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Our hormones do not decline because we age, we age because our hormones decline, " could be called the motto of Forever Ageless, a new book on anti-aging medicine by Ron Rothenberg, M.D., the founder of the California HealthSpan Institute, and Kathleen Becker, M.A., R.N., administrator and clinical coordinator. "Every hormone has a pause" could be regarded as a related motto, indicating that the so-called sex hormones are not the only hormones we need to be concerned about. Rothenberg and Becker point out that we also need to deal with each "pause" e.g. somatopause in the case of growth hormone ; , as well as do something to control the two powerful and potentially pro-aging hormones that increase with age: insulin and cortisol. The book presents a comprehensive anti-aging regimen including hormone replacement, hormonally correct diet aimed chiefly at controlling insulin ; , anti-aging supplements, exercise program and stress reduction. Summarized in this review are some highlights of this new book, with special emphasis on bioidentical hormone replacement. Bioidentical means that the hormones used are chemically identical with the hormones naturally found in the human body--unlike Premarin, Provera or methyltestosterone.
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Fig. 6. Effect of 1 M testosterone in the absence and presence of an aromatase inhibitor, anastrozole, on TNF -stimulated 10 ng ml ; VCAM-1 protein expression as analyzed by ELISA. Values represent absorbance OD ; at 490 nM. Quantitation is expressed as means SEM, obtained from three separate experiments. , Significant difference P 0.05 ; from TNF -only treated cells. * , Significant difference P 0.05 ; from the value in the preceding lane obtained in the absence of anastrozole 100 nM ; . Anastrozole was added to the culture medium containing HUVEC 60 min before the addition of testosterone.
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FOWLER ET AL. and BFC oxidation by compounds with molecular volumes less than 600 3 was unaffected, or only marginally affected, by the substitution of leucine 211 with phenylalanine or tyrosine. Changes in inhibition potencies of up to 43-fold were observed for compounds of molecular volume greater than 600 3 in the L211F and L211Y mutants. It is concluded that these mutations have reduced the CYP3A4 active site volume in a region remote from the catalytic center to create enzymes with effective active site volumes of 600 3. The ability of vinblastine, troleandomycin, and cyclosporin A to bind to the smaller active site of the mutants was reduced but not abolished. Similarly, the allosteric character of testosterone and BFC substratesaturation kinetics were reduced, but not abolished, by these mutations. It is likely that the CYP3A4 active site is flexible enough to accommodate substrate molecules with molecular volumes up to 750 3 or simultaneous binding of more than one smaller molecule. However, in the L211F and L211Y mutants, the amount of strain placed upon the enzyme when accommodating compounds of molecular volume 600 3 may have been increased, making such interactions less favorable.
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SkBF. Red blood cell RBC ; flux was measured via Laser-Doppler flowmetry DRT-4, Moor Instruments, Devon, UK ; on the ventral forearm to gain an index of SkBF. RBC flux was divided by MAP to produce an index of cutaneous vascular conductance CVC RBC flux MAP ; . CVC values are reported as a percentage of maximum CVC, which was achieved by locally heating each site to 43C until a plateau was reached for a minimum of 10 min. This temperature has been previously shown to elicit maximal dilation 19, 24, 38 ; . Tc and mean Tsk. Tc was measured via a wireless core body temperature monitoring system CorTemp2000, HQ ; . All subjects swallowed a disposable temperature sensor 8 10 h before the protocol. An unweighted average of five copper-constantan thermocouples, placed on the skin of the chest, abdomen, back, thigh, and calf, were used to measure mean Tsk. We did not use a weighted average to calculate Tsk because the thermocouples were placed under a waterperfused suit. Mean body temperature Tb ; was calculated as 0.8 Tc ; 0.2 mean Tsk ; Hormone and catecholamine profiles. Venous blood samples were collected from the antecubital vein from all subjects on each study day. Samples from women were collected for measurement of circulating levels of estradiol and progesterone to verify menstrual cycle phase and circulating catecholamine concentrations. Venous blood samples collected from men were used to measure the concentrations of testosterone, dihydrotestosterone, and catecholamines. All samples were collected after 30 min quiet rest in the supine position. Estradiol, progesterone, testosterone, and dihydrotestosterone samples were collected in 8.5-ml plastic collection tubes BD Vacutainer SST Gel & Clot Activator, Becton Dickinson, Franklin Lakes, NJ ; , and catecholamine samples were collected in 10-ml glass collection tubes BD Vacutainer heparin sodium, Becton Dickinson ; . Samples were separated via centrifuge at 1, 300 g for 12 min at 4C. Samples were stored frozen at 70C until transported to Oregon Medical Laboratories Eugene, OR ; for serum analysis of estradiol, progesterone, testosterone, and dihydrotestosterone all measured via radioimmunoassay ; and plasma analysis of catecholamines measured via high-performance liquid chromatography ; . Orthostatic tolerance. Orthostatic tolerance was estimated during the heated tilts by using a cumulative stress index CSI ; . The CSI allowed us to quantitatively compare the orthostatic tolerance between visits in subjects as well as across subject groups. The CSI was calculated by summing the products of the sine of each tilt angle and the duration of time completed at that tilt stage. A higher CSI indicates a greater orthostatic tolerance, with the maximum score equaling 20.4% gravitational stress times minutes for subjects who completed the full heated tilt test. Data Analysis The ECG, beat-to-beat arterial blood pressure, RBC flux, Tc, and Tsk signals were all digitized and stored on a computer at 250 Hz for later analysis with signal processing software Windaq, DataQ Instruments, Akron, OH ; . These data were averaged over the last 2 min of each completed tilt stage throughout the progressive preliminary, thermoneutral, and heated tilt tests. In addition, data were also averaged in 30-s intervals over the 2 min before presyncope in all women who failed to complete the full heated tilt tests. The intervals are as follows: 120 90 s before presyncope -90 ; , 90 60 s before presyncope -60 ; , 60 30 s before presyncope -30 ; , and 30 s to point of presyncope 0 ; . This heat-to-presyncope comparison was preformed on seven of the eight women because one woman completed the full heated tilt on two out of three study days and was therefore omitted from this comparison. Additionally, men were not included in this comparison because the majority of men completed the full heated tilt. All subjects completed the thermoneutral tilt test with the exception of one man who showed signs of presyncope and was returned to the supine position 1 min before completion of the full 60 head-up tilt. Data from the 60 thermoneutral head-up tilt in this.
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Penalty Determinations When determining the amount of a penalty, the judges should consider what penalty would best punish the violator for the harm caused by the violation and deter future similar violations by the violator and other licensees. The judges should avoid blindly assessing "consistent" penalties without regard to the specifics of each case. Each violation must be reviewed according to the individual circumstances of the case. The Legislature intended each Board of Judges to use the qualifications, experience, and collective wisdom of its members to act as an adjudicatory body when considering violations of the Act or the Rules. To ensure due process for the affected licensees, every violation must be judged on the evidence presented to the judges, with the judges weighing the evidence and the credibility of the witnesses. Mitigating Aggravating Circumstances Because the facts of each case will vary, an exhaustive list of mitigating or aggravating circumstances is not practical. Generally, mitigating or aggravating circumstances must be shown by persuasive, credible evidence that the circumstances were actually present in the instant case, not mere speculation that the circumstances could have been present. An example of mitigating circumstances is when the trainer presents credible evidence that another individual actually caused the greyhound to race with a prohibited substance in its system. An example of aggravating circumstances is when the staff or other party to the proceeding presents credible evidence that the trainer administered a prohibited substance or permitted a prohibited substance to be administered despite warnings that the administration of the substance would likely result in a positive test. The amount of the substance in a sample should not be considered a mitigating or aggravating factor. The definition of a prohibited substance adopted by the Commission in 319.1 b ; establishes a zero-tolerance standard. In other words, the presence in a post-race sample of any amount of a prohibited drug, chemical, or other substance is a per se violation of the Commission's rules. Penalty Recommendations The following recommended penalties should be followed in all cases in the absence of persuasive, credible evidence of mitigating circumstances justifying a lesser penalty or aggravating circumstances justifying an enhanced penalty. The recommended penalties for medication violations offer a range of penalties, including fines, suspension, and loss of purse. By offering a range of penalty, it is the intent of the Commission that for a first violation involving a particular substance, the penalty would be at the lower end of the range, absent mitigating or aggravating circumstances. Conversely, for a subsequent violation for a particular substance, the penalty would be at the higher end of the range. The penalty should be enhanced for subsequent violations regardless of when the subsequent violations occur with respect to the first violation. Because a licensee's compliance history with respect to a particular substance is incorporated into the recommended penalties.
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77 [p 298] Bayer AS, Edwards JE Jr, Seidel JS, Guze LB.: Candida meningitis. Report of seven cases and review of the english literature. Medicine 55: 477-486, 1976.
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He pharmaceutical industry justifies its extraordinary profits largely by the claim that they are necessary as an incentive to continue its vital research. The implication is that if the public wants new cures for diseases, it should give the industry free rein. It is important, then, to ask just how innovative the pharmaceutical industry really is. We think the answer is not very. Drug companies greatly exaggerate their role in the scientific work leading to the discovery of new drugs. As we have already noted, the development of important new drugs is usually the culmination of many discoveries in basic science laboratories outside the pharmaceutical industry. This work increases the understanding of the molecular basis of disease and thereby identifies promising targets and models for the design of new drugs. Most of this groundbreaking research, done with support from the National Institutes of Health NIH ; or other institutions, appears in scientific journals before the big companies become involved. The industry is certainly not the major engine of discovery and medical progress that it would have the public believe. Public investment in research has been primarily responsible for the great medical advances society is enjoying, and this is likely to be so the future as well. A general idea of the relative contribution of the pharmaceutical industry to the underlying medical research that leads to the development of new drugs can be gained from a recent study published in the journal Health Affairs. The study reported that in 1998 only about 15 percent of the scientific articles cited in patent applications for clinical medicine came from industry research, while 54 percent came from academic centers, 13 percent from government, and the rest from vari.
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Marijuana use may trigger a heart attack in one of several ways, said Mittleman Marijuana Increases Heart Attack "We know that after smoking a single marijuana cigarette, there is a doseRisk? dependent increase in heart rate, WASHINGTON, DC -- Reuters; June typically a doubling in heart rate is not 11, 2001 Will Dunham ; -- The risk of a at all surprising. There are also heart attack jumps nearly five-fold complicated effects on blood pressure." during the first hour after smoking Marijuana use is also linked to a rise in marijuana, posing a particular threat to the heart's demand for oxygen, while middle-aged users of the drug, according simultaneously lowering the supply of to a study appearing in the journal oxygen in the blood. Circulation, published by the American [In rebuttal to the claims of this Heart Association. The researchers said the results support research, the Lindesmith Center-Drug Researchers led by Dr. Murray the belief that dysfunctional neural Policy Foundation noted on June 15, Mittleman, director of cardiovascular mechanisms and psychological decision2001 that an analysis of the methods epidemiology at Beth Israel Deaconess making processes may contribute to a used in this study reveals glaring flaws. Medical Center in Boston, interviewed broad range of "impulse" disorders. The sample size was statistically 3, 882 people who had suffered a heart Breiter added, "A challenge for future insignificant and no casual relationship attack. The likelihood of suffering a work is to determine the roles played by was established. Out of 3, 882 patients heart attack was 4.8 times greater in the the different components of this circuitry who had heart attacks, 124 were current first hour after smoking marijuana when in the cognitive, emotional, and marijuana smokers and only 9 had compared to periods of non-use of the motivational processes involved in smoked within an hour of their heart drug, Mittleman found. In the second anticipation, evaluation, and decisionattacks. hour after smoking the drug, the risk was making." According to the Lindesmith Center, the 1.7 times greater. Starting in the third The study was published in the May 24, hour after smoking marijuana, no conclusions reached on the basis of this 2001 issue of Neuron. small sample are inappropriate and, significant risk rise was documented. essentially, "junk science." Even Americans Support Drug "I think the message is that for assuming that Mittleman's conclusions Treatment Over Jail individuals who are entering the age are correct, "the fact that heart attack group where coronary disease is USA -- ABCNews; June 6, 2001 -- A risk for an otherwise healthy 50-yearprevalent -- particularly if they have new survey found that most Americans old man is about 10 in 1 million established coronary disease or have are in favor of treatment over jail for highlights the sensationalism of the multiple risk factors -- that they should first- and second-time drug offenders. widespread publicity the study is think about whether it's reasonable to According to an ABCNews poll, receiving."] continue smoking marijuana, " 69% of the 1, 024 adults surveyed said they believe treatment programs would Mittleman said. #57 - July 2001 be better than incarceration for drug Smoking marijuana was less risky as a users. Benefits of Patient-Regulated heart attack trigger than using cocaine, Methadone which raises the risk 25-fold during the The telephone poll conducted May 16first hour after use, the study found. The WASHINGTON, DC -- Journal of 20 also showed that better-educated heightened risk from marijuana was people tend to support treatment over Substance Abuse Treatment; roughly equivalent to vigorous exercise Implementation of a clinic policy of jail, as do women and for someone of average fitness, and democrats independents. According to client-regulated methadone dosing; more dangerous than sexual intercourse April 2001, Vol. 20, No. 3: Pp. 225-230 the survey, 66% of men and 62% of Republicans favor treatment, compared for a sedentary person. Robles E, Miller FB, Gilmore-Thomas KK, McMillan DE ; -- Methadone.
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Most cases of angioedema are not HAE because swelling attacks are typically caused by something other than C1-inhibitor deficiency, usually an allergic reaction. Laboratory analysis of blood samples or genetic testing is required to establish the HAE diagnosis. There are two specific blood tests that confirm HAE: 1. C1-inhibitor quantitative antigenic ; 2. C1-inhibitor functional Traditionally, HAE has been classified into two types. The most common form of the disease--Type I--is characterized by low quantitative levels of C1-inhibitor and affects about 85% of patients. Type II HAE affects the other 15% of patients who have normal or elevated levels of C1-inhibitor, but the protein does not function properly. Several investigators have noted a familial and therefore inherited ; angioedema, exclusively in women with normal levels of C1INH, that is correlated with conditions creating high estrogen levels--for example, pregnancy or the use of oral contraceptives. This estrogen-dependent estrogen-related inherited angioedema is often referred to as HAE III. A recent paper in the American Journal of Human Genetics implicates a mutation in the gene for human coagulation Factor XII as the potential cause for swellings in these patients, for instance, testostrone side effects.
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Centered around thriving university cities, the Swedish biotech regions offer a good mix of innovative industries, great R&D environments and opportunities for high quality lifestyles. The Stockholm Uppsala region and Medicon Valley Malm Lund and Copenhagen on the Danish side ; , each with more than 100 companies, rank among the leading European biotech clusters. Distances are short, facilitating cross-collaboration between biotech firms and
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Action Position pillow under patient's head. On side with knee drawn up to the abdomen and clasped by the hands. Support the patient in this position. b ; Sitting: Patient sits on firm surface with arms resting on a table, and with the head resting on the arms. 3 Support, encourage and observe the patient throughout the procedure. 4 Assist the doctor as required. The doctor will proceed as follows: a ; Clean the skin with alcohol-based solution e.g. chlorhexidine in 70% isopropyl alcohol ; . b ; Identify the area to be punctured and inject the skin and subcutaneous layers with local anaesthetic. c ; Introduce Tuohy or spinal needles usually between third and fourth lumbar vertebrae. d ; Ensure epidural space has been entered. e ; Inject test dose of drug may be performed ; . f ; Thread epidural catheter through barrel of Tuohy needle. g ; Attach the bacterial filter. h ; Apply transparent occlusive dressing and tape to the catheter insertion site. i ; Inject solution into epidural space via catheter. Position the patient according to the doctor's instructions, tilting if appropriate. Take vital signs observations: blood pressure and respirations at least every 6 minutes for 30 minutes, and then 15 minutes for next 90 minutes. Take pulse every 15 minutes for 2 hours, or more frequently if the patient's condition dictates. Make the patient comfortable. Usually the patient is nursed flat for the first 36 hours, then slowly elevated into a sitting position. Bedclothes should not constrict the feet. Assess pain regularly using a visual analogue scale or pain chart if appropriate. Observe the patient's movements and facial expressions. Discuss insufficient or ineffective analgesia with the anaesthetist.
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TABLE 3. Multivariate Analysis of Gln192Arg SNP Association With Stroke.
The main effect of visceral fat is still a change in your appearance, but in severe cases your internal organs can become compressed so that normal functions like breathing and eating can be affected. Buffalo hump is the term given to accumulation of fat across the back of the shoulders and was one of the earliest and most physically distressing symptoms of lipodystrophy to be reported. Treatments include: Many of the investigational drugs used to lower cholesterol and triglyceride are being studied to treat fat accumulation see section opposite ; . Steroid treatment for lipodystrophy, particularly for fat accumulation, is also being studied. Although steroids have the potential to reduce fat accumulation, they may worsen symptoms of fat loss. Recombinant Human Growth Hormone rHGH ; showed the potential to reduce visceral abdominal fat and fat pads from the back of the neck and shoulders in several small studies. Benefits have been reported in the short term but fat accumulation reportedly reappears again after the treatment is stopped. Dosing at 3 or mg daily may be more appropriate to minimise side effects. Growth hormone can increase insulin resistance, and screening and monitoring is very important. It is available in some studies in the UK. It is also available on a named patient basis but it is relatively expensive and not generally easy to obtain. Dihydrotestosterone gel Andractim ; has been used to treat breast enlargement gynecomastia ; in men.
Fig. 2. Structures of tesfosterone and some of the most common synthetic derivatives used as anabolics.
Figure 2. Health sector VC-financing in 19952004. Source: PWC yearbook for 2004.
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The reproductive consequences of photoperiod and melatonin administration were compared in adult white-footed mice Peromyscus leucopus ; . Animals were exposed either to a long photoperlod 16 hours of light: 8 hours of dark ; with and without subcutaneous melatoninbeeswax implants or to a short photoperiod 8 hours of light: 16 hours of dark ; for six weeks. Following treatment with either a short photoperiod or melatonin, testicular weights and volumes as well as plasma testosteron4 levels were significantly P 0.01 ; reduced relative to animals maintained under long daily photoperiods without melatonln Implants. Under the conditions of the present study, chronic melatonin administration is as repressive to the reproductive status as is a short photoperlod in adult white-footed mice. Key words: white-footed testosterone.
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