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1
Roberts, Benjamin. Sex, Drugs and Rock 'n' Roll in the Dutch Golden Age. NL Amsterdam: Amsterdam University Press, 2017. http://dx.doi.org/10.5117/9789462983021.
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Binge drinking and illicit sex were just as common in the Dutch Golden Age as they are today, if not more so. Sex, Drugs and Rock 'n' Roll in the Dutch Golden Age is a compelling narrative about the generation of young men that came of age in the Dutch Republic during the economic boom of the early seventeenth century. Contrary to their parents' wishes, the younger generation grew up in luxury and wore extravagant clothing, grew their hair long, and squandered their time drinking and smoking. They created a new youth culture with many excesses; one that we today associate with the counterculture generation of the 1960s. With his engaging storytelling style and humorous anecdotes, Roberts convincingly reveals that deviant male youth behavior is common to all times, especially periods when youngsters have too much money and too much free time on their hands.
2
McDermott, Christopher Warren. An internship with Goldberg-Zoino and Associates, Inc. 1986.
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3
Mee, Jon. The Revolutionary Decade. Edited by David Duff. Oxford University Press, 2018. http://dx.doi.org/10.1093/oxfordhb/9780199660896.013.2.
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This chapter examines the literature of the controversy over the French Revolution. It discusses the polemical texts that contributed directly to the controversy associated with Burke, Godwin, Paine, and Wollstonecraft, but also the culture wars that perpetuated it in terms of the novel, poetry, and the theatre. In the 1790s, some of the great names associated with Romanticism came to literary maturity, Blake, Coleridge, and Wordsworth among them. The chapter reminds readers that it was a golden age of satire as a consequence of the ideological conflict, but also a decade when the definitions of literature and culture entered a period of crisis and redefinition.
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Marmysz, John. Yukio Mishima and the Return to the Body. Edinburgh University Press, 2018. http://dx.doi.org/10.3366/edinburgh/9781474424561.003.0013.
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In this chapter, the life, work and philosophy of the Japanese author Yukio Mishima are explored. It is argued that the most interesting and profound properties of Mishima’s thought, his writings, and of the films associated with his thought and writings, are those that leave us with a sense of the open-ended struggle involved in his effort to define himself. The chapter examines some of Mishima’s most important literary works – including Confessions of a Mask, Temple of the Golden Pavilion, The Sailor Who Fell From Grace With the Sea, Patriotism, and The Sea of Fertility – as well as cinematic interpretations of these works by directors such as Paul Schrader, Lewis John Carlino, and Yukio Mishima himself. It is concluded that for Mishima, the defeat of nihilism was ultimately realized in his suicide by ritual seppuku.
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Holes, Clive. Orality, Culture, And Language. Edited by Jonathan Owens. Oxford University Press, 2013. http://dx.doi.org/10.1093/oxfordhb/9780199764136.013.0012.
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This article explores the relationship between linguistic form and function in the varying cultural landscapes of the contemporary Arabic-speaking world, including spontaneous speech, the contemporary electronic media (television, radio, the Internet), cinema, theater, and traditional performed oral literature, which have been revived and “reinvented.” It is shown that the relationship between orality and language in Arabic is complex. The layman’s mental landscape is of a “high,” literary, codified variety of the language strongly identified with a unifying religion (Islam) and a “golden age” of past imperial and literary glories, carrying great cultural prestige; and a “low,” chaotic (often regarded as grammarless) but homely variety associated with domesticity, intimacy, and the daily round. The emotional resonances of the two varieties are and always have been different. Consequently, they have, through the ages, occupied separate functional niches in all linguistically mediated communication, be it speech, writing, song, poetry, cinema, or theater.
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Bolsover, Gillian. China. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190931407.003.0010.
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Computational propaganda is a growing concern in Western democracies, with evidence of online opinion manipulation orchestrated by robots, fake accounts, and misinformation in many recent political events. China, the country with the most sophisticated regime of Internet censorship and control in the world, presents an interesting and under-studied example of how computational propaganda is used. This chapter summarizes the landscape of current knowledge in relation to public opinion manipulation in China. It addressees the questions of whether and how computational propaganda is being used in and about China, whose interests are furthered by this computational propaganda; and what is the effect of this computational propaganda on the landscape of online information in and about China. It also addresses the issue of how the case of computational propaganda in China can inform the current efforts of Western democracies to tackle fake news, online bots, and computational propaganda. This chapter presents four case studies of computational propaganda in and about China: the Great Firewall and the Golden Shield project; positive propaganda on Twitter aimed at foreign audiences; the anti–Chinese state bots on Twitter; and domestic public opinion manipulation on Weibo. Surprisingly, I find that there is little evidence of automation on Weibo and little evidence of automation associated with state interests on Twitter. However, I find that issues associated with anti-state perspectives, such as the pro-democracy movement, contain a large amount of automation, dominating Chinese-language information in certain hashtags associated with China and Chinese politics on Twitter.
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Selva-O’Callaghan, Albert, and Ernesto Trallero-Araguás. Association with malignancy. Edited by Hector Chinoy and Robert Cooper. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198754121.003.0008.
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Nearly one-third of adult myositis patients additionally have some type of associated cancer, observed most commonly in dermatomyositis patients. The relationship between cancer and myositis is generally considered a paraneoplastic phenomenon; that is, in one way or another, the two conditions are related. A parallel course of the diseases—myositis improves after cancer is cured and when cancer recurs, myositis worsens—is considered a classical paraneoplastic criterion. Nevertheless, this parallel clinical course does not always occur in true cancer-associated myositis, or perhaps it cannot be seen because of the interference of therapy. Based on epidemiologic studies, the current gold standard for the diagnosis of cancer-associated myositis is a temporal criterion: diagnosis of the two diseases within a 3-year period, although to a certain extent, this is an arbitrary standard.
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Davey, Patrick, Sherif Gonem, Salman Siddiqui, and David Sprigings. Chronic obstructive pulmonary disease. Edited by Patrick Davey and David Sprigings. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199568741.003.0134.
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The Global Initiative for Chronic Lung Disease (GOLD) states that ‘chronic obstructive pulmonary disease (COPD), a common preventable and treatable disease, is characterised by persistent airflow limitation that is usually progressive and is associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles and gases. Exacerbations and comorbidities contribute to the overall severity in individual patients.’
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Duckett, Victoria. Nullius in Verba. University of Illinois Press, 2017. http://dx.doi.org/10.5406/illinois/9780252039669.003.0002.
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This chapter challenges the notion that Sarah Bernhardt mouthed her lines on film due to her inability to act in a fittingly naturalistic way for film, and that her famous “golden voice” is brutally denied in a media that gives us the spectacle of an actress mouthing lines that we cannot hear. The chapter explains why an actress who was famous for her voice and gesture acts on silent film in terms of art nouveau acting, changes in visual literature, and the ongoing use of musical accompaniment—all of which allow us to reinterpret Bernhardt's relationship to the silent screen. It argues that Bernhardt's films record her gestural fame on the live stage, and that this fame was associated with her use of the spiral as a structuring device for action. It shows that the music that accompanied Bernhardt's films served the same purpose as it did on the live stage—to develop and expand the emotional resonance of her performance.
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Bissell, Lesley-Anne, Dwomoa Adu, and Paul Emery. The patient with rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome, or polymyositis. Edited by Giuseppe Remuzzi. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0166.
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Renal disease is a well-recognized cause of ill health and death in rheumatoid arthritis. Three broad categories of renal disease occur. The first—and by far the most common—arises from the nephrotoxicity of the drugs used in the treatment of arthritis, particularly with non-steroidal anti-inflammatory drugs. Disease-modifying antirheumatic drugs such as gold and D-penicillamine may lead to proteinuria and a glomerulonephritis in 10–30% of patients. Ciclosporin is associated with significant nephrotoxicity and hypertension. A second major but diminishing cause of renal disease in rheumatoid arthritis is amyloidosis. Thirdly, rheumatoid arthritis may be associated with the development of glomerulonephritis. The main types described are a mesangial proliferative glomerulonephritis with or without immunoglobulin A deposits, a membranous nephropathy, and a focal segmental necrotizing glomerulonephritis of the vasculitic type.Renal disease in mixed connective tissue disease and polymyositis is infrequent, but the former can be associated with a membranous and mesangial proliferative glomerulonephritis.Sjögren syndrome is rarely associated with clinically significant renal disease, but patients can present with proteinuria, acidosis, or hyperchloraemia. Interstitial nephritis and immune complex glomerulonephritis reflect the exocrinopathy and circulating immune complex disease pathognomonic of Sjögren syndrome. Evidence for effective treatment of the renal complications is lacking. Corticosteroids and cyclophosphamide are most commonly used, with newer biological drugs, such as rituximab, showing promise.
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Abou-Al-Shaar, Hussam, and Mark A. Mahan. Dumbbell Nerve Sheath Tumors. Edited by Meghan E. Lark, Nasa Fujihara, and Kevin C. Chung. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190617127.003.0019.
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A dumbbell tumor is a nerve sheath tumor that arises from a spinal nerve in the neural foramen and grows as a dumbbell-shaped mass. The differential diagnosis for a dumbbell tumor includes schwannoma, neurofibroma, malignant peripheral nerve sheath tumor, and metastases, among others. MR imaging is considered the gold-standard imaging modality for diagnosis of dumbbell tumors. Surgical approaches that are tailored to the individual patient’s case can be utilized. The chapter reviews dumbbell tumors, including a case example and covers the incidence, clinical presentation, imaging features, decision-making strategy, surgical approaches, outcomes, and potential complications associated with their management.
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Wright, Laura. Sunnyside. British Academy, 2020. http://dx.doi.org/10.5871/bacad/9780197266557.001.0001.
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This book traces developments in the history of British house-names from the tenth century, beginning with medieval house-naming practices referencing the householder’s name, the householder’s occupation, and the appearance of the house. In the early fourteenth century heraldic names appeared on commercial premises: tavern names such as la Worm on the Hope, and shop names such as the Golden Tea Kettle & Speaking Trumpet. From the eighteenth century five main categories are identified: the transferred place-name, the nostalgically rural, the commemorative, names associated with the nobility, and the latest fashion or fad. From the nineteenth century new developments are ‘pick & mix’ names consisting of uncoupled elements from British place-names joined together in new combinations, and jocular house-names. Historically, the house-name Sunnyside predominates in Scotland, and is traced through Middle English, Medieval Latin, Anglo-Norman French Scottish Gaelic, and the influence of Old Norse, recording a prehistoric Nordic land-division practice known as solskifte. It was spread southwards in the eighteenth century by Nonconformists, and became a Quaker shibboleth. Quakers took the name to North America where it remains in use as a church name. A specific historic Sunnyside in the Scottish Borders influenced author Washington Irving to name his famous New York Sunnyside, which boosted the name’s popularity. London Sunnysides of the 1870s were grand suburban residences owned by rich industrialist Nonconformists with Scottish family ties, confirming the trend.
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Crescenzi, Mark J. C., Rebecca H. Best, and Bo Ram Kwon. Reciprocity in International Studies. Oxford University Press, 2018. http://dx.doi.org/10.1093/acrefore/9780190846626.013.414.
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Reciprocity refers to the character of the actions and reactions between two or more actors. This character is commonly one of responding in kind to the actions of another. As such, reciprocity is considered one of the fundamental processes observed by scholars in the study of international relations (IR). In the realm of international politics, the study of reciprocity typically encompasses formal/experimental and empirical research. Some scholars look at ethical dimensions and the propagation of norms such as the Golden Rule, while others undertake empirical analysis of patterns of reciprocity in search of answers to questions about the existence, predictability, and diffusion of reciprocity. As a concept, reciprocity has applications in a range of IR topics such as the basic ingredients of cooperation, the escalation and return of conflict, and the adherence to international law. Within the realm of conflict processes, the iterated Prisoner’s Dilemma (PD) and formal frameworks are often used to represent arms races and similar security concerns. Related to the iterated PD is the work of Robert Axelrod, who demonstrated the robustness of the reciprocal strategy known as tit-for-tat (TFT). One puzzle on reciprocity that deserves consideration in future research is that the expectation of a long time horizon for interaction should stimulate the incentive to cooperate, but long time horizons may also be associated with long pasts. One way to find the answer to this puzzle is to incorporate reciprocity into more general models of international interaction.
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Germann, Julian. Unwitting Architect. Stanford University Press, 2021. http://dx.doi.org/10.11126/stanford/9781503609846.001.0001.
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The global rise of neoliberalism since the 1970s is widely seen as a dynamic originating in the United States and the United Kingdom, and only belatedly and partially repeated by Germany. From this Anglocentric perspective, Germany's emergence at the forefront of neoliberal reforms in the eurozone is perplexing, and tends to be attributed to the same forces conventionally associated with the Anglo-American pioneers. This book challenges this ruling narrative. It recasts the genesis of neoliberalism as a process driven by a plenitude of actors, ideas, and interests. And it lays bare the pragmatic reasoning and counterintuitive choices of German crisis managers obscured by this master story. This book argues that German officials did not intentionally set out to promote neoliberal change. Instead they were more intent on preserving Germany's export markets and competitiveness in order to stabilize the domestic compact between capital and labor. Nevertheless, the series of measures German policy elites took to manage the end of golden-age capitalism promoted neoliberal transformation in crucial respects: it destabilized the Bretton Woods system; it undermined socialist and social democratic responses to the crisis in Europe; it frustrated an internationally coordinated Keynesian reflation of the world economy; and ultimately it helped push the US into the Volcker interest-rate shock that inaugurated the attack on welfare and labor under Reagan and Thatcher. From this vantage point, the book illuminates the very different rationale behind the painful reforms German state managers have demanded of their indebted eurozone partners.
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Casey, Steven. The War Beat, Pacific. Oxford University Press, 2021. http://dx.doi.org/10.1093/oso/9780190053635.001.0001.
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From Pearl Harbor to Hiroshima and Nagasaki, a group of highly courageous correspondents covered America’s war against Japan. Based on a wealth of previously untapped primary sources, War Beat, Pacific provides the first comprehensive account of what these reporters witnessed, what they were allowed to publish, and how their reports shaped the home front’s perception of some of the most pivotal battles in American history. In a dramatic and fast-paced narrative, the book takes us from MacArthur’s doomed defense on the Philippines and the navy’s overly strict censorship policy at the time of Midway through the bloody battles on Guadalcanal, New Guinea, Tarawa, Saipan, Leyte and Luzon, Iwo Jima and Okinawa, detailing the cooperation, as well as conflict, between the media and the military as they grappled with the enduring problem of limiting a free press during a period of extreme crisis. At the heart of this book are the brave, sometimes tragic stories of reporters like Clark Lee and Vern Haugland of the Associated Press, Byron Darnton and Tillman Durdin of the New York Times, Stanley Johnston and Al Noderer of the Chicago Tribune, George Weller of the Chicago Daily News, Keith Wheeler of the Chicago Times, and Robert Sherrod of Time magazine. Twenty-three correspondents died while reporting on the Pacific War. Many more sustained serious wounds. War Beat, Pacific shows how both the casualties and the survivors deserve to be remembered as America’s golden generation of journalists.
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Hunter, David J., Frank W. Roemer, and Ed Riordan. Imaging: magnetic resonance imaging. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0018.
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Magnetic resonance imaging (MRI) overcomes many of the limitations associated with conventional radiography, the technique historically regarded as the gold standard in imaging of osteoarthritis (OA). MRI allows visualization of changes and pathologies in joint tissues including cartilage and the menisci, the two tissue components responsible for the indirect radiographic marker of joint space narrowing, decreasing the length of time that must elapse before disease progression can be detected. Other elements of the joint can also be analysed simultaneously: a key development in the understanding of OA. This chapter focuses on the utility of MRI in observational studies and clinical trials, detailing the available MRI techniques and quantitative/qualitative measurements, and their correlation with tissue damage. The possible future directions of MRI in OA are also discussed, with a view to its potential utility in identifying disease-modifying interventions.
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Horne, Gerald. Pan-Africanism Is the News. University of Illinois Press, 2018. http://dx.doi.org/10.5406/illinois/9780252041198.003.0011.
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This chapter explores the decline of the Associated Negro Press (ANP). It did not take long for the mainstream press to realize that the ANP was sitting on a journalistic goldmine with its direct pipeline to one of the biggest stories of the decade, if not the century: decolonization and how it intersected with the battle against Jim Crow. Claude Barnett was in an advance wave of African Americans descending upon Africa seeking to take advantage of the perceived gold rush delivered by decolonization. Another viselike pressure that the ANP found hard to resist was the other major force of that conflicted era: anticommunism. Unlike the past, the Negro press was now reluctant to hire talented writers with radical associations. As this high drama was unfolding, Barnett continued to live the good life in Chicago, making it difficult to grasp the far-reaching changes just over the horizon.
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Lippert, Amy DeFalco. Consuming Identities. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190268978.001.0001.
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Along with the rapid expansion of the market economy and industrial production methods, innovations including photography, lithography, and steam printing created a pictorial revolution in the nineteenth century. Consuming Identities: Visual Culture in Nineteenth-Century San Francisco explores the significance of that revolution in one of its vanguard cities: San Francisco, the revolving door of the gold rush and the hub of Pacific migration and trade. The proliferation of visual prints, ephemera, spectacles, and technologies transformed public values and perceptions, and its legacy was as significant as the print revolution that preceded it. In their correspondence, diaries, portraits, and reminiscences, thousands of migrants to the city by the Bay demonstrated that visual media constituted a central means by which to navigate the bewildering host of changes taking hold around them in the second half of the nineteenth century. Images themselves were inextricably associated with these world-changing forces; they were commodities, but they also possessed special cultural qualities that gave them new meaning and significance. Visual media transcended traditional boundaries of language and culture that had divided groups within the same urban space. From the 1848 conquest of California and the gold discovery to the disastrous earthquake and fire of 1906, San Francisco anticipated broader national transformations in the commodification, implementation, and popularity of images. For the city’s inhabitants and visitors, an array of imagery came to mediate, intersect with, and even constitute social interaction in a world where virtual reality was becoming normative.
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Berrill, Andrew, Will Jones, and David Pegg. Regional anaesthesia of the trunk. Edited by Philip M. Hopkins. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199642045.003.0053.
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Analgesia of the thorax and abdomen can be challenging. Surgical incisions are commonly associated with severe postoperative pain. Whilst continuous epidural analgesia remains the ‘gold standard’ in terms of postoperative pain relief after major surgery, there remain concerns regarding rare serious side effects. It has been difficult to demonstrate conclusive evidence of improvement in outcomes when epidural analgesia is used. Superior pain relief and a reduction in postoperative respiratory morbidity are, however, clear advantages of regional anaesthesia. Interest has increased in techniques such as paravertebral and rectus sheath blocks in part due to the ready availability of high-definition portable ultrasound equipment, but also in response to concerns regarding neuraxial blockade and the development of enhanced recovery pathways. In addition, novel approaches to analgesia of the trunk, such as the transversus abdominis plane block, have been developed and are now widely used as part of a multimodal analgesic regimen. In this chapter, techniques of neuraxial and peripheral nerve block are discussed along with their indications and complications.
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Rettberg, Angelika, Carlo Nasi, Ralf J. Leiteritz, and Juan Diego Prieto, eds. Different Resources, Different Conflicts? The Subnational Political Economy of Armed Conflict and Crime in Colombia. Universidad de los Andes, 2020. http://dx.doi.org/10.30778/2019.116.
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This book explores some of the risks associated with sustainable peace in Colombia. The book intentionally steers away from the emphasis on the drug trade as the main resource fueling Colombian conflicts and violence, a topic that has dominated scholarly attention. Instead, it focuses on the links that have been configured over decades of armed conflict between legal resources (such as bananas, coffee, coal, flowers, gold, ferronickel, emeralds, and oil), conflict dynamics, and crime in several regions of Colombia. The book thus contributes to a growing trend in the academic literature focusing on the subnational level of armed conflict behavior. It also illustrates how the social and economic context of these resources can operate as deterrents or as drivers of violence. The book thus provides important lessons for policymakers and scholars alike: Just as resources have been linked to outbreaks and transformations of violence, peacebuilding too needs to take into account their impacts, legacies, and potential
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Greenberg, Jennifer L., Katherine E. Limoncelli, and Sabine Wilhelm. Body Dysmorphic Disorder by Proxy. Edited by Katharine A. Phillips. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190254131.003.0008.
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This chapter reviews the literature on body dysmorphic disorder (BDD) by proxy, outlines its clinical presentation using a case example, and describes the currently recommended treatment approach. BDD by proxy is a variant of BDD characterized by a preoccupation with perceived defects or flaws in another person’s appearance. Preoccupations commonly involve a loved one, such as a child or significant other, although any person can be the focus of concern. BDD by proxy is associated with high levels of psychosocial impairment, distress, and shame. Research on BDD by proxy and its treatment is extremely limited. Cognitive-behavioral therapy (CBT) is the gold-standard psychosocial intervention for patients with BDD; however, CBT for BDD does not focus on other persons of concern, nor does it address the interpersonal impairment specific to BDD by proxy. There is some preliminary support for the use of a modified CBT for BDD by proxy, which is described in this chapter.
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Covic, Adrian, Mugurel Apetrii, Luminita Voroneanu, and David J. Goldsmith. Vascular calcification. Edited by David J. Goldsmith. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0120_update_001.
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Vascular calcification (VC) is a common feature of patients with advanced CKD and it could be, at least in part, the cause of increased cardiovascular mortality in these patients. From a morphologic point of view, there are at least two types of pathologic calcium phosphate deposition in the arterial wall—namely, intima calcification (mostly associated with atherosclerotic plaques) and media calcification (associated with stiffening of the vasculature, resulting in significantly adverse cardiovascular outcomes). Although VC was viewed initially as a passive phenomenon, it appears to be a cell-mediated, dynamic, and actively regulated process that closely resembles the formation of normal bone tissue, as discovered recently. VC seems to be the result of the dysregulation of the equilibrium between promoters and inhibitors. The determinants are mostly represented by altered calcium and phosphorus metabolism, secondary hyperparathyroidism, vitamin D excess, high fibroblast growth factor 23, and high levels of indoxyl sulphate or leptin; meanwhile, the inhibitors are vitamin K, fetuin A, matrix G1a protein, osteoprotegerin, and pyrophosphate. A number of non-invasive imaging techniques are available to investigate cardiac and vascular calcification: plain X-rays, to identify macroscopic calcifications of the aorta and peripheral arteries; two-dimensional ultrasound for investigating the calcification of carotid arteries, femoral arteries, and aorta; echocardiography, for assessment of valvular calcification; and, of course, computed tomography technologies, which constitute the gold standard for quantification of coronary artery and aorta calcification. All these methods have a series of advantages and limitations. The treatment/ prevention of VC is currently mostly around calcium-mineral bone disease interventions, and unproven. There are interesting hypotheses around vitamin K, Magnesium, sodium thiosulphate and other potential agents.
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Woywodt, Alexander, and Diana Chiu. Drug-induced and toxic glomerulopathies. Edited by Neil Turner. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199592548.003.0082.
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Glomerulopathies induced by particular exogenous compounds or molecules include those attributable to toxicity, and those caused by inducing an immune or autoimmune response. Tubules are more commonly the target of toxicity as they absorb and concentrate components of filtrate. Damage to endothelial cells may account for thrombotic microangiopathy in response to calcineurin inhibitors. Endothelial cells are also likely to be the target in drug-induced small vessel vasculitis. Toxicity to podocytes accounts for focal segmental glomerulosclerosis caused by pamidronate and other agents. Chloroquine can cause a remarkable pseudo-storage disorder with inclusions in podocytes that resemble those seen in Fabry disease. The mechanism by which drugs cause minimal change disease, another podocyte disorder, is not known. Membranous nephropathy may be caused by exposure to gold, mercury, and some other drugs; this is antibody mediated and presumably the targets are altered podocyte surface molecules. Inhibitors of the mammalian target of rapamycin (mTOR) cause proteinuria, possibly through effects on vascular endothelial growth factor, inhibitors of which are associated with not only proteinuria (an expected podocyte effect) but also thrombotic microangiopathy (endothelial cell effect). This latter may be through disturbing podocyte-endothelium cross-signaling.
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Baumgartner, Helmut, Stefan Orwat, Elif Sade, and Javier Bermejo. Heart valve disease (aortic valve disease): aortic stenosis. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780198726012.003.0032.
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Echocardiography has become the gold standard for the assessment of patients with aortic stenosis (AS). It allows morphological assessment of the aortic valve and provides information on the aetiology of the disease. The quantification of AS includes primarily the measurement of transaortic jet velocities and gradients as well as the calculation of the valve area, thus combining flow-dependent and relatively flow-independent variables. Awareness of potential pitfalls is fundamental when assessing these variables. Haemodynamic consequences of AS on left ventricular (LV) size, wall thickness, and function as well as associated valve lesions and estimates of pulmonary artery pressure are required for the comprehensive evaluation of the disease. In the setting of classical low-flow–low-gradient AS with reduced LV systolic function, low-dose dobutamine echocardiography is of particular diagnostic and prognostic importance. The entity of severe low-flow–low-gradient AS in the presence of preserved LV function remains a particular diagnostic challenge. For accurate differentiation from pseudo-severe AS or misclassified moderate AS, an integrated approach including additional variables such as the extent of valve calcification by computed tomography may be required. In addition to the assessment of AS aetiology and quantification of its severity, echocardiography can provide predictors of outcome that may have a major impact on the decision for intervention.
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Abhishek, Abhishek, and Michael Doherty. Investigations of calcium pyrophosphate deposition. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199668847.003.0051.
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Joint aspiration and microscopic examination of the aspirated synovial fluid remains the gold standard for the diagnosis of calcium pyrophosphate crystal deposition (CPPD). If synovial fluid aspiration is not feasible, plain radiography and/or ultrasound scanning may be used to detect chondrocalcinosis (CC) which predominantly occurs due to calcium pyrophosphate (CPP) crystals, and this can be used as a diagnostic surrogate for CPPD as suggested by the EULAR Task Force. Acute CPP crystal arthritis often associates with a brisk acute phase response (elevated C-reactive protein (CRP) and/or erythrocyte sedimentation rate (ESR), plasma viscosity) and neutrophilia. A mildly raised CRP and/or ESR may be present in chronic CPP crystal inflammatory arthritis. On the contrary, asymptomatic CC, or CPPD with osteoarthritis does not cause raised acute phase reactants. As CPPD most commonly occurs due to increasing age and osteoarthritis, investigations to screen for underlying metabolic abnormalities should be carried out in those with early-onset CPPD (under 55 years), or in those with florid polyarticular CC. As hyperparathyroidism gets more common with ageing its presence should be specifically sought in all age groups. Tests for other predisposing metabolic conditions should only be carried out in the presence of specific clinical features. Genotyping for mutations, especially in the ANKH gene, may be warranted in those with a family history of premature CPPD and no evidence of inherited metabolic predisposition, but such testing is unavailable to most clinicians.
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Nates, Joseph L., and Sharla K. Tajchman. Indirect calorimetry in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0205.
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Critically-ill patients have unpredictable and dynamic metabolic demands that are difficult to predict and quantify. Combined with the high incidence of pre-existing or development of malnutrition in the ICU, these metabolic demands have deleterious effects on outcomes when patients are provided with inadequate or inappropriate nutrition support. Providing adequate nutritional support that meets these varying metabolic demands is a long-standing challenge in the intensive care unit (ICU). Indirect calorimetry (ICal) is a tool that allows ICU practitioners to accurately assess energy expenditure (EE) in critically-ill patients with unpredictable metabolic demands to optimize nutrition support. ICal provides clinicians with a patient’s measured EE (MEE), a quantification of cellular metabolism, and respiratory quotient (RQ), a reflection of which substrates are primarily being utilized for fuel. Study results help clinicians target optimal nutritional goals and prevent adverse effects associated with both under- and overfeeding patients. Recent studies have suggested avoiding caloric deficits and providing tight caloric control may improve morbidity and mortality outcomes in critically-ill patients, though more studies are needed to verify this potential benefit. Currently, there are no specific guideline recommendations to help clinicians utilize ICal in the ICU. Although ICal is considered to be the gold standard for determining EE in critically-ill patients, its use remains limited by availability, cost, and the need for trained personnel for correct use.
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Romagnoli, Stefano, and Giovanni Zagli. Blood pressure monitoring in the ICU. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199600830.003.0131.
Full textAbstract:
Two major systems are available for measuring blood pressure (BP)—the indirect cuff method and direct arterial cannulation. In critically-ill patients admitted to the intensive care unit, the invasive blood pressure is the ‘gold standard’ as a tight control of BP values, and its change over time is important for choosing therapies and drugs titration. Since artefacts due to the inappropriate dynamic responses of the fluid-filled monitoring systems may lead to clinically relevant differences between actual and displayed pressure values, before considering the BP value shown as reliable, the critical care giver should carefully evaluate the presence/absence of artefacts (over- or under-damping/resonance). After the arterial pressure waveform quality has been verified, the observation of each component of the arterial wave (systolic upstroke, peak, systolic decline, small pulse of reflected pressure waves, dicrotic notch) may provide a number of useful haemodynamic information. In fact, changes in the arterial pulse contour are due the interaction between the heart beat and the whole vascular properties. Vasoconstriction, vasodilatation, shock states (cardiogenic, hypovolaemic, distributive, obstructive), valve diseases (aortic stenosis, aortic regurgitation), ventricular dysfunction, cardiac tamponade are associated with particular arterial waveform characteristics that may suggest to the physician underlying condition that could be necessary to investigate properly. Finally, the effects of positive-pressure mechanical ventilation on heart–lung interaction, may suggest the existence of an absolute or relative hypovolaemia by means of the so-called dynamic indices of fluid responsiveness.
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Lameire, Norbert, Raymond Vanholder, and Wim Van Biesen. Clinical approach to the patient with acute kidney injury. Edited by Norbert Lameire. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780199592548.003.0222_update_001.
Full textAbstract:
The prognosis of acute kidney injury (AKI) depends on early diagnosis and therapy. A multitude of causes are classified according to their origin as prerenal, intrinsic (intrarenal), and post-renal.Prerenal AKI means a loss of renal function despite intact nephrons, for example, because of volume depletion and/or hypotension.There is a broad spectrum of intrinsic causes of AKI including acute tubular necrosis (ATN), interstitial nephritis, glomerulonephritis, and vasculitis. Evaluation includes careful review of the patient’s history, physical examination, urinalysis, selected urine chemistries, imaging of the urinary tree, and eventual kidney biopsy. The history should focus on the tempo of loss of function (if known), associated systemic diseases, and symptoms related to the urinary tract (especially those that suggest obstruction). In addition, a review of the medications looking for potentially nephrotoxic drugs is essential. The physical examination is directed towards the identification of findings of a systemic disease and a detailed assessment of the patient’s haemodynamic status. This latter goal may require invasive monitoring, especially in the oliguric patient with conflicting clinical findings, where the physical examination has limited accuracy.Excluding urinary tract obstruction is necessary in all cases and may be established easily by renal ultrasound.Distinction between the two most common causes of AKI (prerenal AKI and ATN) is sometimes difficult, especially because the clinical examination is often misleading in the setting of mild volume depletion or overload. Urinary chemistries, like calculation of the fractional excretion of sodium (FENa), may be used to help in this distinction. In contrast to FENa, the fractional excretion of urea has the advantage of being rather independent of diuretic therapy. Response to fluid repletion is still regarded as the gold standard in the differentiation between prerenal and intrinsic AKI. Return of renal function to baseline or resuming of diuresis within 24 to 72 hours is considered to indicate ‘transient, mostly prerenal AKI’, whereas persistent renal failure usually indicates intrinsic disease. Transient AKI may, however, also occur in short-lived ATN. Furthermore, rapid fluid application is contraindicated in a substantial number of patients, such as those with congestive heart failure.‘Muddy brown’ casts and/or tubular epithelial cell casts in the urine sediment are typically seen in patients with ATN. Their presence is an important tool in the distinction between ATN and prerenal AKI, which is characterized by a normal sediment, or by occasional hyaline casts. There is a possible role for new serum and/or urinary biomarkers in the diagnosis and prognosis of the patient with AKI, including the differential diagnosis between pre-renal AKI and ATN. Further studies are needed before their routine determination can be recommended.When a diagnosis cannot be made with reasonable certainty through this evaluation, renal biopsy should be considered; when intrarenal causes such as crescentic glomerulonephritis or vasculitis are suspected, immediate biopsy to avoid delay in the initiation of therapy is mandatory.