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MicroRNAs were discovered during experiments designed to learn how genes coordinate animal development. This chapter begins with the early studies that taught us the importance of microRNAs for mammalian development by studying what happened when key genes were deleted in mice. It ranges from studies that knocked out genes from the entire organism towards refined approaches that removed microRNAs at defined moments from specific tissues, including the heart and the visual system. A detailed review is taken of the genes that microRNAs regulate during brain development and their contribution to the diversity of cell types. These studies reveal the essential role for the microRNA system broadly, as well as how certain developmental events are more or less tolerant of disruption to the microRNA system. This chapter also reviews which microRNAs are the first to control gene activity after fertilisation and how environmental and parental experience can change microRNA activity. The chapter also includes explanations of the scientific toolkit needed to delete or deliver biogenesis components and microRNA genes, and how microRNAs have been used as tools in stem cell research.
Hearts of cotorsion pairs on extriangulated categories are abelian categories. On the other hand, hearts of twin cotorsion pairs are not always abelian. They were shown to be semi-abelian by Liu and Nakaoka. Moreover, Hassoun and Shah proved that they are quasi-abelian under certain conditions. In this article, we first show that the heart of any twin cotorsion pair has a largest exact category structure and is always quasi-abelian. We also provide a sufficient and necessary condition for the heart of a twin cotorsion pair being abelian. Then by using the results we have got, we investigate the almost split sequences in the hearts of twin cotorsion pairs. Finally, as an application, we show that a Krull–Schmidt, Hom-finite triangulated category has a Serre functor whenever it has a cluster tilting object.
In the first chapter I introduce some methodological issues pertaining to the history of mental health: on the one hand, the issue of anachronism, the problem of retrospective diagnosis, on the other, the importance of maintaining intelligibility across cultures. When it comes to the ancient world, there are specific problems related to the nature of medical sources in Greek and Latin, and our limited access to the medical practices underlying them; in addition, the genre 'biography of disease' has its own pitfalls, namely those of attributing ‘essence’ to what appears, prima facie, to be most of all a construct: a disease concept or label such as phrenitis. Finally, in this chapter I consider the label phrenitis, its etymological meanings and the implications of the name vis-à-vis localization (chest? lungs? diaphragm? heart?) and mental life (mind? character? soul? mental capacities?). I also discuss the ‘Homeric’ appeal of the phrēn/phrenes, the name of the body part from which the label originates. The poetic archaism of phrēn/phrenes combined with its medical use made it both understandable as a generic term for mental life and specifically a ‘medical’ term to indicate the diaphragm, and contributed to making phrenitis a long-lasting disease concept.
Valvular diseases are classified either as obstructing outflow (i.e., stenosis) or inadequately closing/coapting (i.e., regurgitation). Many mild–moderate valve lesions exist in a compensated or well-tolerated state; the tenets of hemodynamic management become particularly important in the severe or acute setting.
Phrenitis is ubiquitous in ancient medicine and philosophy. Galen mentions the disease innumerable times, patristic authors take it as a favourite allegory of human flaws, and no ancient doctor fails to diagnose it and attempt its cure. Yet the nature of this once famous disease has not been understood properly by scholars. This book provides the first full history of phrenitis. In doing so, it surveys ancient ideas about the interactions between body and soul, both in health and in disease. It also addresses ancient ideas about bodily health, mental soundness and moral 'goodness', and their heritage in contemporary psychiatric ideas. Readers will encounter an exciting narrative about health, illness and care as embedded in ancient 'life', but will also be forced to reflect critically on our contemporary ideas of what it means to be 'insane'. This title is also available as open access on Cambridge Core.
Acute coronary syndromes (ACS) are hard to diagnose because their clinical presentation is broad. Current guidelines suggest early clinical risk stratification to the optimal site of care. The aim of this study was to investigate the ability of Thrombolysis in Myocardial Infarction (TIMI); History, Electrocardiogram, Age, Risk Factors, Troponin (HEART); and Global Registry of Acute Coronary Events (GRACE) risk scores to predict the development of major adverse cardiac events (MACE) and the angiographic severity of coronary artery disease (CAD) in patients diagnosed with non-ST-segment elevation acute coronary syndrome (NSTEACS) in the emergency department (ED). In addition, independent variables associated with the development of MACE were also examined.
Methods:
This study is a prospective, observational, single-center study. All patients over 18 years of age who were planned to be hospitalized for pre-diagnosed NSTEACS (NSTEMI + UAP) were included in the study consecutively. Patients’ demographic information and all variables necessary for calculating risk scores (TIMI, HEART, and GRACE) were recorded. Two experienced cardiologists evaluated all coronary angiograms and calculated the Gensini score.
Results:
The median age was 60 (IQR: 18) years, and 220 (61.6%) were male of the 357 patients included in the study. In this study, 91 MACE (52 percutaneous coronary interventions [PCI], 28 coronary artery bypass graft [CABG], three cerebrovascular disease [CVD], and eight deaths) occurred. The 30-day MACE rate was 25.5%. The low-risk group constituted 40.0%, 1.4%, and 68.0% of the population, respectively, in TIMI, HEART, and GRACE scores. Multiple logistic regression models for predicting MACE, age (P = .005), mean arterial pressure (MAP; P = .015), and High-Sensitive Troponin I (P = .004) were statistically significant.
Conclusion:
The ability of the GRACE, HEART, and TIMI risk scores to predict severe CAD in patients with NSTEACS is similar. In patients with NSTEACS, the HEART and GRACE risk scores can better predict the development of MACE than the TIMI risk score. When low-risk groups are evaluated according to the three risk scores, the HEART score is more reliable to exclude the diagnosis of NSTEACS.
Though the Hippocratic text On the Heart has garnered significant attention in the twentieth and twenty-first centuries from classicists, physicians and historians of medicine alike, no commentary on this important work currently exists. There remain, however, central questions of interpretation concerning a number of important points: in particular, how the author understands the structure and functioning of the heart.
The significance of this text for the history of cardiovascular medicine can be found first in its position as being radically advanced in its portrayal of the inner structure of the heart when compared with any other Hippocratic text. At the same time, the text falls dramatically short of the discoveries of the Alexandrian researchers who studied during the Hellenistic period—that is, around the same period as this text’s likely composition. In addition, this work contains the first extant description of the valves of the heart, and its detailed descriptions of a cuspid valve and the chordae tendineae have led several scholars to imagine that this text even contains evidence of either a systematic dissection of an animal heart or—what seems impossible outside of Alexandria, Egypt at that time—evidence of the dissection of a human heart.
This article intends to provide a full commentary on the text by consolidating, and in some cases correcting, previous interpretive attempts to understand an often referenced, and at times misinterpreted, ancient medical treatise.
Intrauterine growth restriction (IUGR) exerts a negative impact on developing cardiomyocytes and emerging evidence suggests activation of oxidative stress pathways plays a key role in this altered development. Here, we provided pregnant guinea pig sows with PQQ, an aromatic tricyclic o-quinone that functions as a redox cofactor antioxidant, during the last half of gestation as a potential antioxidant intervention for IUGR-associated cardiomyopathy.
Methods:
Pregnant guinea pig sows were randomly assigned to receive PQQ or placebo at mid gestation and fetuses were identified as spontaneous IUGR (spIUGR) or normal growth (NG) near term yielding four cohorts: NG ± PQQ and spIUGR ± PQQ. Cross sections of fetal left and right ventricles were prepared and cardiomyocyte number, collagen deposition, proliferation (Ki67) and apoptosis (TUNEL) were analyzed.
Results:
Cardiomyocyte endowment was reduced in spIUGR fetal hearts when compared to NG; however, PQQ exerted a positive effect on cardiomyocyte number in spIUGR hearts. Cardiomyocytes undergoing proliferation and apoptosis were more common in spIUGR ventricles when compared with NG animals, which was significantly reduced with PQQ supplementation. Similarly, collagen deposition was increased in spIUGR ventricles and was partially rescued in PQQ-treated spIUGR animals.
Conclusion:
The negative influence of spIUGR on cardiomyocyte number, apoptosis, and collagen deposition during parturition can be suppressed by antenatal administration of PQQ to pregnant sows. These data identify a novel therapeutic intervention for irreversible spIUGR-associated cardiomyopathy.
Discussion of effects sex can have on different aspects of health including cardiovascular, pain perception, and brain health. Special issues between sex and situations such as pregnancy, diabetes, and heart disease. Tips for addressing worries about physical health and sex, including supporting one’s partner.
Japanese whalers use the electric lance as a secondary method of killing minke whales (Balaenoptera acutorostrata). The lances are dropped into the body, and currents varying between 2.2 and 14. OA, with a mean of 6.8A, are applied.
When currents of 5A were applied to the carcasses of dead whales, varying in size from 1.8 to 15.7m in length, no current densities induced in the target organs were sufficient to cause either insensibility (10mA cm−2 in the brain), or to cause ventricular fibrillation (0.5mA cm−2 in the heart), except in a few cases where electrodes were specifically placed to span the heart. When electrodes were placed in positions normally used in whaling operations, no current densities were produced which would have been sufficient to cause brain and cardiac dysfunction.
Further investigations on changes in current density with time post mortem after application of a controlled current of 5A showed, during a 60 hour period, a fourfold increase in the current density in the heart, and more than a twofold increase in the brain. Thus contrary to previous criticisms, if these studies had been carried out on live animals, all current densities would have been below threshold values.
There are no records of signs of epileptic form seizure, which are associated with an effective electrical stun, in whales subjected to the electric lance.
It is concluded that the electric lance as used in whaling operations is ineffective and likely to cause extra pain and suffering to an already distressed animal.
The surgical treatment of transposition of the great arteries, ventricular septal defect, and significant left ventricular outflow tract obstruction continues to evolve. The survival of an unrepaired transposition of the great arteries into late adulthood is a rarity. Even when large intracardiac shunts are present, it remains a lethal cyanotic CHD if it is not surgically corrected soon after birth. We present our experience of two cases, both of whom underwent a single-stage arterial switch operation and an aortic valve replacement for this defect.
This chapter analyzes the sermon given by Francisco de la Concepción Barbosa (1729) in the funeral rites for the heart of Baltasar de Zuñiga, marquis of Valero (1658-1727) and Viceroy of New Spain from 1716 to 1722. Once he returned to Spain, he arranged that, after his death, his heart would be embalmed and buried in the high altar of the Corpus Christi Franciscan convent for the Indian Cacicasthat he founded in Mexico in 1719 and was authorized by Luis I in 1724. It studies two aspects of the colonial discourse of the funeral for the heart: (a) its symbolic and emblematic context, as an imaginary relic that aspires to immortality beyond the corruption and fragmentation of the body; and (b) its historical context, in connection to the case of Bishop Fernandez de Santa Cruz, who also donated his heart to the convent of Santa Monica in Puebla (1699).
Here we uncover the mysteries of the baby as it develops in the womb, discussing how fetal development is controlled. We give insights into aspects of pregnancy not widely known, from the fetus starting to breathe months before it is born, to the question of whether it sleeps – and dreams. We discuss the ways in which information about the mother’s life and her environment affect the baby’s development. Although birth may seem the first major milestone for a baby, we emphasise that many other milestones have been passed before that, inside the womb, out of sight but over which parents can have substantial influence. We give insights into new discoveries about how the organs of the fetal body develop in prediction of the world in which that individual ‘expects’ to live, and what happens when the prediction turns out to be wrong. The idea that the fetus is preparing for life after birth will get the reader thinking about the long-term consequences of the way a fetus develops. Each of us is unique as a result of our development – and nobody is perfect. Our unique development starts from the moment of conception, which introduces the next chapter on sex.
A critical component of the theory of the multiple reserves is that the health of the body is good for the health of the brain. The brain is dependent on all other body parts for maintenance of its functions. This dependence upon other bodily functions is especially prominent in older persons, because of their lower reserve capacities. Research has shown that intensive blood pressure control is more effective than standard blood pressure control in reducing the risk of cognitive impairment. It is certainly true that "what is good for the heart is good for the brain.” It is valuable to have the best possible heart, lung, kidney, liver, and endocrine function. Diabetes increases the risk of Alzheimer’s disease as well as small and large strokes. Avoidance of obesity and physical exercise can lower the risk of diabetes. A high-fiber diet can improve insulin responsiveness and diminish the severity of diabetes. The recommendations in this book are good for the health of the heart, lungs and other organs as well as directly beneficial to the nervous system. Good systemic health means good physical reserve. Good physical reserve helps to maintain healthy brain function throughout life.
The ECG is a non-invasive representation of the activity of the cardiac electrical conducting system. ECGs are widely available in all hospitals and therefore interpretation is of great importance. ECGs allow assessment of cardiac rate, recognition of conduction blocks, myocardial ischaemia, life-threatening arrhythmias, and the effects of drugs. Therefore ECGs provide a wealth of information allowing safe and appropriate treatment strategies for patients. This chapter summarises the most salient features of common arrhythmias seen in clinical practice.
This chapter provides a detailed overview of the cardiovascular system in the context of perioperative care. The cardiovascular system is responsible for the delivery of oxygen around the body and the return of this blood to the heart. This blood is then pumped to the lungs and back to the heart. The systemic and pulmonary circulations have a number of important differences between them. The heart beats repeatedly in a process known as the cardiac cycle, which has two distinct phases, systole, and diastole. The conduction system of the heart allows for the chambers of the heart to contract in a well-coordinated manner. Problems with the cardiovascular system occur frequently under anaesthesia and can have numerous causes, some of which are explored in this chapter.
Telemann’s numerous compositions for the Christmas season reflect important changes in the understanding and celebration of the feast day throughout his prolific career. The early Christmas cantatas are influenced by an understanding of the feast that combined Lutheran mysticism with a language emphasizing the personal relationship between Christ and the believer through the physical/corporeal as well as emotional concepts: love, heart, desire, and so on. Telemann transferred this language to musical compositions featuring highly emotional melodic lines, often employing musical topi (such as sigh figures) that were familiar from pietist songs and operatic love arias. In his later works, especially in the cantata Die Hirten bei der Krippe to a text by Ramler, the focus shifts from personal emotionality to a divine encounter in nature. The pastoral sphere, influenced by the physico-theology of the time, replaces love arias from the earlier works. This chapter traces developments both in Telemann’s music and in theological discourse around the middle of the eighteenth century. It is not the understanding of Christmas that changes but rather the communicative function of emotion and affect both transforms and shifts throughout Telemann’s lifetime.
Axons of postganglionic neurons branch many times close to their effector cells and have hundreds to thousands of varicosities, which contain transmitter(s) packed in vesicles. Excitation of the postganglionic neurons spreads over all its branches and invades all varicosities. Signal transmission from postganglionic neurons to most effector cells occurs through specific neuroeffector synapses. In the heart, acetylcholine released by parasympathetic cardiomotor axons reacts with junctional muscarinic receptors that are coupled via a intracellular second-messenger pathway to the cellular effectors. Arterioles and small arteries are influenced by neural release of noradrenaline and ATP from the varicosities of the vasoconstrictor axons. The ATP reacts with junctional purinoceptors and opens ligand-gated cation channels, which cause activation of voltage-sensitive calcium channels and resultant action potentials. Noradrenaline released from the postganglionic vasoconstrictor terminals reacts with junctionally and extrajunctionally located a-adrenoceptors leading to slow depolarization in some blood vessels. The influence exerted by autonomic neurons on their effector tissues may be modulated by local and remote non-neural signals. The mechanisms of neuroeffector transmission in different autonomic targets are diverse. As no exceptions have yet been found, it is not far-fetched to assume that neuroeffector transmission is specific for all target cells innervated by postganglionic neurons.
William Harvey’s demonstration of the circulation of the blood is one of the Scientific Revolution’s most influential and lasting achievements. But in spite of Harvey’s innovation, and paradoxically given the extent to which he came to be represented as a founder of modern science, he tied himself to ancient authorities and sought to insulate natural philosophy and the art of medicine from the new mechanical-corpuscular and chemical philosophies of the period. The reception of Harvey’s work, both in physiology and later in embryology, shows that Harvey’s research program won numerous early converts, who used his program for their own ends, including support for the new philosophies, in the cases of René Descartes and Robert Boyle. Untethered from his preferred Scholastic framework, Harvey’s conceptual foundations, techniques, and conclusions led to new discoveries, and unresolved questions in Harvey’s account about the movement of the heart, nature of the blood, and respiration would motivate intense inquiry. The circulation of the blood and later physiology therefore provide an essential perspective for the examination of early modern disputes about experimentation and its limits, the rhetoric of novelty, the unity of nature, and the very notion of life.
In the absence of evidence-based guidelines, paediatric cardiologists monitor patients in the ambulatory care setting largely according to personal, patient, institutional, and/or financial dictates, all of which likely contribute to practice variability. Minimising practice variability may optimise quality of care while incurring lower costs. We sought to describe self-reported practice patterns and physician attitudes about factors influencing their testing strategies using vignettes describing common scenarios in the care of asymptomatic patients with tetralogy of Fallot and d-transposition of the great arteries.
Methods:
We conducted a cross-sectional survey of paediatric cardiologists attending a Continuing Medical Educational conference and at our centre. The survey elicited physician characteristics, self-reported testing strategies, and reactions to factors that might influence their decision to order an echocardiogram.
Results:
Of 267 eligible paediatric cardiologists, 110 completed the survey. The majority reported performing an annual physical examination (66–82%), electrocardiogram (74–79%), and echocardiogram (56–76%) regardless of patient age or severity of disease. Other tests (i.e. Holter monitors, exercise stress tests or cardiac MRIs) were ordered less frequently and less consistently. We observed within physician consistency in frequency of test ordering. In vignettes of younger children with mild disease, higher frequency testers were younger than lower frequency testers.
Conclusions:
These results suggest potential practice pattern variability, which needs to be further explored in real-life settings. If clinical outcomes for patients followed by low frequency testers match that of high frequency testers, then room to modify practice patterns and lower costs without compromising quality of care may exist.