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Catecholamines, through stimulation of ADRs spanning the surface of human adipocytes, are known to be important in the regulation of plasiminogen activator inhibitor-1 PAI-1 ; expression and secretion. Aerobic exercise training AEX ; enhances both catecholamine sensitivity and fibrinolytic activity. The purpose of this study was to examine the contribution of ADR gene polymorphisms and their genegene interactions to the variability of exercise training-induced PAI-1 activity response. Thirty-four healthy sedentary men n 10 ; and women n 24 ; , aged 50-75 yrs completed 6 wks of dietary stabilization followed by baseline testing, 6 months of AEX, and final testing. ADR gene markers Glu12 Glu9 2bADR, Trp64Arg 3ADR, and Gln27Glu 2ADR ; were identified by PCR-RFLP. In multivariate analysis covariates: age, gender and change in % total body fat ; , the best fit model for response of PAI-1 activity included main effects of all 3 ADR gene loci and the effects of each of their gene-gene interactions P 0.005 ; with genetic factors contributing prominently to the overall model explained variance 43% ; . Change in % total body fat did not contribute significantly to the model P 0.77 ; . In general, carriers of variant alleles Glu9 2b-, Arg64 3-, and or Glu27 2-ADR ; demonstrated greater reduction of PAI-1 activity. In conclusion, the response of PAI-1 activity to AEX in older adults is associated with this multilocus ADR genotype, independent of changes in % total body fat.
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Safe but time consuming. Appropriate in highly motivated patients with ability to contract pelvic muscles who have no evidence of pelvic prolapse. Improves patient's ability to correctly identify contraction of pelvic muscles. No evidence of long-term benefit for decreasing incontinence frequency. May improve patient's ability to correctly contract pelvic muscles. No evidence of benefit compared with Kegel exercises alone. Not FDA-approved for treatment of stress incontinence. No good evidence of efficacy. May be appropriate in patients with other indications for these medications. Balanced and selective serotonin and norepinephrine reuptake inhibitor that increases urethral sphincter contraction during the storage phase of urination cycle. In final stages of FDA review. Patient sits in an FDA-approved chair that stimulates pelvic muscles via a low-intensity magnetic field. Treatments are administered twice weekly in 20-minute sessions for 8 weeks. Appropriate in patients with uncomplicated, mild stress incontinence who have never undergone surgery. Can be used on a temporary or occasional basis, such as in patients with exercise-induced incontinence. Requires manipulation and manual dexterity. Can be used on a temporary or long-term basis; often used in older patients who have not responded to other therapies. Long-term use requires monitoring for vaginal infection and ulceration. Can be used on a temporary or occasional basis, such as for exerciseinduced incontinence. Requires manipulation and manual dexterity. Most effective treatment, but incontinence may recur over time. Best treatment in patients with stress incontinence accompanied by uterine prolapse. Urethral sling created under local anesthesia, often in outpatient surgical unit. Effectiveness similar to that of colposuspension. Periurethral injection of collagen results in high short-term cure rates, but effectiveness diminishes over time. Appropriate in patients with difficult-to-control incontinence in whom urodynamic testing reveals intrinsic sphincter deficiency.
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VII. HOSPITAL COURSE A thorough discussion of what has transpired during the patients hospital stay up to the current time. It should include any new problems or changes in the previously listed problems, therapy drug and non-drug ; , lab values, vital signs and the overall clinical condition of the patient. The problem list in VII above should be revised if any changes have occurred during the hospital course. VIII. ASSESSMENT At this point, an assessment of the patient problems and therapy should be made. Evaluation and critique of the therapy already received by the patient would be appropriate. The student should correlate the problem list with the medications the patient has received and or is currently receiving. In evaluating the drug therapy, thorough consideration should be given to the various therapeutic alternatives available to treat each problem. Any recommended changes in drug therapy should be discussed and the specific therapeutic outcome desired clarified. IX. PLAN A plan should be developed which includes the recommended changes in drug therapy as identified in the assessment. A plan for monitoring of the final drug regimen to assure the desired therapeutic outcomes are occurring and the undesirable toxicities are minimized. X. DISCUSSION not needed for this Psych rotation ; The student should be familiar with all aspects of the drug therapy and problems being treated. Some aspect of the case may be isolated and discussed if appropriate. A. Discussion of Disease State The student should include a discussion of incidence, etiology, pathophysiology, Clinical symptomatology, Laboratory and Diagnostic Findings, Therapeutic options, Prognosis, complications, and natural course of disease. B. Discussion of Pharmacology Management Student will discuss the classical management and therapeutic options, therapeutic endpoint and goals of therapy. Included should be adverse effect of Pharmacologic therapy and Monitoring Parameters.
The main advantages to both newer thiazolidinediones were a small increase in hdl or good cholesterol, and less too-low blood sugar levels than three other older, cheaper drugs studied - glimepiride amaryl ; , glipizide glucotol ; , glyburide micronase, diabbeta, glynase prestab ; - known as second-generation sulfonylureas and
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