possible. The advanced section will introduce practical aspects of colour, pulsed wave, continuous wave, and tissue Doppler imaging and present some of their many limitations, which explain why considerable supervision is required to develop skills in these modalities.
Pericardial assessment
Authors: Alam Shirjel , Gillies Michael
Published: April 2019

This chapter will outline the anatomy and physiology of the pericardial space and common causes of pericardial collections seen in critically ill patients. It will explain how to recognize a pericardial collection and answer these important questions—is it definitely pericardial? What is its size? What is its composition? Are there any associated abnormalities? And is it clinically significant? Simple collections will be distinguished from a haemopericardium and a pyocardium, which require surgical management. Finally, it will discuss the two-dimensional signs of cardiac tamponade that should guide the intensivist towards pericardial drainage in life-threatening cases. The advanced section of this chapter will introduce the spectral Doppler signs of pulsus paradoxus that indicate cardiac tamponade.
Lung ultrasound, sonoanatomy, and standard views
Authors: Miller Ashley
Published: April 2019

This chapter outlines the technique for performing a systematic assessment of the lung using ultrasound that ensures that significant pathology can be identified. A 3-point scan is described, and the appearances of normal lung are reviewed.
Pleural assessment
Authors: Stephens Jennie
Published: April 2019

This chapter describes the use of ultrasound to assess pleural disease in the intensive care setting. The ultrasound signs of pneumothorax are described and the specificity reviewed, with the pitfalls highlighted. The assessment and quantification of pleural effusions are outlined, together with the limitations and pitfalls.
Aortic assessment
Authors: Clark Thomas , Macnaughton Peter
Published: April 2019

Imaging the aorta is an advanced skill, although important pathology may be identified by the critical care sonographer when undertaking focused transthoracic echocardiography and basic abdominal ultrasound. This chapter outlines the appearances of the normal aorta in focused echocardiography and abdominal ultrasound. The ultrasonic appearances of an aortic aneurysm and dissection are described.
Haemodynamic instability
Authors: Gray Lewis , Morris Craig
Published: April 2019

This chapter will discuss how two-dimensional echo can be used to evaluate ventricular performance in terms of preload (volume status), systolic function (pump status), and filling pressure (pressure status). Using these parameters, it will describe an integrative approach to haemodynamic assessment that categorizes the patient into one of seven characteristic states that become immediately recognizable. It will also present useful practical tips on using echo in clinical practice and avoiding its pitfalls.
Trauma
Authors: Kirk-Bayley Justin , Doyle James
Published: April 2019

Focused assessment with sonography for trauma (FAST) continues to have a role in the primary assessment of the seriously injured patient, despite the widespread availability of early computed tomography scanning. This chapter describes how to undertake a FAST and an extended FAST scan, with examples of common pathology. The benefits, together with the limitations and pitfalls, are outlined.
Protocols of exercise testing in athletes and cardiopulmonary testing: assessment of fitness
Authors: Guazzi Marco , Adami Paolo Emilio
Published: April 2019

Exercise and cardiopulmonary exercise testing are essential in the evaluation of the cardiovascular response to exercise. They are clinically used to evaluate the subject’s capacity to tolerate increasing work loads. Throughout the tests electrocardiographic, haemodynamic, and symptomatic responses are monitored to assess ischaemic, hypertensive, and arrhythmic manifestations of disease. Ventilatory expired gas analysis may also be performed, as it provides fundamental information, particularly in patients with congestive heart failure or other exercise-induced limitations.
Electrophysiological study
Authors: Antz Matthias
Published: April 2019

An electrophysiological (EP) study is performed for diagnostic reasons, for risk assessment, and for therapy of arrhythmias. It can be useful in athletes with palpitations or documented arrhythmias of unclear origin, in non-sustained ventricular tachycardia, structural heart disease, or electrical abnormalities such as the Brugada syndrome, and for treatment of ectopic beats, supraventricular or ventricular tachycardia, and atrial fibrillation.
Bicuspid aortic valve disease and competitive sports: key considerations and challenges
Authors: Wessler Benjamin S. , Pandian Natesa G.
Published: April 2019

Bicuspid aortic valve (BAV) is a common congenital disorder. It could simply be a minor anatomic abnormality or be associated with progressive aortic stenosis, aortic regurgitation, and aortic dilation. If an athlete is recognized to have a BAV, questions arise with regard to whether they can pursue their selected sports, particularly elite athletic activity, and what type of follow-up examinations are necessary and how often should be done. Valvular disorders such as the degree of aortic stenosis and aortic regurgitation, aortic size, and coexisting disorders are also influencing factors. The absence of robust controlled studies, which are difficult to perform, make decision-making difficult, although recommendations by expert panels provide some guidance. The general consensus is that athletes with BAV with normal valvular function and no aortic dilation can participate in all athletic activities. Those with mild aortic dilation should undergo annual screening, some more frequently than others. Those with moderate or severe valvular stenosis or regurgitation should be managed based on the haemodynamic impact of the valve lesion. Athletes with coexisting lesions or syndromes should be evaluated comprehensively. The overall recommendation to an individual athlete should incorporate many factors and employ a multidisciplinary approach.
Incidence of sudden cardiac death in athletes
Authors: Drezner Jonathan A. , Harmon Kimberly G.
Published: April 2019

Sudden cardiac death (SCD) is the leading cause of fatalities in competitive athletes during sports and exercise. These tragic events often receive intense public attention and stimulate debate regarding the most appropriate prevention strategies. A precise understanding of SCD incidence is needed to guide effective screening programmes and proper emergency preparations at athletic events. However, published estimates of SCD incidence vary widely, and are strongly influenced by the methodology used for case identification (numerator) and calculations of the population at risk (denominator). Studies searching only media reports or catastrophic insurance claims tend to underestimate SCD risk. Few studies with mandatory reporting of SCD are available, leaving significant knowledge gaps in our understanding of SCD in competitive athletes. In general, SCD is more common in males, black athletes, and male basketball players. This chapter reviews the incidence of SCD in athletes and examines differences based on gender, race, sport, and geographic region.
Cardiovascular screening of adult/senior competitive athletes
Authors: Vanhees Luc , Börjesson Mats
Published: April 2019

Regular physical activity at moderate to intense intensity provides substantial health benefits. Therefore individuals should be encouraged to increase their level of physical activity. However, acute bouts of moderate to vigorous exercise may induce cardiovascular (CV) complications, such as malignant arrhythmias and sudden cardiac death/arrest (SCD/SCA), in adults and seniors, mainly due to known or occult cardiovascular disease. The rationale for cardiovascular evaluation and screening is to minimize these dangerous cardiac complications and to ensure safe participation in competitive or leisure-time sports. In individuals engaged in moderate to intense leisure-time physical activities or sporting activities, cardiovascular evaluation should be based on theidentification and severity of the underlying cardiovascular disease. The extent of the evaluation should depend on the intended level of physical activity, the habitual level of exercise and the individual risk profile. Several recommendations for screening, evaluation, and eligibility, given by international societies in Europe and the USA, are discussed. For adult/senior competitive athletes, screening should consist of, at least, personal and familial history (including symptoms), clinical examination, resting ECG, and graded maximal exercise testing, with the last of these mainly in subjects with increased CV risk. Depending on the underlying disease or risk, additional examinations may be required.
Resuscitation on the field: basic and advanced life support and automatic external defibrillators
Authors: Link Mark S. , Estes III Mark
Published: April 2019

Resuscitation on the playing field is at least as important as screening in the prevention of death. Even if a screening strategy is largely effective, individuals will suffer sudden cardiac arrests. Timely recognition of a cardiac arrest with rapid implementation of cardiopulmonary resuscitation (CPR) and deployment and use of automated external defibrillators (AEDs) will save lives. Basic life support, including CPR and AED use, should be a requirement for all those involved in sports, including athletes. An emergency action plan is important in order to render advanced cardiac life support and arrange for transport to medical centres.
Diagnosis and management of hypertension in athletes
Authors: Caselli Stefano , Niebauer Josef
Published: April 2019

Arterial hypertension is the most common cardiovascular abnormality reported in the setting of pre-participation screening of large athletic populations. Identification of high blood pressure values during the evaluation of an athlete may raise concern about appropriate management and indications with respect to competitive sport participation, representing a potential cause for exclusion from competitive sports. The diagnostic approach, risk stratification, and clinical management of hypertension in athletes are extensively reviewed and discussed in this chapter.
Glomerular disease
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Understanding of the pathogenesis of nephrotic syndrome is rapidly increasing and new treatments are evolving. However, these diseases remain difficult to manage, with little evidence to help decide on optimum treatment strategies.
Vasculitis
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

This chapter describes the presentation, investigation, and management of children with vasculitis.
Renal tumours
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Wilms tumour is the commonest renal tumour, and may be associated with syndromes. Overall the prognosis is good, but that is not the case for the rarer renal tumours.
Transplantation
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Kidney transplantation offers children with chronic kidney disease stage 5 the best chance of long-term survival and is associated with lower morbidity than long-term dialysis. However, transplantation surgery and the necessary long-term immunosuppressive therapy expose the child to an increased risk of a number of different complications, including infection, metabolic abnormalities, and malignancy. In the era of modern immunosuppressive therapy, acute rejection rates are low; however, there remain significant challenges regarding the management of recurrent disease and chronic antibody-mediated rejection.
Allostasis and neuroprogression in major psychiatric disorders
Authors: Grande Iria , Kapczinski Flávio , Camino Sebastián , Vázquez Gustavo , Vieta Eduard
Published: April 2019

The hypothesis of allostasis may be a pertinent model to explain the course of psychiatric illnesses by means of stress and to explain the dimensional impact of mental disorders on the organism, not only on the brain but on other organs of the body. Moreover, it is also suitable to explain the neuroprogression of psychiatric disorders from a ‘wear and tear’ approach, detailing the progressive increase of cognitive impairment, accelerated ageing, and rates of medical and psychiatric comorbidities that patients with major psychiatric disorders have. In this chapter, the concepts of allostasis, allostatic load, and allostatic overload are detailed from a neuroprogressive approach and their application to neuropsychiatric illnesses is explained in relation to anxiety disorders, affective disorders, such as unipolar depression and bipolar disorder, and psychotic syndromes.
Mitochondrial function and inflammation pathways in the neuroprogression of mental disorders
Authors: Andreazza Ana C. , Kale Rajas P. , Duong Angela , Molina Fabio , Tye Susannah J.
Published: April 2019

Stress, mitochondrial dysfunction, and inflammation are key pathophysiological processes contributing to neuroprogression in mental illness. These factors independently and collectively impact critical cellular mechanisms essential for healthy brain development and function. As these damaging processes continue, cellular debris (damaged DNA and proteins) accumulates, and neuronal integrity is impaired. In addition to this, the myelin sheath that encapsulates neurones to enable smooth and efficient communication throughout the brain is impaired. This chapter outlines how these factors are impacted by stress, inflammation, and mitochondrial function and how they work independently, and together, to increase risk for the development of mental illness, as well as to promote neuroprogression of the illness over time. We discuss how targeting these pathophysiological processes through interdependent factors such as the NLRP3 inflammasome, which sits at the intersection of these mechanistic pathways, may unlock opportunities to limit neuroprogression in the future.
The role of immuno-inflammatory abnormalities in neuroprogression
Authors: Brietzke Elisa , Yamagata Ana S. , Cerqueira Raphael , Rizzo Lucas B. , McIntyre Roger S. , Mansur Rodrigo B.
Published: April 2019

Immuno-inflammatory dysfunction has become a well-consolidated contributor to mental illness pathophysiology. A consistent body of evidence supports the involvement of the immune system in symptomatic expression during acute episodes of severe mental illnesses, but also suggests that this system is involved in longitudinal trajectories of disease. Several explanations have been proposed as possible causes of immune-inflammatory abnormalities in severe mental illnesses, including genetic factors, environmental factors, and complex phenomena such as the premature ageing of the immune system (immunosenescence). Considering the heterogeneity in illness trajectories and the remarkable interindividual variation of immune parameters in individuals with mental illness, it is possible that, for each individual, a unique set of factors operates in a complex interaction of causative and moderator agents. A personalized approach to the role of inflammation in neuroprogression is probably the future for prevention and development of disease-modifying interventions.
Depression and neuroprogression: Sirtuins and mitochondria as crucial hubs
Authors: Anderson George , Maes Michael
Published: April 2019

Neuroprogressive processes in major depressive disorder (MDD) can occur in association with recurrent episodes. The primary biological underpinnings are mediated by increases in the levels of immune-inflammation, tryptophan catabolites, mitochondrial dysfunction, and oxidative and nitrosative stress. Such biochemical alterations may be driven by changes in many peripheral and central sites, including in the gut, as well as by early developmental priming, such as prenatal stressors and breastfeeding consequences. As such, the conceptualization of MDD is shifted from simple psychological and central biochemical models to one that includes whole body processes over a developmental timescale. This provides a model that better integrates wider bodies of data relevant to the aetiology and course of MDD, and which therefore underpins the neuroprogressive processes that can occur over the course of MDD. This also significantly challenges current MDD (and wider psychiatric) classification by shifting classification to one based on biological processes rather than one based on subjective phenomenology.
Functioning and illness progression in severe mental illness
Authors: Rosa Adriane R. , Lima Flávia
Published: April 2019

Traditionally the effectiveness of treatments in psychiatry has been driven by the medical model, where treatment response and remission rates are used as the major measures of efficacy. However, there is increasing evidence suggesting the need for additional measures to complement symptomatic evaluation. Individuals with severe mental illnesses experience impairment across a number of domains of everyday functioning, including social and occupational functioning, residential maintenance, medication management, and basic self-care. This is particularly important since such impairment occurs even in clinical remission periods and may occur immediately after illness onset, worsening with the progressive course. Therefore, the assessment of psychosocial functioning is crucial in individuals with severe mental illnesses, as are the rates of functional recovery, which have been indicated as a further measure of treatment response in investigation setting and clinical practice.