Datasets:

int1306866
/

test002

title stringclasses 18 values	content stringlengths 2 999	contents stringlengths 19 1.02k
InternalMed_Harrison	Beta Blockers β-Adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other proposed mechanisms by which beta blockers lower blood pressure include a central nervous system effect and inhibition of renin release. Beta blockers are particularly effective in hypertensive patients with tachycardia, and their hypotensive potency is enhanced by coadministration with a diuretic. In lower doses, some beta blockers selectively inhibit cardiac β1 receptors and have less influence on β2 receptors on bronchial and vascular smooth muscle cells; however, there seems to be no difference in the antihypertensive potencies of cardioselective and nonselective beta blockers. Some beta blockers have intrinsic sympathomimetic activity, although it is uncertain whether this constitutes an overall advantage or disadvantage in cardiac therapy. Beta blockers without intrinsic sympathomimetic activity decrease the rate of sudden	InternalMed_Harrison. Beta Blockers β-Adrenergic receptor blockers lower blood pressure by decreasing cardiac output, due to a reduction of heart rate and contractility. Other proposed mechanisms by which beta blockers lower blood pressure include a central nervous system effect and inhibition of renin release. Beta blockers are particularly effective in hypertensive patients with tachycardia, and their hypotensive potency is enhanced by coadministration with a diuretic. In lower doses, some beta blockers selectively inhibit cardiac β1 receptors and have less influence on β2 receptors on bronchial and vascular smooth muscle cells; however, there seems to be no difference in the antihypertensive potencies of cardioselective and nonselective beta blockers. Some beta blockers have intrinsic sympathomimetic activity, although it is uncertain whether this constitutes an overall advantage or disadvantage in cardiac therapy. Beta blockers without intrinsic sympathomimetic activity decrease the rate of sudden
Neurology_Adams	Further evidence of a genetic factor in the causation of MS is the finding that certain histocompatibility locus antigens (HLAs) are more frequent in patients with MS than in control subjects. The strongest association is with the DR locus on chromosome 6. Other HLA haplotypes that are overrepresented in MS (HLA-DR2 and, to a lesser extent, -DR3, -B7, and -A3) are thought to be markers for an MS “susceptibility gene”—possibly an immune response gene. The presence of one of these markers increases the risk that an individual will develop MS by a factor of 3 to 5. These antigens may indeed prove to be related to the frequency of the disease, but their presence is not invariable and their exact role is far from clear. A genome-wide association study identified several alleles, interleukin (IL)-2Rα, and IL7Rα in addition to the previously established HLA loci, as heritable risk factors for MS (International Multiple Sclerosis Genetics Consortium). These findings, although they apply to a	Neurology_Adams. Further evidence of a genetic factor in the causation of MS is the finding that certain histocompatibility locus antigens (HLAs) are more frequent in patients with MS than in control subjects. The strongest association is with the DR locus on chromosome 6. Other HLA haplotypes that are overrepresented in MS (HLA-DR2 and, to a lesser extent, -DR3, -B7, and -A3) are thought to be markers for an MS “susceptibility gene”—possibly an immune response gene. The presence of one of these markers increases the risk that an individual will develop MS by a factor of 3 to 5. These antigens may indeed prove to be related to the frequency of the disease, but their presence is not invariable and their exact role is far from clear. A genome-wide association study identified several alleles, interleukin (IL)-2Rα, and IL7Rα in addition to the previously established HLA loci, as heritable risk factors for MS (International Multiple Sclerosis Genetics Consortium). These findings, although they apply to a
Immunology_Janeway	A lymphocyte expresses many exact copies of a single antigen receptor that has a unique antigen-binding site (see Section 1-12). The clonal expression of antigen receptors means that each lymphocyte is unique among the billions of lymphocytes that each person possesses. Chapter 4 described the structural features of immunoglobulins and T-cell receptors, the antigen receptors on B cells and T cells, respectively. We saw that the vast repertoire of antigen receptors results from variations in the amino acid sequence at the antigen-binding site, which is composed of the two variable regions from the two chains of the receptor. In immunoglobulins, these are the heavy-chain variable region (VH) and the light-chain variable region (VL), and in T-cell receptors, the Vα and Vβ regions. The immunoglobulin domains of these regions contain three loops that comprise three hypervariable regions, or complementarity-determining regions (CDRs) (see Section 4-6) that determine the receptor’s antigen	Immunology_Janeway. A lymphocyte expresses many exact copies of a single antigen receptor that has a unique antigen-binding site (see Section 1-12). The clonal expression of antigen receptors means that each lymphocyte is unique among the billions of lymphocytes that each person possesses. Chapter 4 described the structural features of immunoglobulins and T-cell receptors, the antigen receptors on B cells and T cells, respectively. We saw that the vast repertoire of antigen receptors results from variations in the amino acid sequence at the antigen-binding site, which is composed of the two variable regions from the two chains of the receptor. In immunoglobulins, these are the heavy-chain variable region (VH) and the light-chain variable region (VL), and in T-cell receptors, the Vα and Vβ regions. The immunoglobulin domains of these regions contain three loops that comprise three hypervariable regions, or complementarity-determining regions (CDRs) (see Section 4-6) that determine the receptor’s antigen
Neurology_Adams	Lesions of the macula, retina, or optic nerve cause a scotoma (an island of impaired vision surrounded by normal vision) rather than a defect that extends to the periphery of one visual field (“field deficit”). Scotomas are named according to their position (central, cecocentral) or their shape (ring, arcuate). A small scotoma that is situated in the macular part of the visual field may seriously impair visual acuity.	Neurology_Adams. Lesions of the macula, retina, or optic nerve cause a scotoma (an island of impaired vision surrounded by normal vision) rather than a defect that extends to the periphery of one visual field (“field deficit”). Scotomas are named according to their position (central, cecocentral) or their shape (ring, arcuate). A small scotoma that is situated in the macular part of the visual field may seriously impair visual acuity.
InternalMed_Harrison	the per-specimen cost of point-of-care testing, in terms both of reagents and supplies and of personnel, is often greater than that of centralized testing. Other concerns relate to the adequacy of personnel training for point-of-care testing, the quality of the results, and the incorporation of results into the medical record.	InternalMed_Harrison. the per-specimen cost of point-of-care testing, in terms both of reagents and supplies and of personnel, is often greater than that of centralized testing. Other concerns relate to the adequacy of personnel training for point-of-care testing, the quality of the results, and the incorporation of results into the medical record.
InternalMed_Harrison	30-35 Based on estimates from the United Nations 25-30 Population Division, 809 million people were 20-25 15-20 age 60 years or older in 2012, of whom 279 mil 5-10 million in less developed countries (as classified < 5 by the United Nations). The countries with the largest populations of those age 60 and older	InternalMed_Harrison. 30-35 Based on estimates from the United Nations 25-30 Population Division, 809 million people were 20-25 15-20 age 60 years or older in 2012, of whom 279 mil 5-10 million in less developed countries (as classified < 5 by the United Nations). The countries with the largest populations of those age 60 and older
Surgery_Schwartz	Serial magnetic resonance imaging may be necessary to confirm the diagnosis.31Potassium Hyperkalemia Treatment options for symptomatic hyperka-lemia are listed in Table 3-14. The goals of therapy include reducing the total body potassium, shifting potassium from the extracellular to the intracellular space, and protecting the cells from the effects of increased potassium. For all patients, exogenous sources of potassium should be removed, including potassium supplementation in IV fluids and enteral and paren-teral solutions. Potassium can be removed from the body using a cation-exchange resin such as Kayexalate that binds potas-sium in exchange for sodium. It can be administered either orally, in alert patients, or rectally. Immediate measures also should include attempts to shift potassium intracellularly with glucose and bicarbonate infusion. Nebulized albuterol (10 to 20 mg) may also be used. Use of glucose alone will cause a rise in insulin secretion, but in the acutely ill, this	Surgery_Schwartz. Serial magnetic resonance imaging may be necessary to confirm the diagnosis.31Potassium Hyperkalemia Treatment options for symptomatic hyperka-lemia are listed in Table 3-14. The goals of therapy include reducing the total body potassium, shifting potassium from the extracellular to the intracellular space, and protecting the cells from the effects of increased potassium. For all patients, exogenous sources of potassium should be removed, including potassium supplementation in IV fluids and enteral and paren-teral solutions. Potassium can be removed from the body using a cation-exchange resin such as Kayexalate that binds potas-sium in exchange for sodium. It can be administered either orally, in alert patients, or rectally. Immediate measures also should include attempts to shift potassium intracellularly with glucose and bicarbonate infusion. Nebulized albuterol (10 to 20 mg) may also be used. Use of glucose alone will cause a rise in insulin secretion, but in the acutely ill, this
InternalMed_Harrison	Glucose tolerance is classified into three broad categories: normal glucose homeostasis, DM, or impaired glucose homeostasis. Glucose tolerance can be assessed using the fasting plasma glucose (FPG), the response to oral glucose challenge, or the hemoglobin A1c (HbA1c). An FPG <5.6 mmol/L (100 mg/dL), a plasma glucose <140 mg/dL (11.1 mmol/L) following an oral glucose challenge, and an HbA1c <5.7% are considered to define normal glucose tolerance. The International Expert Committee with members appointed by the ADA, the European Association for the Study of Diabetes, and the International Diabetes Federation have issued diagnostic criteria for DM (Table 417-2) based on the following premises: (1) the FPG, the response to an oral glucose challenge (oral glucose tolerance test [OGTT]), and HbA1c differ among individuals, and (2) DM is defined as the level of glycemia at which diabetes-specific complications occur rather than on deviations from a population-based mean. For example, the	InternalMed_Harrison. Glucose tolerance is classified into three broad categories: normal glucose homeostasis, DM, or impaired glucose homeostasis. Glucose tolerance can be assessed using the fasting plasma glucose (FPG), the response to oral glucose challenge, or the hemoglobin A1c (HbA1c). An FPG <5.6 mmol/L (100 mg/dL), a plasma glucose <140 mg/dL (11.1 mmol/L) following an oral glucose challenge, and an HbA1c <5.7% are considered to define normal glucose tolerance. The International Expert Committee with members appointed by the ADA, the European Association for the Study of Diabetes, and the International Diabetes Federation have issued diagnostic criteria for DM (Table 417-2) based on the following premises: (1) the FPG, the response to an oral glucose challenge (oral glucose tolerance test [OGTT]), and HbA1c differ among individuals, and (2) DM is defined as the level of glycemia at which diabetes-specific complications occur rather than on deviations from a population-based mean. For example, the
Physiology_Levy	Controls: rest Sens 1 Sens 2 •Fig. 17.41 Effects of Different Stimuli on Regional Blood Flow in the Contralateral Human Cerebral Cortex. Sens1,low-intensityelectricalstimulationofthehand;Sens2,high-intensity(painful)electricalstimulationofthehand.Otherstimuliareasnoted.(RedrawnfromIngvarDH.Brain Res. 1976;107:181.) on stimulation. The sympathetic nervous system exerts the most prominent effect on cerebral blood flow during pathophysiological conditions.	Physiology_Levy. Controls: rest Sens 1 Sens 2 •Fig. 17.41 Effects of Different Stimuli on Regional Blood Flow in the Contralateral Human Cerebral Cortex. Sens1,low-intensityelectricalstimulationofthehand;Sens2,high-intensity(painful)electricalstimulationofthehand.Otherstimuliareasnoted.(RedrawnfromIngvarDH.Brain Res. 1976;107:181.) on stimulation. The sympathetic nervous system exerts the most prominent effect on cerebral blood flow during pathophysiological conditions.
Neurology_Adams	The most important neurotransmitter substances from the point of view of basal ganglionic function are glutamate, GABA, dopamine, acetylcholine, and serotonin. A more complete account of this subject may be found in the reviews of Penney and Young, of Alexander and Crutcher, and of Rao. The following is what is known with a fair degree of certainty. Glutamate is the neurotransmitter of the excitatory projections from the cortex to the striatum and of the excitatory neurons of the subthalamic nucleus. GABA is the inhibitory neurotransmitter of striatal, pallidal, and substantia nigra (pars reticulata) projection neurons.	Neurology_Adams. The most important neurotransmitter substances from the point of view of basal ganglionic function are glutamate, GABA, dopamine, acetylcholine, and serotonin. A more complete account of this subject may be found in the reviews of Penney and Young, of Alexander and Crutcher, and of Rao. The following is what is known with a fair degree of certainty. Glutamate is the neurotransmitter of the excitatory projections from the cortex to the striatum and of the excitatory neurons of the subthalamic nucleus. GABA is the inhibitory neurotransmitter of striatal, pallidal, and substantia nigra (pars reticulata) projection neurons.
Neurology_Adams	A considerable group of patients come to the physician with physical complaints, the most common being dizziness, a vague mental “fogginess,” and nondescript headaches. The patient’s inability to give a coherent account of his symptoms bears witness to the presence of dementia. Sleep disturbances, especially insomnia, are prominent in some cases and a particular disorder relating to the acting out of dreams during REM sleep marks some of the degenerative dementia. Sometimes the mental failure is brought to light more dramatically by a severe confusional state attending a febrile illness, a concussive head injury, an operative procedure, or the administration of some new medicine, as discussed in the following text and in Chap. 19. As noted there, the family almost uniformly, but mistakenly, dates an abrupt onset of dementia to the time of the intercurrent illness, a fall, or an operation.	Neurology_Adams. A considerable group of patients come to the physician with physical complaints, the most common being dizziness, a vague mental “fogginess,” and nondescript headaches. The patient’s inability to give a coherent account of his symptoms bears witness to the presence of dementia. Sleep disturbances, especially insomnia, are prominent in some cases and a particular disorder relating to the acting out of dreams during REM sleep marks some of the degenerative dementia. Sometimes the mental failure is brought to light more dramatically by a severe confusional state attending a febrile illness, a concussive head injury, an operative procedure, or the administration of some new medicine, as discussed in the following text and in Chap. 19. As noted there, the family almost uniformly, but mistakenly, dates an abrupt onset of dementia to the time of the intercurrent illness, a fall, or an operation.
Physiology_Levy	18. What are the roles of saccades and smooth pursuit movements in visual tracking? 19. What is nystagmus, and what types of sensory stimulation can drive nystagmus in a normal individual? 20. What is the somatotopic organization of the different CNS regions involved in motor control. ovements are the major way in which humans interact with the world. Most activities— including running, reaching, eating, talking, writing, and reading—ultimately involve motor acts. Thus motor control is a major task of the central nervous system (CNS), and from an evolutionary perspective, it is probably the reason that nervous systems first arose. Not surprisingly, a large amount of the CNS is devoted to motor control, which can be defined as the generation of signals to coordinate contraction of the musculature of the body and head, either to maintain a posture or to make a movement (transition between two postures).	Physiology_Levy. 18. What are the roles of saccades and smooth pursuit movements in visual tracking? 19. What is nystagmus, and what types of sensory stimulation can drive nystagmus in a normal individual? 20. What is the somatotopic organization of the different CNS regions involved in motor control. ovements are the major way in which humans interact with the world. Most activities— including running, reaching, eating, talking, writing, and reading—ultimately involve motor acts. Thus motor control is a major task of the central nervous system (CNS), and from an evolutionary perspective, it is probably the reason that nervous systems first arose. Not surprisingly, a large amount of the CNS is devoted to motor control, which can be defined as the generation of signals to coordinate contraction of the musculature of the body and head, either to maintain a posture or to make a movement (transition between two postures).
Immunology_Janeway	It has become apparent that there are many different phenotypic subtypes of asthma. These subtypes are being recognized because patients differ widely in responsiveness to different therapies, in the nature of the inflammatory cell infiltrates that are present in their airways, and in the molecular signature of inflammatory mediators that can be recovered from the airways. Many investigators refer to these subtypes as asthma ‘endotypes.’ The expectation is that classification of patients’ asthmas by endotype will elucidate differences in the underlying pathophysiology of their disease and will improve therapeutic outcomes by permitting their therapy to be matched to the underlying molecular disorder that is leading to symptoms. Some of the most common endotypes include common allergic asthma, exercise-induced asthma, neutrophil-predominant (as opposed to eosinophil-predominant) asthma, and steroid-resistant severe asthma. The fundamental driver of the allergic response in allergic	Immunology_Janeway. It has become apparent that there are many different phenotypic subtypes of asthma. These subtypes are being recognized because patients differ widely in responsiveness to different therapies, in the nature of the inflammatory cell infiltrates that are present in their airways, and in the molecular signature of inflammatory mediators that can be recovered from the airways. Many investigators refer to these subtypes as asthma ‘endotypes.’ The expectation is that classification of patients’ asthmas by endotype will elucidate differences in the underlying pathophysiology of their disease and will improve therapeutic outcomes by permitting their therapy to be matched to the underlying molecular disorder that is leading to symptoms. Some of the most common endotypes include common allergic asthma, exercise-induced asthma, neutrophil-predominant (as opposed to eosinophil-predominant) asthma, and steroid-resistant severe asthma. The fundamental driver of the allergic response in allergic
InternalMed_Harrison	Terminally ill patients have a wide variety of advanced diseases, often with multiple symptoms that demand relief, and require noninvasive therapeutic regimens to be delivered in flexible care settings. Fundamental to ensuring quality palliative and end-of-life care is a focus on four broad domains: (1) physical symptoms; (2) psychological symptoms; (3) social needs that include interpersonal relationships, caregiving, and economic concerns; and (4) existential or spiritual needs. A comprehensive assessment screens for and evaluates needs in each of these four domains. Goals for care are established in discussions with the patient and/or family, based on the assessment in each of the domains. Interventions then are aimed at improving or managing symptoms and needs. Although physicians are responsible Decedents, % 60.00 50.00 40.00 30.00 20.00 10.00 0.00 FIgURE 10-1 Graph showing trends in the site of death in the last two decades.	InternalMed_Harrison. Terminally ill patients have a wide variety of advanced diseases, often with multiple symptoms that demand relief, and require noninvasive therapeutic regimens to be delivered in flexible care settings. Fundamental to ensuring quality palliative and end-of-life care is a focus on four broad domains: (1) physical symptoms; (2) psychological symptoms; (3) social needs that include interpersonal relationships, caregiving, and economic concerns; and (4) existential or spiritual needs. A comprehensive assessment screens for and evaluates needs in each of these four domains. Goals for care are established in discussions with the patient and/or family, based on the assessment in each of the domains. Interventions then are aimed at improving or managing symptoms and needs. Although physicians are responsible Decedents, % 60.00 50.00 40.00 30.00 20.00 10.00 0.00 FIgURE 10-1 Graph showing trends in the site of death in the last two decades.
Surgery_Schwartz	clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL, LaMonte MJ, Walker JM, Cloward TV, Davidson LE, Crosby RD. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7(5):605-610. 98. Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809-814. 99. Palla A, Digiorgio M, Carpene N, et al. Sleep apnea in mor-bidly obese patients: prevalence and clinical predictivity. Respiration. 2009;78(2):134-140. 100. Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C.	Surgery_Schwartz. clinical and research-based psychiatric assessment in bariatric surgical candidates. Surg Obes Relat Dis. 2010;6(6):628-634. 96. Rasmussen JJ, Fuller WD, Ali MR. Sleep apnea syndrome is significantly underdiagnosed in bariatric surgical patients. Surg Obes Relat Dis. 2012;8(5):569-573. 97. Kolotkin RL, LaMonte MJ, Walker JM, Cloward TV, Davidson LE, Crosby RD. Predicting sleep apnea in bariatric surgery patients. Surg Obes Relat Dis. 2011;7(5):605-610. 98. Daltro C, Gregorio PB, Alves E, et al. Prevalence and severity of sleep apnea in a group of morbidly obese patients. Obes Surg. 2007;17(6):809-814. 99. Palla A, Digiorgio M, Carpene N, et al. Sleep apnea in mor-bidly obese patients: prevalence and clinical predictivity. Respiration. 2009;78(2):134-140. 100. Sareli AE, Cantor CR, Williams NN, et al. Obstructive sleep apnea in patients undergoing bariatric surgery—a tertiary cen-ter experience. Obes Surg. 2011;21(3):316-327. 101. Lee YH, Johan A, Wong KK, Edwards N, Sullivan C.
Neurology_Adams	of neurosyphilis with these syndromes. The meningitis may persist in an asymptomatic state and, ultimately, after a period of years, may lead to parenchymal damage. In some cases, however, there is a natural subsidence of the meningitis.	Neurology_Adams. of neurosyphilis with these syndromes. The meningitis may persist in an asymptomatic state and, ultimately, after a period of years, may lead to parenchymal damage. In some cases, however, there is a natural subsidence of the meningitis.
Immunology_Janeway	the instability sequence, resulting in increased translation and more IL-2 protein. Finally, PI 3-kinase helps activate the protein kinase Akt (see Section 7-17), which generally promotes cell growth and survival, increasing the total production of IL-2 by activated T cells.	Immunology_Janeway. the instability sequence, resulting in increased translation and more IL-2 protein. Finally, PI 3-kinase helps activate the protein kinase Akt (see Section 7-17), which generally promotes cell growth and survival, increasing the total production of IL-2 by activated T cells.
Cell_Biology_Alberts	Riboswitches are particularly common in bacteria, in which they sense key small metabolites in the cell and adjust gene expression accordingly. Perhaps their most remarkable feature is the high specificity and affinity with which each recognizes only the appropriate small molecule; in many cases, every chemical feature of the small molecule is read by the RNA (Figure 7–55C). Moreover, the binding affinities observed are as tight as those typically observed between small molecules and proteins.	Cell_Biology_Alberts. Riboswitches are particularly common in bacteria, in which they sense key small metabolites in the cell and adjust gene expression accordingly. Perhaps their most remarkable feature is the high specificity and affinity with which each recognizes only the appropriate small molecule; in many cases, every chemical feature of the small molecule is read by the RNA (Figure 7–55C). Moreover, the binding affinities observed are as tight as those typically observed between small molecules and proteins.
Neurology_Adams	Diagnosis Because the symptoms of plumbism are nonspecific, the diagnosis depends on an appreciation of the potential causative factors and the results of certain laboratory tests. Lead lines at the metaphyses of long bones and basophilic stippling of red cells are seen but are too inconstant to be relied on, but basophilic stippling of bone marrow erythroblasts is uniformly increased. Impairment of hemoglobin synthesis, which is exquisitely sensitive to the toxic effects of lead, results in the increased excretion of urinary coproporphyrin (UCP) and of Δ-aminolevulinic acid (ALA). These urinary indices and the lead concentrations in the serum bear an imperfect relationship to the clinical manifestations. In the test for UCP, which is readily performed in the clinic and emergency department, a few milliliters of urine are acidified with acetic acid and shaken with an equal volume of ether; if coproporphyrin is present, the ether layer will reveal a reddish fluorescence under a Wood	Neurology_Adams. Diagnosis Because the symptoms of plumbism are nonspecific, the diagnosis depends on an appreciation of the potential causative factors and the results of certain laboratory tests. Lead lines at the metaphyses of long bones and basophilic stippling of red cells are seen but are too inconstant to be relied on, but basophilic stippling of bone marrow erythroblasts is uniformly increased. Impairment of hemoglobin synthesis, which is exquisitely sensitive to the toxic effects of lead, results in the increased excretion of urinary coproporphyrin (UCP) and of Δ-aminolevulinic acid (ALA). These urinary indices and the lead concentrations in the serum bear an imperfect relationship to the clinical manifestations. In the test for UCP, which is readily performed in the clinic and emergency department, a few milliliters of urine are acidified with acetic acid and shaken with an equal volume of ether; if coproporphyrin is present, the ether layer will reveal a reddish fluorescence under a Wood
Pathoma_Husain	Normal PT/PTT-Coagulation factors are not affected. 3. F. Initial treatment is corticosteroids. Children respond well; adults may show early response, but often relapse. 1. IVIG is used to raise the platelet count in symptomatic bleeding, but its effect is short-lived. 2. Splenectomy eliminates the primary source of antibody and the site of platelet destruction (performed in refractory cases). IV. MICROANGIOPATHIC HEMOLYTIC ANEMIA A. Pathologic formation of platelet microthrombi in small vessels 1. Platelets are consumed in the formation of microthrombi. 2. RBCs are "sheared" as they cross microthrombi, resulting in hemolytic anemia with schistocytes (Fig. 4.2). B. Seen in thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) C. TTP is due to decreased ADAMTS13, an enzyme that normally cleaves vWF multimers into smaller monomers for eventual degradation. Fig. 4.1 Petechiae involving skin. Fig. 4.2 Schistocyte. 1.	Pathoma_Husain. Normal PT/PTT-Coagulation factors are not affected. 3. F. Initial treatment is corticosteroids. Children respond well; adults may show early response, but often relapse. 1. IVIG is used to raise the platelet count in symptomatic bleeding, but its effect is short-lived. 2. Splenectomy eliminates the primary source of antibody and the site of platelet destruction (performed in refractory cases). IV. MICROANGIOPATHIC HEMOLYTIC ANEMIA A. Pathologic formation of platelet microthrombi in small vessels 1. Platelets are consumed in the formation of microthrombi. 2. RBCs are "sheared" as they cross microthrombi, resulting in hemolytic anemia with schistocytes (Fig. 4.2). B. Seen in thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS) C. TTP is due to decreased ADAMTS13, an enzyme that normally cleaves vWF multimers into smaller monomers for eventual degradation. Fig. 4.1 Petechiae involving skin. Fig. 4.2 Schistocyte. 1.
Psichiatry_DSM-5	Cannabis use disorder among adults typically involves well-established patterns of daily cannabis use that continue despite clear psychosocial or medical problems. Many adults have experienced repeated desire to stop or have failed at repeated cessation attempts. Milder adult cases may resemble the more common adolescent cases in that cannabis use is not as frequent or heavy but continues despite potential significant consequences of sustained use. The rate of use among middle-age and older adults appears to be increasing, likely because of a cohort ef— fect resulting from high prevalence of use in the late 1960s and the 19705.	Psichiatry_DSM-5. Cannabis use disorder among adults typically involves well-established patterns of daily cannabis use that continue despite clear psychosocial or medical problems. Many adults have experienced repeated desire to stop or have failed at repeated cessation attempts. Milder adult cases may resemble the more common adolescent cases in that cannabis use is not as frequent or heavy but continues despite potential significant consequences of sustained use. The rate of use among middle-age and older adults appears to be increasing, likely because of a cohort ef— fect resulting from high prevalence of use in the late 1960s and the 19705.
Obstentrics_Williams	By week 14, the loop of Henle is functional and reabsorption occurs (Smith, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Although the fetal kidneys produce urine, their ability to concentrate and modiy the pH is limited even in the mature fetus. Fetal urine is hypotonic with respect to fetal plasma and has low electrolyte concentrations.	Obstentrics_Williams. By week 14, the loop of Henle is functional and reabsorption occurs (Smith, 1992). New nephrons continue to be formed until 36 weeks. In preterm neonates, their formation continues after birth. Although the fetal kidneys produce urine, their ability to concentrate and modiy the pH is limited even in the mature fetus. Fetal urine is hypotonic with respect to fetal plasma and has low electrolyte concentrations.
Pediatrics_Nelson	One third of children with HSP develop renal involvement, which can be acute or chronic. Although renal involvement is mild in most cases, acute glomerulonephritis manifested by hematuria, hypertension, or acute renal failure can occur. Most cases of glomerulonephritis occur within the first few months of presentation, but rarely patients develop late renal disease, which ultimately can lead to chronic renal disease, including renal failure. Figure 87-1 Rash of Henoch-Schönlein purpura on the lower extremities of a child. Note evidence of both purpura and petechiae.	Pediatrics_Nelson. One third of children with HSP develop renal involvement, which can be acute or chronic. Although renal involvement is mild in most cases, acute glomerulonephritis manifested by hematuria, hypertension, or acute renal failure can occur. Most cases of glomerulonephritis occur within the first few months of presentation, but rarely patients develop late renal disease, which ultimately can lead to chronic renal disease, including renal failure. Figure 87-1 Rash of Henoch-Schönlein purpura on the lower extremities of a child. Note evidence of both purpura and petechiae.
Surgery_Schwartz	barriers to expansion. To date, the most headline-grabbing procedures have been the transvaginal and transgastric removal of the gallbladder84-86 (Fig. 14-25). To ensure safety, all human cases thus far have involved laparoscopic assistance to aid in retrac-tion and ensure adequate closure of the stomach or vagina. To date, thousands of transvaginal and transgastric procedures have been performed internationally, with two large registries dem-onstrating noninferiority to conventional laparoscopy.87 The fact that the vast majority of these procedures are being done trans-vaginally creates an obvious limitation in applicability.The rapid growth of endoscopic technology catalyzed by NOTES has already spun off new technologies capable of performing a wide variety of endoscopic surgical procedures from EMR, to ablation of Barrett’s esophagus, to creation of competent antireflux valves in patients with gastroesophageal reflux disease.Peroral esophageal myotomy (POEM) has shown promise as a	Surgery_Schwartz. barriers to expansion. To date, the most headline-grabbing procedures have been the transvaginal and transgastric removal of the gallbladder84-86 (Fig. 14-25). To ensure safety, all human cases thus far have involved laparoscopic assistance to aid in retrac-tion and ensure adequate closure of the stomach or vagina. To date, thousands of transvaginal and transgastric procedures have been performed internationally, with two large registries dem-onstrating noninferiority to conventional laparoscopy.87 The fact that the vast majority of these procedures are being done trans-vaginally creates an obvious limitation in applicability.The rapid growth of endoscopic technology catalyzed by NOTES has already spun off new technologies capable of performing a wide variety of endoscopic surgical procedures from EMR, to ablation of Barrett’s esophagus, to creation of competent antireflux valves in patients with gastroesophageal reflux disease.Peroral esophageal myotomy (POEM) has shown promise as a
Pharmacology_Katzung	One therapeutic application of this otherwise toxic effect of nitrite has been discovered. Cyanide poisoning results from complexing of cytochrome iron by the CN− ion. Methemoglobin iron has a very high affinity for CN−; thus, administration of sodium nitrite (NaNO2) soon after cyanide exposure regenerates active cytochrome. The cyanomethemoglobin produced can be further detoxified by the intravenous administration of sodium thiosulfate (Na2S2O3); this results in formation of thiocyanate ion (SCN−), a less toxic ion that is readily excreted. Methemoglobinemia, if excessive, can be treated by giving methylene blue intravenously. This antidote for cyanide poisoning (inhaled amyl nitrite plus intravenous sodium nitrite, followed by intravenous sodium thiocyanate and, if needed, methylene blue) is now being replaced by hydroxocobalamin, a form of vitamin B12, which also has a very high affinity for cyanide and combines with it to generate another form of vitamin B12.	Pharmacology_Katzung. One therapeutic application of this otherwise toxic effect of nitrite has been discovered. Cyanide poisoning results from complexing of cytochrome iron by the CN− ion. Methemoglobin iron has a very high affinity for CN−; thus, administration of sodium nitrite (NaNO2) soon after cyanide exposure regenerates active cytochrome. The cyanomethemoglobin produced can be further detoxified by the intravenous administration of sodium thiosulfate (Na2S2O3); this results in formation of thiocyanate ion (SCN−), a less toxic ion that is readily excreted. Methemoglobinemia, if excessive, can be treated by giving methylene blue intravenously. This antidote for cyanide poisoning (inhaled amyl nitrite plus intravenous sodium nitrite, followed by intravenous sodium thiocyanate and, if needed, methylene blue) is now being replaced by hydroxocobalamin, a form of vitamin B12, which also has a very high affinity for cyanide and combines with it to generate another form of vitamin B12.
Immunology_Janeway	autoantigenic peptides might be expressed at too low a level or bind too poorly to MHC molecules to drive thymic negative selection, but might be present at a sufficient level or bind strongly enough to drive positive selection. This hypothesis is supported by observations that I-Ag7, the MHC class II molecule in NOD mice, binds many peptides very poorly and may therefore be less effective in driving thymic negative selection. 15-23 Genetic variants that impair innate immune responses can predispose to T-cell-mediated chronic inflammatory disease.	Immunology_Janeway. autoantigenic peptides might be expressed at too low a level or bind too poorly to MHC molecules to drive thymic negative selection, but might be present at a sufficient level or bind strongly enough to drive positive selection. This hypothesis is supported by observations that I-Ag7, the MHC class II molecule in NOD mice, binds many peptides very poorly and may therefore be less effective in driving thymic negative selection. 15-23 Genetic variants that impair innate immune responses can predispose to T-cell-mediated chronic inflammatory disease.
InternalMed_Harrison	Neurally mediated syncope comprises a heterogeneous group of functional disorders that are characterized by a transient change in the reflexes responsible for maintaining cardiovascular homeostasis. Episodic vasodilation (or loss of vasoconstrictor tone) and bradycardia occur in varying combinations, resulting in temporary failure of blood pressure control. In contrast, in patients with orthostatic hypotension due to autonomic failure, these cardiovascular homeostatic reflexes are chronically impaired. Cardiac syncope may be due to arrhythmias or structural cardiac diseases that cause a decrease in cardiac output. The clinical features, underlying pathophysiologic mechanisms, therapeutic interventions, and prognoses differ markedly among these three causes.	InternalMed_Harrison. Neurally mediated syncope comprises a heterogeneous group of functional disorders that are characterized by a transient change in the reflexes responsible for maintaining cardiovascular homeostasis. Episodic vasodilation (or loss of vasoconstrictor tone) and bradycardia occur in varying combinations, resulting in temporary failure of blood pressure control. In contrast, in patients with orthostatic hypotension due to autonomic failure, these cardiovascular homeostatic reflexes are chronically impaired. Cardiac syncope may be due to arrhythmias or structural cardiac diseases that cause a decrease in cardiac output. The clinical features, underlying pathophysiologic mechanisms, therapeutic interventions, and prognoses differ markedly among these three causes.
Pharmacology_Katzung	E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability. TABLE 66–1 Important drug interactions. Macrolides The macrolides clarithromycin and erythromycin are known to inhibit CYP3A4 and P-glycoprotein. Azithromycin does not appear to inhibit CYP3A4 but is a modest inhibitor of P-glycoprotein. Monoamine Increased norepinephrine stored in oxidase adrenergic neuron. Displacement inhibitors of these stores by other drugs (MAOIs) may produce acute hypertensive response. MAOIs have intrinsic hypoglycemic activity.	Pharmacology_Katzung. E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability. TABLE 66–1 Important drug interactions. Macrolides The macrolides clarithromycin and erythromycin are known to inhibit CYP3A4 and P-glycoprotein. Azithromycin does not appear to inhibit CYP3A4 but is a modest inhibitor of P-glycoprotein. Monoamine Increased norepinephrine stored in oxidase adrenergic neuron. Displacement inhibitors of these stores by other drugs (MAOIs) may produce acute hypertensive response. MAOIs have intrinsic hypoglycemic activity.
Pharmacology_Katzung	the low extracellular pH favors the charged form, with less of the neutral base available for diffusion across the membrane. Conversely, adding bicarbonate to a local anesthetic—a strategy sometimes used in clinical practice—will raise the effective concentration of the nonionized form and thus shorten the onset time of a regional block.	Pharmacology_Katzung. the low extracellular pH favors the charged form, with less of the neutral base available for diffusion across the membrane. Conversely, adding bicarbonate to a local anesthetic—a strategy sometimes used in clinical practice—will raise the effective concentration of the nonionized form and thus shorten the onset time of a regional block.
Psichiatry_DSM-5	Alterations in neuromuscular control of breathing can occur in association with med- ications or substances used in individuals with mental health conditions, which can cause or exacerbate impairments of respiratory rhythm and ventilation. Individuals taking these medications have a sleep-related breathing disorder that could contribute to sleep distur- bances and symptoms such as sleepiness, confusion, and depression. Specifically, chronic use of long—acting opioid medications is often associated with impairment of respiratory con- trol leading to central sleep apnea. Individuals with central sleep apnea hypopneas can manifest with sleepiness or insomnia. There can be complaints of sleep fragmentation, including awakening with dyspnea. Some individuals are asymptomatic. Obstructive sleep apnea hypopnea can coexist with Cheyne—Stokes breathing, and thus snoring and abruptly terminating apneas may be ob- served during sleep.	Psichiatry_DSM-5. Alterations in neuromuscular control of breathing can occur in association with med- ications or substances used in individuals with mental health conditions, which can cause or exacerbate impairments of respiratory rhythm and ventilation. Individuals taking these medications have a sleep-related breathing disorder that could contribute to sleep distur- bances and symptoms such as sleepiness, confusion, and depression. Specifically, chronic use of long—acting opioid medications is often associated with impairment of respiratory con- trol leading to central sleep apnea. Individuals with central sleep apnea hypopneas can manifest with sleepiness or insomnia. There can be complaints of sleep fragmentation, including awakening with dyspnea. Some individuals are asymptomatic. Obstructive sleep apnea hypopnea can coexist with Cheyne—Stokes breathing, and thus snoring and abruptly terminating apneas may be ob- served during sleep.
Pathology_Robbins	Fig. 16.17 Hepatocyteinjuryinfattyliverdiseaseassociatedwithchronicalcoholuse.(A)Clusteredinflammatorycellsmarkingthesiteofanecrotichepatocyte.AMallory-Denkbodyispresentinanotherhepatocyte(arrow). (B)“Ballooned”hepatocytes(arrowheads) associatedwithclustersofinflammatorycells.Theinsetstainedforkeratins8and18(brown) showsaballoonedcell(dotted line) inwhichkeratinshavebeenubiquitinylatedandhavecollapsedintoanimmunoreactiveMallory-Denkbody,leavingthecytoplasm“empty.”(Courtesy of Dr. Elizabeth Brunt,Washington University, St. Louis, Missouri.) Macroscopically,fattyliverswithwidespreadsteatosisarelarge(weighing4–6kgormore),soft,yellow,andgreasy. Steatohepatitis. ThesechangestypicallyaremorepronouncedwithalcoholusethaninNAFLD,butcanbeseenineither: Hepatocyte ballooning. Singleorscatteredfociofcellsundergoswellingandnecrosis;aswithsteatosis,thesefeaturesaremostprominentinthecentrilobularregions( Fig.16.17A	Pathology_Robbins. Fig. 16.17 Hepatocyteinjuryinfattyliverdiseaseassociatedwithchronicalcoholuse.(A)Clusteredinflammatorycellsmarkingthesiteofanecrotichepatocyte.AMallory-Denkbodyispresentinanotherhepatocyte(arrow). (B)“Ballooned”hepatocytes(arrowheads) associatedwithclustersofinflammatorycells.Theinsetstainedforkeratins8and18(brown) showsaballoonedcell(dotted line) inwhichkeratinshavebeenubiquitinylatedandhavecollapsedintoanimmunoreactiveMallory-Denkbody,leavingthecytoplasm“empty.”(Courtesy of Dr. Elizabeth Brunt,Washington University, St. Louis, Missouri.) Macroscopically,fattyliverswithwidespreadsteatosisarelarge(weighing4–6kgormore),soft,yellow,andgreasy. Steatohepatitis. ThesechangestypicallyaremorepronouncedwithalcoholusethaninNAFLD,butcanbeseenineither: Hepatocyte ballooning. Singleorscatteredfociofcellsundergoswellingandnecrosis;aswithsteatosis,thesefeaturesaremostprominentinthecentrilobularregions( Fig.16.17A
Obstentrics_Williams	The risk of neonatal hypoxia or meconium aspiration is also greater. hus, care for the newborn should be provided immediately by an attendant who can skillfully clear the airway and ventilate a neonate as needed (Chap. 32, p. 608). he severely growth-restricted newborn is particularly susceptible to hypothermia and may also develop other metabolic derangements such as hypoglycemia, polycythemia, and hyperviscosity. In addition, low-birthweight newborns are at higher risk for motor and other neurological disabilities. Risk is greatest at the lowest extremes of birth weight (Baschat, 2009, 2014; Llurba, 2013).	Obstentrics_Williams. The risk of neonatal hypoxia or meconium aspiration is also greater. hus, care for the newborn should be provided immediately by an attendant who can skillfully clear the airway and ventilate a neonate as needed (Chap. 32, p. 608). he severely growth-restricted newborn is particularly susceptible to hypothermia and may also develop other metabolic derangements such as hypoglycemia, polycythemia, and hyperviscosity. In addition, low-birthweight newborns are at higher risk for motor and other neurological disabilities. Risk is greatest at the lowest extremes of birth weight (Baschat, 2009, 2014; Llurba, 2013).
Cell_Biology_Alberts	In plants, plasmodesmata perform Many of the Same Functions as Gap Junctions The tissues of a plant are organized on different principles from those of an animal. This is because plant cells are imprisoned within tough cell walls composed of an extracellular matrix rich in cellulose and other polysaccharides, as we discuss later. The cell walls of adjacent cells are firmly cemented to those of their neighbors, which eliminates the need for anchoring junctions to hold the cells in place. But a need for direct cell–cell communication remains. Thus, plant cells have only one class of intercellular junctions, plasmodesmata. Like gap junctions, they directly connect the cytoplasms of adjacent cells.	Cell_Biology_Alberts. In plants, plasmodesmata perform Many of the Same Functions as Gap Junctions The tissues of a plant are organized on different principles from those of an animal. This is because plant cells are imprisoned within tough cell walls composed of an extracellular matrix rich in cellulose and other polysaccharides, as we discuss later. The cell walls of adjacent cells are firmly cemented to those of their neighbors, which eliminates the need for anchoring junctions to hold the cells in place. But a need for direct cell–cell communication remains. Thus, plant cells have only one class of intercellular junctions, plasmodesmata. Like gap junctions, they directly connect the cytoplasms of adjacent cells.
InternalMed_Harrison	For many LSDs, the accumulated substrates are endogenously synthesized within particular tissue sites of pathology. Other diseases have greater exogenous substrate supplies. For example, they are delivered by low-density lipoprotein receptor–mediated uptake in Fabry and cholesteryl ester storage diseases (CESDs) or by phagocytosis in Gaucher disease type 1. The threshold hypothesis refers to a level of enzyme activity below which disease develops; small changes in enzyme activity near the threshold can lead to or prevent disease. A critical element of this model is that enzymatic activity can be challenged by changes in substrate flux based on genetic background, cell turnover, recycling, or metabolic demands. Thus, a set level of residual 432e-1 enzyme may be adequate for substrate in some tissues or cells but not in others. In addition, several variants of each LSD exist at a clinical level. These disorders therefore represent a continuum of manifestations that are not easily	InternalMed_Harrison. For many LSDs, the accumulated substrates are endogenously synthesized within particular tissue sites of pathology. Other diseases have greater exogenous substrate supplies. For example, they are delivered by low-density lipoprotein receptor–mediated uptake in Fabry and cholesteryl ester storage diseases (CESDs) or by phagocytosis in Gaucher disease type 1. The threshold hypothesis refers to a level of enzyme activity below which disease develops; small changes in enzyme activity near the threshold can lead to or prevent disease. A critical element of this model is that enzymatic activity can be challenged by changes in substrate flux based on genetic background, cell turnover, recycling, or metabolic demands. Thus, a set level of residual 432e-1 enzyme may be adequate for substrate in some tissues or cells but not in others. In addition, several variants of each LSD exist at a clinical level. These disorders therefore represent a continuum of manifestations that are not easily
Gynecology_Novak	A nonclassic form of this disorder may be associated with heterosexual precocious pubertal development (as is the classic form if untreated), but postpubertal hyperandrogenism occurs more often. The androgen excess in individuals with nonclassic 3β-HSD deficiency appears to result from androgens derived from the peripheral conversion of increased serum concentrations of DHEA. This disorder is inherited in autosomal recessive fashion, with allelism at the 3β-HSD gene on chromosome 1 believed to be responsible for the varying degrees of enzyme deficiency.	Gynecology_Novak. A nonclassic form of this disorder may be associated with heterosexual precocious pubertal development (as is the classic form if untreated), but postpubertal hyperandrogenism occurs more often. The androgen excess in individuals with nonclassic 3β-HSD deficiency appears to result from androgens derived from the peripheral conversion of increased serum concentrations of DHEA. This disorder is inherited in autosomal recessive fashion, with allelism at the 3β-HSD gene on chromosome 1 believed to be responsible for the varying degrees of enzyme deficiency.
InternalMed_Harrison	undergoing resection and a complete mediastinal lymph node dissection compared with lymph node sampling. Moreover, complete mediastinal lymphadenectomy added little morbidity to a pulmonary resection for lung cancer when carried out by an experienced thoracic surgeon.	InternalMed_Harrison. undergoing resection and a complete mediastinal lymph node dissection compared with lymph node sampling. Moreover, complete mediastinal lymphadenectomy added little morbidity to a pulmonary resection for lung cancer when carried out by an experienced thoracic surgeon.
Surgery_Schwartz	cells, which may explain large inter-individual variability in innate cytokine profiles observed following injury. Epinephrine infusion at higher doses has been found to inhibit production of tumor necrosis factor (TNF)-alpha in vivo and to enhance the production of the anti-inflammatory cytokine interleukin IL-10.97 Additionally, in vitro studies indi-cate that stress levels of glucocorticoids and epinephrine, acting in concert, can inhibit production of IL-12, a potent stimulator of Th1 responses. Further, they have been shown in vitro to decrease Th1 cytokine production and increase Th2 cytokine production to a significantly greater degree compared to either adrenal hormone alone. Thus, catecholamines secreted from the adrenal, specifically epinephrine, play a role in both innate proinflammatory cytokine regulation, as well as adaptive Th responses, and may act in concert with cortisol during the injury response to modulate cytokine activity.98How are these effects explained? It is	Surgery_Schwartz. cells, which may explain large inter-individual variability in innate cytokine profiles observed following injury. Epinephrine infusion at higher doses has been found to inhibit production of tumor necrosis factor (TNF)-alpha in vivo and to enhance the production of the anti-inflammatory cytokine interleukin IL-10.97 Additionally, in vitro studies indi-cate that stress levels of glucocorticoids and epinephrine, acting in concert, can inhibit production of IL-12, a potent stimulator of Th1 responses. Further, they have been shown in vitro to decrease Th1 cytokine production and increase Th2 cytokine production to a significantly greater degree compared to either adrenal hormone alone. Thus, catecholamines secreted from the adrenal, specifically epinephrine, play a role in both innate proinflammatory cytokine regulation, as well as adaptive Th responses, and may act in concert with cortisol during the injury response to modulate cytokine activity.98How are these effects explained? It is
Cell_Biology_Alberts	Figure 3–62 an evolutionary tree of selected protein kinases. A higher eukaryotic cell contains hundreds of such enzymes, and the human genome codes for more than 500. Note that only some of these, those discussed in this book, are shown. Figure 3–64 The activation of a Src-type protein kinase by two sequential events. As described in the text, the requirement for multiple upstream events to trigger these processes allows the kinase to serve as a signal integrator (Movie 3.11). (Adapted from S.C. Harrison et al., Cell 112:737–740, 2003. With permission from Elsevier.) Figure 3–65 How a Src-type protein kinase acts as a signal-integrating device. A disruption of the inhibitory interaction illustrated for the SH3 domain (green) occurs when its binding to the indicated orange linker region is replaced with its higher-affinity binding to an activating ligand.	Cell_Biology_Alberts. Figure 3–62 an evolutionary tree of selected protein kinases. A higher eukaryotic cell contains hundreds of such enzymes, and the human genome codes for more than 500. Note that only some of these, those discussed in this book, are shown. Figure 3–64 The activation of a Src-type protein kinase by two sequential events. As described in the text, the requirement for multiple upstream events to trigger these processes allows the kinase to serve as a signal integrator (Movie 3.11). (Adapted from S.C. Harrison et al., Cell 112:737–740, 2003. With permission from Elsevier.) Figure 3–65 How a Src-type protein kinase acts as a signal-integrating device. A disruption of the inhibitory interaction illustrated for the SH3 domain (green) occurs when its binding to the indicated orange linker region is replaced with its higher-affinity binding to an activating ligand.
Surgery_Schwartz	multicenter, randomized trial of patients with ARDS from a variety of etiologies, limiting plateau airway pressure to less than 30 cm H2O and tidal volume to less than 6 mL/kg of ideal body weight reduced 28-day mortality by 22% relative to a ventilator strategy that used a tidal volume of 12 mL/kg.56 For this reason, monitoring of plateau pressure and using a low tidal volume strategy in patients with ARDS is now the standard of care. Recent data also suggest that a lung-protective ventila-tion strategy is associated with improved clinical outcomes in ventilated patients without ARDS.57 Importantly, this strategy also has been shown to have benefit for high-risk patients under-going general anesthesia for surgical procedures, leading to a reduced overall rate of pulmonary complications in the peri-operative period as well as a reduced length of stay following surgery.58Pulse OximetryThe pulse oximeter is a microprocessor-based device that inte-grates oximetry and plethysmography to	Surgery_Schwartz. multicenter, randomized trial of patients with ARDS from a variety of etiologies, limiting plateau airway pressure to less than 30 cm H2O and tidal volume to less than 6 mL/kg of ideal body weight reduced 28-day mortality by 22% relative to a ventilator strategy that used a tidal volume of 12 mL/kg.56 For this reason, monitoring of plateau pressure and using a low tidal volume strategy in patients with ARDS is now the standard of care. Recent data also suggest that a lung-protective ventila-tion strategy is associated with improved clinical outcomes in ventilated patients without ARDS.57 Importantly, this strategy also has been shown to have benefit for high-risk patients under-going general anesthesia for surgical procedures, leading to a reduced overall rate of pulmonary complications in the peri-operative period as well as a reduced length of stay following surgery.58Pulse OximetryThe pulse oximeter is a microprocessor-based device that inte-grates oximetry and plethysmography to
Pediatrics_Nelson	Retroperitoneal tumor (lymphoma), retroperitoneal fibrosis, chronic granulomatous disease Bladder Neurogenic dysfunction,* tumor (rhabdomyosarcoma), diverticula, ectopic ureter Urethra Posterior valves,* diverticula, strictures, atresia, ectopic ureter, foreign body, phimosis,* priapism *Relatively common. outlet obstruction in males, present in 1 in 50,000 boys.Parents may note a poor urine stream in affected children.The valves are sail-shaped membranes that arise from the verumontanum and attach to the urethral wall. The prostaticurethra becomes dilated, VUR may be present, and hypertrophied detrusor muscle develops. Renal dilation variesin severity. Some degree of renal dysplasia is often present.Severe obstruction may be associated with oligohydramnios, resulting in lethal pulmonary hypoplasia. Intrauterinerupture of the renal pelvis produces urinary ascites, which is the most common cause of ascites in the newborn period. Available @ StudentConsult.com	Pediatrics_Nelson. Retroperitoneal tumor (lymphoma), retroperitoneal fibrosis, chronic granulomatous disease Bladder Neurogenic dysfunction,* tumor (rhabdomyosarcoma), diverticula, ectopic ureter Urethra Posterior valves,* diverticula, strictures, atresia, ectopic ureter, foreign body, phimosis,* priapism *Relatively common. outlet obstruction in males, present in 1 in 50,000 boys.Parents may note a poor urine stream in affected children.The valves are sail-shaped membranes that arise from the verumontanum and attach to the urethral wall. The prostaticurethra becomes dilated, VUR may be present, and hypertrophied detrusor muscle develops. Renal dilation variesin severity. Some degree of renal dysplasia is often present.Severe obstruction may be associated with oligohydramnios, resulting in lethal pulmonary hypoplasia. Intrauterinerupture of the renal pelvis produces urinary ascites, which is the most common cause of ascites in the newborn period. Available @ StudentConsult.com