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Despite many studies investigating the genetic link, there is still no one specific genetic marker that has been identified as being responsible for the predisposition to the development of MS. Patients may ask for genetic counselling if they are planning to become pregnant, but because of the complexity of genetic control, any form of genetic screening or counselling is difficult. The inherited pattern that occurs does not resemble patterns seen in other genetic diseases that characteristically display dominant, recessive or X linked modes of inheritance, but it is established that MS will occur in families in a rather irregular pattern. The rate of MS among family members of an individual affected by the disease is higher than would be expected by chance, with 20% of people with MS having a family history of at least one additional case of MS Ebers and Sadovnick 1994 ; . However, this cannot be entirely attributed to genetics, as it has to be assumed that most family members share a similar environment and similar lifestyle. Although complicated, it is important as nurses to understand this genetic link in order to answer one of the most common questions a newly diagnosed patient will ask, "Is MS inherited?" When counselling MS patients and their relatives it should be explained that the risk for first-degree relatives of people with MS is greater than the risk to second-degree relatives. Overall, siblings have the highest age adjusted risk followed by parents then children then uncles, aunts and cousins Sandovnick and Ebers 1994 ; . One UK study Robertson et al 1996 ; examined the risks of developing MS in both first and second-degree relatives of a person with the diagnosis and reported the following figures: Sister 4.4% Brother 3.2% Parent 2.1% Child 1.8!
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Dosing Considerations Special attention for dialysis patients. Recommended Dose and Dosage Adjustment The dose is 1.25 mg every six hours administered intravenously over at least five minutes. A clinical response is usually seen within 15 minutes. Peak effects after the first dose may not occur for up to four hours after dosing. The peak effects of the second and subsequent doses may exceed those of the first. No dosage regimen for VASOTEC I.V. has been clearly demonstrated to be more effective in treating hypertension than 1.25 mg every six hours. However, in controlled clinical studies in hypertension, doses as high as 5 mg every six hours were well tolerated for up to 36 hours. There has been inadequate experience with doses greater than 20 mg per day. In studies of patients with hypertension, VASOTEC I.V. has not been administered for periods longer than 48 hours. In other studies, patients have received VASOTEC I.V. for as long as seven days. The dose for patients being converted to VASOTEC I.V. from oral therapy for hypertension with enalapril maleate is 1.25 mg every six hours administered intravenously over at least five minutes. For conversion from intravenous to oral therapy, the recommended initial dose of VASOTEC Tablets is 5 mg once a day with subsequent dosage adjustments as necessary. Patients on Diuretic Therapy: For patients on diuretic therapy the recommended starting dose for hypertension is 0.625 mg administered intravenously over at least five minutes. A clinical response is usually seen within 15 minutes. Peak effects after the first dose may not occur for up to four hours after dosing, although most of the effect is usually apparent within the first hour. If after one hour there is an inadequate clinical response, the 0.625 mg dose may be repeated. Additional doses of 1.25 mg may be administered at six hour intervals. For conversion from intravenous to oral therapy, the recommended initial dose of VASOTEC Tablets for patients who have responded to 0.625 mg of enalaprilat every six hours is 2.5 mg once a day with subsequent dosage adjustments as necessary. Dosage Adjustment in Renal Impairment: The usual dose of 1.25 mg of enalaprilat every six hours is recommended for patients with a creatinine clearance 30 mL min [ 0.50 mL s] serum creatinine of up to approximately 3 mg dL [265.2 mol L] ; . For patients with creatinine clearance 30 mL min [0.50 mL s] serum creatinine 3 mg dL [265.2 mol L] ; , the initial dose is 0.625 mg see WARNINGS AND PRECAUTIONS ; . If after one hour there is an inadequate clinical response, the 0.625 mg dose may be repeated. Additional doses of 1.25 mg may be administered at six hour intervals. For dialysis patients, the initial dose should be 0.625 mg every six hours see WARNINGS AND PRECAUTIONS, Anaphylactoid Reactions during Membrane Exposure ; . For conversion from intravenous to oral therapy, the recommended initial dose of VASOTEC is 5 mg once a day for patients with creatinine clearance 30 mL min [ 0.50 mL s] and 2.5 mg once daily for patients with creatinine clearance 30 mL min [0.50 mL s]. Dosage should then be adjusted according to blood pressure response. Administration VASOTEC I.V. may be administered intravenously as supplied, or mixed with up to 50 one of the following diluents: 5% Dextrose Injection 0.9% Sodium Chloride Injection 0.9% Sodium Chloride Injection in 5% Dextrose 5% Dextrose in Lactated Ringer's Injection Diluted solutions should be used within 24 hours. Parenteral Products: As with all parenteral drug products, VASOTEC I.V. vials should be inspected visually for clarity, particulate matter, precipitate, discoloration and leakage prior to administration, whenever solution and container permit. 10 and vicoprofen.
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5. CONCLUSIONS A new adjustable fuzzy filter is presented in this paper, and its effectiveness is illustrated with numerical simulations. Experimental results reveal that by taking advantage of the self-organizing map to obtain the optimal fuzzy membership functions, this new fuzzy filter offers more efficient filtering capability than the conventional fuzzy filter. However, it i s worth pointing out that in our fuzzy filter the width of the membership function still need to be set in a heuristic way. Future work would therefore include finding another method to get the optimal membership function width. 6. REFERENCES [1] M. Kazmierkovski and H. Tunia, Automatic Control o f Converter-Fed Drives. Amsterdam, The Netherlands: Elsevier, 1994. I. Godler, K. Ohnishi, and T. Yamashita, "Robustness of vibration suppression feedback loop for speed control system, " in Proc. 19th International Conference on Industrial Electronics, Control, and Instrumentation, Bologna, Italy, Nov. 1993, pp. 1831-1835. Matlab: High-Performance Numeric Computation and Visualization Software; User's Guide. Natick, MA: The MathWorks, 1993. Simulink: Dynamic System Simulation Software; User's Guide. Natick, MA: The MathWorks, 1995. W. Leonhard, Control of Electrical Drives. Berlin: Springer-Verlag, 1996. S. Futami, N. Kyura, and S. Hara, "Vibration absorption control of industrial robots by acceleration feedback, " IEEE Trans. on Industrial Electronics, vol. 30, pp. 299-305, Aug. 1983. H. Hirabayashi, J. Chiba, and A. Akahane, "Vibration suppression of strain wave gearing, " in Proc. JSME Conference on Robotics and Mechatronics, Osaka, Japan, June 1990, pp. 789-794. B. Kosko, Fuzzy Engineering. Upper Saddle River, NJ: Prentice-Hall, 1997. F. Russo, "Noise cancellation using nonlinear fuzzy filters, " in Proc. IEEE Instrumentation and Measurement Technology Conference, Ottawa, Canada, May 1997, pp. 772-777. F. Russo, "Fuzzy systems in instrumentation: Fuzzy signal processing, " IEEE Trans. on Instrumentation and Measurement, vol. 45, pp. 683-689, Apr. 1996. C.-T. Lin and C.-F. Juang, "An adaptive neural fuzzy filter and its applications, " IEEE Trans. on Systems, Man, and Cybernetics, vol. 27, pp. 635-656, Aug. 1997. L.-X. Wang and J. M. Mendel, "Fuzzy adaptive filters, with application to nonlinear channel equalization, " IEEE Trans. on Fuzzy Systems, vol. 1, pp. 161-170, Aug. 1993. M. Sugeno and M. Nishida, "Fuzzy control of model car, " Fuzzy Sets and Systems, vol. 16, pp. 103-113, 1985. S. K. Mitra and J. F. Kaiser, Eds., Handbook for Digital Signal Processing. New York, NY: John Wiley & Sons, 1993. T. Kohonen, "The self-organizing map, " Proc. IEEE, vol. 78, pp. 1464-1480, 1990. T. Kohonen, Self-Organizing Maps. Berlin: SpringerVerlag, 1995 and vioxx.
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| Vasotec canadaCombination with 1, 3-bis 2-chloroethyl ; -1-nitrosourea to treat malignant brain tumors. Chinese Medical Journal, 1990, 103, 658-665 Tseng, S. H. et al. Resveratrol suppresses the angiogenesis and tumor growth of gliomas in rats. Clinical Cancer Research, 2004, 10, 2190-2202 Velasco, G., et al., et al. Hypothesis: cannabinoid therapy for treatment of gliomas? Neuropharmacology, 2004, 47, 315-323 Blasquez, C., et al. Cannabinoids inhibit the vascular endothelial growth factor pathway in gliomas. Cancer Research, 2004, 64, 5617-5623 Guzman, M. et al. A pilot clinical study of Delta 9 ; -tetrahydrocannabinol in patients with recurrent glioblastoma multiforme. British Journal of Cancer 2006, 95 2 ; , 197-203 176. Lonser, R. R., et al. Induction of glioblastoma multiforme in nonhuman primates after therapeutic doses of fractionated whole-brain radiation therapy. Journal of Neurosurgery, 2002, 97 6 ; , 1378-1389 177. Vitaz, T. W., et al. Brachytherapy for brain tumors. J. of Neuro-Oncology, 2005, 73, 71-86 Souhami, l. et al. Randomized comparison of steretoactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: Report of Radiation Therapy Oncology Group 93-05 protocol. Int. J. of Radiation Oncology, Biol Phys. 2004, 60 3 ; , 853-860 179. Ogawa, K. et al. Phase II trial of radiotherapy after hyberbaric oxygenation with chemotherapy for high-grade gliomas. British J of Cancer, 2006, 95 7 ; , pp. 862--868 180 Cokgor, G. et al. Results of a Phase II trial in the treatment of recurrent patients with brain tumors treated with Iodine 131 anti-tenascin monoclonal antibody 81C6 via surgically created resection cavities. Proceedings of the American Society of Clinical Oncology, 2000, Abstract 628 181. Reardon, D. A., et al. Phase II trial of murine 131 ; I-labeled antitenascin monoclonal antibody 81C6 administered into surgically created resection cavities of and warfarin.
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CABELL: N'T SMOKE CIGARETTES ANYMORE. THE SCHOOL DISTRICT IS NOW TESTING ITS ATHLETES NOT ONLY FOR ALCOHOL AND DRUGS, BUT ALSO FOR TOBACCO. PROSPT: It's a strong statement for us athletically to take a stand against the tobacco industry and, you know, I just don't think athletes need to smoke. I don't think any kid needs to smoke. CABELL: IF AN ATHLETE'S URINE TEST SHOWS POSITIVE FOR TOBACCO, OFFICIALS WILL FIRST NOTIFY THE PARENTS AND TELL THE STUDENT TO QUIT. WITH A SECOND OFFENSE, STUDENT ATHLETES WILL BE REQUIRED TO TAKE A TOBACCO EDUCATION COURSE AND FACE FURTHER DRUG TESTING. WITH A THIRD OFFENSE, THEY WILL BE SUSPENDED FROM ONE-FOURTH OF THEIR UPCOMING ATHLETIC CONTESTS. IT'S NOT A TOTAL BAN BUT IT IS INCENTIVE NOT TO SMOKE. QUARTERBACK LANCE RHODES ADMITS SOME OF HIS TEAMMATES DO SMOKE. LANCE RHODES, QUARTERBACK: At our school, yes sir, there's a few that do a few that have quit because we've set it straight at our school. CABELL: THE TESTING WILL BE RANDOM BUT OFFICIALS SAY AT LEAST HALF THE ATHLETES IN ALL SPORTS WILL BE TESTED AND RE-TESTED REGULARLY IF THEY FAIL. RON SWANN, ATHLETIC DIRECTOR: If your child tests positive for tobacco in the seventh grade. CABELL: THE TESTING, IN FACT, EXTENDS TO THE MIDDLE SCHOOLS. OFFICIALS SAY NEITHER PARENTS NOR STUDENTS HAVE OBJECTED. RHONDA SPANHOUR: And I'm very proud to be part of a community that agrees with this and is kind of pioneering that and I think it's definitely the wave of the future. CABELL: LEGAL CHALLENGES? ATHLETIC DIRECTOR RON SWANN SAYS THE COURTS ARE ON THEIR SIDE. SWANN: If you participate in something after school hours, then you can pretty much put on them the rules that the community wants for you to have on that group of students. CABELL: THE ACLU CONCEDES AS LONG AS STUDENTS AND PARENTS AGREE TO THE TESTING, IT'S PROBABLY LEGAL BUT A DANGEROUS PRECEDENT. ARTHUR SPITZER, ACLU: Once Big Brother starts on the path towards chemical testing, who knows where that will end? CABELL: BUT FOR THE STUDENT ATHLETES IN HOOVER, THAT'S APPARENTLY NOT AN ISSUE YET. BRIAN CABELL, CNN, HOOVER, ALABAMA, because vasotdc blood pressure.
H23 * A PHASE II TRIAL OF SALVAGE TEMOZOLOMIDE IN PRIMARY CNS LYMPHOMAS PCNSL ; : AN INTERIM ANALYSIS Michele Reni1, Andrs Jos Maria Ferreri1, James Perry2, Francesco Zaja3, Warren Mason4, Enrico Franceschi5, Daniele Bernardi6, Caterina Stelitano7, Marco Candela8, Andrea Pace9, Roberto Bordonaro10, Eugenio Villa1 1 S. Raffaele H. Scientific Institute, Milan; 2Bayview Regional Cancer Centre, Toronto Regional; 3Udine; 4Princess Margaret Hospital, Toronto; 5Bellaria Hospital Bologna; 6CRO Aviano; 7Reggio Calabria; 8Ospedale Regionale Torrette Ancona; 9Dipartimento di Neuroscienze Regina Elena Roma; 10Dipartimento di Oncologia, Catania, Italy PCNSL is treated empirically with drugs known to be active only in systemic nonHodgkin's lymphoma NHL ; . Based on this strategy, over the past decade, the addition of chemotherapeutic agents to high dose methotrexate HDMTX ; has resulted in increased toxicity without improved survival. Further advances in the treatment of PCNSL will require the identification of new active agents. A multicenter phase II trial on temozolomide as salvage therapy for PCNSL was started in January 2000. Eligibility criteria included NHL limited to brain at diagnosis and failure, negative HIV serology, age 17 years, ECOG PS 4, and previous treatment including HDMTX and or radiotherapy RT ; . Treatment consisted of temozolomide 150 mg m2 day, for 5 days every 4 weeks until progression, unacceptable toxicity, or refusal, or for 2 courses after maximal objective response. Temozolomide would be considered an active agent for PCNSL if a minimum response rate of 35% was observed alpha 0.05; beta 0.10 ; . The maximum response rate of no interest was 15%. This study was to enrol a maximum of 38 pts provided that a minimum of 4 23 pts had a response to treatment. Temozolomide would be considered an active agent if 9 38 responses were noted. Twenty-three pts with a median age of 60 years have been enrolled. The median time-to-failure following initial treatment was 16 months range 4130 ; : 20 pts had recurrent disease, and 3 progression during initial treatment. Failure involved multiple sites in 15 patients. Previous treatment consisted of HDMTX-based chemotherapy alone n 4 ; , or and xenical.
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Galloway, M.P. and White, F eds. ; , CRC Press: Boca Raton, .J., pp. 115161 1992 ; . Schultz, W. Getting formal with dopamine and reward. Neuron 36, 241263 2002 ; . Reviews evidence that dopamine neurons code the discrepancy between the prediction and occurrence of rewards, thereby contributing to reward-related learning. Everitt, B.J., Dickinson, A.D., and Robbins, T.W. The neuropsychological basis of addictive behaviour. Brain Res. Rev. 36, 129138 2001 ; . Di Chiara, G. The role of dopamine in drug abuse viewed from the perspective of its role in motivation. Drug Alcohol Depend. 38, 95137 1995 ; . Chao, S.Z., Ariano, M.A., Peterson, D.A., and Wolf, M.E. Dopamine D1 receptor stimulation increases GluR1 surface expression in nucleus accumbens neurons. J. Neurochem. 83, 704712 2002 ; . First demonstration that dopamine receptors regulate AMPA receptor trafficking. Nestler, E.J. Molecular basis of long-term plasticity underlying addiction. Nat. Rev. Neurosci. 2, 119128 2001 ; . A concise review of candidate mechanisms by which drugs of abuse may trigger long-lasting changes in brain, focusing on CREB and FosB. Wolf, M.E. Addiction: making the connection between behavioral changes and neuronal plasticity in specific pathways. Molec. Intervent. 2, 146157 2002 ; . Evaluates possible correlations between LTP and LTD in specific pathways and behavioral changes in animal models of addiction. Marina E. Wolf, PhD, is Professor and Acting Chair in the Department of Neuroscience at the Chicago Medical School. E-mail marina.wolf finchcms. edu; fax 847 ; -578-8515 and verapamil.
Iloprost including one death ; versus 13.7% of placebo patients including four deaths ; p 0.024 ; . Overall, mortality was 2.5%. Haemodynamics deteriorated in placebo patients while pulmonary vascular resistance improved in iloprost-treated subjects in pre-inhalation conditions. The acute inhalation induced a significant improvement in pulmonary artery pressure and cardiac output that lasted for about 60 min. Further significant treatment effects included improvements in NYHA class p 0.032 ; , Mahler Dyspnoea Transition Index p 0.015 ; and EuroQol Visual Analogue Scale p 0.016 ; . Adverse events reported more frequently for iloprost were flushing of the skin, jaw pain transient and mild ; , and syncope, which was more frequently rated serious but was not associated with clinical deterioration. Endothelin receptor antagonism Increased plasma levels of ET-1, a vasoconstrictor and mitogen polypeptide produced by the endothelial cells have been reported in both experimental models and human PAH [56, 57]. It is not clear whether overexpression of ET-1 is a marker or a mediator of PAH. In patients with PPH, ET-1 plasma levels are inversely related to cardiac output and directly related to right atrial pressure and pulmonary vascular resistance [57]. In addition, elevated plasma levels of ET-1 in the same group identify a subset of patients with the worst prognosis [58]. Moreover, an elevated grade of ET-1-like immunoreactivity has been identified in almost all sections of pulmonary vascular bedincluded plexiform lesions, suggesting that the local production of ET-1 may contribute to the pathogenesis of PPH [59]. All these changes represent a strong rationale for attempting the antagonism of ET-1 effects. The leading mechanism to antagonise ET-1 effects is the direct blockade of ET-1 receptors, which has been achieved by both peptide and nonpeptide drugs [60]. Two pharmacologically and molecularly distinct endothelin receptors subtypes have been identified: ETA and ETB. Both receptors are abundant in vascular smooth muscle cells and their stimulation produces vasoconstriction and proliferation. ETB receptors are predominant in vascular endothelial cells, where their stimulation favours ET-1 clearance and induces the production of NO and prostacyclin. The latter physiological negative feedback mechanism aims to protect against excessive activation of the endothelin system. ET-1 receptor antagonists prevent and reverse pathological and haemodynamic changes in experimental models of both hypoxiaand monocrotaline-induced pulmonary hypertension [61]. The favourable effects observed in experimental models have led to clinical trials in patients with PAH. Bosentan studies The orally active dual ET-1 ETA and ETB ; receptor antagonist bosentan has been tested in two double-blind, placebo-controlled studies in patients with PPH or PAH associated with connective tissue.
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2.5 Differential Diagnosis and Management It is important to distinguish globus sensation from dysphagia or odynophagia by careful history-taking. Investigations of patients with globus should be geared at ruling out a pathology of the ear, nose and throat ENT ; spherules e.g., oropharyngeal carcinoma ; , pathologic gastroesophageal reflux or esophageal motility disorder, especially achalasia. In this regard, a complete physical and otolaryngological examination should be performed, as well as a barium swallow with a solid bolus such as bread or a barium tablet ; to exclude a mechanical problem and to look for an obvious, underlying motility disorder. Once confirmed by the absence of any organic pathology, globus sensation is best managed by simple reassurance. 2.6 Management There is no treatment beyond reassurance. No diagnostic tests are indicated. If deep-seated emotional features exist, they may warrant a psychiatric opinion.
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