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Health Benefits of Biotin
<p>Health Benefits of Biotin</p>
Dr. Constance Odom, MD Picture of Dr. Constance Odom, MD
Medically reviewed by
Written by our editorial team.
Last Edited 5 min read
Biotin is a B-vitamin, and is also known by the name of vitamin B7. It was once known as coenzyme R, or vitamin H. The H stood for Haar und Haut, the German words for Hair and Skin. Biotin is water soluble, which means that it dissolves in water, and has many important functions in the body.
Biotin is necessary for the functions of several enzymes that are known as carboxylases, which are biotin-containing enzymes that participate in important metabolic functions, like the production of glucose and fatty acids. Commonly recommended, the intake is about five micrograms per day in infants and thirty micrograms in adults. This can be increased to thirty five micrograms per day in breastfeeding women.
Deficiency for biotin is fairly rare, but some groups of people are more likely to experience it in mild forms, such as pregnant women. Other factors, such as consuming raw eggs, can cause a deficiency. But to do something like that, you'd have to dine on raw eggs for quite a long amount of time. Raw egg whites contain a protein called avidin, which binds to biotin and prevents it from being absorbed by the body. Thankfully, it's rendered inactive during cooking.
Biotin is a key vitamin for energy production, and several enzymes require it to properly function. These enzymes are specifically involved in fat, protein, and carb metabolizm, and initiate crucial parts of the metabolic processes of these nutrients. Biotin plays a role in fatty acid synthesis by assisting enzymes that activate reactions important to breaking down fatty acids. It's also important in gluconeogenisis, which is the metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates. Gluconeogenesis is one of the several main mechanisms used by humans and many animals to maintain blood glucose levels, avoiding hypoglycemia. It's also important in the breakdown of amino acids, as biotin-containing enzymes are involved in the metabolism of several important kinds, such as leucine.
Biotin is important for more cosmetic purposes as well, such as brittle nails for one. Brittle nails are nails that are weak can become easily chipped, cracked, or split. It's very common to have brittle nails, unfortunately, as an estimated twenty percent of people around the globe are effected. But, in one study, eight people with brittle nails were given 2.5mg of biotin, per day, for a minimum of six up to fifteen months. Thickness in the nails improved by twenty five percent in all eight participants, and nail splitting was also reduced. In yet another study, thirty five people with brittle nails found that 2.5mg of biotin a day for one and a half to seven months improved symptoms in sixty seven percent of participants. These studies were rather small, however, and more research is certainly needed.
In a similar cosmetic vain, biotin is also often associated with an increase of hair growth, and not just any kind, but healthier, and stronger hair. And while more research is certainly needed to back this claim, a deficiency in biotin may lead to hair loss, which indicated and importance in the vitamin when it comes to maintaining a lush mane of hair. Whether or not it improves hair growth in healthy people, the jury's still out on that, but people with even a slight deficiency should certainly see results from added supplementation.
Biotin may even help controlling the blood sugar levels of those who have diabetes. Type two diabetes is a metabolic disease, and is characterized by high blood sugar levels and impaired insulin function. Recently, researches have studied how biotin supplements affect blood sugar levels in type two diabetics, and some evidence shows that biotin concentrations in blood may be lower in people with diabetes, compared to healthier individuals. Studies in diabetics given biotin alone have, as of it, provided mixed results. On the other hand, several controlled studies have shown that biotin supplements, combined with the mineral chromium, may lower blood sugar levels in some people with type two diabetes.
When it comes to skin, Biotin's role in skin healthy isn't fully understood, but it is known that you may get red, scaly skin rashes if you have a biotin deficiency. Other studies have also suggested that biotin deficiency may sometimes cause a skin disorder known as seborrheic dermatits, or cradle cap, as it's more commonly known. Biotin's role in skin healthy could possibly be related to it's effect on fat metabolism, which is important for the skin and may be impaired when dealing with a deficiency.
Biotin is important when it comes to pregnancy and breastfeeding, and require an increased requirement for the vitamin. It's actually been estimated that about half of all women who get pregnant may develop a mild deficiency in the vitamin. This means that it may start to affect their well being, but not enough to cause noticeable symptoms. Deficiencies are thought to occur in pregnant women thanks to faster breakdown during pregnancy. Additional, a major cause for concern in these women is that animals studies have found that a biotin deficiency has shown to be alongside many birth defects, and may be a contributing factor. Nevertheless, remember to always consult your doctor or dietitian/nutritionist before taking supplements during pregnancy and while breastfeeding.
Biotin also may affect multiple sclerosis, which is an autoimmune disease. In MS, the protective covering of nerve fibers in the brain, spinal cord, and eyes is damaged or destroyed. This protective covering is called myelin, and biotin is known to be an important factor in producing it. In fact, a pilot study in twenty three people with progressive Multiple Sclerosis tested the use of high doses of biotin, and over ninty percent of participants had some degree of improvement. And of course, this finding needs much more study, at least two randomized controlled trials have been carried out in people with progressive MS. The final results have not been published, but the preliminary results are promising.
Biotin is found in a rather wide variety of foods, which means that deficiency while not impossible, is rare. Such foods include Wheat germ, whole-grain cereals, whole wheat bread, eggs, dairy products, peanuts, soya nuts, Swiss chard, salmon, and chicken are all sources of biotin, alongside organ meats, such as liver and kidney and mushrooms. A bit of it is even produced by the bacteria in your stomach, on it's own or as a component of mixed vitamin supplements.
To top all of these benefits off, biotin is considered extremely safe. Even massive doses of up to three hundred milligrams a day, which is what was used to test multiple sclerosis and it's effects, have not led to any adverse side effects. And because it's a water-soluble vitamin, excess of it is lead out of the body in urine. However, there have been some reports of high-dose biotin causing strange results on thyroid tests, so check with a doctor before using if you are currently taking thyroid medication.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your physician about the risks and benefits of any treatment. Nu Image Medical may not offer the medications or services mentioned in this article.
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How Aromatherapy Works
Aromatherapy works by stimulating receptors in the nose responsible for smell, sending messages by olfactory cells to the part of the brain that controls the drive for survival, emotions, and instinct called the limbic system. The olfactory cells recognize scents as specific aromatic molecules that fit into receptors on these cells. Although not fully understood, scientists believe that these nerve signals’ action causes powerful mood changes in response to particular smells.
Massage Therapy in Harmony with Aromatherapy
Massage therapy, combined with essential oils, candles and incense, stimulates positive emotions and relaxation, equipping clients with coping mechanisms for many other health issues. An aromatherapy massage is a popular multi-purpose way of using supplemental care for health issues. The skin absorbs essential oils maintaining suppleness, it offers pain relief, and the aroma’s mental stimulation provides clients with the ultimate massage session.
VIP Mobile Massage offers specialist care for each client, operating 7-days a week from 9:00 AM to 11:00 PM. Call us on 305-586-1267 to book an appointment or inquire about our services.
About Author
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When it comes to maximizing your gains in strength and muscle mass, understanding the role of hormones in strength training and muscle growth is crucial. Hormones act as messengers in your body, orchestrating the complex processes that lead to muscle hypertrophy and strength enhancements. In this comprehensive guide, we'll delve into the specifics of how hormones influence your fitness journey.
The Key Hormones Involved in Muscle Growth
Several hormones play pivotal roles in muscle growth. Among the most influential are testosterone, growth hormone (GH), and insulin-like growth factor 1 (IGF-1). Each of these hormones facilitates muscle hypertrophy in distinct ways:
• Testosterone: Known as the primary male sex hormone, testosterone is critical for protein synthesis and muscle repair. It directly influences the anabolic environment in the body, promoting the growth of muscle fibers.
• Growth Hormone: Released by the pituitary gland, GH stimulates overall growth and cell reproduction. It promotes the release of IGF-1, which further enhances muscle growth.
• Insulin-like Growth Factor 1: IGF-1 works alongside GH to stimulate muscle growth and repair, thereby boosting muscle hypertrophy.
Testosterone: The Anabolic Powerhouse
Testosterone is often dubbed the king of anabolic hormones. A study published in the Journal of Applied Physiology showed that men with higher testosterone levels experienced greater muscle mass and strength gains from resistance training compared to those with lower levels (source). Here's how it works:
1. Increased Protein Synthesis: Testosterone enhances the rate at which muscle proteins are synthesized, aiding in quicker recovery and growth.
2. Reduced Muscle Breakdown: It decreases the activity of catabolic hormones that break down muscle tissue, preserving the muscle mass you work hard to build.
3. Enhanced Neural Adaptations: Higher testosterone levels can improve neuromuscular communication, leading to more effective strength training sessions.
Understanding the impact of testosterone can help you adjust your training and lifestyle to optimize its levels. Factors such as sleep, nutrition, and resistance training intensity all play roles in maintaining healthy testosterone levels.
Growth Hormone and IGF-1: The Dynamic Duo
The relationship between growth hormone and IGF-1 is akin to a duo of superheroes working together to combat muscle atrophy. Growth hormone stimulates the liver to produce IGF-1, which then circulates to the muscles and promotes growth. This relationship was highlighted in a review by the European Journal of Endocrinology (source).
Growth hormone peaks during sleep, making quality rest essential for maximizing muscle growth. Incorporating proper sleep hygiene and a balanced diet rich in protein can significantly enhance GH and IGF-1 levels, contributing to better muscle gains.
Practical Tips for Maximizing Hormonal Benefits
Here are some actionable steps to make the most of your hormonal responses for muscle growth:
• Optimize Your Sleep: Aim for 7-9 hours of quality sleep per night to support GH production.
• Focus on Compound Movements: Exercises like squats, deadlifts, and bench presses stimulate testosterone and GH release more than isolation exercises.
• Eat a Balanced Diet: Ensure you get enough protein, healthy fats, and carbs to fuel muscle growth and hormonal balance.
• Manage Stress: High stress levels can increase cortisol, a catabolic hormone. Practice stress-reducing activities like meditation or yoga.
Conclusion: Boost Your Gains by Understanding Hormones
Understanding the role of hormones in strength training and muscle growth can give you the edge you need to optimize your workouts and nutrition. By focusing on hormones like testosterone, growth hormone, and IGF-1, you can create an optimal internal environment for muscle hypertrophy. Implement the practical tips we've discussed, and you'll be on your way to maximizing your strength and muscle gains.
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Heart Murmurs and Other Sounds
During a regular medical checkup, your doctor will use a stethoscope to listen to your heartbeat to determine whether your heart is beating pro...
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What Are Heart Murmurs and Other Sounds?
During a regular medical checkup, your doctor will use a stethoscope to listen to your heartbeat to determine whether your heart is beating properly and has a normal rhythm. This gives the doctor information concerning the health of your heart. If your doctor hears a “murmur” or any other abnormal sounds coming from your heart, it may be an early indicator of a serious heart condition.
How Are Heart Murmurs and Other Sounds Evaluated?
A normal heartbeat has two sounds, a lub (sometimes called S1), and a dub (S2). These are caused by the closing of valves inside the heart. If there are problems in the heart, there may be additional sounds or abnormal sounds.
Your doctor will listen to your heart with a stethoscope (a medical device used for listening (auscultation) to the heart, lungs, and other organs of the human body). If problems are detected, your doctor may order an echocardiogram (a test that uses sound waves to create a moving picture of the heart) to get a better understanding of the abnormal sounds detected.
Heart Murmurs
The most common abnormal heart sound is a heart murmur. A murmur is a blowing, whooshing, or rasping sound that occurs during a heartbeat. There are two kinds of heart murmurs, innocent (also called physiological) and abnormal murmurs.
An innocent murmur is found in children, and is due to small holes between the different chambers of the heart. This usually does not cause significant problems, but may need to be monitored over time. An abnormal murmur in a child is due to congenital (present at birth) heart malformations, and may need to be corrected with surgery.
An adult abnormal murmur is usually due to problems with the valves that separate the chambers of the heart. If a valve does not close tightly and some blood leaks backward, this is called regurgitation. If a valve has become too narrow or becomes stiff, known as stenosis, it can also cause a murmur.
Murmurs are graded depending on how loud the sound is. The scale for grading is from one to six, where a one is very faint and a six is very loud—so loud it may not need a stethoscope to be heard. Murmurs are also categorized as occurring either during the first sound (S1) as systole murmurs, or during the second sound (S2) as diastole murmurs.
Galloping Rhythms
Other heart sounds include a “galloping” rhythm, with the occurrence of additional heart sounds S3 and S4. An S3 gallop or “third heart sound” is a sound that occurs after the diastole, S2 “dub” sound. In young athletes or pregnant women, it is likely to be harmless, but in older adults, it may indicate heart disease.
An S4 gallop is an extra sound before the S1 systole “lub” sound. This is always a sign of disease, likely the failure of the left ventricle of the heart. You may also have both an S3 and an S4 sound, and this is called a “summation gallop” when the heart is beating very fast. A summation gallop is very rare.
Other Sounds
Clicks or short, high-pitched sounds may also be heard during the regular heartbeat. This could indicate a mitral valve prolapse, when one or both flaps of the mitral valve are too long. This can cause some regurgitation of blood into the left atrium.
Rubbing sounds may be heard in patients with certain kinds of infections. A rubbing sound is usually caused by an infection in the pericardium due to a virus, bacteria, or fungus.
If your doctor finds any abnormal heart sounds, he or she may ask you questions about your family. If any of your family members also have abnormal heart sounds or have a history of heart problems, it is important to tell your doctor. It may make diagnosing the cause of your abnormal heart sounds easier.
You doctor will also ask if you’ve had any other symptoms, such as bluish skin, chest pain, fainting, distended neck veins, shortness of breath, swelling, or weight gain. Your doctor may also listen to your lung sounds and see if you have signs of liver enlargement. These symptoms may provide clues about what type of heart problem you are experiencing.
What Are the Causes of Heart Murmurs and Other Sounds?
The heart is made up of four chambers. The two upper chambers are called the atria and the two lower chambers are called the ventricles. Valves are located between these chambers to make sure that blood always flows in one direction.
The tricuspid valve goes from the right atrium to the right ventricle. The mitral valve leads from the left atrium to the left ventricle. The pulmonary valve goes from the right ventricle out to the pulmonary trunk, and the aortic valve goes from the left ventricle to the aorta. The pericardial sac surrounds the heart and protects it. Problems with these parts of the heart may lead to unusual sounds that can be detected by listening with a stethoscope or by performing an echocardiogram test.
Congenital Malformations
Murmurs, especially in children, may be caused by congenital (present at birth) heart malformations. These can be benign and never cause symptoms or can be severe malformations that require surgery or even a heart transplant. Innocent murmurs include pulmonary flow murmurs, Still’s murmur, and a venous hum.
One of the more serious congenital problems that is a cause of heart murmurs is called the “Tetralogy of Fallot”. This is a set of four defects in the heart that lead to episodes of cyanosis. Cyanosis is when the skin of an infant or child turns blue from lack of oxygen during activity (like crying or feeding).
Another heart problem that causes a murmur is patent ductus arteriosus, in which a connection between the aorta and the pulmonary artery fails to close correctly after birth. Other congenital problems include atrial septal defect, coarctation of the aorta, and ventricular septal defect.
Heart Valve Defects
In adults, murmurs are usually the result of problems with the heart valves. This may be caused by an infection, such as endocarditis or infectious endocarditis. Valve problems can also simply occur as a part of the aging process due to wear and tear on the heart.
Regurgitation, or backflow, is when the valves do not close properly. The aortic valve can have aortic regurgitation. The mitral valve can have regurgitation, either acute (caused by a heart attack or a sudden infection) or chronic (caused by high blood pressure, infection, mitral valve prolapse, or other causes). The tricuspid valve can also suffer from regurgitation, usually caused by the enlargement (dilatation) of the right ventricle. Pulmonary regurgitation is caused by the backflow of blood into the right ventricle when the pulmonary valve cannot close completely.
Stenosis is a narrowing or stiffening of a valve. Mitral stenosis occurs most often due to rheumatic fever (a complication of untreated strep throat or scarlet fever). Mitral stenosis can cause fluid to back up into the lungs, causing pulmonary edema. Aortic stenosis can also occur because of rheumatic fever, and it may cause heart failure. Tricuspid stenosis can occur because of rheumatic fever or heart injury. Pulmonary valve stenosis is usually a congenital problem and runs in families. Aortic and tricuspid stenosis can also be congenital.
Another cause of heart murmurs is stenosis due to hypertrophic cardiomyopathy. The muscle of the heart thickens making it harder to pump blood through the heart. This results in a heart murmur. This is a very serious disease that is often passed on through families.
Causes of Clicks
Heart clicks are caused by problems with the mitral valve. Mitral valve prolapse is the most common cause, when one or both flaps of the mitral valve are too long. This can cause some regurgitation of blood into the left atrium.
Causes of Rubs
Heart rubs are caused by friction between layers of the pericardium—a sac around the heart. This is usually caused by an infection in the pericardium due to a virus, bacteria, or fungus.
Causes of Galloping Rhythms
A galloping rhythm of the heart, with a third or fourth heart sound, is very rare. An S3 sound is likely caused by an increased amount of blood within the ventricle. This may be harmless, but could indicate heart problems, such as congestive heart failure. An S4 sound is caused by blood being forced into a stiff left ventricle. This is a sign of serious heart disease.
What Can Be Expected in the Long-term?
Abnormal heart sounds often indicate some type of heart disease. This may be treated with medication, or may require surgery. It is important to follow up with a heart specialist and learn the details of your condition.
Written by: Christine Case-Lo
Edited by:
Medically Reviewed by: [Ljava.lang.Object;@7fb372e7
Published: Aug 1, 2012
Published By: Healthline Networks, Inc.
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Nevertheless, when the MTSE string length was risen to 8 or 10 carbons, fewer proteins adducts had been noticed regardless of the duration or dosage of incubation tested
Nevertheless, when the MTSE string length was risen to 8 or 10 carbons, fewer proteins adducts had been noticed regardless of the duration or dosage of incubation tested. Ideally, these real estate agents could have low toxicity against regular cells fairly, and can inhibit the development and proliferation of tumor cells specifically. Our group while others possess previously proven that breasts cancer cells show increased MCH-1 antagonist 1 mitochondrial air consumption weighed against non-tumorigenic breasts epithelial cells. This shows that it might be possible to provide redox active substances towards the mitochondria to selectively inhibit tumor cell rate of metabolism. To show proof-of-principle, some mitochondria-targeted smooth electrophiles (MTSEs) continues to be designed which selectively accumulate inside the mitochondria of extremely energetic breasts tumor cells MCH-1 antagonist 1 and alter mitochondrial proteins. A prototype MTSE, IBTP, Mouse monoclonal to 4E-BP1 inhibits mitochondrial oxidative phosphorylation considerably, resulting in reduced breasts tumor cell proliferation, cell connection, and migration at high concentrations after short-term publicity [2, 7, 9, 10], although exact mechanisms stay defined poorly. In this scholarly study, we analyze the bioenergetic outcomes of directing electrophilic TPP bifunctional substances towards the mitochondrion. These substances, termed mitochondria-targeted smooth electrophiles, (MTSEs), MCH-1 antagonist 1 differ considerably within their reactivity from poisonous electrophilic medicines and environmental toxicants extremely, that are very difficult electrophiles [11] fairly. Hard electrophiles type adducts with hard nucleophiles such DNA bases and serine proteins residues; whereas smooth electrophiles type adducts with smooth cellular nucleophiles, cysteine thiols particularly. While hard electrophiles possess regularly been dismissed as therapeutics because of the systemic toxicity in medication studies, there is certainly accumulating proof that smooth electrophiles are much less poisonous in and natural model systems [11, 12]. Additionally it is vital that you consider how the smooth electrophile course of substances have a variety of reactivity spanning many purchases of magnitude [13]. The reactivity of the smooth electrophile can be straight proportional towards the poisonous results also, with an increase of reactive substances exhibiting higher toxicity in mobile and animal versions [14C16]. Therefore, chances are that smooth electrophiles of low reactivity fairly, including MTSEs, could be useful as restorative agents. Actually, other such smooth electrophiles possess known helpful physiological effects you need to include diet electrophiles within broccoli (sulforaphane) and curry (curcumin) [17], aswell as created anti-inflammatory prostanoids such as for example 15-deoxy prostaglandin J2 [18 endogenously, MCH-1 antagonist 1 19]. One of the most essential factors in developing book drug leads can be ensuring specific discussion of the substances with desired focus on protein(s). In the entire case of MCH-1 antagonist 1 electrophilic signaling substances, the specificity of response depends upon the chemical substance properties from the substances themselves, including hydrophobicity, reactivity, electrophile softness, and focus on softness [11]. Generally, lower reactivity from the electrophile leads to higher selectivity for particular targets. Probably the most reactive smooth nucleophiles inside the cell are selenocysteine and deprotonated (or low pKa) cysteine residues [20, 21]. While cysteine exists generally in most protein, it represents significantly less than 2% of the full total protein amino acidity composition. Furthermore, not absolutely all cysteines are vunerable to oxidative changes, since few cysteines can be found mainly in the deprotonated fairly, nucleophilic type [21, 22] which can be reactive with electrophiles. It really is therefore that specific proteins thiols are poised to mediate varied redox signaling reactions to multiple stimuli [23]. Oddly enough, accessible reactive proteins thiols can be found in the energetic sites of several mitochondrial protein. Mitochondrial protein face probably the most reducing environment inside the cell and so are susceptible to changes because of the fairly high internal mitochondrial matrix pH due to the proton pumping from the electron transportation string [24]. Mitochondrial proteins that are redox-sensitive consist of mitochondrial dehydrogenases such as for example -ketoglutarate dehydrogenase [25], isocitrate dehydrogenase [26], and mitochondrial aldehyde dehydrogenase [27], aswell as the mitochondrial complexes I, II, and V [28, 29]. To be able to determine the consequences of mitochondrial proteins changes on the rate of metabolism of tumor cells, we synthesized some MTSEs that alkylate mitochondrial protein and analyzed the differential ramifications of a prototype MTSE on oxidative phosphorylation and glycolysis in tumorigenic versus non-tumorigenic breasts cells. Furthermore, we established the resultant ramifications of MTSEs on breasts tumor cell proliferation, adhesion and migration. This scholarly study shows that MTSEs cause.
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Open Access
Review | May 2021
Risk Stratification and Clinical Utility of Polygenic Risk Scores in Ophthalmology
Author Affiliations & Notes
• Ayub Qassim
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Emmanuelle Souzeau
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Georgie Hollitt
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Mark M. Hassall
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Owen M. Siggs
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Jamie E. Craig
Department of Ophthalmology, Flinders University, Flinders Medical Centre, Bedford Park, Australia
• Correspondence: Ayub Qassim, Department of Ophthalmology, Flinders University, Level 2 Car Park Tenancies, 1 Flinders Drive, Bedford Park, SA 5042, Australia. e-mail: [email protected]
Translational Vision Science & Technology May 2021, Vol.10, 14. doi:https://doi.org/10.1167/tvst.10.6.14
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Ayub Qassim, Emmanuelle Souzeau, Georgie Hollitt, Mark M. Hassall, Owen M. Siggs, Jamie E. Craig; Risk Stratification and Clinical Utility of Polygenic Risk Scores in Ophthalmology. Trans. Vis. Sci. Tech. 2021;10(6):14. https://doi.org/10.1167/tvst.10.6.14.
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Abstract
Combining genetic and clinical data into an informative risk prediction profile has been an important ambition of personalized medicine. Single-nucleotide polymorphisms are commonly found throughout the genome and account for the majority of interindividual genetic variation. To date, genome-wide association studies have led to the discovery of thousands of disease-associated loci, including across dozens of ophthalmic diseases and traits. However, compared with the clinical utility of identifying rare Mendelian variants, the translation of these results to clinical practice has so far been limited because such variants are found commonly in the population, and individually account for a very small risk. Recently, combining large numbers of these genetic variants into polygenic risk scores (PRS) has shown clinically meaningful risk prediction across several common diseases. PRS have the potential to translate the discovery of common risk variants into individualized disease risk prediction, prognostication, and may enable targeted treatments. In this context, we review the clinical utility of PRS in three common, genetically complex ophthalmic conditions: primary open angle glaucoma, age-related macular degeneration, and myopia.
Translational Relevance: Common genetic variants can be used to effectively stratify the risk of disease development and progression and may be used to guide screening, triaging, monitoring, or treatment thresholds.
Introduction
The rapid development of genomics in recent years has substantially accelerated our understanding of the genetic architecture of many complex diseases. The increased affordability and throughput of genomic assays, development of better tools to process genomic data, and the availability of increasingly large public datasets has allowed an unprecedented exploration of human genomic variation. Over the past decade, genome-wide association studies (GWAS) have been extensively used to find associations between a disease or trait and genetic loci, represented by single-nucleotide polymorphisms (SNPs). SNPs are variations in a single DNA building block (nucleotide) in the gene. A few million SNPs are found in each person's unique genetic sequence, bearing in mind that the majority are not thought to be associated with any disease.1 Only relatively common SNPs—with allele frequency of at least 1%—are statistically confidently discovered to be associated with a trait in GWAS, although increasing sample sizes and newer analytical approaches are continuously improving the ability to detect robust associations with rarer variants.
A better understanding of an individual's risk of disease, the severity of disease in those who develop it, and their response to therapy are cornerstones of personalized medicine—the notion that screening, management, and interventions can be tailored specifically to an individual, or at least stratified across groups of similar individuals. This review will focus on the polygenic risk model of diseases, and its application in ophthalmology with a focus on primary angle glaucoma (POAG), age-related macular degeneration (AMD), and myopia, the leading causes of blindness worldwide.2
Polygenic Model of Complex Diseases
Monogenic or Mendelian diseases are primarily driven by alterations in a single gene. These genetic variants are typically rare but have a high effect size and penetrance, meaning that they generally confer a high risk of developing the associated disease. For example, rare pathogenic variants in the OPTN (optineurin) gene and copy number variants of the TBK1 (Tank-binding kinase 1) gene lead to familial normal tension glaucoma with highly penetrant autosomal dominant inheritance.3,4 Similarly, most retinal dystrophies arise from Mendelian variants and over 330 such retinal dystrophy genes have been identified, such as mutations in RHO (rhodopsin) leading to retinitis pigmentosa.5
In contrast, complex diseases have a polygenic genetic architecture, which may involve hundreds or thousands of contributing genes.6 In these common complex diseases, each genetic variant has a relatively small effect and does not lead to the disease by itself. Therefore the discovery of these disease-associated genomic variants requires studies of large cohorts, especially for common variants with very small effect sizes. This is commonly the result of GWAS in which millions of genetic variants are studied across many thousands of individuals for association to a disease or trait. It is important to note that individual SNPs discovered by GWAS are relatively common in the normal population, often with a minor allele frequency above 1%. That is, these variants are present in at least 1% of the normal population if heterozygous, or slightly lower proportions accounting for homozygous people; thus the study of disease association of these variants requires a large and ideally well-phenotyped cohort. Disease association for rarer variants requires a different approach such as linkage mapping or whole-exome sequencing of families with the same rare disease. Many common adult-onset diseases have polygenic and environmental contributions, including POAG, AMD, type 2 diabetes, dyslipidemia, and coronary artery disease.610 For example, although there is a strong genetic contribution to AMD risk, smoking has been well established as a key modifiable environmental risk factor for the development and progression of AMD.11,12
Although each SNP explains only a small proportion of genetic risk and heritability, the additive effects of tens or hundreds, up to hundreds of thousands in some studies, of SNPs amount to a risk equivalent to a single monogenic variant.13 Furthermore, common variants of very small effect sizes are difficult to isolate statistically from noise in GWAS, yet they still contribute to disease risk and account at least partially for the missing heritability unexplained by the currently discovered variants.14 As larger studies discover additional loci,8,9,15 it is evident that SNPs with small effect sizes conjointly play a significant role in genetic risk.16 The complex interplay of these genetic networks and the effect of one locus on multiple phenotypes (termed pleiotropy), likely owing to their involvement in a shared biological pathway, as well as environmental influences are important in the development of complex traits.16,17
Development of Polygenic Risk Scores
A polygenic risk score (PRS)—also known as a genetic risk score—is a quantitative probabilistic summary of an individual's genetic susceptibility to a disease or trait (Fig.). In its simplest form, it is a sum of the number of risk alleles carried by an individual.18 More commonly, the variants are weighted by their magnitude of effect on the disease or trait—the estimated regression coefficient of the variant—based on the summary statistics of the GWAS.18 This allows the risk score to reflect the effect size of the variants in addition to their total numbers, and therefore is a more accurate risk predictor.
Figure.
Development and clinical utility of a PRS for a sample disease.
Figure.
Development and clinical utility of a PRS for a sample disease.
Disease-associated SNPs included in a PRS are discovered via GWAS, in which several million SNPs are statistically compared with a disease (case–control setting) or phenotype. To minimize false discovery from multiple testing, a stringent genome-wide P value threshold of 5 × 10−8 is used in discovery studies, and P value adjustment methods such as Bonferroni correction are used for validation studies. However, SNPs with borderline significance not meeting the genome-wide threshold may still be associated with disease,16,19 thus a PRS may improve the estimate of the “true” genetic risk and predictive power by including a larger number of SNPs using more lenient statistical thresholds.18 To account for correlated and coinherited SNPs (said to be in high linkage disequilibrium [LD]), SNPs that are in high LD to others are usually excluded via P value thresholding; alternatively, LD is modeled into the PRS mathematically using methods such as LDpred or lassosum.20,21
When applied in a clinical context, the raw number of an individual's PRS (e.g., 12.395) is not intuitive to interpret, and so is better presented as their percentile risk relative to the normal population or study cohort (e.g., 90th percentile). For instance, a person in the 90th percentile of a weighted PRS carries disease-associated alleles whose combined effect sizes—i.e., the genetic burden—exceeds that of 90% of the normal population or study cohort. A commonly used PRS stratification method is quintiles, in which the bottom 20% is considered low risk, the top 20% as high risk, and the rest as intermediate risk.9,13,22,23 Similarly, tertile or decile groups may be used. Importantly, a PRS allows disease risk stratification but is never a diagnostic tool: its clinical utility is best achieved when combined with demographic and/or clinical factors usually evaluated in routine clinical risk assessment.
Authors sometimes seek to quantify the utility of a PRS using the area under the receiver operating characteristic curve (AUC). AUC is a summary statistic that indicates the discriminatory powers of a test to differentiate a binary outcome or set of categories. Mathematically, it is calculated as the area under the curve fitted to all the test sensitivities for each corresponding specificity (often one minus specificity). It can be used to set an optimal test threshold for maximized sensitivity or specificity. Although commonly reported in the PRS literature, the AUC has been justifiably criticized because of its lack of clinical interpretation—it is a metric of test performance in the study cohort and does not inform the individual about their risk, nor does it quantify the magnitude of risk.24 Furthermore, from a clinical point of view, PRS is best suited as a genetic disease risk probability index (e.g., on a continuous spectrum of risk) as opposed to the dichotomous end-point approach commonly used in AUC calculations. In the case of age-related diseases such as POAG and AMD, a limitation of any dichotomous end-point study is the uncertain likelihood of younger individuals developing the disease in question later in life, which can be mitigated to some extent by prespecified age thresholds. Instead, the utility of the PRS can be reported by how informative it is in identifying high-risk individuals compared with low-risk or average-risk individuals. This can be done by reporting the odds ratio (OR) of developing the disease between the genetic risk groups and in reference to the general population risk, or additionally, by reporting the PRS association to a disease-specific metric, such as the age of diagnosis, or other measures of severity.
Clinical Utility of the PRS in Ophthalmology
The clinical utility of PRS relies on its ability to effectively identify individuals who would benefit from modified screening approaches for disease detection (frequency or age threshold for screening tailored to risk group) or interventions for disease management or progression (e.g., prioritization of therapeutic interventions, and management of risk and benefits of interventions). In nonophthalmic diseases, the clinical utility of PRS has been mainly reported in cardiovascular diseases, diabetes, inflammatory bowel diseases, cancers, and psychiatric conditions.13,2529 For instance, disease risk stratification by PRS is effectively able to identify individuals at the highest risk of developing coronary artery disease, stroke, atrial fibrillation, and type 2 diabetes.13,28 This allows early intervention with lifestyle modification or medications, which has been shown to attenuate disease risk in high-risk individuals.28,30,31 For example, statin therapy has a greater absolute risk reduction of primary coronary heart events in high-risk PRS individuals than intermediate or low-risk groups.22 Furthermore, screening programs, particularly for breast, prostate, and colorectal cancers, can be effectively personalized to the individualized risk based on PRS and demographic stratification.26,32 An overview of personalized clinical utility of PRS has been reviewed elsewhere.33 We will review the potential clinical utility of PRS in three common, genetically complex ophthalmic conditions: POAG, AMD, and myopia.
Primary Open Angle Glaucoma
Glaucoma is the leading cause of irreversible blindness worldwide affecting over 64 million people and expected to increase in prevalence with the aging population.34 Primary open angle glaucoma is the most common subtype, in which the iridocorneal angle is open and there is no secondary cause of elevated intraocular pressure (IOP). It is one of the most heritable of all common diseases,35 and first-degree relatives of individuals with POAG are at 9.2-fold higher relative risk of developing glaucoma.36 The study of the genetic architecture of POAG has been complemented by genetic association studies of related ocular traits associated with POAG — termed endophenotypes — namely IOP and optic disc nerve head morphology such as the vertical cup-to-disc ratio (VCDR).37 POAG and its endophenotypes are highly heritable with recent association studies reporting over 100 loci associated with IOP, over 50 with VCDR, and over 100 correlated with POAG.15,38,39
The high heritability of POAG and its correlated endophenotypes, in addition to the effectiveness of early intervention (e.g., topical medications, laser, or incisional surgery) to prevent otherwise irreversible vision loss, has made POAG a focus of PRS stratification. The earliest studies have demonstrated significant but modest discriminatory powers for a glaucoma PRS.4042 In 2015, Tham et al.41 developed a glaucoma PRS combining seven IOP-associated and 18 VCDR-associated SNPs known at the time, and reported a modestly higher odds of developing POAG in the top tertile of the PRS relative to the bottom tertile in a multiethnic cohort from Singapore (IOP-PRS OR, 2.50; 95% confidence interval [CI], 1.54–4.02; VCDR-PRS OR, 2.31 [95% CI, 1.50–3.55]). Mabuchi et al.40 conducted an unweighted PRS utilizing nine IOP-associated SNPs in a Japanese cohort and reported a modest association with higher tension POAG (OR per risk allele = 1.12; 95% CI, 1.01–1.24). These early studies were limited by including only a small number of SNPs in the PRS and applying it to relatively small POAG cohorts. Mabuchi et al.40 also did not weight the loci effect size—an approach now superseded by weighted PRS.18
Backed up by larger GWAS, recent glaucoma PRS studies have utilized an increasingly larger number of variants associated with POAG and its endophenotypes. MacGregor et al.15 generated a PRS using 101 IOP-associated SNPs and two previously reported VCDR-associated SNPs, and showed that the top PRS decile of an independent Australian case–control glaucoma cohort had a significantly higher risk of POAG relative to the bottom decile (OR, 5.6 [95% CI, 4.1 – 7.6]). This magnitude of risk was previously only reported for rarer monogenic variants.43 Gao et al.44 constructed an inclusive PRS using 1691 SNPs associated with IOP using a more lenient statistical threshold (P < 5 × 10−5) and reported a six-fold higher POAG risk in the top quintile relative to the bottom quintile of an internal validation dataset (OR, 6.34 [95% CI, 4.82–8.33]). This improved risk prediction can be attributed to a more inclusive SNP selection in the PRS; however, a limitation of this approach was that the test cohort and the GWAS discovery cohort were both from the UK Biobank and thus share geographic, temporal, and methodological properties. We recently reported a PRS derived from 146 IOP-associated SNPs to be associated with higher maximal IOP, younger age of glaucoma diagnosis, more family members affected, and higher treatment intensity in an independent Australian cohort.23 These findings were also validated in an independent cohort of early glaucoma cases, further supporting the utility of IOP-derived variants in glaucoma risk stratification.23
Another PRS constructed from 68 VCDR-associated SNPs applied to a Latino population showed a relatively modest risk of POAG (OR, 1.75 [95% CI, 1.09–2.81] for the top quintile relative to the bottom quintile).45 This is likely owing to input SNPs being derived from GWAS of primarily European and Asian ancestries, which are unlikely to capture all risk variants relevant to the Latino population. Additionally, VCDR variants alone have a lower discriminatory power in identifying POAG and highlights the importance of utilizing multiple glaucoma endophenotypes at a more inclusive statistical threshold. Most recently our group reported a comprehensive POAG PRS utilizing multiple correlated traits (glaucoma diagnosis, IOP, and optic disc diameter adjusted VCDR) inclusive of 2673 uncorrelated SNPs. In an independent case–control POAG cohort, individuals in the top decile of the PRS distribution had 14.9-fold higher risk (95% CI, 10.7–20.9) of glaucoma relative to the bottom decile, along with an even greater risk in high-tension glaucoma cases only (top decile vs. bottom decile of the PRS OR, 21.5, 95% CI, 12.5–37.0).38 The addition of PRS significantly improved glaucoma risk prediction compared with a model with age and sex alone, which supports the added utility of PRS compared with demographic risk factors in risk stratification (AUC 0.76, 95% CI, 0.72–0.81 vs. 0.71, 95% CI, 0.67–0.76; P = 2.8 × 10−4).38
The transferability of glaucoma PRS—which are currently primarily derived from European ancestry individuals—have been studied in South Asian and African cohorts. Our aforementioned European ancestry–derived multitrait glaucoma PRS was predictive of glaucoma in the South Asian Ancestry individuals of the UK Biobank (AUC = 0.76 in a model with age and sex, 95% CI, 0.73–0.79).38 PRS based on glaucoma-associated loci discovered in European or Asian cohorts have shown to have transferability in risk predicting glaucoma risk in African cohorts.4648 Bonnemaijer et al.47 reported that a weighted PRS inclusive of 15 glaucoma-associated SNPs was associated with POAG in an African ancestry cohort (OR 1.59, 95% CI, 1.26–1.93), whereby the top PRS quintile had a two-fold increase in POAG risk relative to the bottom PRS quintile. Interestingly, despite the predictive ability of the weighted PRS, none of these loci were individually associated with POAG in this cohort.47 This is in keeping with the GWAS results reported by Hauser et al.,49 whereby the majority of POAG risk loci previously identified in European cohorts had a significantly smaller effect sizes and statistical significance in African ancestry individuals. Thus the predictive ability of the PRS would improve by identifying ancestry-specific variants (which may be not be the same variants identified in European ancestry only GWAS due to transethnic LD patterns) and improving fine mapping to identify causal variants.48 It is encouraging that the current PRS show some evidence of transethnic transferability despite the limitations of ethnic diversity in the discovery cohorts and the variability in effect sizes of risk loci between ancestries.49
The natural history of POAG and the benefits of early intervention make glaucoma a compelling disease for further clinical trials of PRS testing. Our study demonstrated that the glaucoma PRS was associated with a younger age of glaucoma diagnosis with individuals in the top decile being diagnosed on average 7 years earlier than the bottom decile group.38 This is in keeping with the results from another POAG PRS study that utilized 12 POAG-associated SNPs reporting younger age of POAG diagnosis (5 years younger on average in the top 5% of the PRS relative to the bottom 5%).50 Another study showed a similar trend in the age of diagnosis in a Japanese POAG cohort, using a PRS inclusive of 17 IOP-related variants.51 Furthermore, our findings showed structural progression of early glaucoma and likelihood for incisional surgery in individuals with advanced glaucoma and high PRS, even after adjustment for known risk factors of progression of age and IOP.38 We also reported that individuals with a high IOP-associated PRS had a higher early-morning and outside office hours IOP even after adjustment for a clinically measured IOP, whereby individuals in the highest quintile of the PRS were 5.4-fold more likely (95% CI, of OR 1.3–23.6) to have early-morning IOP spikes relative to the lowest quintile.52 Interestingly, this association was stronger using a PRS exclusive to IOP-associated variants than a more comprehensive glaucoma PRS, suggesting an added benefit of trait-specific PRS in predicting phenotypic variations of a disease.52 Ultimately, a comprehensive and validated glaucoma PRS may be used to personalize glaucoma monitoring and management in high-risk compared with average- or low-risk individuals.
Currently, genetic testing can be done in early-onset glaucoma cases to identify individuals and their relatives at a higher risk of glaucoma.53 Individuals carrying variants in genes known to cause early-onset glaucoma such as MYOC would benefit from genetic counseling and a personalized approach to screening and management. Further, common variants may influence the penetrance of incompletely penetrant “monogenic” variants. Our aforementioned PRS effectively stratifies cumulative glaucoma risk in MYOC p.Gln368Ter carriers, the most common disease-causing variant for POAG, with individuals in the highest tertile of the PRS having six-fold increase in absolute risk of glaucoma by age 60 years relative to the lowest tertile.38
The latest glaucoma PRS risk stratification is promising in identifying individuals not carrying single high-impact variants to be at a higher risk of developing advanced glaucoma and disease progression.23,38 A PRS-based risk stratification will be more effective in combination with demographic risk factors and may be best applied to older individuals (50 years or older), those with a family history of glaucoma, or those who may have optic disc features suspicious of developing glaucoma.54 In addition, PRS may aid in triaging referrals of “glaucoma suspects” to specialists by identifying high-risk individuals prior to clinical review, resource allocations in light of increasing glaucoma prevalence, and potentially a targeted screening program.54
Age-Related Macular Degeneration
AMD is known to be a highly heritable disease, and a recent large GWAS has discovered genetic variations distributed over 34 loci accounting for over half of the disease heritability.8 Although AMD is a complex disease with several common and rare genetic variants associated with the disease, variants in the genes ARMS2/HTRA1 and CFH account for a much larger risk than other genes.8 The AMD-associated variants in these genes are common in individuals of European ancestry (minor allele frequency of 20%–40%), and each account for a two- to three-fold increased risk of AMD.8,55
The discovery of relatively large-effect size genetic variants for AMD has led to a great interest in developing models of disease prediction, including those incorporating environmental and ocular risk factors.8,5557 For instance, a model with 26 AMD-associated SNPs alongside age and sex was highly predictive of late AMD (AUC, 0.82; 95% CI, 0.79–0.86), outperforming nongenetic risk models (AUC, 0.78; 95% CI, 0.74–0.82).58 After the discovery of additional AMD risk variants using a GWAS of 16,144 AMD patients, Fritsche et al.8 reported an AMD PRS including 52 AMD-associated SNPs (of which seven were rare variants with minor allele frequency <1%), in which individuals in the highest decile had a 44-fold higher risk of developing advanced AMD relative to the lowest decile. Of note, this magnitude of risk is likely an overestimate as the test dataset was a modeled general population derived from the discovery case–control dataset.
Several studies have used PRS and known ocular and environmental risk factors to stratify AMD progression risk: the majority focusing on variants strongly associated with AMD such as those in CFH and ARMS2.5963 For instance, the presence of two or more risk alleles in CFH and/or ARMS2 was associated with progression of AMD during a 10-year follow-up (OR, 2.03; 95% CI, 1.46–2.81), which appeared to be synergistic with known environmental risk factors.60 More broadly, a recent machine learning–derived model inclusive of PRS, age, diet, smoking, education, and ocular measurements was found to be highly predictive of incident advanced AMD at 5, 10, and 15 years follow-up (AUC, 0.92; 95% CI, 0.90–0.95 at 10 years).64
As observed in POAG and many other conditions, the inclusion of additional AMD risk variants in a PRS improves its predictive performance. Ding et al.57 used a PRS comprising 34 AMD-associated SNPs to stratify the risk of progression to late AMD over up to 10.3 (SD 1.7) years. There were markedly increased rates of progression to late AMD in individuals at the highest quartile of the PRS (50% progression) compared with the lowest quartile (6.9% progression) and the intermediate group (22% progression), which was further replicated in an independent cohort.57 Similarly, an AMD PRS predicted second-eye involvement in unilateral AMD cases in a Japanese cohort (51% 10-year hazard rate in the top decile vs. 2.3% in the lowest decile).65 Another PRS comprising all 52 AMD-associated variants was applied to an independent prospective German cohort of AMD patients, and was associated with drusen load in agreement with earlier reports from the AREDS cohort.66,67 Moreover, the 52-variant PRS was associated with drusen progression in individuals with low drusen load at baseline, and both drusen and AMD progression to late disease in those with intermediate drusen load during the mean 6.5 years of follow-up.66
Seddon and Rosner68 have incorporated 13 AMD-associated risk loci into a predictive model including known demographic and ocular risk factors (baseline AMD grading) in the AREDS cohort and further validated this in an independent longitudinal AMD cohort. This risk model was predictive of AMD progression to advanced disease (AUC, 0.90 over 12 years), geographic atrophy (AUC, 0.87), and neovascular disease (AUC, 0.86). Of note, both common and rare genetic variants were included in the model; these variants are only a subset of the known AMD-associated risk loci because the authors used a stepwise regression approach with P value thresholds as the inclusion criteria for genetic variants.68 This approach is useful for optimizing variable selection in the model but excludes small effect-size variants, which may additively infer additional risk. The authors further investigated the added utility of PRS in a nongenetic risk model using the Net Reclassification Improvement method, in which predicted risk stratification at baseline is compared with progression outcome between two models. The model incorporating PRS improved the classification of eyes that ultimately progressed to AMD, with progressing eyes more likely to be classified as high risk, and nonprogressing eyes as low risk, when genetic factors were considered. For instance, 63% of eyes that progressed while being classified as “medium risk of progression” (10%–30% risk over 10 years) in a nongenetic model, were more appropriately identified as “high or very high risk of progression” by the addition of genetic loci to the model.68 This highlights the improved risk stratification and added clinical utility of an AMD PRS compared with known demographic and ocular risk factors.
In summary, an AMD PRS incorporating all possible loci vastly improves on existing clinical risk stratification for both disease onset and progression. However, aside from antioxidant and mineral supplementation, there are no effective early therapies in dry AMD.69 Despite this, AMD risk factor modification such as smoke cessation and weight loss may be valuable interventions in high-risk individuals. This has previously led the American Academy of Ophthalmology to recommend against routine genetic screening for complex diseases such as AMD.70 Of note, this recommendation was published in 2012 and does not consider the evolving evidence for using the PRS in risk prediction.
Myopia
The etiology of myopia is complex, with both environmental and genetic factors, as well as the interaction between them, contributing to the clinical presentation of myopia and its progression.71 Our understanding of common genetic variants associated with myopia is largely derived from GWAS using refractive error as a continuous variable (measured as spherical equivalent) and self-reported history and age of diagnosis of myopia.72,73 A multicohort meta-analysis inclusive of individuals of both European and Asian ancestry has discovered 167 loci associated with refractive error, of which 138 loci were further replicated in the UK Biobank cohort.74
Using these results, Tedja et al.74 created a comprehensive myopia PRS from 7307 variants, which explained 7.8% of the refractive error variance of an independent Dutch cohort. Individuals in the highest PRS decile were at 40-fold greater risk of myopia relative to the lowest decile.74 Furthermore, 24% of people in the highest decile had high myopia (defined by a spherical equivalent of –6 diopters or worse) compared with 2% in the lowest decile.74 More recently, Ghorbani Mojarrad et al.75 have used a multitrait PRS combining GWAS of refractive error (spherical equivalent), age of onset of spectacle wear, and years spent in full-time education utilizing 7372 variants. This multitrait analysis approach leverages the correlated nature of these myopia-related traits despite the overlapping GWAS samples. Individuals in the highest decile of this multitrait myopia PRS had 6.1-fold (95% CI, 3.4–10.9) higher risk of developing high myopia relative to the rest, a risk that could not otherwise be inferred readily using demographic risk factors. This is of particular clinical significance, as high myopia is associated with complications that can lead to irreversible vision impairment, most commonly as a result of myopic macular degeneration.76 Finally, combining the myopia PRS with information on the number of myopic parents was more predictive (R2 = 7%) than either risk factor alone (R2 = 4.8% and 2.6% for number of myopic parents and PRS, respectively), highlighting the added predictive ability of a PRS-inclusive model.77
Despite these findings, myopia PRS have several important limitations. Environmental risk factors, such as near-work and outdoor time, have a high impact on the etiology and progression of myopia in contrast to common genetic loci with low effect-sizes.71,74 Further, gene-environment interactions significantly affect the clinical phenotype. For instance, Verhoeven et al.78 have reported lower education significantly masks the genetic penetrance of developing myopia, possibly related to lower time spent in near-work. Among individuals with a high-risk PRS group, the odds of developing a refractive error of at least –3 diopters had a stepwise decline with decreasing education level with an OR of 51, 22, and 7 among high, intermediate, and primary levels of education.78 This is in agreement with several other studies of myopia-associated variants showing differential and heterogeneous risks of myopia development depending on age and education levels.7982
Screening and diagnosis of myopia is relatively easy and affordable especially at a younger age, thereby limiting the clinical utility of genetic testing in myopia prediction. For instance, in a longitudinal study of Chinese twin children, baseline refraction, age, and sex was sufficient to predict risk of high myopia, and the addition of a myopia PRS did not improve the model (AUC 0.9569 vs. 0.9567 respectively; P = 0.7).83 A key limitation of this study, however, is that the PRS was not derived from an ancestrally matched population, likely resulting in a lower signal-to-noise ratio and incorrectly estimating the effect size of the included variants. Despite this, PRS may be useful in identifying individuals at high risk of developing pathological myopia, in which irreversible vision loss is threatened by progressive retinal atrophy, retinal detachment, or choroidal neovascularization.74,76 This subgroup may benefit from regular screening, counseling, and lifestyle modification such increased time outdoors, which may reduce progression.84
Future Directions, Advantages, and Limitations of the PRS
Complex diseases are often diagnosed late in life with a long period of preclinical or “asymptomatic” disease. A key advantage of PRS risk stratification is the ability to identify individuals before they develop symptoms or irreversible pathology, and in some cases also predict the risk of progression.15,38,57,68,74 Risk stratification is best utilized in which early low-risk intervention can alter the natural history of a disease and improve quality of life, as has been reported across a range of cardiovascular conditions.22,28,31,85 In addition, lifestyle modification (such as increasing time outdoors for myopia, or smoking cessation and dietary modification for AMD) and earlier or more frequent screening strategies can be an effective means of minimizing vision loss. POAG represents an ideal case scenario for the clinical utility of PRS: it is one of the most heritable common human diseases without any strong environmental or lifestyle risk factors35; has a prolonged asymptomatic disease phase with irreversible vision loss54; has good outcomes with early cost-effective and low-risk treatment that can effectively halt vision loss86,87; there are highly sensitive and noninvasive screening methods available using optical coherence tomography88; and the availability of highly predictive PRS of disease risk and phenotype.23,38
In health care systems with finite resources, targeting high-risk individuals with low-risk interventions, and minimizing screening and interventions in low-risk individuals, will improve the cost-benefit ratio of these strategies and optimize resource allocation. There will be a significant clinical and economic advantage to target screening strategies to individuals at high risk of developing a disease, while saving resources spent on screening low-risk individuals, as has been shown in the cancer screening setting.26,32,89 PRS can readily be generated from public GWAS summary statistics, and easily updated as newer and larger studies are completed. Because the germline genome is fixed, once generated genomic data can be queried simultaneously at any time with any number of disease-specific PRS. This is particularly beneficial in the fast-paced GWAS literature, in which new risk variants are continuously being reported and can be used to generate new and improved PRS. However, additional research is needed on how best to counsel patients on the risk of multiple diseases and the ethical challenges this imposes. One approach could be a tiered analysis during the lifetime of the individual for different diseases, based on other relevant acquired risks (notably age) and interventions and lifestyle modifications available at the time.
PRS are an increasingly effective and accurate measure of the genetic component of disease risk, which typically outperforms self-reported family history.38,77,90,91 Although family history can capture some of the genetic risk of a disease, it is often incomplete, imprecise, and strongly confounded by shared environmental risk factors.90 Additionally, sporadic cases with no known family history of a disease would also benefit from genetic risk prediction. Nonetheless, PRS is not aimed at replacing clinical history or screening programs as it is not a diagnostic test; rather PRS can serve to improve risk stratification, screening, and clinical decision-making. There is still a need for prospective studies to test the clinical validity and utility of PRS in routine clinical practice. The design of such studies could involve stratification of disease risk based on PRS, potentially followed by randomization of high-risk patients into treatment and control (standard of care) arms. The implementation of PRS in ophthalmic practice can be done at the general practitioner level (primary prevention), optometrists (screening), and specialists (phenotypic and prognostic); however, further research is needed in this area.
There are some challenges to the implementation of PRS in clinical practice. To date, a disproportionate majority of the large-scale GWAS—and thus the PRS derived from them—were performed in populations of European ancestry.92 There is evidence that there is a disparity in LD patterns and risk allele frequencies between African and non-African populations, which impairs the translation of a majority of the current PRSs to African populations.93 Therefore the predictive power of a PRS derived from a majority European ancestry cohort can be lower when applied to other ethnicities.92 For example, although a glaucoma PRS derived from a cohort of European ancestry was predictive of glaucoma risk in South Asian individuals, it had a slightly better predictive power in an independent cohort of European ancestry (AUC of 0.76, 95% CI, 0.73–0.79 vs. AUC of 0.79, 95% CI, 0.75–0.84, respectively).38 Validation studies and mixed-ancestry GWAS are essential for the effective translation of PRS to clinical practice. Furthermore, there is little consensus on the methodology to calculate PRS, or the analysis methods used to report findings. For instance, reports of top to bottom decile comparisons exaggerate the performance of PRS for clinical settings, in which a relative risk comparison to the general population risk is more clinically relevant. This limits ease of comparison, replication, and validation of the published scores. An evidence-based and consistent analysis approach, as well as detailed reporting of the variants and methods used to generate each score, will address these issues. This is currently being addressed by the active development of The Polygenic Score Catalog, an online repository of published PRS with full annotation of variants, weights, and reported performance metrics.94 Finally, PRS research should aim to address clinical questions on the utility of the score in a disease-specific manner, rather than focusing solely on statistical prediction accuracies. For instance, a younger age of disease diagnosis (and thus a higher morbidity) or risk of disease progression or vision loss in the affected or contralateral eye would be more relevant as a translational clinical outcome. Clinicians and genetic counselors are then needed to communicate genetic risk to patients in a personalized manner with actionable monitoring frequencies and lifestyle or pharmacologic intervention suggestions. This implementation, however, will require additional clinician education, updated guidelines, and end-user engagement.
For the adaptation of PRS into clinical practice to be successful, comprehensive understanding of population attitudes toward such testing is critical. It is known that in general, genetic susceptibility testing is well received and supported. Preliminary studies have shown positive interest in genetic testing for Mendelian variants for glaucoma, particularly when applied in appropriate circumstances, such as in families with a strong family history.95 However, little is known about factors associated with uptake of PRS. A pilot study on using genetic testing to guide behavioral modification for AMD risk reduction reported that about one-third of the participants implemented specific personal protective behaviors following optometrist-guided genetic counseling.96 Another pilot study assessing uptake of polygenic risk information for breast cancer in women identified that a family history of disease, higher levels of education, and perceived benefit of testing were factors associated with improved uptake.97 However, more research is needed to better understand barriers to implementation and factors, which may influence patient decision-making.
Conclusions
PRS is a powerful tool in disease risk stratification, and prognostication in common complex diseases. The ideal clinical use scenario is in conditions in which early intervention will alter the natural history of the disease and reduce morbidity or mortality. We have summarized the existing literature supporting the utility of PRS risk stratification in three major ophthalmic conditions: POAG, AMD, and myopia. In these heritable diseases, PRS is highly informative of disease risk and may offer additional information about disease progression. A major advantage of PRS is the ability to calculate the risk of multiple diseases and phenotypes at any point in life using data from a single genotyping array. Importantly, it is not intended to be a diagnostic test, but rather a risk stratifying tool. Future research should focus on the clinical implementation of the PRS to inform personalized and targeted clinical decision-making.
Acknowledgments
Supported by the National Health and Medical Research Council (NHMRC Program Grant APP1150144 and Project Grant APP1157571). AQ was funded by a full-time Avant Doctor in Training scholarship. JEC was an NHMRC Practitioner Fellow.
Disclosure: A. Qassim, None; E. Souzeau, None; G. Hollitt, None; M.M. Hassall, None; O.M. Siggs, None; J.E. Craig, None
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Figure.
Development and clinical utility of a PRS for a sample disease.
Figure.
Development and clinical utility of a PRS for a sample disease.
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✓ Evidence Based
Heron Pose Yoga: Benefits, How To Do And Precautions
Listen to this article
🎯 Key Points
• Strengthens the legs and core muscles.
•
• Improves balance and posture.
•
• Stretches the hip flexors and opens the chest.
•
• Increases focus and mental clarity.
•
• Can help alleviate lower back pain and sciatica.
Heron Pose, also known as Krounchasana in Sanskrit, is a popular yoga pose that offers a wide range of benefits for both the body and mind. This pose is named after the heron, a beautiful bird known for its grace and elegance. In Heron Pose, practitioners mimic the bird’s posture, creating a sense of strength, stability, and poise. This article will explore the various benefits of Heron Pose, provide a step-by-step guide on how to do it correctly, and highlight some precautions to keep in mind while practicing this pose. Whether you are a beginner or an experienced yogi, incorporating Heron Pose into your yoga routine can offer numerous advantages for your overall well-being.
Benefits of Heron Pose Yoga.
Heron Pose Yoga, also known as Krounchasana, is a powerful yoga pose that offers numerous physical, mental, and emotional benefits. Here are some of the key advantages of practicing Heron Pose Yoga:
1. Increased flexibility.
Heron Pose Yoga involves deep stretching of the hamstrings, calves, and lower back. Regular practice helps to improve flexibility in these areas, allowing for better mobility and reducing the risk of injuries.
2. Strengthened leg muscles.
Holding the Heron Pose requires engaging the muscles in the legs, including the quadriceps and hamstrings. This helps to build strength and endurance in the lower body, leading to improved balance and stability.
3. Improved digestion.
The compression of the abdomen during Heron Pose stimulates the digestive organs, enhancing their function and promoting better digestion. This can alleviate issues like bloating, constipation, and indigestion.
4. Toned core muscles.
As you balance in Heron Pose, your core muscles are activated to maintain stability. This not only helps to tone and strengthen the abdominal muscles but also supports a healthy posture and spinal alignment.
5. Enhanced concentration and focus.
The combination of balance, deep breathing, and concentration required in Heron Pose Yoga helps to calm the mind and improve mental focus. Regular practice can sharpen cognitive abilities and enhance overall concentration.
6. Stress relief and relaxation.
Engaging in Heron Pose Yoga encourages deep breathing and relaxation, activating the parasympathetic nervous system. This promotes a state of calmness and reduces stress and anxiety, leading to improved mental well-being.
fiqo desk
7. Improved posture and spinal health.
Heron Pose Yoga involves sitting with an elongated spine, which helps to improve posture and strengthen the back muscles. This can alleviate back pain, correct postural imbalances, and promote a healthy spine.
8. Increased hip mobility.
The hip joint is a common area of tightness for many individuals. Heron Pose Yoga involves opening and stretching the hips, increasing their range of motion and relieving tension in the hip flexors.
9. Boosted circulation.
The various movements and stretches in Heron Pose Yoga help to improve blood circulation throughout the body. This increased circulation delivers more oxygen and nutrients to the cells, promoting overall health and vitality.
10. Mind-body connection.
Heron Pose Yoga encourages a deep connection between the mind and body through conscious breathing, focus, and awareness. This helps to cultivate mindfulness and self-awareness, fostering a greater sense of well-being and self-acceptance.
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Incorporating Heron Pose Yoga into your regular practice can provide a multitude of physical, mental, and emotional benefits, contributing to a healthier and more balanced lifestyle.
How To Do Heron Pose Yoga?
If you are interested in practicing Heron Pose, here is a step-by-step guide on how to do it correctly:
1. Begin by sitting on the floor with your legs extended straight in front of you. Keep your spine elongated and your shoulders relaxed.
2. Bend your right knee and draw it towards your torso, ensuring that your foot remains grounded on the floor.
3. Take hold of your right foot with both hands, clasping your fingers around the sole or ankle, depending on your comfort level.
4. Inhale deeply, lengthening your spine even further, and exhale as you gently lift your right leg off the floor. As you do this, try to keep your back straight and maintain balance.
5. Straighten your right leg as much as possible without forcing it. This may take some time and practice, so be patient with yourself.
6. Once your leg is fully extended, flex your right foot, pointing your toes towards the ceiling. This will help deepen the stretch and engage the muscles in your leg.
7. Keep your left leg firmly grounded on the floor, maintaining stability and balance throughout the pose.
8. Slowly and mindfully, tilt your upper body forward from the hips, hinging at the waist. Reach towards your right foot with your hands, trying to bring your torso closer to your leg. Remember to keep your spine long and avoid rounding your back.
9. Find a comfortable position for your hands – you can either hold onto your foot, ankle, or shin, depending on your flexibility. The key is to avoid straining or overstretching.
10. Stay in this pose for several breaths, focusing on your breath and allowing your body to relax and surrender into the stretch. With each exhale, you can try to deepen the stretch gently, but always listen to your body’s limits.
11. When you are ready to release the pose, slowly and with control, bring your torso upright, releasing your foot and placing it back on the floor.
12. Take a moment to observe any sensations or changes in your body, and then repeat the same steps on the other side, bending your left knee and extending your left leg.
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Remember, as with any yoga posture, it is crucial to listen to your body and respect its limitations. If you have any pre-existing injuries or medical conditions, it is advisable to consult with a qualified yoga instructor before attempting Heron Pose. Regular practice of this pose can help improve flexibility, strengthen the muscles, and cultivate a sense of calm and focus. Enjoy the journey of exploring Heron Pose and the transformative benefits it can bring to your yoga practice.
Who Can Do Heron Pose Yoga?
Anyone who is looking to improve their balance, flexibility, and core strength can benefit from practicing Heron Pose yoga. This pose, also known as Krounchasana, can be modified to accommodate different skill levels, making it accessible to a wide range of yoga practitioners.
Beginners can start by sitting on a blanket or block to reduce the intensity of the stretch, while more advanced practitioners can deepen the pose by straightening their lifted leg and reaching for their extended foot. However, individuals with knee or ankle injuries should exercise caution and consult with a healthcare professional before attempting this pose. With regular practice and proper alignment, Heron Pose can help individuals develop a sense of groundedness, enhance focus, and promote overall well-being.
Who Should Avoid Heron Pose Yoga?
While Heron Pose offers numerous benefits like stretching the hamstrings and improving digestion, there are certain individuals who should avoid attempting this pose. Individuals with knee injuries, particularly those with ligament tears or severe arthritis, should avoid Heron Pose as it places a significant amount of strain on the knees.
Pregnant women should also avoid this pose, especially during the later stages of pregnancy, due to the pressure it exerts on the abdomen. Additionally, individuals with chronic back pain or spinal issues should exercise caution or seek guidance from a qualified yoga instructor before attempting this pose. It is crucial to prioritize safety and listen to one’s body when deciding whether or not to practice Heron Pose.
Precautions To Take While Doing Heron Pose Yoga.
– Warm up your body properly before attempting the Heron Pose to prevent any strains or injuries.
– Practice on a non-slip surface or use a yoga mat to ensure stability and avoid slipping.
– Start with the basic version of the pose and gradually progress to more advanced variations as your flexibility and strength improve.
– Engage your core muscles to maintain balance and stability throughout the pose.
– Avoid forcing your body into the pose; instead, listen to your body and only go as far as you feel comfortable.
– If you have any knee or hip injuries, use props like blankets or blocks to support your knees and hips.
– Focus on your breath and maintain a relaxed state of mind while performing the pose to enhance the benefits and avoid unnecessary strain.
– If you have any pre-existing medical conditions, such as high blood pressure or glaucoma, consult with a healthcare professional before attempting the Heron Pose.
– If you experience any pain or discomfort during the pose, slowly release and come out of the pose.
Bottom Line.
Heron Pose Yoga offers numerous benefits for both the mind and body. By practicing this pose regularly, individuals can improve their balance, strengthen their leg muscles, and increase their flexibility. Additionally, Heron Pose Yoga helps to calm the mind, reduce stress, and enhance concentration. Whether you are a beginner or an experienced yogi, incorporating Heron Pose into your practice can greatly contribute to your overall well-being. So, why not give it a try and experience the transformative effects of Heron Pose Yoga for yourself?
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Secret Curves
/ Health / Not Losing Weight From Intermittent Fasting
Not Losing Weight From Intermittent Fasting
Celebrities like Terry Crews have popularized intermittent fasting—not eating for lengths at a time—as a weight loss tool.
The practice doesn’t guarantee you’ll drop pounds, but it can help you consume fewer calories—which aides in weight loss.
As a refresher, there are different ways to fast, but people generally follow three common schedules: alternate-day fasting, whole-day fasting, or time-restricted fasting. Melanie Boehmer, R.D. at Lenox Hill Hospital, recommends starting with time-restricted fasting. The 16:8 format, meaning you only eat for eight hours in a day, is popular for this method.
It’s always frustrating when the scale is stuck on the same number—despite your best efforts. If you’ve been fasting and haven’t seen results, it’s a good time to analyze your strategy.
Here are some common reasons that explain why you’re not losing weight from intermittent fasting.
You’re eating too many calories
You want to start a food journal before embarking on any kind of diet, says Melanie Boehmer, R.D. at Lenox Hill Hospital.
“It is helpful to monitor your intake to at least understand what your baseline is,” Boehmer tells Men’s Health.
Track everything you eat in a given week using FitDay.com, Lose It!, or MyFitnessPal.
Then, determine how many calories your body needs to maintain its current weight. This can be done using a formula or the body weight planner by the National Institute of Health.
From there, it’s just a matter of comparing your actual intake to what you need. It goes without saying that you won’t lose weight—regardless of fasting—if you consume too many calories
You underestimate portions
If you’re not losing weight—despite staying within your calorie needs—then it’s time to look at serving sizes. It’s common to miscalculate how much you’re actually eating, which leads to consuming more calories than you think. This is particularly true with calorie-dense foods such as cheese.
For example, a one-ounce serving of full fat cheese equals about four dice. Use a food scale—or eyeball portions with this tutorial—to more accurately calculate food intake.
You’re not eating enough
If you’ve hit a weight loss plateau after losing a few pounds, Boehmer says you may be eating too few calories.
That’s because our bodies adjust to whatever we throw at them, she says.
“If on average you’re only taking in 1200 calories, which is something none of us should be doing on a regular basis, your body is going to learn to function on 1200 calories.”
Reduce calories slowly and aim for more moderate weight loss, says Boehmer. She advises cutting enough calories to lose about a pound a week.
“When we talk about losing weight, the goal is always to lose as much weight eating thee most that you can so you don’t create that metabolic inhibitor,” she says.
Melissa Matthews Health Writer Melissa Matthews is the Health Writer at Men’s Health, covering the latest in food, nutrition, and health.
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1b12e5f89ebc6a1a4f0280c20029c85e
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-4,485,250,004,467,683,000
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Flossing Matters. Here’s Why!
Flossing Matters. Here’s Why!
The holiday season is officially here, and we all know what that means–delicious food and sweets galore! While heading straight to the couch after your holiday meal to digest while watching TV may be your first instinct, we are here with 3 reasons why you should consider taking a quick detour to floss first.
1. Flossing prevents cavities.
Forgetting to floss after a long day may seem harmless at the time, but the more you do it, the more damage you’re causing to your body. Plaque and bacteria feed on the sugar and food particles that remain in your mouth after eating. This build-up of bacteria and plaque can eat away at the enamel on your teeth, causing cavities and tooth decay.
2. Flossing keeps your gums healthy.
Some people may not like flossing because their gums get red or tend to bleed easily. However, if your gums bleed when you floss, that is your body’s response to trying to fight off the bacteria and plaque in your mouth. Flossing is a physical way of helping your gums do so. While the bleeding may be heavier at first, it should decrease the more you floss–and the healthier your gums get. Flossing can prevent gingivitis and gum disease, which occur when plaque and bacteria build-up.
3. Flossing helps your overall health.
Studies have shown that an unhealthy, bacteria-filled mouth can lead to serious health issues such as heart disease, stroke, and even bacterial pneumonia. Keeping your teeth and gums healthy now will cause your body to thank you later. The more you floss, the better off you are!
Perhaps one of the best things about flossing is how easy it is to take proper care of your body. Aside from keeping healthy teeth, gums, and overall health, a clean mouth equals a clean and bright smile. So, this holiday season, after you finish a delicious meal with your loved ones, take an extra 2 minutes to floss. Your smile will thank you!
Contact Crabtree Valley Dental to schedule your next appointment today.
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Min menu
Pages
Main natural nutrients for men's health
Main natural nutrients for men's health
The state of health :
physical and mental health has a significant impact on all spheres of
men's life and social activity. To preserve them
a healthy lifestyle must be followed.
Dr. Irina Popkova
• a dietitian, notes in a recent Gazeta.Ru that
• a healthy lifestyle involves regular physical activity
• a balanced diet and good sleep.
She says:
"A man needs a balanced and varied diet.
It should include high protein foods (poultry and meat)
"slow"
carbohydrates (grain and whole grain bread)
fresh vegetables and leafy vegetables
(parsley, dill, cabbage, etc.)
In addition :
it needs to normalize and wake up its sleep system, so that at least 8 hours of
continuous sleep per day. It will not harm the addition of regular physical activity.
It also has to reduce stress factors as much as possible.
Problems with the partner, struggles at work
increased anxiety - all of this can cause reduced libido. "
The expert explains that
1. the most important nutrients are zinc
2. magnesium
3. Arginine and carnitine.
It says:
• "Zinc is necessary to raise the level of testosterone
• the main male sex hormone. It is found in pumpkin seeds
• seafood and nuts.
Magnesium also stimulates the production of testosterone.
In addition :
it is considered the "main anti-stress element."
Magnesium also reduces the excitement of the nervous system
reduces anxiety :
enhances energy. So taking it is important in case of intense physical activity
as it increases the body's stamina. Magnesium
is found in dark chocolate, mackerel and salmon ".
According to nutritionists, the amino acid L-arginine directly affects the process of
erection, as it improves the circulation of the male organ. Pumpkin seeds
are rich in it. Peanuts, walnuts and poultry meat should also be added to the diet.
It says:
"L-carnitine is really strong for energy.
This substance is found in beef and lamb.
If the diet is not diversified and there is a lack of vitamins, mineral elements
and amino acids, nutrients can be taken to improve the state of health. "
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86366b9a982bc93a1cb873a2507519a5
|
3,795,296,201,230,627,000
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Quantitative computerized western blotting.
Dalit Talmi-Frank*, Charles L. Jaffe, Gad Baneth
*Corresponding author for this work
Research output: Contribution to journalArticlepeer-review
3 Scopus citations
Abstract
Western blotting allows analysis of antibody reactivity against multiple antigens separated according to their molecular weights. The distinction between immune dominant and recessive antigens is often difficult and carried out by qualitative or empirical means. Quantitative computerized western blotting (QCWB) addresses this difficulty by analyzing reactivity to specific antigens and providing a statistically measurable value for each band. This allows differentiation between immunodominant and immunorecessive determinants. QCWB is appropriate for either single time point analysis or longitudinal studies where multiple time points are evaluated and the reactivities against individual bands compared. This technique can be used to study humoral responses to complex antigenic mixtures such as allergens and infectious agents, or to identify serologic markers for early diagnosis of cancer, autoimmune, or infectious diseases, or to monitor patient's clinical status.
Original languageAmerican English
Pages (from-to)103-113
Number of pages11
JournalMethods in Molecular Biology
Volume536
DOIs
StatePublished - 2009
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Add to MyChemicals Print Friendly Page
Chemical Datasheet
FURFURYL ALCOHOL
6.1 - Poison
Chemical Identifiers | Hazards | Response Recommendations | Physical Properties | Regulatory Information | Alternate Chemical Names
Chemical Identifiers
The Chemical Identifier fields include common identification numbers, the NFPA diamond U.S. Department of Transportation hazard labels, and a general description of the chemical. The information in CAMEO Chemicals comes from a variety of data sources.
CAS Number UN/NA Number DOT Hazard Label USCG CHRIS Code
• 98-00-0 (FURFURYL ALCOHOL)
• Poison
NIOSH Pocket Guide International Chem Safety Card
Furfuryl alcoholexternal link
NFPA 704
Diamond Hazard Value Description
2
3 1
Blue Health 3 Can cause serious or permanent injury.
Red Flammability 2 Must be moderately heated or exposed to relatively high ambient temperatures before ignition can occur.
Yellow Instability 1 Normally stable but can become unstable at elevated temperatures and pressures.
White Special
(NFPA, 2010)
General Description
A clear colorless liquid. Flash point 167°F. Boiling point 171°F. Denser than water. Contact may irritate skin, eyes and mucous membranes. May be toxic by ingestion and skin contact and moderately toxic by inhalation.
Hazards
The Hazard fields include special hazard alerts air and water reactions, fire hazards, health hazards, a reactivity profile, and details about reactive groups assignments and potentially incompatible absorbents. The information in CAMEO Chemicals comes from a variety of data sources.
Reactivity Alerts
none
Air & Water Reactions
Slightly soluble in water.
Fire Hazard
Excerpt from ERG Guide 153 [Substances - Toxic and/or Corrosive (Combustible)]:
Combustible material: may burn but does not ignite readily. When heated, vapors may form explosive mixtures with air: indoors, outdoors and sewers explosion hazards. Those substances designated with a (P) may polymerize explosively when heated or involved in a fire. Contact with metals may evolve flammable hydrogen gas. Containers may explode when heated. Runoff may pollute waterways. Substance may be transported in a molten form. (ERG, 2020)
Health Hazard
Inhalation causes headache, nausea, and irritation of nose and throat. Vapor irritates eyes; liquid causes inflammation and corneal opacity. Contact of skin with liquid causes dryness and irritation. Ingestion causes headache, nausea, and irritation of mouth and stomach. (USCG, 1999)
Reactivity Profile
Acetyl bromide reacts violently with alcohols or water, [Merck 11th ed., 1989]. Mixtures of alcohols with concentrated sulfuric acid and strong hydrogen peroxide can cause explosions. Example: An explosion will occur if dimethylbenzylcarbinol is added to 90% hydrogen peroxide then acidified with concentrated sulfuric acid. Mixtures of ethyl alcohol with concentrated hydrogen peroxide form powerful explosives. Mixtures of hydrogen peroxide and 1-phenyl-2-methyl propyl alcohol tend to explode if acidified with 70% sulfuric acid, [Chem. Eng. News 45(43):73(1967); J, Org. Chem. 28:1893(1963)].
FURFURYL ALCOHOL will polymerize rapidly and at times with explosive force in the presence of strong mineral acids, [NFPA 491M, 1991]. Alkyl hypochlorites are violently explosive. They are readily obtained by reacting hypochlorous acid and alcohols either in aqueous solution or mixed aqueous-carbon tetrachloride solutions. Chlorine plus alcohols would similarly yield alkyl hypochlorites. They decompose in the cold and explode on exposure to sunlight or heat. Tertiary hypochlorites are less unstable than secondary or primary hypochlorites, [NFPA 491 M, 1991]. Base-catalysed reactions of isocyanates with alcohols should be carried out in inert solvents. Such reactions in the absence of solvents often occur with explosive violence, [Wischmeyer(1969)]. An explosion occurred in a laboratory when cyanoacetic acid was reacted with furfuryl alcohol in an attempt to form the ester, furfuryl cyanoacetate. The explosion occurred a few minutes after the agitator was turned on and heat applied, [MCA Case History 858(1963)]. In the attempt to prepare furfuryl formate from furfuryl alcohol and concentrated formic acid an explosion occurred, [Chem. Eng. News 18:72(1940)].
Belongs to the Following Reactive Group(s)
Potentially Incompatible Absorbents
Use caution: Liquids with this reactive group classification have been known to react with the absorbents listed below. More info about absorbents, including situations to watch out for...
Response Recommendations
The Response Recommendation fields include isolation and evacuation distances, as well as recommendations for firefighting, non-fire response, protective clothing, and first aid. The information in CAMEO Chemicals comes from a variety of data sources.
Isolation and Evacuation
Excerpt from ERG Guide 153 [Substances - Toxic and/or Corrosive (Combustible)]:
IMMEDIATE PRECAUTIONARY MEASURE: Isolate spill or leak area in all directions for at least 50 meters (150 feet) for liquids and at least 25 meters (75 feet) for solids.
SPILL: Increase the immediate precautionary measure distance, in the downwind direction, as necessary.
FIRE: If tank, rail car or tank truck is involved in a fire, ISOLATE for 800 meters (1/2 mile) in all directions; also, consider initial evacuation for 800 meters (1/2 mile) in all directions. (ERG, 2020)
Firefighting
Excerpt from ERG Guide 153 [Substances - Toxic and/or Corrosive (Combustible)]:
SMALL FIRE: Dry chemical, CO2 or water spray.
LARGE FIRE: Dry chemical, CO2, alcohol-resistant foam or water spray. If it can be done safely, move undamaged containers away from the area around the fire. Dike runoff from fire control for later disposal.
FIRE INVOLVING TANKS OR CAR/TRAILER LOADS: Fight fire from maximum distance or use unmanned master stream devices or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tank. ALWAYS stay away from tanks engulfed in fire. (ERG, 2020)
Non-Fire Response
Excerpt from ERG Guide 153 [Substances - Toxic and/or Corrosive (Combustible)]:
ELIMINATE all ignition sources (no smoking, flares, sparks or flames) from immediate area. Do not touch damaged containers or spilled material unless wearing appropriate protective clothing. Stop leak if you can do it without risk. Prevent entry into waterways, sewers, basements or confined areas. Absorb or cover with dry earth, sand or other non-combustible material and transfer to containers. DO NOT GET WATER INSIDE CONTAINERS. (ERG, 2020)
Protective Clothing
Excerpt from NIOSH Pocket Guide for Furfuryl alcoholexternal link:
Skin: PREVENT SKIN CONTACT - Wear appropriate personal protective clothing to prevent skin contact.
Eyes: PREVENT EYE CONTACT - Wear appropriate eye protection to prevent eye contact.
Wash skin: WHEN CONTAMINATED - The worker should immediately wash the skin when it becomes contaminated.
Remove: WHEN WET OR CONTAMINATED - Work clothing that becomes wet or significantly contaminated should be removed and replaced.
Change: No recommendation is made specifying the need for the worker to change clothing after the workshift.
Provide: QUICK DRENCH - Facilities for quickly drenching the body should be provided within the immediate work area for emergency use where there is a possibility of exposure. [Note: It is intended that these facilities provide a sufficient quantity or flow of water to quickly remove the substance from any body areas likely to be exposed. The actual determination of what constitutes an adequate quick drench facility depends on the specific circumstances. In certain instances, a deluge shower should be readily available, whereas in others, the availability of water from a sink or hose could be considered adequate.] (NIOSH, 2022)
DuPont Tychem® Suit Fabrics
No information available.
First Aid
EYES: First check the victim for contact lenses and remove if present. Flush victim's eyes with water or normal saline solution for 20 to 30 minutes while simultaneously calling a hospital or poison control center. Do not put any ointments, oils, or medication in the victim's eyes without specific instructions from a physician. IMMEDIATELY transport the victim after flushing eyes to a hospital even if no symptoms (such as redness or irritation) develop.
SKIN: IMMEDIATELY flood affected skin with water while removing and isolating all contaminated clothing. Gently wash all affected skin areas thoroughly with soap and water. IMMEDIATELY call a hospital or poison control center even if no symptoms (such as redness or irritation) develop. IMMEDIATELY transport the victim to a hospital for treatment after washing the affected areas.
INHALATION: IMMEDIATELY leave the contaminated area; take deep breaths of fresh air. IMMEDIATELY call a physician and be prepared to transport the victim to a hospital even if no symptoms (such as wheezing, coughing, shortness of breath, or burning in the mouth, throat, or chest) develop. Provide proper respiratory protection to rescuers entering an unknown atmosphere. Whenever possible, Self-Contained Breathing Apparatus (SCBA) should be used; if not available, use a level of protection greater than or equal to that advised under Protective Clothing.
INGESTION: If the victim is conscious and not convulsing, give 1 or 2 glasses of water to dilute the chemical and IMMEDIATELY call a hospital or poison control center. Generally, the induction of vomiting is NOT recommended outside of a physician's care due to the risk of aspirating the chemical into the victim's lungs. However, if the victim is conscious and not convulsing and if medical help is not readily available, consider the risk of inducing vomiting because of the high toxicity of the chemical ingested. Ipecac syrup or salt water may be used in such an emergency. IMMEDIATELY transport the victim to a hospital. If the victim is convulsing or unconscious, do not give anything by mouth, ensure that the victim's airway is open and lay the victim on his/her side with the head lower than the body. DO NOT INDUCE VOMITING. IMMEDIATELY transport the victim to a hospital. (NTP, 1992)
Physical Properties
The Physical Property fields include properties such as vapor pressure and boiling point, as well as explosive limits and toxic exposure thresholds The information in CAMEO Chemicals comes from a variety of data sources.
Chemical Formula:
• C5H6O2
Flash Point: 167°F (NTP, 1992)
Lower Explosive Limit (LEL): 1.8 % (NTP, 1992)
Upper Explosive Limit (UEL): 16.3 % (NTP, 1992)
Autoignition Temperature: 736°F (USCG, 1999)
Melting Point: -24°F (NTP, 1992)
Vapor Pressure: 0.4 mmHg at 68°F ; 1 mmHg at 89.2°F (NTP, 1992)
Vapor Density (Relative to Air): 3.4 (NTP, 1992)
Specific Gravity: 1.13 at 68°F (USCG, 1999)
Boiling Point: 338°F at 760 mmHg (NTP, 1992)
Molecular Weight: 98.1 (NTP, 1992)
Water Solubility: greater than or equal to 100 mg/mL at 73°F (NTP, 1992)
Ionization Energy/Potential: data unavailable
IDLH: 75 ppm (NIOSH, 2022)
AEGLs (Acute Exposure Guideline Levels)
No AEGL information available.
ERPGs (Emergency Response Planning Guidelines)
No ERPG information available.
PACs (Protective Action Criteria)
Chemical PAC-1 PAC-2 PAC-3
Furfuryl alcohol (98-00-0) 15 ppm 42 ppm 250 ppm LEL = 18000 ppm
(DOE, 2018)
Regulatory Information
The Regulatory Information fields include information from the U.S. Environmental Protection Agency's Title III Consolidated List of Lists, the U.S. Cybersecurity and Infrastructure Security Agency's Chemical Facility Anti-Terrorism Standards, and the U.S. Occupational Safety and Health Administration's Process Safety Management of Highly Hazardous Chemicals Standard List (see more about these data sources).
EPA Consolidated List of Lists
No regulatory information available.
CISA Chemical Facility Anti-Terrorism Standards (CFATS)
No regulatory information available.
OSHA Process Safety Management (PSM) Standard List
No regulatory information available.
Alternate Chemical Names
This section provides a listing of alternate names for this chemical, including trade names and synonyms.
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Benign Prostate Hyperplasia
June 14, 2023
Back to Curriculum
Benign Prostate Hyperplasia (BPH), also known as enlarged prostate, is a common condition that affects men as they age. It is characterized by an increase in the size of the prostate gland, which is located near the bladder and urethra.
Symptoms of BPH may include:
• Difficulty starting urination
• Weak urine stream
• Dribbling after urination
• Frequent urination, particularly at night
• Urinary retention or the inability to completely empty the bladder
• Urinary tract infections
The exact cause of BPH is not known, but it is believed to be related to hormonal changes that occur as men age. Specifically, the hormone testosterone is converted into a more potent form called dihydrotestosterone (DHT), which can cause the prostate gland to grow.
Diagnosis of BPH involves a combination of medical history, physical exam, and tests such as urine flow studies and ultrasound imaging to measure the size of the prostate gland.
Treatment for BPH varies depending on the individual and the severity of symptoms. In some cases, lifestyle changes such as limiting fluid intake before bedtime or reducing alcohol and caffeine consumption can help manage symptoms. Medications such as alpha blockers or 5-alpha reductase inhibitors may also be prescribed to help relax the muscles around the prostate gland or to reduce the production of DHT.
In cases where symptoms are severe or complications such as urinary retention or recurrent urinary tract infections occur, surgery may be necessary to remove or reduce the size of the prostate gland. It is important to work with a healthcare professional to develop a treatment plan that is tailored to the individual's specific needs.
Upload raw DNA data to get started with your free DNA raw data analysis and contribute to NutraHacker Research on Benign Prostate Hyperplasia today!
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COVID-19 Information
Research
We are interested in understanding the mechanisms of oncogenic transformation in relation to alterations in fundamental transcriptional networks, focusing on the function of the Myc and E2F transcription factor families which are misregulated or overexpressed in a large fraction of human cancers. My laboratory was among the first to describe the chromosomal translocation between c-myc and the immunoglobulin locus in 1982 and we have studied various aspects of Myc function ever since. The oncogenic activity of these transcription factors depends on protein domains associated with transcriptional activation, which provides an avenue to study both cancer biology and the mechanisms of gene regulation. A major contribution of my lab was the discovery of the link between Myc and E2F and the TRRAP-containing histone acetyltransferase complexes, which is currently the dominant model for the mechanism of Myc transactivation. Our studies of Myc cofactors continue, but we have also discovered another fundamental mechanism involving an unexpected aspect of gene regulation, mRNA cap methylation. A second general area of interest is the characterization of distal regulatory elements for c-myc and other critical genes involved in growth control, some of which are linked to inherited cancer risk.
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Understanding Normal A1C Levels: What You Need to Know
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Understanding Normal A1C Levels: What You Need to Know. Photo by Anna Urlapova on Pexels.com
Contents
Understanding Normal A1C Levels: What You Need to Know
At https://diabetescure4u.com/, we understand the importance of maintaining optimal health and keeping track of your blood sugar levels. One key indicator of blood sugar control is the A1C level. In this comprehensive guide, we will delve into what A1C levels are, why they matter, and what constitutes normal A1C levels. By the end of this article, Understanding Normal A1C Levels: What You Need to Know, you will have a clear understanding of how to interpret your A1C results and how to take steps towards better health.
What is A1C?
A1C, also known as glycated hemoglobin, is a vital measurement used to assess average blood glucose levels over a span of two to three months. It provides valuable insights into long-term blood sugar control, helping individuals and healthcare professionals monitor diabetes management effectively.
Why are A1C Levels Important?
Maintaining normal A1C levels is crucial for overall health, especially for individuals with diabetes. High A1C levels are associated with an increased risk of complications such as cardiovascular disease, kidney problems, nerve damage, and eye issues. By keeping your A1C levels within the target range, you can minimize these risks and lead a healthier life.
What are Normal A1C Levels?
The American Diabetes Association (ADA) provides general guidelines for A1C target levels, which can vary slightly depending on individual circumstances. However, for most people, the recommended target is to keep their A1C levels below 7%. This level corresponds to an average blood glucose level of around 154 mg/dL (milligrams per deciliter).
It’s important to note that individual targets may vary based on factors such as age, overall health, and the presence of other medical conditions. It’s best to consult with your healthcare provider to determine the specific target range that is most suitable for you.
Factors Influencing A1C Levels
Several factors can impact A1C levels, and it’s crucial to understand them to gain better control over your blood sugar. Here are some key factors to consider:
Diet and Nutrition
Maintaining a balanced and healthy diet is vital for managing A1C levels. Focus on consuming nutrient-rich foods, including whole grains, lean proteins, fruits, and vegetables. Limit your intake of sugary and processed foods, as they can cause blood sugar spikes.
Physical Activity
Engaging in regular physical activity can help lower A1C levels by increasing insulin sensitivity and promoting weight management. Aim for at least 150 minutes of moderate-intensity aerobic exercise per week, along with strength training exercises.
Medications and Insulin Therapy
If you have been prescribed medications or insulin therapy, it’s crucial to take them as directed by your healthcare provider. These treatments can help regulate blood sugar levels and keep your A1C within the target range.
Stress Management
Chronic stress can contribute to elevated blood sugar levels. Incorporate stress management techniques such as deep breathing exercises, meditation, and engaging in activities you enjoy to help maintain healthier A1C levels.
Regular Monitoring
Regularly monitoring your blood sugar levels and A1C can provide valuable insights into your progress and enable you to make necessary adjustments to your diabetes management plan. Work closely with your healthcare team to develop a monitoring schedule that suits your individual needs.
Conclusion
Understanding and maintaining normal A1C levels is essential for individuals with diabetes or those at risk of developing the condition. By following a healthy lifestyle, incorporating regular exercise, and adhering to your healthcare provider’s recommendations, you can keep your A1C levels within the target range and reduce the risk of complications.
Remember, it’s crucial to consult with your healthcare provider to determine your specific target range based on your individual circumstances. By taking proactive steps towards better blood sugar control, you can enjoy a healthier and more fulfilling life.
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Telogen phase | The last phase of the hair cycle
0
658
fase telogen
The telogen phase is the third part of the hair cycle that comes after the anagen phase and catagen phase.
The telogen phase usually lasts from three to five months.
During the final phase of the follicular cycle, the hair stops growing and becomes totally keratinized.
The dermal papilla enters a state of rest and no longer provides nutrients to the hair since it is totally grown and does not require additional substances to live.
Telogen phase and club-shaped hair
The “club-shaped” hair is a totally mature hair that no longer has access to blood supply because it no longer has the need to grow. The hair bulb is now made of keratin and is ready to leave the scalp so that another hair can regrow. Losing even more than 100 hairs a day that are finishing the telogen phase is a very normal thing to do.
Follicular activity during the telogen phase
In the preceding follicular phase, referred to as the catagen phase, the follicle shrinks rapidly so that no more blood can reach the hair. Next, the follicle works on the formation of the new hair by renewing its cells and the previous hair remains anchored to the follicle until it is expelled. During the creation of the new hair, the old one leaves the place by detaching itself from its anchoring base.
Body hair and the telogen phase.
In addition to having a much shorter anagen phase than hair, body hairs are in the anagen phase for much longer. This means that a body hair will never become as long as a hair and therefore our body can never be completely covered in hair.
Disorders related to the third phase of the follicular cycle .
It is completely normal for a small portion of hair to go together in the telogen phase and it has been shown to approach about 20% of the entire scalp. In case the percentage of hair in telogen phase is well above 20% we could be faced with a dysfunction. These problems can be dictated by external agents or they can have a genetic hereditary component.
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Why is healthy food essential to eat? And how it effect on our health 2021?
Photo of author
Written By Farwa Sidique
Lorem ipsum dolor sit amet consectetur pulvinar ligula augue quis venenatis.
Why is healthy food essential to eat?
Why is healthy food essential to eat?A wholesome eating regimen generally consists of nutrient-dense ingredients from all essential meal groups and lean proteins, entire grains, healthy fat, and culmination and greens of many colours.
Why is healthy food essential to eat? And how it effect on our health 2021?
PC: Jannis Brandt
unsplash
Healthful consuming approach changing ingredients that comprise fats delivered salt and sugar with more fantastic nutritious options.
Following a wholesome eating regimen has many fitness blessings, constructing sturdy bones, protective the coronary heart, stopping disorder, and boosting mood.
This article seems on the pinnacle eight blessings of a wholesome eating regimen and the proof at the back of them.
Heart fitness: According to the Centers for Disease Control and Prevention (CDC), coronary heart disorder is the primary purpose for dying for adults worldwide.
The American Heart Association (AHA) country that nearly 1/2 of U.S. adults stay with a few shapes of cardiovascular disorder.
High blood strain, or high blood pressure, is a developing issue inside the U.S. The situation can lead to coronary heart assault, coronary heart failure, and stroke.
Some root document that it’s far feasible to save you as much as 80% of untimely coronary heart disorder and stroke diagnoses with lifestyle changes, including growing bodily hobby and wholesome consumption.
The ingredients humans devour can lessen their blood strain and assist their coronary heart-healthy.
The nutritional processes to forestall high blood pressure eating regimen, called the DASH eating regimen, consists of masses of wholesome ingredients for the coronary heart. The software recommends the following:
• Consuming masses of greens, culmination, and entire grains
• Selecting fats-loose or low fats dairy products, fish, poultry, beans, nuts, and vegetable oils
• Proscribing saturated and trans fats consumption, including fatty meats and complete-fats dairy products
• Proscribing liquids and ingredients that comprise delivered sugars
• Proscribing sodium consumption to much less than 2 – 300 milligrams in step with day — preferably 1,500 mg daily— and growing intake of potassium, magnesium, and calcium
High fibre ingredients also are essential for retaining coronary heart-healthy.
The AHA country that nutritional fibre facilitates blood LDL cholesterol and lowers the danger of coronary heart disorder, stroke, obesity, and kind two diabetes.
The scientific network has lengthily diagnosed the hyperlink among fat and coronary heart-associated illnesses, including coronary heart disorder.
Limiting certain kinds of fat also can enhance coronary heart fitness. For instance, putting off fat reduces the stages of low-density lipoprotein LDL cholesterol. This sort of LDL cholesterol reasons plaque to acquire inside the arteries, growing the danger of coronary heart assault and stroke.
Reducing blood strain also can sell coronary heart fitness. A character can obtain this through proscribing salt consumption to no more significant than 1,500 milligrams in step with day.
Food producers upload salt to many processed and rapid ingredients. Someone who desires to decrease their blood strain must keep away from those products.
Learn more effective approximately the DASH eating regimen here.
1. Reduced most cancers danger:
Eating ingredients that comprise antioxidants can lessen someone’s danger of growing most cancers by protecting cells from harm.
The presence of loose radicals inside the frame will increase the danger of most cancers. However, antioxidants assist do away with them to decrease the chance of this disorder.
Many phytochemicals observed in culmination, greens, nuts, and legumes act as antioxidants, along with beta-carotene, lycopene, and nutrients A, C, and E.
According to the National Cancer Institute, even though human beings’ trials are inconclusive, laboratory and animal research can hyperlink certain antioxidants to a discounted occurrence of loose radical harm because of most cancers.
Foods excessive in antioxidants include:
• Berries including blueberries and raspberries
• Darkish leafy greens
• Pumpkin and carrots
• Nuts and seeds
Having obesity might also additionally increase someone’s danger of growing most cancers and bring about poorer outcomes. Maintaining a mild weight might also further lessen those risks.
In a 2014 study, researchers observed that an eating regimen wealthy in culmination decreased the danger of higher gastrointestinal tract cancers.
They also observed that an eating regimen wealthy in greens, culmination, and fibre diminished the danger of colorectal most cancers. At the same time, an eating regimen rich in fibre reduces the threat of liver most cancers.
1. Better mood:
Some proof shows a near courting among eating regimen and mood.
In 2016, researchers observed that diets with an excessive glycemic load might also cause improved signs of depression and fatigue.
An eating regimen with an excessive glycemic load consists of many refined carbohydrates, including the ones observed in smooth liquids, cakes, white bread, and biscuits. Vegetables, entire fruit, and entire grains have a decrease glycemic load.
If someone suspects they’ve signs of depression, speak to a physician or intellectual fitness expert who can assist.
1. Improved intestine fitness:
The colon is complete of evidently happening microorganism, which plays critical roles in metabolism and digestion.
Certain lines of microorganisms additionally produce nutrients K and B, which advantage the colon. These lines further assist in combating dangerous organisms and viruses.
An eating regimen low in fibre and excessive sugar and fats alters the intestine microbiome, growing inflammation inside the area.
However, an eating regimen wealthy in greens, culmination, legumes, and entire grains presents an aggregate of prebiotics and probiotics that assist top microorganisms in thriving inside the colon.
These fermented ingredients are wealthy in probiotics:
• Yoghurt
• Kimchi
• Sauerkraut
• Miso
• Kefir
Fibre is prebiotic without problems and is plentiful in legumes, grains, culmination, and greens. It additionally promotes everyday bowel movements that may assist save your bowel most cancers and diverticulitis.
1. Improved memory:
A healthy eating regimen might also additionally preserve cognition and mind fitness.
2015 take a look at recognized vitamins and meals that shield in opposition to cognitive decline and dementia. The researchers determined the below points to be beneficial:
• Nutrition D, nutrition C, and nutrition E
• Omega-3 fatty acids
• Flavonoids and polyphenols
• Fish
Among different diets, the Mediterranean eating regimen carries a lot of those vitamins.
1. Weight loss:
Maintaining a slight weight can assist lessen the danger of continual fitness problems. Having obesity or weight problems are dangerous elements for numerous conditions, along with:
• Coronary heart disease
• Kind two diabetes
• Negative bone density
• Some cancers
Many healthy meals and vegetables, fruits, and beans decrease in energy than full processed meals.
A man or woman can decide their calorie necessities using steerage from the Dietary Guidelines for Americans 2015–2020.
Maintaining a healthy eating regimen loose from processed meals can assist someone’s lives inside their day-by-day restrictions without tracking calorie consumption.
Dietary fibre is especially critical for dealing with weight. Plant-primarily based full meals include masses of nutritional fibre, allowing adjusting starvation to make human beings experience fuller longer.
In 2018, researchers determined that an eating regimen wealthy in fibre and lean proteins resulted in weight loss without tracking calorie consumption.
1. Diabetes management:
A healthy eating regimen can assist someone with diabetes in:
• Dealing with blood glucose levels
• Keeping blood pressure and cholesterol inside goal ranges
• Stopping or delaying headaches of diabetes
• Retaining a slight weight
Human beings with diabetes need to restrict their consumption of meals with introduced sugar and salt. They have to additionally don’t forget fending off fried meals excessive in saturated and fats.
1. Strong bones and teeth:
An eating regimen with adequate calcium and magnesium is critical for sturdy bones and teeth. Keeping the bones healthy can decrease the danger of bone problems later in life, such as osteoporosis.
The following meals are wealthy in calcium:
• Low fats dairy products
• Broccoli
• Cauliflower
• Cabbage
• Canned fish with bones
• Tofu
• Legumes
Food producers regularly improve cereals and plant-primarily based kinds of milk with calcium.
Magnesium is plentiful in many meals. Several first-rate assets consist of inexperienced leafy vegetables, nuts, seeds, and complete grains.
Common Questions:
Why is being healthful crucial?
Staying healthful bodily can assist you in living healthful emotionally too. Suppose you’re consuming the proper meals and maintaining fit. In that case, your frame will be sturdy and assist you in addressing pressure and additionally combating illness. Eating correctly and frequently exercising while you’re a teen will help you live in good health later in life.
What are the advantages of consuming results?
Fruits are a first-rate supply of essential nutrients and minerals, and they’re excessive in fibre. Fruits additionally offer a wide variety of health-boosting antioxidants, which include flavonoids. Eating a food regimen excessively in result and greens can lessen a human’s threat of developing coronary heart disease, cancer, inflammation, and diabetes.
What is healthful consumption?
Healthy consuming means consuming a selection of foods that provide you with the vitamins you want to hold your health, sense good, and feature energy. These vitamins encompass protein, carbohydrates, fat, water, nutrients, and minerals. Nutrition is crucial for everyone.
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Skip to content
Exactly What to Do If You Burn Your Tongue, According to a Doctor
We asked an MD to weigh in and give us the treatment plan for a burnt tongue.
If you're like us, you've experienced a burnt tongue one too many times. We're all guilty of trying to drink our coffee or tea too quickly, right?
But you know the feeling—you submerge your tongue into an all-too-toasty treat, and once you've realized it's too hot for comfort, the damage has already been done.
Your tastebuds can quite literally feel swollen for hours on end, thanks to that unexpected blast of heat that they briefly endured. Sometimes, it may feel like you can't taste food correctly for several hours after those painful few seconds have come and gone.
To help burnt tongues everywhere, we spoke with Cedrina L. Calder, MD, to find out exactly what you need to do after you burn your tongue on a piping hot meal or drink.
What should you do immediately after you've burned your tongue?
"After you realize that you've burned your tongue, you should immediately spit out the food or liquid if possible. This is to prevent the food or drink from continuing to burn your mouth, throat or esophagus," says Calder. "Next, hold some ice water in your mouth to cool the burned area on your tongue. You can also use cold milk or yogurt, which helps coat and soothe the damaged tissue."
Treatment:
"It's important to keep the burn clean. This can be done by doing salt water rinses daily," she says. Calder also recommends that you continue to hold ice water, cold milk, or yogurt in your mouth to numb the affected area, as this will help alleviate the discomfort. Honey is also a good, natural way to treat the tender area because it helps the wounded area heal.
Depending on how severe the burn is, Calder says you can also opt for a topical benzocaine ointment and take an over-the-counter pain reliever such as Advil.
What should you absolutely NOT do after you burn your tongue?
"After burning your tongue, you should avoid hot foods and liquids, spicy foods, acidic foods and beverages, and tobacco. All of these can irritate the already damaged tissue," says Calder. "You should also avoid brushing your tongue until it heals."
What happens to your tongue when you "burn" it, and how long does it take for a burnt tongue to heal?
Calder explains that once you have burned your tongue, you essentially damage its tissue cells, and it could take between two to three days to get back to normal. "If it takes much longer than that, or you develop blisters, you should see your doctor for an evaluation," she says.
If you burn your tongue repeatedly, could this damage your taste buds long-term?
"If the burn is severe enough, you can damage your taste buds. However, this is typically only temporary, as they normally grow back without any issues," says Calder.
Any tips on how you can avoid burning your tongue?
Calder's advice is pretty simple, yet wise, for those of us who repeatedly scorch our tongue's precious tissue cells.
"To avoid burning your tongue, allow foods and liquids to cool off properly before eating or drinking. Cheesy foods, soups, coffee, and tea all are common culprits when it comes to tongue burns," says Calder.
Cheyenne Buckingham
Cheyenne Buckingham is the former news editor of Eat This, Not That! Read more about Cheyenne
Filed Under
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Âçÿòòÿ êðîâ³ íà àíàë³çè âèêîíóºòüñÿ ò³ëüêè íàòùåñåðöå (íàòîùàê). ̳æ îñòàíí³ì ïðèéîìîì ¿æ³ òà âçÿòòÿì êðîâ³ ïîâèííî ïðîéòè íå ìåíøå 8 ãîäèí (áàæàíî 12 ãîäèí). Ìîæíî ïèòè âîäó. Íàïî¿ íå äîçâîëÿþòüñÿ.
Çà 1-2 äí³ äî äîñë³äæåííÿ áàæàíî âèêëþ÷èòè ç ðàö³îíó õàð÷óâàííÿ æèðíó, ñìàæåíó, ãîñòðó ¿æó òà àëêîãîëü. Çà 1,5-2 ãîäèíè äî âçÿòòÿ êðîâ³ áàæàíî óòðèìàòèñÿ â³ä ïàë³ííÿ.
ßêùî âè ïðèéìàºòå ë³êè, ïðîêîíñóëüòóéòåñü ó ë³êàðÿ ïðî êîðèñòü äîñë³äæåíü â äàíèé ïåð³îä.
Ô³ç³îòåðàïåâòè÷í³ òà ä³àãíîñòè÷í³ ïðîöåäóðè, ô³çè÷í³ ïåðåíàâàíòàæåííÿ âïëèâàþòü íà ðåçóëüòàòè àíàëèç³â.
Óâàãà
• Äëÿ âèçíà÷åííÿ êîðòèçîëó, ïðîëàêòèíe, ÀÊÒà çäàâàòè êðîâ íåîáõ³äíî â ñòàí³ åìîö³îíàëüíîãî ñïîêîþ, òîìó ùî ñòðåñ çì³íþº ð³âåíü öèõ ãîðìîí³â.
• Ïðåíàòàëüíèé ñêðèí³íã âàã³òíèõ ïðîâîäèòüñÿ ò³ëüêè â îêðåñëåí³ ñòðîêè âàã³òíîñò³: â I òðèìåñòð³ (PAPP-A, Áåòà-ÕÃ×) íà 11-14 òèæí³, â II òðèìåñòð³ (çàãàëüíèé ÕÃ×, ÀÔÏ) íà 15-18 òèæí³. Çà ìåæàìè âêàçàííûõ ñòðîê³â ä³àãíîñòè÷íà ö³íí³ñòü á³îõ³ì³÷íèõ ïîêàçíèê³â ñêðèí³íãó íåâåëèêà.
• Êðîâ íà ÏÑÀ ñë³ä ñäàâàòè äî àáî íå ðàí³øå í³æ ÷åðåç 10 äí³â ïîñëÿ ðåêòàëüíîãî îáñòåæåííÿ ÷è ìàñàæó ïåðåäì³õóðîâî¿ çàëîçè, òðàíñðåêòàëüíîãî ÓÇÎ, öèñòîñêîﳿ, êîëîíîñêîﳿ. ϳñëÿ á³îïñ³¿ ïåðåäì³õóðîâî¿ çàëîçè íå ðåêîìåíäóºòüñÿ äîñë³äæóâàòè ð³âåíü ÏÑÀ ïðîòÿãîì 1 ì³ñÿöÿ. Çà 2 äí³ äî ñäà÷³ êðîâè³/em> íåîáõ³äíî óòðèìóâàòèñÿ â³ä åÿêóëÿö³¿.
Ïðè ïîâòîðíèõ äîñë³äæåííÿõ äîòðèìóéòåñü îäíàêîâèõ ïåðåäóìîâ äëÿ äîñë³äæåíü:
â îäí³é ëàáîðàòî𳿠òà â îäèí ³ òîé æå ÷àñ äîáè.
Îáíîâëåíî ( 23.08.2022 )
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How Long you should Rest between Sets
How Long you should Rest between Sets? | Comprehensive Guide
Picture this: You step into the gym, fueled by the desire to sculpt your body and achieve new heights of strength. As you prepare to embark on your fitness journey, a burning question arises: How long should I rest between sets?
For ages, gym-goers have been perplexed by the question of rest intervals during long pre-workout sessions. Today, we will delve into the realm of rest intervals to uncover the secrets of muscle growth, hypertrophy, weight loss, and overall performance. So, grab your water bottle, lace up your trainers, and let’s embark on this exhilarating quest together.
How Long You Should Rest Between Sets – All Details 2023:
Here are some of the major things that you need to understand before going into further detail about this specific topic. So, be sure to read all about them on this list and then share your experience with me through the below comment box.
1. Understanding the Science:
To grasp the importance of rest between sets, we must first acknowledge the intricate mechanisms of muscle growth. When we engage in resistance training, tiny tears occur in our muscle fibers.
These micro-injuries act as signals for our bodies to repair and rebuild the muscles, leading to growth and increased strength. Rest periods between sets play a vital role in this process.
2. The Quest for Muscle Growth:
If your primary goal is muscle growth (hypertrophy), it’s essential to find the optimal rest time that allows for maximum recovery and subsequent exertion. Research suggests that rest intervals of around 1-2 minutes strike a balance between allowing sufficient recovery while maintaining a high level of intensity.
Moreover, This timeframe allows your muscles to replenish energy stores and remove metabolic waste, setting the stage for the next set of exercises.
3. The Weight Loss Journey:
For those on a weight loss journey, rest periods take on a slightly different role. Shorter rest intervals of 30 seconds to 1 minute can keep your heart rate elevated and promote calorie burning.
By minimizing rest time, you can transform your workout into a high-intensity interval training (HIIT) session, which is known for its potent fat-burning effects. However, be mindful that shorter rest periods may impact your strength and power output during subsequent sets.
4. The Impact of Exercise Type:
The type of exercise you engage in also influences the ideal rest time. Compound movements, such as squats, deadlifts, and bench presses, recruit multiple muscle groups and typically require longer rest periods of 2-3 minutes.
These exercises demand greater effort and place more significant stress on your muscles. In contrast, isolation exercises that target specific muscle groups, such as bicep curls or leg extensions, may allow for shorter rest intervals of 1-2 minutes.
5. Exploring the Myth of No Rest:
Now, let’s address the notion of eliminating rest time between sets altogether. While it may seem tempting to keep pushing without breaks, it’s crucial to understand the limitations. While there are training techniques like supersets and drop sets that involve minimal rest, these should be used strategically and sparingly.
Overdoing it can lead to premature fatigue, compromising your form, and increasing the risk of injury. Balancing intensity with adequate rest is key to sustainable progress.
6. The Role of Pre-Workout:
Ah, the beloved pre-workout supplement, the elixir that fuels our workouts. You may wonder how its duration factors into the equation. Typically, the effects of pre-workout last for one to three hours, depending on the specific product and your body’s response.
Furthermore, It provides an initial surge of energy and focus, which can enhance performance during your workout. However, it’s important to note that pre-workout is not a substitute for proper rest and recovery. It’s merely a temporary boost, and its effects will eventually fade.
7. The Journey to Finding Your Sweet Spot:
As with any fitness-related question, the ideal rest time between sets is highly individualized. It’s essential to listen to your body, experiment, and make adjustments based on your goals and personal response.
Some individuals may thrive with shorter rest periods, while others may require longer breaks. Take note of how your body feels during different rest intervals and observe the impact on your performance and recovery.
8. Resting Time & Body Optimization:
Keep in mind that progress in your fitness journey is not solely determined by the clock ticking away during rest periods. It’s about finding the perfect balance that optimizes your performance while preventing excessive fatigue.
Remember, the goal is to challenge yourself while allowing enough time for your muscles to recover and adapt.
9. What to do in Resting Intervals?
Incorporate periods of active recovery during your rest intervals. This could involve stretching, foam rolling, or performing light cardiovascular exercises to promote blood flow and aid in the removal of metabolic byproducts.
These active recovery techniques can enhance your overall recovery process and prepare your muscles for the next set.
10. Mental Rejuvenation & Rest:
Don’t underestimate the power of mental rejuvenation during rest periods. Take a few moments to focus on your breathing, clear your mind, and visualize success. Use this time to recharge your mental energy and approach each set with renewed determination and focus.
Lastly, don’t be afraid to seek guidance from fitness professionals or trainers who can provide personalized advice based on your specific goals and needs. They can help tailor your rest periods to align with your training program and ensure that you’re making the most of your time in the gym.
Also Read: How to Get More Vascular?
Frequently Asked Questions:
Is a 2-minute rest between sets too long?
According to the National Strength and Conditioning Association’s book, “Essentials of Strength Training & Conditioning,” two to five minutes between sets is optimal for increasing strength and power. Between sets, 30-60 seconds of rest are ideal for increasing hypertrophy (muscle growth).
Can you rest too long between sets?
How Long You Should Rest Between Sets? It is not necessary to rest too much between sets if you still have time to complete your workout. The answer would not be two minutes, even if there were. It is advisable to rest for two minutes between sets.
How much rest is between leg days?
There is even the possibility of injury as a result of this. You should not exercise your legs for five days in a row, as your body requires rest, so stick to three days with recovery time in between workouts.
How long did Arnold rest between sets?
It is important to note that despite the intensity of his leg training, Arnold usually kept his rest periods between sets short, not exceeding one minute. The result was a “flushing” effect, maintaining maximum blood flow to the muscles throughout the session.
Final Verdict:
How Long You Should Rest Between Sets? The question of how long to rest between sets is multifaceted and depends on various factors such as your goals, exercise intensity, and individual response.
Experimentation and self-awareness are key to finding the optimal rest intervals that maximize muscle growth, support weight loss, and enhance overall performance. Embrace the journey of self-discovery, and let the power of rest propel you toward your fitness aspirations.
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Exposure Therapy for Anxiety
1What Is Exposure Therapy?
Exposure therapy is a form of psychological therapy that aims at helping people overcome anxiety disorders or fears. In this procedure, they are exposed to a stimulus or situation that may trigger their panic or anxiety. The therapist will show them proper strategies to control their fears and reduce distress over time. Depending on the disorders, there are different forms of exposure therapy. Keep reading the next sections to learn more about them. [1]
Back
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Free Worldwide Shipping
1-Year Warranty
Made In USA
Snoring Mouthpiece Vs Cpap
Sleep apnea is a very common health problem in the United States, with an estimated 22 million people suffering and 80 percent of these cases are considered moderate to severe sleep obstruction. Sleep apnea is commonly due to high blood pressure, stroke, type 2 diabetes, obesity and other cardiovascular problems.
Obstructive sleep apnea is the most common type of sleep apnea and causes breathing to repeatedly stop and start during sleep. This happens because the throat muscles intermittently relax and block the airway during sleep causing loud snoring. This snoring is loud enough to disturb your own sleep as well as those near you and often causes a sufferer to wake up gasping or choking as the breathing intermittently stops and starts.
Using A CPAP Machine
This is a serious medical condition experienced by 22 million Americans daily and so finding a solution has become very desired. It is commonly treated with a Continuous Positive Airway Pressure (CPAP) machine which has been shown to be highly effective.
man using cpap machine
However, it is also very common for many sleep apnea sufferers to find the machine uncomfortable due to the CPAP masks. The masks fit over your nose and in some cases the mouth too, with straps around your head to hold it in place. The motor blows air through a large tube known as a cannula that connects the motor to the mask. The mask has often be cited to cause a disturbed night sleep, thus not solving the initial problem. Due to the uncomfortability, users may inconsistently use the CPAP machine and seek a CPAP alternative.
Using A Snoring Mouthpiece
For sleep apnea sufferers, another possible solution for snoring is a mouthpiece. Sleep apnea mouthpieces are a great snoring solution. Studies show mouthpieces are effective in treating sleep apnea by moving the jaw forward and increasing the size of the airway, reducing resistance and making breathing easier. The mouthpieces are custom made and are typically adjustable.
It is recommended that before considering challenging and invasive treatments like CPAP and surgery, to try a sleep apnea mouthpiece. They act as a snoring treatment by reducing airway turbulence which is to blame for the loud noise present for sleep apnea sufferers.
Mouthpieces have many advantages over CPAP machines including it’s small compact size and user accessibility and ease, this results in better compliance when compared to CPAP. These features make users more consistent thus solving the problem more effectively, in fact users commonly experience relief from the first night of use. Due to the size they are also great for individuals who travel frequently as they can fit inside your pocket, unlike the CPAP machines.
If you or someone you know is suffering with sleep apnea, it is important to consider all the treatment options to find the best snoring solution for you and your specific needs. If you want something that is small, compact and easy to use then the mouthpiece is a great option to help you finally have an undisturbed night sleep.
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Íàâèãàöèÿ ïî ñàéòóÍàâèãàöèÿ ïî ñàéòó
86 âûïóñê ìåäèöèíñêîé ðàññûëêè îò 26.06.2016
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Çàíÿòèå ÝÒÈÌ ïåðåä ñíîì ìîæåò âðåìåííî ëèøèòü âàñ çðåíèÿ
Çàíÿòèå ÝÒÈÌ ïåðåä ñíîì ìîæåò âðåìåííî ëèøèòü âàñ çðåíèÿ
Ýòî çàíÿòèå âåñüìà ðàñïðîñòðàíåíî â ñåãîäíÿøíåì ìèðå òåõíîëîãèé, è, ïî ñëîâàì ó÷åíûõ, îíî ìîæåò çàñòàâèòü âàñ èñïóãàòüñÿ çà ñâîå çðåíèå.
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Workouts During Pregnancy
Exercise benefits both mom and the infant. While being active, it’s crucial to avoid overdoing it, pay attention to your body, and preserve safety.
If you’re expecting for the first time, your body is undoubtedly changing. These could show themselves in your physical look or energy levels, depending on where you are in the process. Perhaps you’ve lost a few pounds or decreased your workout intensity.
Body changes can be difficult to adjust to because not everyone in society enjoys the thought of putting on or losing weight. Lest we forget, a whole industry is based on providing rewards for losing weight. But expansion is advantageous during pregnancy. In the weeks prior to delivery, accepting your body’s changes and slowing down your movements may help you and your unborn child stay safe. Exercise should be designed to support your body rather than to modify it.
“You are everything your baby requires exactly as you are,” asserts Laura Fletcher, a licensed doula and coach who advises clients on how to boost their ovarian reserve.
She continues by stating that regular exercise is crucial at all stages of life, including pregnancy. To safeguard themselves and their unborn child, people may need to pay closer attention to a few things when pregnant.
Benefits of Working Out While Pregnant
Even if your exercise regimen may alter from what it was before becoming pregnant, engaging movement in your daily routine can have a number of health advantages, such as:
• Making you feel better.
• Avoiding gaining too much weight.
Encouraging relaxation and strength.
Making you feel better
Exercise can boost mood whether you’re pregnant or not by increasing the brain’s production of endorphins and serotonin. Exercise during pregnancy may help reduce stress brought on by hormonal and changes in lifestyle.
Avoiding gaining too much weight.
Doctors are not attempting to get you bikini ready when they advise against unneeded weight gain. They are assisting you in lowering your risk of serious issues developing during your pregnancy.
“Don’t get me incorrect you ought to gain weight – it’s anticipated, it’s normal – but there are healthy varies of weight loss versus excessive weight gain,” explains Dr. Asima Ahmad. an OB-GYN in Chicago who is also the co-founder and chief medical officer of Carrot Fertility, a healthcare company specializing in fertility treatment. “If you can reach your goal weight before getting pregnant, that’s fantastic.
If not, concentrating on maintaining a healthy weight gain while keeping your body active can help lower pregnancy risks.
A 2016 CDC survey found that the majority of pregnant women acquire more weight than is considered safe or healthy for them. The initial body mass index, which is a measurement of body fat based on height and weight, determines how much weight is considered to be a healthy pregnancy weight increase. These are healthy rates of weight increase during pregnancy, per the Centers for Disease Control and Prevention, for women carrying a single child, not twins or more:
standard BMI. Those with a normal BMI, which is regarded as falling between 18.5 and 24.9, should gain weight in a healthy manner to gain between 20 and 35 pounds.
small BMI. Those who are underweight or have a BMI under 18.5 may be able to gain up to 40 pounds without risking health problems.
large BMI. People who are obese or overweight, defined as having a BMI of 30 or more, may be able to comfortably gain as little as 11 pounds.
Obese or overweight pregnant women at an increased chance of developing a number of life-threatening illnesses, such as preeclampsia, gestational diabetes, and gestational hypertension. Pregnant women with gestational hypertension experience high blood pressure, lack of protein in the urine, and other kidney or heart issues. Usually, it goes away after childbirth.
Another high blood pressure syndrome that can develop in late pregnancy and is occasionally brought on by gestational hypertension is preeclampsia. According to studies, preeclampsia can strike 15% to 25% of those who have gestational hypertension. Preeclampsia can raise risks for seizures and other problems, some of which are life-threatening, for both the pregnant woman and the fetus. Mothers of color and Black people are disproportionately affected.
Encouraging relaxation and strength.
If you were quite active prior to becoming pregnant, maintaining your level of activity may help you feel like yourself and enable you to engage in the activities and pastimes you enjoy. However, try to keep in mind that it’s normal for your athletic ability to fluctuate during these few months.
Best Workouts for Pregnancy
Your greatest bet throughout pregnancy is likely to be the exercises listed below:
1. Walking.
2. Yoga without heat.
3. Swimming.
4. exercising using light weights.
“Overdoing it generally results in discomfort or possibly cramping, overall exhaustion or fatigue,” continues Fletcher.
Fletcher continues, “The best gauge is naturally listening to our body and our doctors. “Slow down, take a break, or stop completely if we feel overextended.”
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ORCiD
Adam M. Kaye: 0000-0002-7224-3322
Document Type
Article
Publication Title
Pain Physician
ISSN
2150-1149
Volume
23
Issue
2
First Page
85
Last Page
85
Publication Date
3-1-2020
Abstract
BACKGROUND: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration's (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine.
OBJECTIVES: The aim of this review is to describe the current regulatory guidelines set in place by the FDA, specifically the terminology around "minimal manipulation" and "homologous use" within Regulation 21 CFR Part 1271, and specifically how this applies to the use of BMC in interventional musculoskeletal medicine.
METHODS: The methodology utilized here is similar to the methodology utilized in preparation of multiple guidelines employing the experience of a panel of experts from various medical specialties and subspecialties from differing regions of the world. The collaborators who developed these position statements have submitted their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these position statements. The literature pertaining to BMC, its effectiveness, adverse consequences, FDA regulations, criteria for meeting the standards of minimal manipulation, and homologous use were comprehensively reviewed using a best evidence synthesis of the available and relevant literature. RESULTS/Summary of Evidence: In conjunction with evidence-based medicine principles, the following position statements were developed: Statement 1: Based on a review of the literature in discussing the preparation of BMC using accepted methodologies, there is strong evidence of minimal manipulation in its preparation, and moderate evidence for homologous utility for various musculoskeletal and spinal conditions qualifies for the same surgical exemption. Statement 2: Assessment of clinical effectiveness based on extensive literature shows emerging evidence for multiple musculoskeletal and spinal conditions. • The evidence is highest for knee osteoarthritis with level II evidence based on relevant systematic reviews, randomized controlled trials and nonrandomized studies. There is level III evidence for knee cartilage conditions. • Based on the relevant systematic reviews, randomized trials, and nonrandomized studies, the evidence for disc injections is level III. • Based on the available literature without appropriate systematic reviews or randomized controlled trials, the evidence for all other conditions is level IV or limited for BMC injections. Statement 3: Based on an extensive review of the literature, there is strong evidence for the safety of BMC when performed by trained physicians with the appropriate precautions under image guidance utilizing a sterile technique. Statement 4: Musculoskeletal disorders and spinal disorders with related disability for economic and human toll, despite advancements with a wide array of treatment modalities. Statement 5: The 21st Century Cures Act was enacted in December 2016 with provisions to accelerate the development and translation of promising new therapies into clinical evaluation and use. Statement 6: Development of cell-based therapies is rapidly proliferating in a number of disease areas, including musculoskeletal disorders and spine. With mixed results, these therapies are greatly outpacing the evidence. The reckless publicity with unsubstantiated claims of beneficial outcomes having putative potential, and has led the FDA Federal Trade Commission (FTC) to issue multiple warnings. Thus the US FDA is considering the appropriateness of using various therapies, including BMC, for homologous use. Statement 7: Since the 1980's and the description of mesenchymal stem cells by Caplan et al, (now called medicinal signaling cells), the use of BMC in musculoskeletal and spinal disorders has been increasing in the management of pain and promoting tissue healing. Statement 8: The Public Health Service Act (PHSA) of the FDA requires minimal manipulation under same surgical procedure exemption. Homologous use of BMC in musculoskeletal and spinal disorders is provided by preclinical and clinical evidence. Statement 9: If the FDA does not accept BMC as homologous, then it will require an Investigational New Drug (IND) classification with FDA (351) cellular drug approval for use. Statement 10: This literature review and these position statements establish compliance with the FDA's intent and corroborates its present description of BMC as homologous with same surgical exemption, and exempt from IND, for use of BMC for treatment of musculoskeletal tissues, such as cartilage, bones, ligaments, muscles, tendons, and spinal discs.
CONCLUSIONS: Based on the review of all available and pertinent literature, multiple position statements have been developed showing that BMC in musculoskeletal disorders meets the criteria of minimal manipulation and homologous use.
KEY WORDS: Cell-based therapies, bone marrow concentrate, mesenchymal stem cells, medicinal signaling cells, Food and Drug Administration, human cells, tissues, and cellular tissue-based products, Public Health Service Act (PHSA), minimal manipulation, homologous use, same surgical procedure exemption.
Creative Commons License
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@article {Murphye000645, author = {Georgina A V Murphy and Gregory B Omondi and David Gathara and Nancy Abuya and Jacintah Mwachiro and Rose Kuria and Edna Tallam-Kimaiyo and Mike English}, editor = {, and , and Agedo, Dorothy and Obonyo, Perez A and Kawira, Anne and Mbuya, Leah and Ochieno, Fredrick and Sammy, Diana M and Mwikali, Agnes and Musoke, Rachel and Nyamai, Rachel and Kuria, Rose and Wesonga, Bridget and Mokua, Judith N}, title = {Expectations for nursing care in newborn units in Kenya: moving from implicit to explicit standards}, volume = {3}, number = {2}, elocation-id = {e000645}, year = {2018}, doi = {10.1136/bmjgh-2017-000645}, publisher = {BMJ Specialist Journals}, abstract = {Neonatal mortality currently accounts for 45\% of all child mortality in Kenya, standing at 22 per 1000 live births. Access to basic but high quality inpatient neonatal services for small and sick newborns will be key in reducing neonatal mortality. Neonatal inpatient care is reliant on nursing care, yet explicit nursing standards for such care do not currently exist in Kenya. We reviewed the Nursing Council of Kenya {\textquoteleft}Manual of Clinical Procedures{\textquoteright} to identify tasks relevant for the care of inpatient neonates. An expert advisory group comprising major stakeholders, policy-makers, trainers, and frontline health-workers was invited to a workshop with the purpose of defining tasks for which nurses are responsible and the minimum standard with which these tasks should be delivered to inpatient neonates in Kenyan hospitals. Despite differences in opinions at the beginning of the process, consensus was reached on the minimum standards of neonatal nursing. The key outcome was a comprehensive list and grouping of neonatal nursing task and the minimum frequency with which these tasks should be performed. Second, a simple categorisation of neonatal patients based on care needs was agreed. In addition, acceptable forms of task sharing with other cadres and the patient{\textquoteright}s family for the neonatal nursing tasks were agreed and described. The process was found to be acceptable to policy-makers and practitioners, who recognised the value of standards in neonatal nursing to improve the quality of neonatal inpatient care. Such standards could form the basis for audit and quality evaluation.}, URL = {https://gh.bmj.com/content/3/2/e000645}, eprint = {https://gh.bmj.com/content/3/2/e000645.full.pdf}, journal = {BMJ Global Health} }
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Mini Big Hype
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LifeStyle
How To Eat Right During Pregnancy
By Anett Ume, MA, RD, LDN
Following a nutritious diet during pregnancy is important to keep the mother and the developing baby healthy. Although the general recommendations, like eating whole grains, lots of fruits and vegetables, low-fat dairy, and lean protein still apply, eating while pregnant is not the same. Your diet strongly determines the health of your baby, so you might want to watch what nutrients are important to keep your fetus healthy, prevent birth defects, and what foods can cause problems. Here are some notes to consider per a registered dietitian:
Contents
Increased calorie needs and appropriate weight gain
Let’s start with the most common question: how much should a pregnant woman eat? Generally, women can continue their pre-pregnancy recommended calorie intake in the first trimester but need an additional 340 calories per day in their second, and an additional 450 calories per day in their third trimester to provide the nutrient needs of the fast-developing baby. The easiest way is to incorporate 1-2 extra snacks daily but increasing portion sizes can also help. When it comes to weight gain, 2-6 lb. is recommended throughout the first trimester, followed by 0.5-1 lb. per week thereafter, depending on your previous weight status. If you are underweight, you might need to eat more to support a healthy environment for your child and avoid him/her being born premature or small for gestational age. Ask your medical provider how much is best for you.
Examples of 300-calorie snacks:
• ½ cup Greek yogurt with 1 Tbs honey and 1 Tbs chopped nuts/seeds/ chia seeds
• 1 apple or banana with 2 Tbs peanut butter
• ¾ cup oatmeal with ½ cup 2% milk and 1 Tbs dried raisins or cranberries
• ½ cup trail mix
• 1 toast with butter, ½ avocado, and 1 oz mozzarella cheese
• 2 Tbs hummus, ¼ cup pumpkin seeds, carrot sticks
Get the important nutrients
Protein: There is an increased need for protein during pregnancy due to the growing life inside of your body. Choose lean meat, cooked seafood (check below what is safe to eat), and low-fat pasteurized milk daily. Add high-protein snacks such as peanut butter, yogurt, cheese, unsalted nuts, and seeds.
Folic acid: This vitamin helps prevent birth defects of the brain and spinal cord. It is found in leafy green vegetables such as spinach, berries, nuts, beans, broccoli, whole grains, seeds, seafood, fortified cereals, and oranges.
Iron: Increased iron is necessary to ensure the fetus is receiving adequate oxygen, growing properly, and has enough fetal blood production. The best sources of iron include enriched grain products, leafy green vegetables, beans, lentils, and animal proteins: poultry, fish, beef, and pork.
Calcium and Vitamin D: Calcium is needed to build teeth and bones, and it allows the heart, muscles, and nerves to function properly. Inadequate intake can cause pregnancy-induced hypertension and pre-eclampsia which can lead to preterm birth. Eat dairy and milk products, fortified cereal, soy beverages, greens, almonds, sardines, tofu, and avocado often. Vitamin D helps the absorption of calcium, it is found in egg yolk, salmon, fortified milk, and orange juice.
Women with vegan, vegetarian, or restricted diet are more at risk of inadequate intake of necessary nutrients, especially iron and calcium. Even if your diet includes a wide variety of foods, it is still needed to take your prenatal vitamins daily to ensure you receive all the nutrients that you and your growing baby need.
Avoid caffeine and added sugar
Caffeine passes through the placenta and can affect your baby. It is recommended to avoid or limit your caffeine intake below 200 mg per day (about 1 cup of coffee). Don’t forget, many other drinks, including soda, teas, and energy drinks contain caffeine. Too much of it can increase the risk of preterm birth, low birth weight, gestational diabetes, miscarriage, and growth retardation. Added sugar should be limited to avoid excessive weight gain, and complications such as pre-eclampsia, gestational diabetes, and preterm birth.
Don’t drink any alcohol
No amount of alcohol is safe during pregnancy, so it should be strictly avoided. Drinking alcohol while pregnant is the leading cause of birth defects and increases the risk of miscarriage and low birth weight. Any amount of alcohol affects the baby’s neurological, cognitive, and cardiological health, and kidney function that cannot be cured later after birth.
Avoid these foods and the risk of foodborne illness
• Unpasteurized milk and juices, soft cheeses such as *feta, camembert, and gorgonzola, because they can contain listeria.
• Hot dogs and lunch meat unless you heat them until steaming hot before eating.
• Raw or undercooked meat, egg, fish, sushi, raw smoked seafood.
• Bigeye tuna, mackerel, marlin, shark, swordfish, and tilefish as they can be high in mercury. Canned tuna, bass, wild-caught salmon, shrimp, trout, catfish, and tilapia are safe to eat.
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Journal Information
Vol. 28. Issue. 2.April 2008
Pages 123-238
DOI:
Full text access
Hidden chronic kidney disease. A matter of decimals
Enfermedad renal oculta. Una cuestión de decimales
Visits
...
Pedro Jesús Labrador Gómeza, M.. Jiméneza, T.. Mengottia, J.. Labradora
a Unidad de Nefrología y Servicio de Análisis Clínicos, Hospital Virgen del Puerto, Plasencia, Cáceres, España,
Article information
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To the editor
The SEN recommends estimating the glomerular filtration rate (GFR) by means of the MDRD-4 equation, using the serum creatinine levels (sCr) approximated to 2 decimals if the units are mg/dL.1
We analyzed the impact on the prevalence of chronic renal disease (CRD) if one decimal is used instead of two decimals, as recommended. We calculated the systematic error and the dispersion (normal and absolute difference between the results of the MDRD-4 with the two approaches) and the inter-method variability by means of the relative difference (absolute difference divided by the mean of the GFR using the approaches multiplied by 100). We also analyzed the impact on the prevalence of hidden renal disease (HRD). We collected 8,967 consecutive blood analytical parameters from patients older than 18 years, requested from Primary Health Care. Through a personal code we identified 8,070 subjects (10.3% of the population of the area), with a mean age of 57.4 ± 18.8 years (range 18-107), of which 62.9% were women; and 40.7% were older than 65 years. If a patient had more than one determination done, we selected the lowest sCr value, to avoid the error attributed to acute renal failure.
By using sCr expressed with 2 decimals, we identified 640 people with GFR < 60 mL/min/1.73 m2 (68.9% women), and the prevalence of CRD was 7.3%; whereas when the sCr value was expressed with one decimal, 699 people were identified (69.8% women) and the prevalence was 8%, which means an increment of 9%.
For the total population the mean bias was -0.3 ± 2.8 mL/min/1.73 m2, with a dispersion of 2 ± 2.1 mL/min/ 1.73 m2 and a GFR variability of 0.6 ± 0.6%. This analysis was completed with a Bland-Altman plot to see the correlation between the dispersion and the MDRD-4 equation using 2 decimals. The dispersion increases as the GFR increases (r = 0.128, p < 0.001), even in patients with CRD (r = 0.427, p < 0.001). The dispersion was not affected either by age or sex (data not shown). For the sCr values the dispersion shows a saw-like hyperbolic curve associated to the approach with one decimal of the sCr, similar to that described for the GFR and sCr levels, so that for sCr values < 1.5 mg/dL the decrease of the dispersion is exponential.
The diagnosis of HRD defined by a GFR < 60 mL/min/1.73 m2 and normal sCr values (for women < 1.2 mg/dL and for men < 1.3 mg/dL) was made in 320 patients when two decimals were employed (50%), and in 253 (39.5%), when only one decimal was employed, with a decrease of 26%. Among women, 288 (65.3%) were diagnosed with HRD with 2 decimals and 251 (56.9%) with one decimal, that is a decrease of 15%; while among men, 32 (16.1%) were diagnosed with 2 decimals and 2 (1%) with one decimal, that is a decrease of 1.500%.
Our results are obtained from a not selected population from Primary Health Care, with a prevalence of CRD that is similar to that found in randomized studies performed on the general population2 and is coherent with previous data from our area.3 The study shows that although there is a close relation between the results of the GFR using one or two decimals, the use of one decimal overestimates the prevalence of CRD by 9% and underestimates the prevalence of HRD by 26%. These differences highlight the importance of following the recommendations when performing studies in this field.
Bibliography
[1]
Gracia S, Montanes R, Bover J y cols. Recomendaciones sobre la utilización de ecuaciones para la estimación del filtrado glomerular en adultos. Nefrología 2006; 26: 658-665. [Pubmed]
[2]
Otero A, Gayoso P, García F y cols. Epidemiology of chronic renal disease in the Galician population: results of the pilot Spanish EPIRCE study. Kidney Int Suppl 2005; S16-S19. [Pubmed]
[3]
Labrador PJ, Macías M, Mengotti T y cols. Estimación sistemática del filtrado glomerular en el Área sanitaria de Plasencia. Nefrología 2006; 26: 514. [Pubmed]
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Inhibition of bone morphogenetic proteins signaling suppresses metastasis melanoma: A proteomics approach
Bhuvanesh Sukhlal Kalal, Prashant Kumar Modi, Dinesh Upadhya, Pratip Saha, Thottethodi Subrahmanya Keshava Prasad, Vinitha Ramanath Pai
Research output: Contribution to journalArticlepeer-review
1 Citation (Scopus)
Abstract
Background: Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-β superfamily, known to promote the tumor invasion and metastasis. There are continual progresses in understanding the role of BMP signaling pathways in carcinogenesis. However, the biological significance of BMPs in human melanoma has received very little attention. The study aimed to explore the effect of BMP inhibition on melanoma treated with LDN193189 (BMP inhibitor) using a quantitative proteomics approach in a melanoma xenograft model. Materials and methods: Melanoma tumor was induced in C57BL6 mice and treated intraperitoneally with LDN193189 for ten consecutive days. Post-treatment, tumors were collected, and comparative proteomics was performed using a high-resolution Orbitrap Fusion Tribrid mass spectrometer. Results: Treatment of melanoma with LDN193189 at 3 mg/kg body weight twice daily showed a significant decrease in the growth rate of the tumor compared to the other doses tested. Quantitative proteomic profiling identified 3231 proteins. Bioinformatics analysis of the 131 differentially expressed proteins selected by their relative abundance revealed that LDN193189 induces alterations in the cellular and metabolic process and the proteins that are involved in protein binding and catalytic activity in melanoma. Conclusions: Down-regulation of metallothionein (MT) 1 and MT2, emerging proteins for their role in tumor formation, progression, and drug resistance and transcription factor EB that plays a crucial role in the regulation of basic cellular processes, such as lysosomal biogenesis and autophagy, were identified upon inhibition of the BMP pathway in melanoma, suggesting their roles in melanoma growth. Understanding the role of these proteins will provide new directions for treating cancer.
Original languageEnglish
Pages (from-to)11081-11093
Number of pages13
JournalAmerican Journal of Translational Research
Volume13
Issue number10
Publication statusPublished - 2021
All Science Journal Classification (ASJC) codes
• Molecular Medicine
• Clinical Biochemistry
• Cancer Research
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Categories
Uncategorized
How Much Does Smile LASIK Cost?
If you are thinking about getting LASIK eye surgery, you may want to know how much the Smile LASIK procedure costs. The procedure is less expensive than some alternatives, but you should be aware of potential risks. For one, SMILE requires less recovery time. In addition, it may overcorrect or undercorrect your vision. It may also be less expensive than LASIK, which is the most popular form of refractive surgery.
SMILE is a less invasive procedure
Compared to traditional LASIK surgery, Smile LASIK is a less-invasive alternative. It uses a laser to reshape the cornea, and the outer layer of the cornea, known as the epithelium, is gently removed. The remaining cornea is then reshaped by a cool excimer laser. This procedure is ideal for patients who have a thin or irregular cornea, are predisposed to chronic dry eye, or have high-risk occupations.
With SMILE, only a small opening is made in the cornea. The surgery is noiseless and odourless. A numbing eyedrop is given before the procedure, and the patient will be awake for only a few minutes. The laser is also much less invasive than LASIK, with the procedure lasting only 35 seconds. The surgeon will carefully remove the lenticule from the cornea using a specialized laser.
SMILE is less expensive
If you’re considering laser eye surgery, SMILE is a good choice for a number of reasons. Unlike traditional LASIK, the SMILE procedure does not create a hinging flap, and it uses a different type of laser to build up tissue within the cornea. After removing the middle layer, a surgeon uses stimulated light amplification to reshape the cornea. Because the cornea is less invasive, less laser exposure and invasion is achieved.
SMILE requires no stitches, and the procedure only takes between 10 and 15 minutes for each eye. The SMILE laser will be programmed with a map of your eye. The surgeon will then place a suction ring on the surface of the cornea, and fire the laser to sculpt the lenticule within the cornea. The resulting reshaped cornea will allow your surgeon to remove the lens and improve your vision.
SMILE may overcorrect or undercorrect your vision
If you’ve never undergone LASIK, Smile LASIK may seem like the perfect choice. However, the procedure is not without risk. Depending on your personal eye condition, Smile may overcorrect or undercorrect your vision. Some patients may experience an inflammation or infection, which usually resolves on its own without any treatment. During the postoperative period, lubricating eye drops may be prescribed. Patients should continue to follow up with their ophthalmologists in the weeks following the procedure.
Before undergoing SMILE, it’s important to understand how the procedure works. A standard script for education includes an illustrated hand drawing of the procedure. It is important to understand what the overall goal of the procedure is, how it works, and which level of correction is ideal. Patients should also ask about the risks of overcorrection and undercorrection. It’s important to understand all the risks and potential complications, and SMILE is designed to help you throughout your journey.
SMILE has a shorter recovery period
While both SMILE and LASIK have similar benefits, the procedures differ in how much disruption occurs to the eye. SMILE has a much shorter recovery time, which makes it a good choice for people with relatively minor vision problems. SMILE also requires only one incision, whereas LASIK requires two. The procedure also creates a smaller scar and the patient typically experiences less dry eye following SMILE, which is beneficial for those with sensitive eyes.
The first step in SMILE is a comprehensive eye exam with an ophthalmologist, during which you can discuss any questions you may have and discuss your expectations. Your ophthalmologist will perform a comprehensive eye examination to ensure that no other vision problems exist. They will map the cornea to ensure the exact placement of laser incisions. After the reshaping is complete, you will need someone to drive you home. You will also be required to avoid activities that can cause particles to enter your eye.
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touchENDOCRINOLOGY touchENDOCRINOLOGY
Diabetes
Read Time: 13 mins
What is Glycaemic Variability and which Pharmacological Treatment Options are Effective? A Narrative Review
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Published Online: Jul 12th 2023 touchREVIEWS in Endocrinology. 2023;19(2):16-21 DOI: http://doi.org/10.17925/EE.2023.19.2.4
Authors: Juan Miguel Huertas Cañas, Maria Alejandra Gomez Gutierrez, Andres Bedoya Ossa
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Abstract
Article
Article Information
Abstract:
Overview
Glycated haemoglobin is currently used for diagnosis and follow-up of diabetes mellitus. However, it has important limitations; as it only reflects the average glycaemia over the last 3 months, it does not allow the identification of crucial events, such as episodes of hypoglycaemia and hyperglycaemia. Strict control of hyperglycaemia can result in severe hypoglycaemia that can be life threatening and can have important sequelae. Recently, the concept of glycaemic variability has been developed to provide information about the magnitude of glycaemic excursions and the duration of these fluctuations. This new approach has the potential to improve outcomes, decrease the risk of hypoglycaemia, and decrease cardiovascular risk. This review describes the most commonly prescribed non-insulin anti-diabetic drugs for diabetes management, their mechanism of action, and the existing evidence about their effectiveness in improving glycaemic variability and diabetes control.
Keywords
Continuous glucose monitoring, diabetes mellitus, glycaemic variability, hyperglycaemia, hypoglycaemia
Article:
The incidence of diabetes has increased in recent years, and advances in technology have allowed for multiple ways to predict the outcomes of patients with diabetes, and have improved quality of life and lowered morbidity and mortality.1 For decades, glycated haemoglobin (HbA1c) has been used as a marker of long-term glycaemic control, and its usefulness as a predictor of complications in type 2 diabetes mellitus (T2D) was established in 1993 in the Diabetes Control and Complications Trial (DCCT).2,3 In 1999, the UK Prospective Diabetes Study (UKPDS) confirmed that reducing exposure to hyperglycaemia through intensive treatment with insulin or oral anti-diabetic drugs significantly reduced the incidence of complications in T2D.4 There is an important association between mortality and increased HbA1c; in the DCCT cohort, a 10% increase in HbA1c was associated with a 56% increase in mortality.5 Nevertheless, its use has considerable limitations, as it is an average of the behaviour of glycaemia over the last 3 months and does not highlight significant excursions. This implies that it has a low capacity to predict the risk of severe hypoglycaemia, which was demonstrated in the DCCT that concluded that only 8% of episodes can be predicted by parameters known at that time, including HbA1c.6 Additionally, significant glycaemic excursions, including those generated by aggressive treatment, affect cognitive function, quality of life, cardiovascular disease and all-cause mortality.7,8 This attempt to optimize treatment has been described as a trade-off between glycaemic control and iatrogenic hypoglycaemia.9,10 In this context, measuring glycaemic variability (GV) represents a way to achieve treatment goals while avoiding the risks associated with both severe hypoglycaemia and prolonged exposure to hyperglycaemia.11
GV is defined as the measure of fluctuations in glucose or other parameters of glycaemic homeostasis over a given period. Although GV was initially approximated based on self-monitoring glucose measurements, these values represented a limited profile of glycaemic behaviour.11 With the advent of technologies such as continuous glucose monitoring (CGM), it is possible to obtain a more complete record and measure blood glucose at 5-minute intervals and overnight.12 CGM has proven useful for optimizing treatment in patients with diabetes, with multiple options to measure it, including real-time flash and professional.13,14 A wide repertoire of methods is currently used to assess GV, representing in some cases its short-term or long-term behaviour. Short-term GV refers to glucose fluctuations during the day that are usually measured with a CGM system, from which data, including the standard deviation (SD) of the average glycaemia, the coefficient of variation (CV) and the mean amplitude of glycaemic excursions (MAGE), are obtained.12 Although there are more complex ways to assess short-term GV, they are rarely used in clinical practice.12 Long-term GV refers to fluctuations in blood glucose over months to years. This is based on serial measurements of Hb1Ac, fasting blood glucose (FBG) and/or post-prandial blood glucose, from which the SD and CV are calculated.15,16
GV has been linked to unfavourable outcomes in patients with diabetes, specifically regarding the pathophysiological implications of high GV.16–19 Glycaemia oscillations are associated with the microvascular and macrovascular complications frequently observed in patients with diabetes. Macrovascular complications include coronary artery disease, cerebrovascular disease and peripheral vascular disease, whereas microvascular complications include neuropathy, retinopathy, nephropathy and lower limb ischaemia.20,21 Multiple studies indicate that fluctuations in glycaemia generate oxidative stress and activate the inflammatory cascade, which is more deleterious than sustained hyperglycaemia in the long term22–24 and occurs rather early in the course of the disease.25–27 The mechanism responsible is suspected to be an increased activation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase resulting in excessive production of reactive oxygen species, oxidative DNA damage and decreased superoxide dismutase activity.28 Additionally, GV contributes to the inflammatory response, with evidence that increased GV results in increased expression of proinflammatory mediators, including interleukin-6 and tumour necrosis factor α, compared with sustained hyperglycaemia.29 Fluctuations in glycaemia also affect nitric oxide synthesis30 and may suppress endothelial protective mechanisms against glycotoxicity-induced damage.31 The aforementioned mechanisms and the increased risk for hypoglycaemia implicates GV as a key factor in the development and progression of most complications associated with T2D.12,32
Despite this, there are no clearly defined reference values for GV. Possibilities include SD, CV, interquartile range, MAGE, mean absolute relative difference (MARD) and mean inter-day risk range; these allow us to determine which patients have stable glycaemic control and which have labile control.16 Among these, CV stands out since there is a consensus that establishes normal values. CV correlates with the risk of hypoglycaemia and is clinically useful as an indicator of GV. GV is considered stable when the CV is <36%, whereas CV values >36% indicate a labile GV and predict a high probability of a severe hypoglycaemia episode in the next 6 months.33
Recently, the time in range (TIR) metric was identified, which is defined as the percentage of time in which blood glucose is in a given range.20,34 In 2017, the Advanced Technologies and Treatments for Diabetes group reached a consensus to standardize the use of CGM;33 before this, different ranges were used, affecting comparison between studies. In general terms, the consensus established the following goals: >70% of a day with blood glucose 70–180 mg/dL (3.9–10.0 mmol/L), <4% at <70 mg/dL (3.9 mmol/L), <1% at <54 mg/dL (3.0 mmol/L), <25% at >180 mg/dL (10.0 mmol/L) and <5% at >250 mg/dL (13.9 mmol/L).35 There are individualized goals according to age group, clinical profile and other variables, but these are not the subject of this article.
Considering the above, GV needs to be added to the tools for controlling T2D, making it imperative to gain a comprehensive understanding of the impact that existing pharmaceutical interventions have on GV.
Materials and methods
This article is a narrative review in which a literature search of articles in English and Spanish was carried out using PubMed, Medline and Embase databases. The following search key was used: ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (metformin); ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (sulfonylurea compounds); ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (dipeptidyl peptidase four inhibitors); ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (“sodium-glucose transporter two inhibitors”); ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (glucagon-like peptide one agonist); ((voglibose) OR (acarbose)) OR (miglitol)) OR (alpha-glucosidase inhibitors)) AND (type 2 diabetes mellitus)) AND (glycemic variability); ((“glycemic variability”) AND (type 2 diabetes mellitus)) AND (insulin).
Only articles that explicitly addressed GV as one of the study variables and evaluated the response to treatment in patients with T2D were included. Articles evaluating drugs of interest ranging from 2008 to 2022 and that used monotherapy or reference treatment (metformin, insulin) as comparison were included. Articles prior to this time period were taken into account to consider the historical process of diabetes treatment and follow-up. All articles referenced through the descriptors were analysed and coded independently by two investigators, who read each article at least twice. No patient data was used and no interventions were performed.
Results and discussion
Insulin
Insulin therapy is a cornerstone of diabetes management, particularly for patients with type 1 diabetes (T1D) and those with inadequately controlled T2D. Fast-acting insulin, such as lispro and aspart, are typically administered before meals to control post-prandial hyperglycaemia. Meanwhile, basal-like insulins, such as degludec and glargine, provide a more stable and prolonged glycaemic control by mimicking endogenous insulin secretion that occurs between meals and during overnight fasting. By reducing fluctuations in blood glucose levels, basal-like insulins help lower GV, which is a crucial factor in preventing the acute and chronic complications of diabetes.20,36 Moreover, new generation basal-like insulins have been associated with a lower risk of hypoglycaemia and nocturnal hypoglycaemia compared with older-generation insulins.37
Yang et al. compared degludec with glargine and concluded that degludec was superior to glargine in reducing FBG variability in both T1D and T2D; degludec had a longer TIR than glargine 100 units but not longer than glargine 300 units.38 For other indicators of blood glucose variation, including SD, MAGE, mean blood glucose (MBG) and CV, no significant differences were identified between degludec and glargine.38 Vrebalov et al. concluded that there was no statistically significant difference in GV between degludec 100 units and glargine 300 units on parameters such as SD, MBG and CV.39 Oe et al. compared degludec + liraglutide versus a dipeptidyl peptidase 4 (DPP4) inhibitor + basal insulin; MAGE significantly decreased from 74.9 mg/dL (95% CI,60.3–97.7; p<0.05) to 64.8 mg/dL (95% CI, 52.0–78.2; p<0.05) in the degludec + liraglutide group, resulting in a better control of GV compared with the DPP-4 + basal insulin group.36
Basal-like insulins are a valuable treatment option for patients who require intensive glycaemic control while minimizing the risk of hypoglycaemia. However, the choice of insulin therapy should be individualized to each patient, taking into account factors such as age and comorbidities, and should be accompanied by comprehensive diabetes education and regular monitoring.40,41
Metformin
Metformin is one of the most prescribed anti-diabetic drugs, and is considered the ideal initial therapy for patients with T2D due to its low cost, safety profile with low risk of hypoglycaemia, and favourable evidence in cardiovascular protection.42 Metformin lowers serum glucose through various mechanisms such as reducing hepatic glucose production by inhibiting gluconeogenesis and glycogenolysis, improving insulin sensitivity in skeletal muscle, and reducing intestinal glucose absorption.43,44
Pistrosch et al. compared insulin glargine versus metformin as first-line treatments in 75 patients with newly diagnosed T2D, evaluating GV, microvascular function and β cell function.45 In patients in the glargine group, fasting glycaemia decreased and β cell function improved, established by the post-prandial pro-insulin/C-peptide ratio. Regarding GV, the group receiving insulin glargine had greater fluctuations in glycaemia, expressed as MAGE and SD, showing that metformin decreases GV compared with insulin glargine.45
González-Heredia et al. studied the effect of linagliptin versus metformin on GV in a group of 16 patients with impaired glucose tolerance, following both groups for 3 months.46 The linagliptin group showed better glycaemic control when assessed by oral glucose tolerance. In regards to GV, there was no significant difference between groups.46 Takahashi et al. studied a group of Japanese patients and compared the use of high-dose metformin (HMET) as monotherapy (1,500 mg) versus low-dose metformin (750 mg) in combination with linagliptin (LMET + DPP4), and excluded patients with insulin treatment.47 Both groups were assessed by CGM and no clinically significant episodes of hypoglycaemia were observed. There was a lower post-prandial area under the curve (AUC) (p=0.041) in post-prandial glycaemic excursions in the LMET + DPP4 group compared with the HMET group. No significant between-group difference was observed in MAGE or SD.47
Difficulties were encountered during the literature search regarding the effect of metformin on GV because most of the studies compared metformin in combination with another oral anti-diabetic drug and few studies evaluated monotherapy. Since metformin is the standard treatment in T2D, research that met the criteria outlined in the Materials and Methods was limited, partly due to the difficulty of comparing against placebo and due to the high prevalence of metformin as initial treatment.
Dipeptidyl peptidase 4 inhibitors
DPP4 inhibitors are incretin derivatives that inhibit the enzyme that degrades glucagon-like peptide 1 (GLP-1), thereby increasing GLP-1 and gastric inhibitory peptide. This, in turn, increases β cells’ sensitivity and suppresses glucagon secretion.48 The risk of hypoglycaemia with DPP4 inhibitors is low due to their mechanism of action being mediated by GLP-1,48 which also allows its use as combination therapy.49 Although DPP4 inhibitors increase GLP-1 concentration, there are no changes in gastric emptying or gastric accommodation, which is an important difference from GLP-1 analogues.50 Although the mechanism is unknown, it is likely that DPP4 inhibitors decrease incretin secretion due to negative feedback on neuroendocrine cells.50
Kim et al. studied the effects of vildagliptin on GV, oxidative stress and endothelial parameters (urinary 8-iso-prostaglandin F2α and flow-mediated endothelial dilatation) in patients with poorly controlled T2D on metformin monotherapy. Vildagliptin significantly improved glycaemic control and reduced GV reflected in the MAGE and mean of daily differences (MODD).51
Nishimura et al. compared the effect of trelagliptin and alogliptin on GV in 27 patients with T2D, finding a post-prandial decrease in the AUC of -31.2 mg/dL min (95% CI, -105.8 to +43.3) in the trelagliptin group, and an increase of +0.4 mg/dL min (95% CI, -0.4, + 1.1) in the alogliptin group on day 22. The AUC for glycaemia <70 mg/dL was 0 on day 28 for both groups.52
Butaeva et al. compared carbohydrate metabolism markers such as HbA1c, FBG and post-prandial serum glucose, and GV in 51 patients with poorly controlled T2D on metformin monotherapy. The markers were compared before and after adding sitagliptin 100 mg/day or gliclazide modified release 60 mg/day for 3 months.53 The sitagliptin + metformin group obtained better results than the gliclazide + metformin group in the aforementioned markers, highlighting a significant reduction in MAGE and SD, reflecting a decrease in GV.53
Kim et al. studied patients with poorly controlled T2D on metformin monotherapy who were assigned to either vildagliptin or pioglitazone for 16 weeks and using CGM.54 Although there was no reduction in oxidative stress markers, there was a statistically significant reduction in GV in patients who received vildagliptin (MAGE from 93.8 ± 38.0 mg/dL to 70.8 ± 19.2 mg/dL; p=0.046).54 Tan et al. evaluated the effect on GV of adding DPP4 inhibitors to premixed human insulin in patients with T2D, finding an increase in TIR and decreases in SD and MAGE.55
Difficulties were encountered during the literature search regarding the effect of DPP4 inhibitors on GV because no studies evaluated monotherapy versus placebo, and very few compared drugs within the same pharmacological group or with reference drugs for the treatment of T2D, such as metformin or insulin. DPP4 inhibitors have a satisfactory effect on GV with an adequate level of evidence.
Sulphonylureas
Sulphonylureas close adenosine triphosphate-sensitive potassium channels, which eventually stimulates insulin release.56 First-generation sulphonylureas, such as tolbutamide, are associated with weight gain, severe hypoglycaemia, mortality, cardiovascular events and dementia.57 Newer extended-release sulphonylureas are safer due to the reduced risk of hypoglycaemia.56
Kohnert et al. studied 59 patients with T2D treated with metformin, sulphonylureas, a combination of these two, or lifestyle modifications.58 Sulphonylureas were associated with a longer time in hyperglycaemia (10.3 versus 0.9 h/day; p<0.001) when compared with diet alone, with no significant differences regarding hypoglycaemia. The pooled sulphonylurea and metformin group had a higher MAGE (5.7 mmol/L versus 3.6 mmol/L; p≤0.001) when compared with lifestyle modifications alone.58 On the other hand, Uemura et al. evaluated 123 hospitalized patients with a TIR >70% to determine the risk of hypoglycaemia in patients with apparent good metabolic control, with or without the use of sulphonylureas.59 An association was observed between the use of sulphonylureas and greater GV, increasing the %CV by 2.678 (95% CI, 0.211–5.145). In addition, time below range (glycaemia <54 mg/dL) was higher in the sulphonylurea group (0.22% versus 0.00%; p=0.048) and high-dose sulphonylureas were associated with sustained episodes of severe hypoglycaemia (β=0.487; p=0.028).59
Difficulties were encountered in analysing the effect of sulphonylureas on GV, since most of the included studies compared sulphonylureas versus another oral anti-diabetic drug. An adequate level of evidence indicates that sulphonylureas tend to increase GV. We suggest the use of other oral anti-diabetic drugs.
Sodium–glucose cotransporter 2 inhibitors
Sodium–glucose cotransporter 2 (SGLT2) inhibitors inhibit a transport protein thereby increasing urinary glucose excretion, which, in turn, lowers glycaemia.60 SGLT2 inhibitors are useful in T2D as combination therapy with other oral anti-diabetic drugs and insulins to decrease GV and improve TIR.60 Additionally, SGLT2 inhibitors play an important role in increasing β cell mass and decreasing insulin doses required to achieve control.60
Henry et al. compared the impact of dapagliflozin versus placebo on the 24h glycaemic profile in adults with poor glycaemic control who were being treated with stable doses of insulin (≥30 U/day) or metformin (≥1,500 mg/day).61 An 18.2 mg/dL reduction in MBG, an increase in TIR of69.6%, and a reduction in GV was observed in the dapagliflozin group.61
SGLT2 inhibitors improve TIR and serum glucose levels without increasing episodes of hypoglycaemia,24 as suggested by Luo et al.60 When evaluating the effect of adding a dapaglifozin to insulin glargine and oral anti-diabetic therapy, there was a significant decrease in HbA1c, FBG, MBG, MAGE and hyperglycaemic excursions, together with an increase in TIR and a decrease in insulin doses required, without a statistically significant increase in hypoglycaemia episodes.60 A randomized controlled trial studying dapaglifozin as add-on therapy to insulin concluded that dapaglifozin reduced glucose levels but not glucose variability.62
There is controversial evidence that dapaglifozin improves GV, and there is insufficient evidence in order to make a conclusive statement in regards to SGLT2 inhibitors as a group.
Glucagon-like peptide agonists
A better understanding of the incretin system has allowed development of new therapies in T2D, such as GLP-1 receptor agonists, which stimulate the release of insulin in the post-prandial period.48 Endogenous GLP-1 is released into the bloodstream and rapidly degraded by the enzyme DPP4, therefore a molecule with similar action and longer half-life was developed.48 In addition to its insulinotropic effects, GLP-1 agonists significantly reduce body weight,63–65 which is fundamental considering 90% of patients with T2D are overweight or obese.66 There are currently several GLP-1 agonists available, which are divided into two categories: GLP-1 mimetics (natides) and receptor analogues (glutides). Glutides include drugs such as dulaglutide, semaglutide and liraglutide, which are administered subcutaneously.48
In a group of 68 patients with newly diagnosed T2D and a body mass index of 25−35 kg/m2, Li et al. evaluated the effect of insulin + liraglutide versus insulin monotherapy on GV, measured by the flash system.67 They observed a significant decrease in GV according to SD, CV and MAGE, and in oxidative stress markers in the liraglutide combination therapy group.67 Probstfield et al. obtained similar results in 102 patients with high cardiovascular risk, comparing insulin alone versus combination therapy of insulin and exenatide, with an improvement in mean CV (-2.4 versus 0.4; p=0.047).68 A meta-analysis assessing the efficacy of liraglutide on GV evaluated SD, MAGE and other parameters, and concluded that liraglutide was associated with lower GV (MAGE: I2=92%, p<0.01; Z=11.91, p<0.01; mean difference =-2.78, 95% CI -3.24 to -2.32; and SD: I2=93%, p<0.01; Z=3.62, p<0.01; standardized mean difference =-1.77, 95% CI -2.73 to -0.81).69
When comparing the addition of exenatide or placebo to metformin, Frías et al. observed that exenatide once weekly, compared with placebo, reduced MAGE (change from baseline: -15.12 mg/dL versus 2.88 mg/dL, respectively) and SD (change from baseline: -6.30 mg/dL versus 0.72 mg/dL, respectively).70 The exenatide group remained euglycaemic for longer (TIR 77% versus placebo 58%) with less time in hyperglycemia when compared with the placebo group (time in hyperglycemia of 22% versus 48%, respectively) and a similar time in hypoglycaemia (0.7% versus 0.3%, respectively).70 Umpierrez et al. compared the addition of lixisenatide versus placebo to basal insulin therapy.71 In 1,198 patients, there was a statistically significant reduction in SD in the lixisenatide group versus the placebo group (81.45 mg/dL versus 68.13 mg/dL).71 Moreover, when evaluating exenatide versus insulin glargine, McCall et al. identified a statistically significant decrease in mean daily risk (exenatide 16.33 ± 0.45 versus glargine 18.54 ± 0.49; p=0.001) with exenatide, mean daily risk being a parameter derived from glycaemic self-monitoring that quantifies the risk of glycaemic excursions.72 However, a randomized controlled study in China of patients treated with metformin, who additionally received exenatide or insulin glargine, reported a similar efficacy between these two drugs, though weight reduction was greater in the exenatide group.73 Regarding patients with cardiovascular comorbidities, Olmo-Garcia et al. compared insulin glargine with liraglutide (with insulin aspart as a corrective), finding a statistically significant decrease in GV determined by CV (liraglutide 20.98% versus glargine 25.48%) and SD (liraglutide 25.48 versus glargine 34.37) in the liraglutide group.74
In essence, the literature currently supports the use of GLP-1 agonists for controlling GV in T2D, being superior to the active comparator in most cases, in addition to benefits in weight reduction and cardiovascular risk.75,76
α-Glucosidase inhibitors
α-Glucosidase inhibitors impede the absorption of carbohydrates from the small intestine by competitive inhibition. α-Glucosidase inhibitors delay digestion and absorption of carbohydrates, resulting in a slower and less pronounced rise in post-prandial glycaemia.77 They are not associated with hypoglycaemia.78
When comparing acarbose with metformin in patients with T2D using premixed insulin for 12 weeks, a significant improvement in GV indices was observed in both groups.79 However, the acarbose group showed a more pronounced change from baseline in CV (26.3% versus 11.9%, respectively; p=0.022), MAGE (40.5% versus 25.2%, respectively; p=0.007) and SD (38.6% versus 30.1%, respectively; p=0.041) than the metformin group.79 In another study, patients inadequately controlled with metformin + vildagliptin were randomized to either placebo or acarbose as add-on therapy, and assessed by CGM.80 MBG was 20 mg/dL lower in the acarbose group (p<0.05), particularly during the post-prandial period. AUC >180 mg/dL was 40% lower in the acarbose group, time >180 mg/dL was significantly higher in the placebo group (31% versus 8%, respectively; p<0.01) and MAGE was 20 mg/dL lower in the acarbose group.80
Acarbose improves GV. Additionally, combining an α-glucosidase inhibitor to decrease post-prandial glycaemia, and metformin to reduce FBG, may have a complementary effect. Existing literature supports the use of α-glucosidase inhibitors for reducing Hb1Ac, weight81–83 and risk of major adverse cardiovascular events.84,85 However, there is limited evidence that evaluates GV through indices previously mentioned in this article, suggesting that future studies should use these indicies to accurately observe effects on GV and compare pharmacological treatment options.
Conclusion
It is clear that GV affects important goals of diabetes control (Hb1Ac, weight and hypoglycaemia), as well as the outcomes associated with glycaemic excursions. Glycaemic control in patients who are treated with insulin therefore must go beyond the classic control of glycaemic goals, and ensure the lowest GV. In T2D, concomitant non-insulin therapy may offer an alternative to mitigate the variability caused by insulin in susceptible patients. Based on the evidence presented in this review, it becomes evident that sulphonylureas play a deleterious role in terms of GV, while metformin appears to have a neutral effect. Among the options mentioned above, DPP4 inhibitors, GLP-1 agonists and SGLT2 inhibitors demonstrate promising effectiveness in managing GV. Table 1 illustrates the main differences and impact on variability between these oral anti-diabetic drugs. Based on currently available information, establishing a relevant role for any specific group is challenging, identifying a gap in our understanding of GV and its treatment. highlighting a gap in our understanding of GV and its treatment.
Article Information:
Disclosure
Andres Bedoya Ossa has received financial support to attend events from Abbott, AstraZeneca, Servier, Sanofi Aventis and Eli Lilly; speaking for Abbott and Sanofi Aventis; and participated in Data Safety Monitoring Board or Advisory Board for Abbott. Juan Miguel Huertas Cañas and Maria Alejandra Gomez Gutierrez have no financial or non-financial relationships or activities to declare in relation to this article.
Compliance With Ethics
This article involves a review of the literature and did not involve any studies with human or animal subjects performed by any of the authors.
Review Process
Double-blind peer review
Authorship
The named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship of this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.
Correspondence
Andres Bedoya OssaDepartment of Physiological SciencesPontificia Universidad Javeriana, Bogotá, Colombia; [email protected]
Support
No funding was received in the publication of this article.
Access
This article is freely accessible at touchENDOCRINOLOGY.com. © Touch Medical Media 2023
Data Availability
Data sharing is not applicable to this article as no datasets were generated or analysed during the writing of this article.
Received
2023-02-06
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Messa Online Doctor ⏬⏬
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65 Views
Introducing Messa Online Doctor: Revolutionizing Healthcare Accessibility
Messa Online Doctor is a groundbreaking platform that has transformed the way people access healthcare services. In an era where convenience and efficiency are paramount, Messa Online Doctor bridges the gap between patients and medical professionals through its innovative virtual healthcare solutions. With a user-friendly interface and a vast network of qualified physicians, the platform offers individuals the opportunity to conveniently consult with doctors from the comfort of their own homes. By harnessing the power of technology, Messa Online Doctor sets a new standard for accessible and reliable healthcare, ensuring that expert medical advice is just a click away.
Messa Online Doctor
Messa Online Doctor is a web-based platform that provides convenient and accessible healthcare services to patients through virtual consultations. With the advancement of technology, Messa Online Doctor offers an innovative solution for patients seeking medical advice and treatment without the need for in-person visits.
Through this platform, patients can connect with licensed doctors from various medical specialties via video calls or chat sessions. This allows individuals to receive professional medical guidance, diagnosis, prescriptions, and even follow-up care from the comfort of their own homes.
The platform’s user-friendly interface facilitates seamless communication between patients and doctors. Patients can schedule appointments, share their medical history, and discuss their symptoms or concerns. Doctors, on the other hand, can review patient information, provide accurate diagnoses, and recommend appropriate treatments.
Messa Online Doctor prioritizes patient privacy and data security. The platform ensures that all personal information and medical records are kept confidential and comply with relevant data protection regulations.
This digital healthcare service not only enhances convenience but also improves access to medical expertise, especially for individuals residing in remote areas or facing mobility challenges. It eliminates geographical barriers, reduces waiting times, and enables individuals to seek timely medical advice, promoting overall well-being.
Online Doctor in America
An online doctor, also known as a virtual doctor or telemedicine physician, is a healthcare professional who provides medical services remotely through digital platforms in America. This approach has gained significant popularity in recent years due to its convenience and accessibility.
Online doctors in America offer a wide range of services, including consultations, diagnosis, treatment recommendations, and prescription refills. Patients can access these services from the comfort of their own homes using computers, smartphones, or tablets.
One of the key advantages of online doctors is their ability to provide medical care to individuals who may have limited access to traditional healthcare facilities. This is particularly beneficial for individuals residing in remote areas or those with mobility issues.
Virtual consultations with online doctors typically involve video calls or chat-based interactions. Patients can discuss their symptoms and medical concerns, and the doctors can ask relevant questions to assess the situation. Based on the information provided, online doctors can offer diagnoses, recommend appropriate treatments, or advise patients to seek further in-person care if necessary.
It is important to note that online doctors in America adhere to strict guidelines and regulations to ensure patient safety and privacy. They are licensed professionals who follow established medical protocols and maintain electronic health records securely.
In addition to primary care services, some online doctor platforms in America specialize in specific medical fields, such as dermatology, psychiatry, or women’s health. This allows patients to receive expert advice and specialized care without the need for physical visits.
Overall, online doctors in America play a crucial role in expanding access to healthcare and providing convenient medical services. They offer a viable alternative to traditional in-person doctor visits, especially for non-emergency situations.
Virtual Doctor Services
Virtual doctor services, also known as telemedicine or telehealth, refer to the provision of medical care and consultations remotely using telecommunications technology. This innovative approach to healthcare has gained significant popularity in recent years, especially with advancements in digital communication and the increasing need for convenient and accessible medical services.
Through virtual doctor services, patients can connect with healthcare professionals from the comfort of their own homes or any location with an internet connection. This eliminates the need for physical visits to hospitals or clinics, saving time and reducing the burden on traditional healthcare facilities.
One of the primary advantages of virtual doctor services is the ability to provide medical care to individuals who may have limited access to healthcare due to geographical constraints, transportation issues, or mobility limitations. It enables people living in remote areas or underserved communities to receive timely and quality healthcare without having to travel long distances.
The virtual doctor services typically involve real-time video conferencing between the patient and the healthcare provider. Patients can discuss their symptoms, receive medical advice, and even undergo remote examinations through this digital platform. The doctors, on the other hand, can diagnose conditions, prescribe medications, order necessary tests, and provide follow-up consultations.
Furthermore, virtual doctor services have proven to be particularly beneficial in situations where immediate medical attention is required but physical presence is challenging. For instance, they enable timely consultations during emergencies, allow specialists to remotely assist in critical procedures, or provide mental health support to individuals in need.
It’s important to note that while virtual doctor services offer convenience and accessibility, they may not be suitable for all medical conditions. Certain cases still require in-person examinations and treatments. However, for many non-emergency medical needs and routine check-ups, virtual doctor services can be a practical and effective alternative.
Telemedicine in the USA
The concept of telemedicine has gained significant momentum in the United States in recent years. Telemedicine refers to the remote provision of healthcare services using telecommunications technology, allowing patients and healthcare providers to connect virtually.
One of the main advantages of telemedicine is its ability to overcome geographical barriers, particularly in rural areas where access to specialized medical care can be limited. Through telemedicine, individuals residing in remote locations can consult with doctors and specialists without the need for extensive travel.
In the USA, telemedicine has experienced rapid growth due to several factors. Firstly, advancements in technology have made it easier than ever for patients to connect with healthcare professionals remotely. Video consultations, secure messaging platforms, and mobile health applications have all contributed to the expansion of telemedicine services.
Secondly, the COVID-19 pandemic significantly accelerated the adoption of telemedicine in the USA. As social distancing measures were implemented, healthcare providers turned to virtual consultations to ensure continuity of care while reducing the risk of virus transmission. This shift highlighted the convenience and effectiveness of telemedicine, leading to increased acceptance and usage among both patients and healthcare providers.
Furthermore, telemedicine offers various benefits beyond accessibility. It can enhance healthcare efficiency by reducing waiting times, minimizing unnecessary hospital visits, and enabling remote monitoring of patients with chronic conditions. Additionally, telemedicine has the potential to lower healthcare costs by eliminating travel expenses and providing more timely interventions, which can prevent the progression of certain health issues.
Despite its advantages, telemedicine still faces challenges regarding reimbursement policies, licensure requirements, and ensuring patient privacy and data security. Efforts are being made at both federal and state levels to address these concerns and create a more supportive regulatory environment for telemedicine.
Remote Medical Consultation
The advancement of technology has revolutionized the field of healthcare, introducing new possibilities for medical consultations. Remote medical consultation, also known as telemedicine or telehealth, refers to the provision of healthcare services remotely, using telecommunications and digital technologies.
One of the primary benefits of remote medical consultation is the ability to access healthcare professionals from anywhere, overcoming geographical barriers. Patients can consult with doctors, specialists, or other healthcare providers without the need for in-person visits, saving time and effort, especially for individuals living in rural or underserved areas.
A remote medical consultation typically involves the use of video conferencing platforms, secure messaging systems, or mobile applications. Patients can discuss their symptoms, receive medical advice, and even get prescriptions through these virtual encounters. This approach not only enhances convenience but also promotes continuity of care, particularly for patients with chronic conditions who require regular monitoring and follow-up.
Remote medical consultation has gained significant importance during the COVID-19 pandemic, when physical distancing and reducing unnecessary contact became crucial. It has played a vital role in providing medical care while minimizing the risk of exposure to infectious diseases. Additionally, it has facilitated timely access to healthcare services, reduced wait times, and increased overall efficiency in healthcare delivery.
However, it’s important to note that remote medical consultation has certain limitations. Not all conditions can be effectively diagnosed or treated remotely, as some cases may require physical examination, diagnostic tests, or procedures that can only be performed in person. Nonetheless, advancements in technology, such as remote monitoring devices and AI-assisted diagnostics, are continually expanding the scope of remote healthcare.
Telehealth Appointments
Telehealth appointments, also known as virtual doctor visits or telemedicine consultations, refer to medical appointments conducted remotely using digital communication technologies. These appointments allow patients to consult with healthcare professionals from the comfort of their own homes, eliminating the need for in-person visits to clinics or hospitals.
Telehealth appointments have gained popularity and importance, particularly during times when access to healthcare services may be limited or when patients prefer the convenience offered by remote consultations. They provide numerous benefits, including:
• Convenience: Telehealth appointments offer patients the ability to receive medical care without the need for travel or waiting rooms. This is especially beneficial for individuals with mobility challenges, those residing in remote areas, or those with busy schedules.
• Accessibility: Virtual appointments make healthcare more accessible to individuals who may face barriers such as transportation issues, lack of nearby medical facilities, or physical disabilities.
• Time-saving: Patients can save time by avoiding long commutes and waiting times at healthcare facilities. Telehealth appointments often have shorter wait times, allowing patients to receive timely medical attention and advice.
• Continuity of care: Telehealth enables patients to maintain a consistent relationship with their healthcare providers, ensuring ongoing monitoring, follow-ups, and management of chronic conditions.
• Reduced costs: Remote consultations can be more cost-effective compared to in-person visits, as they eliminate expenses associated with travel and parking.
During a telehealth appointment, healthcare professionals use secure video conferencing platforms or dedicated telemedicine apps to interact with patients. They can discuss symptoms, assess conditions, provide medical advice, prescribe medications, and offer referrals for further tests or in-person visits when necessary.
It is important to note that telehealth appointments may not be suitable for all medical conditions, as certain cases require physical examinations or procedures that can only be conducted in-person. However, for many routine check-ups, follow-ups, mental health consultations, and non-emergency medical concerns, telehealth offers a convenient and efficient alternative.
Digital Healthcare Solutions
Digital healthcare solutions refer to the integration of technology in the healthcare sector to improve patient care, enhance efficiency, and streamline processes. These solutions leverage various digital tools and technologies to facilitate communication, data management, diagnosis, treatment, and overall healthcare delivery.
One key aspect of digital healthcare solutions is the implementation of electronic health records (EHRs) or electronic medical records (EMRs). These systems allow healthcare providers to securely store, access, and exchange patient information digitally, eliminating the need for paper-based records. EHRs/EMRs enable comprehensive patient profiles, enabling healthcare professionals to make informed decisions and provide personalized care.
Another significant advancement in digital healthcare is telemedicine or telehealth services. These platforms enable remote consultations between patients and healthcare providers through video conferencing or online messaging. Telemedicine offers convenience, accessibility, and cost-effectiveness, particularly for individuals in remote areas or with limited mobility.
Furthermore, mobile health applications (apps) have gained popularity in the digital healthcare landscape. These apps provide a wide range of functions, including symptom tracking, medication reminders, fitness monitoring, and virtual coaching. They empower individuals to actively manage their health and well-being, promoting preventive care and healthy lifestyle choices.
The use of artificial intelligence (AI) and machine learning algorithms also plays a crucial role in digital healthcare solutions. AI can analyze vast amounts of medical data to identify patterns, predict outcomes, and assist in clinical decision-making. Machine learning algorithms can learn from historical patient data to create predictive models, aiding in early disease detection and personalized treatment plans.
Telemedicine Providers in America
Telemedicine has emerged as a crucial aspect of healthcare delivery in America, offering convenient and accessible medical services remotely. Numerous providers have established themselves in the telemedicine industry, catering to the diverse healthcare needs of the population.
One prominent telemedicine provider in America is Teladoc Health. Teladoc offers virtual consultations with licensed physicians, allowing patients to receive medical advice, diagnoses, and even prescriptions through their online platform. They cover a wide range of specialties, including primary care, dermatology, mental health, and more.
Another notable telemedicine provider is American Well, operating under the brand name Amwell. Amwell offers video visits with healthcare professionals who can address various non-emergency conditions. Their platform facilitates secure and confidential interactions between patients and providers, ensuring high-quality care.
Zocdoc is a popular telemedicine platform that connects patients with doctors across multiple specialties. Users can search for providers based on their location, insurance coverage, and specific healthcare needs. Zocdoc streamlines the process of booking appointments, making it easier for patients to access timely medical care.
In addition to these providers, there are several other telemedicine companies operating in the American market, such as MDLIVE, Doctor on Demand, and PlushCare. Each provider offers unique features and benefits, but they all share the common goal of expanding access to healthcare services through technology.
Telemedicine providers in America have played a crucial role in improving healthcare accessibility, especially in rural areas where access to brick-and-mortar medical facilities may be limited. These platforms have also been instrumental in reducing wait times, increasing convenience, and enhancing patient satisfaction.
Online Medical Diagnosis
Online medical diagnosis refers to the process of using digital platforms and technologies to assess and identify potential medical conditions or diseases. It involves utilizing various tools, questionnaires, and algorithms to gather information from individuals and provide them with a preliminary analysis of their symptoms.
One of the key advantages of online medical diagnosis is its accessibility and convenience. People can access these services from the comfort of their homes, eliminating the need for in-person visits to healthcare facilities. Online platforms often offer symptom checkers, where users can input their symptoms and receive a list of possible conditions that might explain their health issues.
However, it is important to note that online medical diagnosis should not be considered a substitute for professional medical advice. While these platforms can provide initial guidance, they cannot replace the expertise and clinical judgment of trained healthcare professionals.
Online medical diagnosis platforms typically operate by comparing user-provided symptoms against a database of medical knowledge and algorithms. Some platforms also incorporate artificial intelligence and machine learning techniques to enhance diagnostic accuracy. However, these systems are still evolving, and their reliability may vary.
Privacy and data security are critical concerns when it comes to online medical diagnosis. Users must ensure that the platform they choose complies with relevant privacy regulations and safeguards their personal information. Additionally, they should be cautious about sharing sensitive medical details online and verify the credibility and legitimacy of the platform before providing any information.
Virtual Doctor Visits: Revolutionizing Healthcare Delivery
In recent years, virtual doctor visits have gained significant traction as a transformative approach to healthcare delivery. Leveraging advancements in technology, virtual doctor visits, also known as telemedicine or telehealth, allow patients to consult with healthcare professionals remotely through video conferencing or other digital platforms.
One of the primary advantages of virtual doctor visits is improved accessibility to healthcare services. Geographical barriers and limited mobility no longer pose significant obstacles for patients seeking medical advice. With virtual visits, individuals can connect with doctors regardless of their physical location, eliminating the need for travel and reducing waiting times.
Furthermore, virtual doctor visits offer convenience to both patients and healthcare providers. Patients can schedule appointments at their convenience, saving time and avoiding crowded waiting rooms. Additionally, virtual visits enable doctors to manage their time more efficiently, increasing their patient reach and flexibility.
Telemedicine also enhances patient safety by minimizing exposure to contagious diseases. Particularly during pandemics or other emergencies, virtual visits play a crucial role in preventing the spread of infections while ensuring uninterrupted access to healthcare services.
However, it is important to note that virtual doctor visits are not suitable for all medical conditions. While they work well for routine check-ups, follow-ups, and non-emergency consultations, certain conditions may still require in-person examinations and procedures. It is essential to consult with healthcare professionals to determine the suitability of virtual visits based on individual circumstances.
Author
• Jane Moore
Meet Jane, a passionate blogger with a love for all things creative. From DIY projects to healthy recipes, Jane enjoys sharing her ideas and experiences with her readers. She believes that everyone has a unique story to tell, and hopes to inspire others to explore their creativity and pursue their passions. Follow along as Jane shares her journey and tips for living a fulfilling life.
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Easily and safe lose weight without doing exercises
Choose a Low-Carb Diet
If you want to lose weight you should start by avoiding sugar and starch (like bread). This is an old idea: For 150 years or more there have been an infinite number of weight-loss diets based on eating less carbs. What’s new is that dozens of modern scientific studies have proven that, yes, low carb is the most effective way to lose weight.
Obviously it’s still possible to lose weight on fish-waiting-to-be-cookedany diet – just eat less calories than you burn, right? The problem with this simplistic advice is that it ignores the elephant in the room: Hunger. Most people don’t like to “just eat less”, i.e. being hungry forever. That’s dieting for masochists. Sooner or later a normal person will give up and eat, hence the prevalence of “yo-yo dieting”.
The main advantage of low carb diets is that they cause you to want to eat less. Even without counting calories most overweight people eat far fewer calories on low carb. Sugar and starch may increase your hunger, avoiding it may decrease your appetite to an adequate level. If your body wants to eat an appropriate number of calories you don’t need to bother counting them. Thus: Calories count, but you don’t need to count them.
A 2012 study also showed that people on a low carb diet burned 300 more calories a day – while resting! According to one of the Harvard professors behind the study this advantage “would equal the number of calories typically burned in an hour of moderate-intensity physical activity”. Imagine that: an entire bonus hour of exercise every day, without actually doing it.
Bottom line: A low carb diet reduces your hunger and makes it easier to eat less. And it might even increase your fat burning at rest. Study after study show that low carb is the smart way to lose weight and that it improves important health markers.
Cut Back on Sugars and Starches
The most important part is to cut back on sugars and starches (carbs).
These are the foods that stimulate secretion of insulin the most. If you didn’t know already, insulin is the main fat storage hormone in the body.
When insulin goes down, fat has an easier time getting out of the fat stores and the body starts burning fats instead of carbs.
Another benefit of lowering insulin is that your kidneys shed excess sodium and water out of your body, which reduces bloat and unnecessary water weight (1, 2).
It is not uncommon to lose up to 10 pounds (sometimes more) in the first week of eating this way, both body fat and water weight.
This is a graph from a study comparing low-carb and low-fat diets in overweight/obese women (3).
weight-loss-graph-low-carb-vs-low-fat-smaller
The low-carb group is eating until fullness, while the low-fat group is calorie restricted and hungry.
Cut the carbs, lower your insulin and you will start to eat less calories automatically and without hunger (4).
Put simply, lowering your insulin puts fat loss on “autopilot.”
Removing sugars and starches (carbs) from your diet will lower your insulin levels, kill your appetite and make you lose weight without hunger.
Leave a Comment
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Skip to main content
Skin microcirculation and vasopressin infusion: a laser Doppler study
Abstract
Use of arginine vasopressin in the management of refractory vasodilatory shock has been associated with development of ischaemic skin lesions. Because of the increasing popularity of arginine vasopressin, it is important to evaluate its effects on microcirculatory blood flow. Such studies are crucial if we are to appreciate the microcirculatory consequences of our various resuscitation strategies. However, methodological issues must always be considered because they can significantly influence interpretation of the results. Some aspects of use of laser Doppler to evaluate the microcirculation are reviewed within the context of recent findings presented by Luckner and coworkers in this issue of Critical Care.
Introduction
Arginine vasopressin (AVP) is increasingly used in the management of refractory vasodilatory shock. Indeed, it was recently incorporated into the recommendations (grade IIB) proposed by the American Heart Association for treatment of refractory septic shock [1] and the guidelines of the Surviving Sepsis Campaign (grade E) [2]. However, although the global haemodynamic effects of AVP are relatively well described, its effects on the microcirculation are still largely unknown.
In this issue of Critical Care, Luckner and coworkers [3] present an original study in which they evaluated skin micro-vascular blood flow, using laser Doppler fluxmetry, before and after AVP infusion in patients with refractory septic shock. They report that AVP infusion did not impair forearm skin perfusion compared with norepinephrine alone. The authors intended to explore further the results of two of their previous studies: a retrospective analysis [4], in which they reported a 30.2% rate of ischaemic skin lesions with AVP infusion; and a prospective controlled trial [5] that found no difference in the incidence of such lesions between a group of patients treated with AVP plus norepinephrine and patients treated with norepinephrine alone. Of note, it is difficult to draw conclusions regarding the safety of AVP administration on the basis of the latter study because the dose of norepinephrine received by the patients in the AVP/norepinephrine group was half that in the other group.
As mentioned by the authors, their results presented in this issue are in striking contrast to those of several published physiological experiments on the topic. Indeed, animal and human studies [69] have revealed significant dose-dependant impairment in skin blood flow with AVP. Indeed, the skin microvasculature is considered to be a vascular bed that is rather sensitive to AVP [10]. Accordingly, the results of the study presented by Luckner and coworkers are somewhat unexpected, and some methodological issues might account for the discrepancies.
Technical issues: laser Doppler fluxmetry
It is important to note the technical limitations of laser Doppler. Laser Doppler fluxmetry only provides an estimate of the average blood flow in a given volume of tissue; this volume can vary according to its intrinsic refractive properties. Multiple individual and environmental factors, including haemoglobin level and temperature, can also influence the results of laser Doppler fluxmetry [11]. Moreover, laser Doppler fluxmetry does not take into account the type of microvessels under study, their morphology, the direction of flow and, more importantly, the heterogeneity of perfusion; the latter is a key component in the study of microcirculation, especially in sepsis. More specifically, the biological zero, which can represent up to 80% of the total laser Doppler fluxmetry signal, can be modified during ischaemia/reperfusion procedures because it is influenced by vasodilatation [12]. Therefore, various authors have suggested that the biological zero should always be taken into account when red blood cell flux is measured in the skin using laser Doppler fluxmetry [12]. Finally, measurement of differential perfusion is impeded by the rather small signal and oscillatory pattern of basal cutaneous microcirculation [13]. In addition, it is worth noting that vasomotion patterns are highly dependant on probe location relative to the tissue of interest [14]. This could explain, to some extent, the considerable difference reported in baseline vasomotion between groups. These technical issues account for the substantial short-term variability in laser Doppler fluxmetry measurements [15]. Hence, it is apparent that relatively large observed changes or large sample sizes are needed to detect statistically significant differences between groups.
Statistical issues: power calculation and variance
The power of a study is a measure of its ability to detect a statistical difference when it truly exists; it is particularly important to bear this in mind when interpreting studies that return negative findings. The calculated power of the study reported by Luckner and coworkers is approximately 40%, considering the observed difference in primary outcome (area under the curve of the laser Doppler fluxmetry signal) between the two groups. This means that there is a 60% chance that a true difference will remained undetected. With only three additional patients in each group (assuming the same difference in variance between groups) the study would identify a significant difference in microvascular blood flow perfusion and lead to the conclusion that AVP has, in fact, a considerable deleterious impact on skin microcirculation. Finally, the important variance in AVP response (8.56 in the AVP group versus 3.25 in the norepinephrine group; data provided by Luckner and coworkers) suggests that AVP had rather heterogeneous effects from patient to patient and that other factors (e.g. interindividual variability in sensitivity to AVP stimulation, endogenous AVP level, relative adrenal insufficiency, among others) could have played a role.
Conclusion
Luckner and colleagues [3] are to be commended for their pioneering work on the microcirculatory effects of AVP. Such studies are essential if we are to understand better the micro-circulatory consequences of our resuscitation strategies. However, this work should be duplicated, and we should exercise caution interpreting these results as reassurance that AVP is devoid of adverse microcirculatory side effects. Further work examining different microcirculatory beds and using different measurement tools to assess microcirculation will improve our knowledge of the role of AVP in resuscitation.
Abbreviations
AVP:
= arginine vasopressin.
References
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Acknowledgements
We should like to thanks Prof. Daniel G Bichet for inspiring discussions on vasopressin microvascular reactivity.
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Correspondence to Colin Verdant.
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The authors declare that they have no competing interests.
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Cite this article
Bernard, F., Vinet, A. & Verdant, C. Skin microcirculation and vasopressin infusion: a laser Doppler study. Crit Care 10, 135 (2006). https://doi.org/10.1186/cc4884
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Keywords
• Arginine Vasopressin
• Relative Adrenal Insufficiency
• Microcirculatory Blood Flow
• Resuscitation Strategy
• Skin Microcirculation
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Treatment for disease armpit, smelly feet
Treatment for disease armpit, smelly feet
Sweat undertake a variety of tasks, in which a task is the discharge of toxic substances in the body out. The composition of sweat is actually "good food" for the bacteria, including the bacteria Corynebacterium Minitissumum specializes in fatty acid metabolism and creates black spots on ... body odor.
Women often face armpit disease than men
Treatment for disease armpit
Many people suffering with his armpit illness. Just powerful motor, it was a bit hot, 5 to 7 minutes, they were "frozen" a smell medical characteristics of armpit. In the summer, they are afraid to stand out from the crowd, and just a gesture away, wrinkled his nose ... the opposite of that they lost all confidence to work.
They also have to give the vivid, bright color and fashionable for fear of sweating, wet armpit makes people easy to recognize. Throughout the year, they wear dark shirts. Moment, they had to use the toilet deodorant. They also often have to stay away from the active, vibrant agencies.
Armpit is a disease that women have more than men.
There are many terrible smell that just need their glance was seen flying unpleasant smell do people have to go into another direction.
The cause of the armpit be explained by the sweat glands cancel (apocirine) focus a lot in the armpit. Destroy sweat glands is rich in fatty acids and "feed" the good bacteria, which a bacteria Corynebacterium Minitissumum. After the metabolism of fatty acids, bacteria will produce more odor make up the smell.
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Armpit treatment mainly to limit the activities of bacteria and fungi in the arm pit area or reduce the excretion of the sweat glands nach.Cac the most effective methods used is skin hygiene, shaved armpit to limit bacteria reside; wear a cloth material to absorb sweat and topical antiseptics and reduce sweating inherent in the deodorant.
If all these measures did not reduce odor, the doctor will put the issue to destroy the armpit sweat glands by injecting substances to nerve paralysis armpit as Botox, Dysport reduce sweating at the injection site; Surgery to the armpit sweat glands; Using laser beam selectively on prey glands armpit them permanently destroy the sweat glands were burned.
Treatment for smelly feet
Sweat gland activity depends on the sympathetic nervous system.
There are three factors that stimulate the sympathetic nervous dominated sweat glands is temperature, psychological and taste.
Every day your body excrete about 500 - 600 ml of sweat. If irritated psychological, sweat will increase more in the soles of the feet and palms. Maximum excited when the body can excrete 12 liters of sweat in 24 hours. Even 3 liters in one hour.
Foot odor is the doctor's purse is like the smell of urine, like child diapers smell after a long night soggy. The reason is that the sweat glands are at the foot of the sweat glands secrete water (eccrine) helps waste heat, waste residues similar to urinate. The composition of this water through the skin with 98 - 99% water and 1-2% is inorganic, organic (containing the products of protein metabolism, such as urea, ammonia, lactate, sulfate, phosphate and some electrolytes such as Na +, Cl -, K + ...
With these components, after sweating in the legs, folded environment as shoes, will create favorable conditions for the development of bacteria and fungi, break down organic matter in the composition of sweat and decay skin cells forming odor.
Foot odor treatment is required to prevent the growth of fungi in the shoe and not sweating in the feet. To limit the bad leg, you need cleaned in place with clear straps sandals in summer; using any fabric material is easy to absorb sweat and frequently change socks while wearing shoes. Limit the risk of sweating feet more by avoiding the sympathetic nerve stimulation (eat less hot spices, heat; keep emotions calm). If fungal skin in the leg, you should sprinkle fungicide powder into the shoes before and needed to treat this disease so thoroughly.
When these measures do not improve the situation, the doctor will consider paralyzed nerve branches the soles of the feet with topical injections or surgery to the sympathetic ganglia. However, many cases just make hygiene and living in moderation, some time later, the phenomenon of increased sweating odor go away and thus also improved.
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Original Article
Diabetes, Obesity and Metabolism Drug Repositioning Using Temporal Trajectories of Accompanying Comorbidities in Diabetes Mellitus
Namgi Park1,2*orcid, Ja Young Jeon3*orcid, Eugene Jeong4, Soyeon Kim1, Dukyong Yoon5,6orcid
Endocrinology and Metabolism 2022;37(1):65-73.
DOI: https://doi.org/10.3803/EnM.2021.1275
Published online: February 8, 2022
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1Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Korea
2Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
3Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea
4Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
5Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yongin, Korea
6Center for Digital Health, Yongin Severance Hospital, Yonsei University Health System, Yongin, Korea
Corresponding author: Dukyong Yoon. Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 363 Dongbaekjukjeon-daero, Giheung-gu, Yongin 16995, Korea, Tel: +82-31-5189-8450, Fax: +82-31-5189-8566, E-mail: [email protected]
*These authors contributed equally to this work.
• Received: September 21, 2021 • Revised: December 18, 2021 • Accepted: December 22, 2021
Copyright © 2022 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
• Background
Most studies of systematic drug repositioning have used drug-oriented data such as chemical structures, gene expression patterns, and adverse effect profiles. As it is often difficult to prove repositioning candidates’ effectiveness in real-world clinical settings, we used patient-centered real-world data for screening repositioning candidate drugs for multiple diseases simultaneously, especially for diabetic complications.
• Methods
Using the National Health Insurance Service-National Sample Cohort (2002 to 2013), we analyzed claims data of 43,048 patients with type 2 diabetes mellitus (age ≥40 years). To find repositioning candidate disease-drug pairs, a nested case-control study was used for 29 pairs of diabetic complications and the drugs that met our criteria. To validate this study design, we conducted an external validation for a selected candidate pair using electronic health records.
• Results
We found 24 repositioning candidate disease-drug pairs. In the external validation study for the candidate pair cerebral infarction and glycopyrrolate, we found that glycopyrrolate was associated with decreased risk of cerebral infarction (hazard ratio, 0.10; 95% confidence interval, 0.02 to 0.44).
• Conclusion
To reduce risks of diabetic complications, it would be possible to consider these candidate drugs instead of other drugs, given the same indications. Moreover, this methodology could be applied to diseases other than diabetes to discover their repositioning candidates, thereby offering a new approach to drug repositioning.
Drug repositioning is a drug development strategy that discovers new indications that differ from the original indication for approved or investigational drugs [1]. Drug repositioning research has increased in popularity in recent years, given its many advantages over traditional drug development strategies, such as lower investment requirements and a higher success rate [13].
In particular, systematic drug repositioning studies have received considerable attention. By screening multiple diseases or drugs simultaneously, this approach suggests multiple repositioning candidate drugs simultaneously. Cheng et al. [4] quantified the proximity between disease genes and drug targets based on a protein interaction network to discover new indications for 900 U.S. Food and Drug Administration-approved drugs. Xuan et al. [5] discovered new disease-drug associations by calculating the similarities between drugs using drug structure, target protein, and side effects, and integrating them with the similarities between diseases. As these systematic strategies make it possible to discover numerous repositioning candidates simultaneously, they can reduce time and costs for drug repositioning.
However, most studies of systematic drug repositioning have used drug-oriented data such as chemical structures, gene expression patterns, and adverse effect profiles. Thus, it is often difficult to demonstrate candidate drugs’ effectiveness in real-world clinical settings [6].
Therefore, this study used claims data, which represent patient-centered real-world data (RWD), to screen repositioning candidate drugs for multiple diseases simultaneously. As a proof-of-concept study, we targeted type 2 diabetes mellitus (T2DM), which has many complications [79]. We sought candidate repositioning drugs that could prevent or treat diabetic complications, using temporal trajectories of T2DM constructed by Jeong et al. [10].
Data source
We obtained data from the National Health Insurance Service-National Sample Cohort (NHIS-NSC), which is a representative population-based cohort database in South Korea [11]. As the National Health Insurance Service (NHIS) covers virtually the entire South Korean population [12], NHIS-NSC was constructed by stratified random sampling for an accurate representation of the population. It contains socioeconomic data, health examination data, and medical treatment data for 2.2% of the total eligible Korean population [11]. We used data collected from 2002 to 2013 (11 years).
This study was approved by the Ajou University Hospital Institutional Review Board (AJIRB-MED-EXP-20-427), which waived the requirement for informed consent.
The overall scheme of this study
We conducted the study in three steps: selection of target diseases, selection of cases and controls for each disease, and statistical analysis. Fig. 1 demonstrates these steps and the overall scheme of this study.
In the first step, we selected target diseases. Complications of T2DM were selected as target diseases based on the temporal trajectories of accompanying comorbidities of T2DM constructed by Jeong et al. [10]. We describe the details of these trajectories in the “Temporal trajectories of accompanying comorbidities” sub-section. Second, we extracted the cases and controls for each target disease from patients with T2DM to conduct a nested case-control study for each disease-drug pair. Finally, conditional logistic regressions were conducted for each pair, which comprised all target diseases and prescribed drugs, except for topical drugs, fluids, and drugs prescribed for less than 30 days in patients. A candidate repositioning drug was selected when the P<0.05 and the upper limit of the 95% confidence interval (CI) for the odds ratio (OR) was less than 0.99.
Study population
We extracted the patients with T2DM aged over 40 years, who had first developed the condition after 2003 (Fig. 2). Type T2DM was defined as any T2DM-related diagnostic codes (E11–E14) with any prescription of anti-diabetic medications within 1 year of diagnosis. The anti-diabetic medications included metformin, insulin, glimepiride, glibenclamide, gliclazide, glipizide, chlorpropamide, gliquidone, acarbose, voglibose, miglitol, rosiglitazone, pioglitazone, nateglinide, repaglinide, mitiglinide, vildagliptin, gemigliptin, sitagliptin, saxagliptin, linagliptin, alogliptin, and exenatide. To determine the exact diagnosis date for T2DM among the extracted patients, we excluded patients who were diagnosed with T2DM before 2003, who entered the cohort after 2003, or who were initially diagnosed with T2DM coded E14.9. Of those who were initially diagnosed as E14.9, we observed a tendency toward the E14.9 code being assigned to patients whose diagnosis of T2DM mellitus was not confirmed at the first visit. In addition, those who were less than 40 years of age or who had died during the cohort period were also excluded.
Temporal trajectories of accompanying comorbidities
To select target diseases, we used the temporal trajectories of accompanying comorbidities constructed by Jeong et al. [10]. These trajectories were constructed using NHIS-NSC, which was also used in this study, to determine diabetic complications, the pattern of their development, and differences in the pattern by gender and age group. These trajectories provided progression patterns (temporal trajectories) and relative risk for comorbidities of T2DM, which helped us delineate candidate diabetic complications according to their relative risk. Several diseases were determined to be significant but commonly not considered diabetic complications, such as epilepsy and mental and behavioral disorders due to use of alcohol. Therefore, the term “comorbidities” was adopted rather than “complications” in our previous study [10], but these could be candidate complications. In this context, we used the term “complications” generally.
Among three temporal trajectories, namely (Type 2 diabetes → First complication), (First complication → Second complication), and (Second complication → Third complication), we only considered the (Type 2 diabetes → First complication) stage. For this stage, we selected the top 30 diabetic complications (trajectories) with the highest relative risk. Among those, we excluded the (Type 2 diabetes → Type 1 diabetes) trajectory, as it was not a diabetic complication. In this case, patients might have had latent autoimmune diabetes in adults, which is often initially misdiagnosed as T2DM [13], and then correctly diagnosed as type 1 diabetes mellitus. Therefore, we selected 29 diabetic complications as the target diseases. Diagnoses are listed in descending order by their relative risks in Supplemental Table S1.
Matching cases and controls in each trajectory
To conduct a nested case-control study for each disease-drug pair, cases who had developed a complication at least a year after T2DM were obtained. Next, controls who did not develop a complication throughout the observational period (2002 to 2013) were matched in a ratio of 1:2 to the cases in each trajectory. Matching was conducted in two steps (Fig. 1). First, to reduce the error related to the duration of diabetes, controls with the same diagnosis date of T2DM (year and month) were selected. Then, a disease risk score was used to finally match the most similar controls to cases in a ratio of 1:2 [14]. Disease risk score showed statistically better values than exact matching for multiple factors in a nested case-control study [15].
To match variables by disease risk score, we considered gender, age group, the number of days each class of anti-diabetic medications were prescribed as a proportion of the assessment period (from the day first diagnosed with T2DM to a year thereafter), comorbidities, and Charlson comorbidity index (CCI) [16]. The classes of anti-diabetic medications were defined as insulin, biguanides, others (sulfonylureas, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor agonists), and a combination of two or more of the classes (insulin, biguanides, sulfonylureas, thiazolidinediones, meglitinides, alpha-glucosidase inhibitors, dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor agonists). For the comorbidities, we selected macrovascular and microvascular-associated diseases, as the development of diabetic complications is strongly associated with macrovascular and microvascular disorders [17]. Therefore, we selected hypertension, diabetes with complications, arrhythmia, acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, and renal disease as covariates. After the matching, the index dates of controls were assigned as the index dates of the matched cases. We tried to exclude trajectories for which the number of the cases and controls matched was fewer than 100, to ensure statistical power. However, no trajectory was excluded as the number of cases and controls matched was greater than 100 in all 29 trajectories.
Statistical analysis
To discover candidate drugs for drug repositioning that could prevent a complication in each trajectory, the number of days each drug was prescribed was calculated from the diagnosis date of T2DM to the index date as a proportion of that period. We excluded topical drugs, fluids, and drugs prescribed for fewer than 30 days for the patients.
We conducted a conditional logistic regression using the calculated proportion of the prescription days for each drug as an independent variable. As covariates, we used the prescription days for classes of anti-diabetic medications as a proportion of the assessment period (from the first day of T2DM diagnosis to a year thereafter), comorbidities, and CCI. The classes of anti-diabetic medications and the comorbidities were defined as above (see “Matching the cases and controls in each trajectory” sub-section). Finally, a disease-drug pair with P<0.05 and upper limit of the 95% CI for the OR <0.99 was selected as a repositioning candidate.
External validation
To validate this methodology, an external validation study was conducted using an electronic health record (EHR) dataset from Ajou University Hospital. Among the disease-drug pairs, a candidate pair was selected with two criteria: (1) a drug that could be taken in the relatively long term and (2) among those, a drug that was prescribed most in the EHR dataset. In accordance with these two criteria, we selected the (cerebral infarction–glycopyrrolate [Anatomical Therapeutic Chemical (ATC) Classification System code “A03AB02” or “R03BB06”]) candidate pair. Next, we chose comparable drugs to glycopyrrolate, which were used for the same indications as glycopyrrolate. The other anticholinergics for peptic ulcer or obstructive airway diseases (drugs with an ATC code that started with “A03AB” or “R03BB”) were selected as comparator drugs.
As the study population, we selected the patients with T2DM who had first developed the condition after 1999. Then, we extracted the patients who had taken glycopyrrolate and one of the comparator drugs from the patients with T2DM. Next, three exclusion criteria were applied: (1) patients who had taken both glycopyrrolate and one of the comparator drugs; (2) patients whose index date, which was the first prescription date of the drug (glycopyrrolate or one of the comparator drugs), was within 180 days of the diagnosis date of T2DM; and (3) patients whose index date was after the date cerebral infarction was diagnosed. After applying exclusion criteria, extracted patients who had taken glycopyrrolate or one of the comparator drugs were considered as treated or non-treated, respectively. To adjust for confounding factors, treated and non-treated cases were then matched in a ratio of 1:1 using propensity score matching. Matching variables used were gender, age group, and comorbidities.
A Cox proportional hazards model was used to test whether the treated and non-treated groups differed in the development of cerebral infarction. Covariates consisted of hypertension, diabetes with complications, acute myocardial infarction, cardiac arrhythmia, peripheral vascular disease, cerebrovascular disease, and renal disease.
Candidate disease-drug pairs for drug repositioning drawn from RWD
From the NHIS-NSC dataset, 43,048 patients were extracted as the study population. After excluding topical drugs, fluids, and drugs prescribed for fewer than 30 days in the study population, 29,270 disease-drug pairs with 29 trajectories were analyzed.
Of these, 24 pairs with 13 trajectories were identified as candidates for drug repositioning (Table 1). Among these, the top five pairs with the lowest ORs were: mental and behavioral disorders due to use of alcohol–pyridostigmine (OR, 0.51; 95% CI, 0.31 to 0.85); hypertensive renal disease–ondansetron (OR, 0.61; 95% CI, 0.37 to 0.99); sequelae of cerebrovascular disease–lysozyme (OR, 0.66; 95% CI, 0.46 to 0.95); heart failure–pyridostigmine (OR, 0.69; 95% CI, 0.57 to 0.84); and sequelae of cerebrovascular disease–kanamycin (OR, 0.81; 95% CI, 0.69 to 0.95).
External validation using electronic health records from a tertiary hospital
To validate this methodology, we selected a candidate pair using two criteria described in the Methods section. By applying them, we selected the (cerebral infarction–glycopyrrolate [ATC code “A03AB02” or “R03BB06,” which is anticholinergics for peptic ulcer or obstructive airway diseases]) candidate pair with 10,428 prescription records in the EHR dataset.
After the matching, the number of treated and non-treated patients was 596 in each case. Comparison of their baseline characteristics (Table 2) revealed that the treated group was younger and had a higher proportion of females. In terms of comorbidities, the treated group had a higher proportion of hypertension and diabetes with complications. However, the former had a lower proportion of acute myocardial infarction, cardiac arrhythmia, peripheral vascular disease, cerebrovascular disease, and renal disease.
The Kaplan-Meier curve showed a significant difference between the glycopyrrolate-treated and comparator drugs-treated group (Fig. 3). In the Cox proportional hazards model, glycopyrrolate was associated with decreased risk of cerebral infarction compared to the comparator drugs (hazard ratio, 0.10; 95% CI, 0.02 to 0.44), consistent with our study results.
In this study, we presented a methodology to identify candidate disease-drug pairs for drug repositioning. To do this, we used temporal trajectories of accompanying comorbidities in patients with T2DM established in a previous study [10], based on a claims dataset.
Using a nested case-control study for each disease-drug pair, we analyzed 29,270 disease-drug pairs with 29 trajectories. As a result, we identified 24 candidate pairs with 13 trajectories. Most candidate drugs had original indications that were completely different from the predicted indications. For example, pyridostigmine is currently used for myasthenia gravis; however, our results revealed its effectiveness at reducing alcohol-use-related heart failure incidence and mental and behavioral disorders. Amoxicillin and clavulanic acid, which is a combination of antibiotics, was associated with decreased incidence of mental and behavioral disorders due to alcohol use. In contrast, mirtazapine, an antidepressant, was associated with decreased incidence of hypertensive kidney disease.
To validate a candidate pair using an external dataset, we performed a retrospective cohort study on the (cerebral infarction–glycopyrrolate) pair using the EHR dataset from a tertiary hospital in South Korea. The Cox proportional hazards model found a hazard ratio of 0.10 (95% CI, 0.02 to 0.44), which enabled us to support the association of this candidate pair.
Moreover, to determine whether our results were consistent with other studies, we conducted a literature review for the candidate pairs. Several studies corresponded with our results. Regarding the (heart failure–pyridostigmine [used for myasthenia gravis]) pair, which had the lowest OR in this study, it was shown to be effective in double-blind randomized clinical trials, which is a highly reliable study design. It was effective at reducing the incidence of ventricular arrhythmia and improving heart rate variability in patients with heart failure [18]. Further, it was equally effective at reducing heart rate when compared to ivabradine, which was proven effective at reducing hospitalization and mortality due to chronic heart failure [19]. In a study related to the (atherosclerosis–methylprednisolone [a steroid]) pair, the group exposed to the inhaled steroid had a lower incidence of atherosclerosis compared with the non-exposed group, suggesting its effectiveness in preventing atherosclerosis [20]. Studies of the (hypertensive kidney disease–mirtazapine [an antidepressant]) pair confirmed that rats treated with mirtazapine were protected against kidney damage caused by ischemia-reperfusion [21,22].
Contrary to our study, most studies of systematic drug repositioning have utilized drug-oriented data such as chemical structures, gene expression patterns, and adverse effect profiles. Moreover, to the best of our knowledge, most repositioning studies using RWD targeted either a drug or a disease instead of targeting multiple drugs and diseases simultaneously [3,23]. Therefore, there was a need for systematic drug repositioning studies using RWD to analyze multiple disease-drug pairs.
Several systematic drug repositioning studies have used RWD. Using the EHR dataset, Wu et al. [24] screened non-antineoplastic drugs effective at increasing the survival rate for cancers. Retrospective cohort studies conducted of 146 non-antineoplastic drugs using the EHR dataset of 43,310 cancer patients at a university medical center found 22 candidate drugs [24]. However, as this study used an EHR dataset of a single hospital, there was a limitation that it is unknown whether the patients had taken target drugs in other hospitals. Further, as this study analyzed overall survival rate for cancers, the association between a specific cancer type and a drug could not be identified. In contrast, our study had the advantage of having available relatively accurate prescription records by using claims data and identifying the association between a specific disease and a drug.
Our study has several limitations. First, given the nature of retrospective studies, it was difficult to determine whether other confounding factors were present in this study. Second, in the external validation study, we could not determine whether patients had been diagnosed with T2DM or prescribed glycopyrrolate (or comparator drugs) from other hospitals. Using additional datasets for validation would improve reliability.
In summary, we suggested a new methodology for systematic drug repositioning using RWD. We found 24 repositioning candidate disease-drug pairs and validated the (cerebral infarction–glycopyrrolate) pair using EHR. The study results suggest the possibility of using the candidate drugs to lower risks of diabetic complications, instead of other drugs, given the same indications. Moreover, this methodology could be applied to other diseases beyond diabetic complications, to discover their repositioning candidates, thereby offering a new approach to drug repositioning.
Supplemental Table S1
Twenty-Nine Diabetic Complications Used as the Target Diseases in This Study
enm-2021-1275-suppl.pdf
CONFLICTS OF INTEREST
Dukyong Yoon is an employee of BUD.on Inc. BUD.on Inc. did not have any role in the study design, analysis, decision to publish, or the preparation of the manuscript. There are no patents, products in development, or marketed products to declare. The other authors declare that they have no competing interests.
AUTHOR CONTRIBUTIONS
Conception or design: N.P., E.J., D.Y. Acquisition, analysis, or interpretation of data: N.P., J.Y.J., S.K. Drafting the work or revising: N.P., J.Y.J., D.Y. Final approval of the manuscript: J.Y.J., D.Y.
Acknowledgements
This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT; Ministry of Trade, Industry and Energy; Ministry of Health & Welfare; and Ministry of Food and Drug Safety) (Project Number: 1711138152, KMDF_PR_20200901_0095). This work was also supported by a Government-wide R&D Fund project for infectious disease research (GFID), Republic of Korea (grant number: HG18C0067).
Fig. 1
The overall scheme of the methodology. It consisted of three steps: selection of target diseases; selection of cases and controls for each disease; and statistical analysis. NHIS-NSC, National Health Insurance Service-National Sample Cohort; T2DM, type 2 diabetes mellitus; Comp, complication. aMatching variables: gender, age group, days classes of anti-diabetic medications were prescribed as a proportion of the assessment period (from the day first diagnosed with T2DM to a year thereafter), comorbidities, and Charlson comorbidity index (CCI).
enm-2021-1275f1.jpg
Fig. 2
The flowchart of selecting the study population and cases/controls. aAnti-diabetic medications: insulin, metformin, others (sulfonylureas, alpha-glucosidase inhibitors, thiazolidinediones, meglitinides, dipeptidyl peptidase-4 inhibitors, and glucagon-like peptide-1 receptor agonist), and combinations; bComorbidities: hypertension, diabetes with complications, arrhythmia, acute myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, and renal disease.
enm-2021-1275f2.jpg
Fig. 3
Kaplan-Meier curves of the time to the first event (cerebral infarction) in the external validation study. The glycopyrrolate group (blue line) and the comparator drugs group (red line) showed different patterns; the P value of the log-rank test (P in the graph) was less than 0.0001. This indicates that the incidence of cerebral infarction was significantly different between the groups.
enm-2021-1275f3.jpg
Table 1
Twenty-Four Candidate Disease-Drug Pairs for Drug Repositioning
Diabetic complication (ICD-10 code) Drug OR (95% CI) P valuea
Atherosclerosis (I70) Methylprednisolone 0.93 (0.88–0.99) 0.017
Atherosclerosis (I70) Bisacodyl 0.94 (0.89–0.99) 0.016
Atherosclerosis (I70) Hemocoagulase 0.95 (0.90–0.99) 0.014
Atrial fibrillation and flutter (I48) Melilotus extract+proxyphylline 0.89 (0.80–0.99) 0.032
Cerebral infarction (I63) Ondansetron 0.82 (0.70–0.97) 0.018
Cerebral infarction (I63) Glycopyrrolate 0.86 (0.78–0.95) 0.004
Glomerular disorders in diseases classified elsewhere (N08) Methylphenidate 0.94 (0.89–0.99) 0.011
Heart failure (I50) Pyridostigmine 0.69 (0.57–0.84) <0.001
Hemiplegia (G81) Aluminum hydroxide gel+magnesium silicate 0.92 (0.87–0.98) 0.014
Hemiplegia (G81) Chlorpheniramine+phenylephrine 0.95 (0.91–0.99) 0.010
Hypertensive heart disease (I11) Guaifenesin 0.89 (0.80–0.98) 0.018
Hypertensive renal disease (I12) Ondansetron 0.61 (0.37–0.99) 0.044
Hypertensive renal disease (I12) Haloperidol 0.83 (0.70–0.99) 0.037
Hypertensive renal disease (I12) Mirtazapine 0.84 (0.72–0.98) 0.023
Hypertensive renal disease (I12) Aluminum magnesium silicate 40 mg and etc.b 0.87 (0.78–0.97) 0.013
Mental and behavioral disorders due to use of alcohol (F10) Pyridostigmine 0.51 (0.31–0.85) 0.010
Mental and behavioral disorders due to use of alcohol (F10) Amoxicillin+clavulanate 0.90 (0.83–0.98) 0.015
Nephrotic syndrome (N04) Cefazedone 0.89 (0.82–0.97) 0.009
Polyneuropathy in diseases classified elsewhere (G63) Iopromide 0.88 (0.84–0.93) <0.001
Polyneuropathy in diseases classified elsewhere (G63) Midazolam 0.95 (0.91–0.99) 0.011
Retinal disorders in diseases classified elsewhere (H36) Nadroparin 0.89 (0.80–0.99) 0.029
Retinal disorders in diseases classified elsewhere (H36) Flavin adenine dinucleotide+liver extract 0.95 (0.91–0.99) 0.009
Sequelae of cerebrovascular disease (I69) Lysozyme 0.66 (0.46–0.95) 0.026
Sequelae of cerebrovascular disease (I69) Kanamycin 0.81 (0.69–0.95) 0.012
ICD-10, International Classification of Diseases, 10th Revision; OR, odds ratio; CI, confidence interval.
a P value of conditional logistic regression;
b Aluminum magnesium silicate 40 mg and etc. a combination drug of biodiastase-2000+lipase AP6+magne-sium metasilicate aluminum+powdered glycyrrhiza+precipitated calcium carbonate+scopolia extract+sodium carbonate hydroxide+trimebutine.
Table 2
Baseline Characteristics of Treated and Non-Treated Patients
Characteristic Non-treated Treated P value Standardized mean difference
Gender
Male 340 (57.1) 263 (44.1) <0.001 0.261
Female 256 (43.0) 333 (55.9)
Age, yr 67.51±11.38 46.86±9.43 <0.001 −1.975
Hypertension 182 (30.5) 236 (39.6) 0.001 0.191
Diabetes with complication 195 (32.7) 254 (42.6) 0.001 0.205
Acute myocardial infarction 31 (5.2) 7 (1.2) <0.001 −0.231
Cardiac arrhythmia 26 (4.4) 6 (1.0) <0.001 −0.209
Peripheral vascular disease 20 (3.4) 8 (1.3) 0.034 −0.133
Cerebrovascular disease 31 (5.2) 9 (1.5) 0.001 −0.206
Renal disease 92 (15.4) 59 (9.9) 0.005 −0.167
Cerebral infarction 13 (2.2) 2 (0.3) 0.007 −0.166
Values are expressed as number (%) or mean±standard deviation.
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Figure & Data
References
Citations
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• Drug Repositioning: Exploring New Indications for Existing Drug-Disease Relationships
Hun-Sung Kim
Endocrinology and Metabolism.2022; 37(1): 62. CrossRef
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Do Gums Grow Back After Surgery?
Regenerate Gums Naturally
For those who have been experiencing recurrent bad breath and a chronic, painful and uncomfortable mouth condition, you could wish to end the bleeding and redness of gingivitis. You might be suffering from an infection, but in order to eliminate it for good, you want to locate a solution for gingivitis.
The underlying cause of your chronic bad breath may range between tonsillitis or sinus problems to other medical problems. Whatever the problem, a proper diagnosis by a qualified healthcare practitioner is very important therefore you are able to stop the bleeding and inflammation of gingivitis in its own paths and get relief from the pain and soreness that include this.
A very simple cure for Gum Disease is merely by fostering the quantities of good white blood cells. In the event that you make it a place to consume a well-balanced diet filled with fruits, vegetables and whole grains, then it will do your mouth an environment of good, in order for your gum disease may fade away over time.
As far as boosting your immune system can be involved, there are lots of unique things you may try. These range from robotics to eating yogurt, and all of them have their own unique effect in the immune system and help improve your overall wellness. However, it is rather important to receive proper advice from a health care provider before you start any of the natural treatments.
There are several different kinds of antibiotics, that is used as a treatment for gum disease and oral infections. In regards to treating gum disease, you may choose from a range of various antibiotics like erythromycin, penicillin and tetracycline.
When these antibiotics can work against other forms of gum disease, they aren’t as effective at treating gingivitis, that includes a number of underlying causes. If you are currently using antibiotics, you may want to switch to something else as a way to handle your gingivitis and stop it from coming back.
Gum Tissue Regeneration Natural
Yet another method to increase your immune system would be to eat foods that contain probiotics and live cultures. Probiotics are naturally-occurring bacteria that live in the gut and help fight off infections. For More Info Visit Do Gums Grow Back After Surgery?
In summary, there are a number of natural gingivitis treatments you can use that do not involve drugs or surgery. By adhering to a couple of simple suggestions, you can improve your overall health and help your body fight gum disease and make it much less likely to return in the future.
This could be the single most important phase in fighting gum disease, but this may be made better with the perfect kind of toothpaste and brush.
Gingivitis can sometimes result from an infection of the gums. To do so, you need to apply an antiseptic gel that can be bought from your physician and use it to wipe down the gums on a normal basis.
To keep the gums healthy, it’s very important to keep a fantastic healthy diet high in fresh fruit and vegetables. Avoid too many sugary snacks, and avoid any processed foods as these will damage the gums. After you brush, you need to focus on brushing the areas at which plaque is more prone to form, like the teeth and between the teeth.
The best method to prevent a recurrence of gingivitis will be to avoid drinking coffee, tea, wine, soft drinks and alcohol. Each one these things is only going to irritate the gums.
Regrow Gums Fast
You could also help fight off gum disease by improving your immune system. If you take probiotics and live a healthier life style, your mouth will likely be in sound condition to avoid this painful condition from coming and it will also feel much fitter.
Many people have been wondering if there is a means to quit Receding Gums naturally. For those who have a receding gum line, you still are aware it could be quite embarrassing to have. You want to avoid gum disease, period! The good news is there are things which you may do that will actually help one to prevent and reverse your problem.
There are things that you could perform to help with the receding gum line. For instance, eating a diet filled with fruits and vegetables is essential. There are certainly a great deal of foods which are high in anti oxidants, which are very capable of fighting gum disease. Eating foods such as apples, pears, pears, blueberries and cranberries can help you fight gum disease.
You’ll get these kinds of products in any pharmacy. They are easy to use and the majority are affordable. It will be very helpful if you make sure you follow the directions of this toothpaste which you select. There’s also many natural remedies you could test out. The simplest one is to just brush your teeth daily.
Along with brushing your teeth you will also wish to make use of a mouthwash which comprises fluoride. Folliculitis happens since the enamel on your teeth becomes worn out. Utilizing a mouthwash that includes fluoride will help to protect the teeth by getting worn down and permit your gums to become stronger.
After brushing your teeth, it is essential to be gentle and not force your gums to move. By brushing slowly and with your tongue, you’ll find a lot better result than just brushing your teeth.
Regenerate Gum Tissue
The following tip that will help you quit receding gums and prevent gum disease would be to work with a tongue scraper daily. This tool will be a wonderful tool to help you gently loosen the plaque onto your tongue so that it’s going to be easier for one to wash out the pockets which are causing gum disease.
A lot of people have been wondering about how they are able to stop gum disease naturally. There’s absolutely no explanation as to why you can’t stop it and even reverse it by altering your lifestyle and doing some basic measures to help your self.
The absolute most crucial things you could do would be to drink plenty of water. Water is the finest natural antiseptic there really is. It’s going to help to flush out toxins in the entire own body. Plus, it will help flushing away food particles that may have stuck to your teeth.
You should also stay away from eating a lot of foods that are full of starch. As well as starchy foods, you should also limit foods which can be full of sugar. Such as cookies and candies. These foods are in reality a top source of several instances of gingivitis.
Also, drinking a lot of water will help you feel better and help you feel more rested. When you drink loads of water, the own body will have the ability to flush out toxins that have accumulated on your own body. This usually means you will get a better immune system and become healthy overall.
Drinking loads of fluids helps to flush out harmful bacteria as well as the harmful white glucose which have been in carbonated drinks. It also helps you to flush out all kinds of harmful bacteria that can cause plaque in your teeth.
The truth is that there is nothing that will help stop gum disease completely. But, there are some steps that you can choose which may help one to decrease the inflammation and pain that are connected with this disease.
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Start your free 7-day Joon App trial
Child Development
Can Melatonin Help Kids with ADHD?
Updated
August 26, 2022
Table of Contents
Does your child have difficulty falling asleep at night? Well, you are not alone. As many as 70% of children with Attention Deficit/Hyperactivity Disorder (ADHD) experience sleep problems, which can, as a result, affect the child’s functioning during the day.
Not only do sleep problems affect a child’s functioning, but they can also exacerbate symptoms of ADHD. If your child is having difficulty falling asleep or getting an adequate amount of sleep at night, an over-the-counter supplement might be an effective short-term solution. This sleep aid is known as melatonin.
Melatonin to be one of the most commonly used supplements among both adults and children.
In this article, I will outline whether the use of melatonin is safe for children, the proper dosage, common side effects of melatonin, and other effective strategies to help your ADHD child got to sleep at night. Learn more in this article.
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Is Melatonin Safe for Children?
Melatonin is a naturally produced hormone in the brain that is important for sleep initiation, however, it is only released by the brain when it senses darkness and ceases to produce when we are exposed to light. Melatonin can also be produced externally, in labs, where the supplement can be purchased in the form of a pill, chewable tablet, or liquid to help combat sleep difficulties.
Can Melatonin Help Children Fall Asleep?
Research studies have shown that melatonin can help children (who experience difficulties with falling asleep) fall asleep more quickly and improve their total amount of sleep. Additionally, a study reported that the use of melatonin in children was proven effective against the onset of sleep problems in 88% of children with ADHD.
In a study of 27 children with ADHD and insomnia, researchers found that melatonin facilitated a decrease in insomnia symptoms and led children to fall asleep an average of 16 minutes earlier than children with ADHD who did not take a melatonin supplement.
While the proper use and dosage of melatonin is safe for children in the short term, the American Academy of Pediatrics (AAP) advises parents to work closely with their child’s pediatrician before administering melatonin supplements on their own.
How Much Melatonin to Give a Child
According to research, the proper dosage of melatonin depends on how and why you plan to use it. Doctors suggest starting your child on the lowest dose (usually 0.5mg or 1mg) 30 to 90 minutes before bedtime. In addition, children who benefit from utilizing melatonin as a sleep aid do not need more than 3 to 6mg.
Always talk with your child’s pediatrician about the proper use and dosage of melatonin. Most importantly, melatonin should never replace proper sleep hygiene and a good bedtime routine. What makes for a good bedtime routine? Keep reading and the steps for this are to follow.
Can Melatonin Help with ADHD Symptoms?
Children with ADHD often show a pattern of behaviors that can be characterized as hyperactivity, impulsivity, inability to concentrate on tasks, interrupting during conversation, and other symptoms that interfere with overall functioning and development.
In addition, sleep problems for ADHD kids are a common symptom experienced and can lead to other issues such as attention-related difficulties throughout the day. Therefore, getting consistent quality sleep is imperative for any child, with or without ADHD to perform well in the classroom and in daily life.
A lack of quality sleep can lead to issues such as decreased attention, impaired memory, poor decision making, slowed processing speed, and irritability, which can exacerbate the symptoms associated with ADHD.
We know that melatonin can help children sleep better at night, but it is unclear whether melatonin helps improve ADHD symptoms. The bottom line is- more research is needed to better understand the benefits of taking melatonin to help manage ADHD symptoms.
Side Effects of Melatonin
Short-term use of melatonin has few side effects and is generally well accepted by most individuals and children who take it. The most common side effects of melatonin are:
• Day-time drowsiness
• Headaches
• Dizziness
• Nausea
• Increased risk of bed-wetting
However, these side effects are experienced by only a small percentage of children who take melatonin.
Long-term side effects of melatonin use are generally unknown. Considering the long-term effects are unclear, parents are encouraged to consult with their children’s doctor about the use of melatonin and overall health. Discover more melatonin alternatives for children here.
Tips to Consider
• Some dietary supplements might interact with prescribed medications.
• Use of over-the-counter melatonin might place children at risk of an accidental or intentional overdose.
• Parents should ensure that they are storing melatonin safely in the home, out of reach from children and teens.
How to Help Your Child Go to Sleep
While melatonin might offer relief and help your child fall asleep more effectively, other sleep hygiene techniques and healthy sleeping habits should be implemented before bed to improve the quality of sleep in your child. Helping your child with ADHD sleep better is possible! The following steps should be considered:
Consistency in Daily Routines
Children with ADHD often benefit from having a supportive daily routine in place. This can include waking up around the same time every day, even on weekends to create a stable environment and instill healthy sleeping patterns. Doing homework and chores at around the same time each day and making sure your child is getting adequate nutrition and hydration, can help set your child up for success!
Try Joon App To Help Manage Your Child's Routines
Joon app is a game designed for ADHD children to build better habits. The game rewards children by completing tasks set by their parents. Many parents have seen their child become more autonomous, motivated, and disciplined. See how the game works below and claim your 7-day free trial here.
Physical Activity During the Day
Research suggests that physical exercise can help children with ADHD manage their core symptoms. With that said, allowing your child to engage in active hobbies can significantly improve sleep duration and quality of sleep. Not only does physical exercise help your child sleep better and feel well rested in the morning, but it can also improve mood and focus in children with ADHD. Other benefits of children with ADHD engaging in exercise include:
• Better engagement in tasks
• Improved cognitive performance
• Improvement in reading and mathematics skills
• Lower levels of ADHD depression, anxiety, and aggression
• Improvement in executive functioning abilities
Limit Technology Before Bed
There is growing evidence of the effects of blue light on our circadian rhythm or the sleep-wake cycle. Researchers found that blue light from phones, iPads, and computers reduces the amount of naturally produced melatonin, further delaying our ability to fall asleep.
Pediatricians and sleep experts alike have been encouraging parents to limit their child’s use of technology and shutting off screens at least one hour before bedtime. Some parents even recommend shutting off screens two hours before bed, just to be safe.
Calming Techniques Before Bed
Adding a routine before bed that will help your child wind down for the night can be a beneficial part of your child getting quality sleep. Not only is this helpful for a child with ADHD, but it can be helpful for children who have a difficult time relaxing at the end of a long day. Any of the following calming activities can be made a part of you and your child’s nighttime routine:
• Reading a book
• Listening to music
• Breathing exercises
• Meditation or Stretching
• Drinking caffeine-free tea
• Taking a bath
Sleep Environment is Important
This may come off as common sense, but other critical aspects of your child falling and staying asleep can include things like controlling the temperature of the room, making sure the room is dark, cleanliness of the room, and controlling for other important supplemental parts of the environment (favorite stuffed animal nearby, nightlight on, etc.). Of course, these can be individualized based on your child’s needs and interests. For example, this can include:
• Moving objects around so they do not cast a scary shadow
• Moving the bed to another place in the room
• Letting your child choose their own bedding and pajamas
Takeaway
At least 55% to 74% of children with ADHD have symptoms of insomnia, which include difficulty falling and staying asleep. Research suggests that the over-the-counter sleep aid, melatonin, may be a short-term solution to help children with ADHD achieve quality sleep.
With relatively few side effects, melatonin can also help reduce issues that are commonly associated with lack of sufficient sleep, such as decreased attention, slower processing speed, and a decline in memory.
Research indicated that melatonin is safe for children, on a short-term basis, and that it is unclear whether there are long-term side effects associated with melatonin use. While melatonin use can help your child achieve a good night’s sleep, other behavioral techniques should also be consistently implemented to establish an effective bedtime routine.
Lastly, because the research in this area is so limited, make sure to consult with your child’s doctor before you make any changes to your child’s medication regimen, or before you choose to include a supplement like melatonin in your child’s nighttime routine. If a child’s insomnia is severe and causes disruption at home or in school, it might be a good idea to speak with a professional who has knowledge of ADHD in children.
About
Dr. Brittany Ferri, PhD
Brittany is a registered and licensed occupational therapist who holds a PhD in Integrative Mental Health. She is the owner of a writing and consulting company called Simplicity of Health. She has direct experience in program development, behavioral health, pediatrics, and telehealth. She has published five books, lectured at 20+ OT/OTA programs, and has been quoted as a health expert by NBC News, WebMD, CNN, and other outlets.
About
Dr. Brittany Ferri, PhD
Brittany is a registered and licensed occupational therapist who holds a PhD in Integrative Mental Health. She is the owner of a writing and consulting company called Simplicity of Health. She has direct experience in program development, behavioral health, pediatrics, and telehealth. She has published five books, lectured at 20+ OT/OTA programs, and has been quoted as a health expert by NBC News, WebMD, CNN, and other outlets.
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Colon Hydrotherapy Machine For Sale
Home / BLOG / How to Clean Your Bowels Naturally?
How to Clean Your Bowels Naturally?
Some natural ways to cleanse your bowels include drinking plenty of water, eating fiber-rich foods, avoiding processed foods, consuming probiotics, exercising regularly, and practicing stress-reducing techniques such as yoga, meditation, or deep breathing.
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Is Vein Mapping Invasive or Minimally Invasive?
Some vein treatments are invasive, meaning they involve large, surgical incisions in your skin. Other vein treatments are minimally invasive, meaning they involve injections or tiny punctures in your skin. Vein mapping is an ultrasound procedure that analyzes venous health. It is not a treatment, and it is neither invasive nor minimally invasive. Vein doctors conduct this non-invasive examination on the surface of your skin, by bouncing sound waves off your veins. They apply a gel and move a transducer over your skin, much like any other ultrasound.
Is vein mapping painful? No, patients experience no pain whatsoever. The most patients will feel is a bit of pressure if the vein doctor presses down for a closer look at a blood vessel. Vein mapping is not only painless, but it also helps vein doctors diagnose pain. Many patients experience cramping, aching, burning sensations with unhealthy veins. Vein mapping exams help determine the source of the discomfort so vein specialists can resolve it. Book an appointment with our award-winning vein doctors in New Jersey for a gentle vein mapping exam.
Vein issues often require ultrasound guidance to diagnose. Is vein mapping painful or dangerous for the patient? No, the diagnostic procedure is gentle and harmless.
Is There Swelling or Pain After Vein Mapping?
Since vein mapping is non-invasive, there is no swelling or pain afterward. There are no injections or incisions, and the probe only applies gentle pressure on the skin. If you have swelling or pain following vein mapping, it’s likely due to the issue that prompted vein mapping, like vein damage, blood clots, or vein disease.
Spider veins and varicose veins are often caused by Chronic Venous Insufficiency. This disease frequently goes undiagnosed, and it causes swelling, cramping, pain, restlessness, heaviness, and fatigue in the legs. Left untreated, it can also produce ulcerations that won’t heal, persistent dermatitis, and heavy bleeding with skin abrasions. So, call your doctor if you have pain or swelling in your legs, but know that it’s likely due to a vein issue, and not a vein mapping exam.
If you develop sudden pain, redness, warmth, and swelling in a certain area, or if you have chest pain or shortness of breath, go to the emergency room. These symptoms are not caused by vein mapping. They might signify a blood clot, deep vein thrombosis, or pulmonary embolism.
Are Vein Mapping Sound Waves Painful?
Vein mapping uses ultrasound technology to send sound waves through the gel on your skin into your body. The transducer, or probe, captures the sounds as they bounce off your veins, and those sounds are translated into images on a computer. The sound that bounces off the blood vessel indicates its size and how full of fluid it is. This helps vein specialists detect things like blood clots and engorged, or varicose, veins. Patients do not feel any pain as the sound waves travel. Doppler Ultrasound uses no needles, radiation, or dye, so it’s harmless to the patient.
What Are the Least Painful Treatment Options?
Vein mapping helps doctors determine whether you need treatment, and if so, which treatment is best. So, what are the least painful vein treatment options? The best vein treatments for most people are minimally invasive. These treat the vein inside the body, rather than cutting it out. Ask your vein doctor about radiofrequency ablation, endovenous laser ablation, vein adhesives, and mechanochemical ablation, if you want gentle vein care.
These procedures are minimally invasive and require no large incisions or general anesthesia. Patients can walk after treatment and even go back to work. They don’t require downtime or prescription pain medication. They are not painful, and for most patients there is little to no swelling. Surface lasers are less invasive, but they irritate many patients’ skin.
In addition, surface lasers aren’t ideal for varicose veins. The amount of laser energy required to treat large or deep veins would damage the skin. Varicose veins are larger than spider veins, and their source is typically located in a deeper vein. So, a minimally invasive treatment, not a non-invasive or invasive treatment, is the least painful way to treat them. If you have varicose veins, visit a minimally invasive vein treatment center for vein mapping and to achieve painless vein treatment.
Vein stripping surgery (phlebectomy) is typically a more painful way to treat veins, and it has a longer recovery. However, most patients don’t need surgery for their veins. If your vein doctor recommends surgery, ask them why. Valid reasons include existing blood clots, prior failed treatments, or severe tortuosity that minimally invasive devices can’t navigate. If they don’t have an answer, seek a second opinion. If you do need surgery, ask your vein specialist about a less invasive surgery called ambulatory phlebectomy.
How Do You Prepare for Mapping Your Blood Vessels?
Vein mapping requires very little preparation. You don’t need to avoid food the day of your appointment, unless you’re having additional tests that require fasting. It’s helpful to be fully hydrated since that makes your blood vessels easier to map. For most patients, this means six to eight glasses of water for three days before the appointment, and at least three glasses of water on the appointment day, before the procedure. If you aren’t able to hydrate that much, the test will still be conducted. Hydration just enhances the results.
Wear loose clothing to your appointment since the vein doctor will guide the transducer over a portion of your skin. This might include the entire leg, or both legs, so wear something easy to roll up. We can also provide a medical gown if needed or preferred. You will likely lie down throughout the procedure, though you may need to stand for a portion of the time. It takes an average of 30 minutes but can take up to 90 minutes depending on how many areas we need to scan.
Where Can You Schedule an Appointment for Vein Mapping in NJ?
Please contact us to book painless, affordable vein mapping in New Jersey. We have state-of-the-art vein centers in Clifton, Scotch Plains, Woodbridge, Paramus, and Woodland Park. Our vein centers are fully accredited and run by board certified vein doctors. Our physicians specialize in non-invasive and minimally invasive procedures, and they’re Harvard-trained in cutting edge techniques.
Once you’ve scheduled your appointment, our dedicated insurance team will work to secure your coverage. Since our doctors use FDA-approved treatments, most patients achieve full insurance coverage. Our vein doctors are as renowned for conducting their treatments as they are for explaining them. They’ve served as medical textbook contributors, lecturers, and instructors, so they know how to convey what they do. If you have questions about vein mapping or vein treatment, visit us for a consultation. Our doctors won’t leave the room until each of your questions are answered.
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Warts & Molluscum
What Are Warts?
There are many different types of viral infections of the skin that lead to different clinical presentations, but among the most common are warts and molluscum contagiosum.
Warts, or verruca, can present in a multitude of different ways, but all types of warts are caused by the various subtypes of the human papillomavirus. The most common types of warts include common warts, genital warts, plantar warts, and flat warts. Most people will experience some form of warts during their lifetime, and this pervasiveness is due to the virus’ ability to evade destruction by the host immune system. Warts can be transmitted via direct contact, indirect contact, or via autoinoculation. Once the virus is in place the virus promotes keratinocyte proliferation that leads to the ‘warty’ appearance clinically. Warts can be painful, interfere with activities, and cause social distress. If you are experiencing painful warts, MOD Dermatology’s skin doctors in Omaha offer wart removal services. Some types of warts, specifically genital warts and the strains of HPV that cause cervical cancer, can be prevented with the HPV vaccine. Treatment of warts depends on their location, appearance, and immune status of the patient. Typically the treatment is broken into two different categories: destructive and immunologic. Destructive methods can include cryotherapy, salicylic acid, cantharidin, 5-fluorouracil, and laser. Immunologic therapies can include imiquimod, candida antigen injection, or contact sensitization. Because some strains of the HPV virus can cause cancer, and because the clinical appearance of some warts can mimic squamous cell carcinoma, it is important to see a board-certified dermatologist if you have concerns about warts. If you are in need of wart removal in Omaha, the skin doctors at MOD Dermatology are here to provide you with a high level of care.
What Is Molluscum?
Molluscum contagiosum is a common skin condition most often seen in school-aged children, but which can also be found in sexually active adults, and in immunosuppressed individuals. There are options for molluscum and skin growth treatments in Omaha at MOD Dermatology. It is caused by a type of poxvirus that infects the skin. As the name implies, the virus is very easily spread from person to person, usually by skin to skin contact but also by indirect contact with shared items such as towels. Autoinoculation is also common and scratching an affected area can lead to more of the lesions in other areas of the body. In adults, the virus is usually sexually transmitted. Clinically, the lesions of molluscum appear as small, smooth, dome-shaped pink bumps, typically with a dimple in the center. At times the lesions can get crusted, pustular, or have surrounding dermatitis, which can herald the resolution of that lesion. Children that have eczema, or people with altered immune systems, often have more extensive cases of molluscum. While they are often bothersome, the virus is otherwise relatively harmless. The natural course of molluscum is self-resolution over 1-2 years. Because they self-resolve, it is reasonable to leave them alone. However, for those wanting treatment, there are several modalities that can be attempted. MOD Dermatology in Omaha offers molluscum and skin growth treatments including cryotherapy, canthardin, topical tretinoin, curettage, extraction and others.
Call 402-505-8777 to schedule an appointment!
Fremont NE Wart Removal | Dermatologist: Molluscum Treatments
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Home » Frequently asked Questions on Health » Am I suffering from arthritis?
Am I suffering from arthritis?
Q: I am a 36 years old male experiencing knee ache at a particular angle, specially while climbing stairs. I can run, go to the gym for cardio exercises, bend my knee lying down without pain and walk freely. There is no swelling or joint pains except this knee pain. Am I suffering from arthritis? Can I continue exercising? My uric acid and cholesterol are under control with medications.
A:The signs and symptoms are commonly seen in a common condition called Chondromalacia of patella (softening of the knee cap bone). The symptoms are prominent after sitting in one position for a long time keeping the knee bent at some fixed degree like you have faced. You may often feel catching or giving away sensation in the knee. It is not arthritis. You can continue your exercises and normal activities as you are normal. Treatment depends on the underlying cause of the patella (kee cap bone) undersurface bone changes. Most often your condition resolves with
1. T. Voveran 50 mg at time of knee ache
2. Quadriceps exercises
3. Hamstring stretching exercises
If there is no relief after these measures, then arthroscopy of the knee has recently proved extremely reliable in knowing the undersurface of patella bone changes.
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Researched CBD Health Benefits You Didn’t Know About
Updated on March 20, 2021
CBD Health Benefits
CBD is becoming very popular as a supplement, or even as a prescription-strength medical treatment for a variety of health issues. Most people who are familiar with CBD know that it can help reduce pain, relieve stress, and is a strong anti-inflammatory. However, there are other health benefits for more serious disorders and diseases that are still relatively unknown.
When you read a complete guide to CBD, you will learn more about how it interacts with the endocannabinoid system (ECS) that runs through our nervous system and brain. This is the key for how it can have an impact on our health in several ways. Here are three examples that have been backed by scientific research:
#1) It Can Reduce Seizure Activity
One very powerful use of CBD is as a treatment for seizure disorders such as epilepsy. There is no cure for this condition, and while there are some treatments or medications to reduce seizure activity, they don’t work the same for everyone.
For some people, CBD (or a mix of CBD with THC) can be used to reduce the frequency and severity of seizures. In one study, CBD was given to 214 people with severe epilepsy and was found to reduce seizure activity by 36.5%. Another study looked into the effect of CBD for children with Dravet syndrome, a type of epilepsy that is typically drug-resistant. It saw that seizure activity was significantly reduced
#2) It Has Anti-Tumor Properties
Cannabis has long been known as a treatment for people undergoing cancer treatments to reduce pain and improve their appetite. However, there are some early studies that are showing CBD as a potential way to reduce tumors and kill cancer cells. The few studies that have been done were using animals and test tubes with cancer cells.
One test tube study found that a concentrated amount of CBD actually killed human breast cancer cells. Another study using mice found that CBD slowed the spread of breast cancer cells. Lastly, a combination test tube and animal study found that CBD prevented the spread of multiple types of cancer.
#3) It Improves Quality of Life for People with Parkinson’s Disease
Another neurological disorder that CBD has been found to help is Parkinson’s Disease, which is a brain disorder that is characterized as tremors and shaking, stiffness, and loss of balance and coordination. There are no cures, and treatments are limited to potentially slowing the progression of symptoms that typically get more severe over time. One study found that CBD was able to help improve the quality of sleep for people with Parkinson’s disease. Another study found that CBD is able to potentially improve the quality of life, though it also noted that further research was needed.
Epilepsy, cancer and Parkinson’s are three health conditions that have limited options for cures or treatments. They also severely affect quality of life, the latter two can often be fatal. The early research into the potential of CBD as a treatment to prevent seizures, kill or slow the spread of cancer cells, and improve the lives of people with Parkinson’s are a ray of hope for future medical applications.
The Editorial Team at Healthcare Business Today is made up of skilled healthcare writers and experts, led by our managing editor, Daniel Casciato, who has over 25 years of experience in healthcare writing. Since 1998, we have produced compelling and informative content for numerous publications, establishing ourselves as a trusted resource for health and wellness information. We offer readers access to fresh health, medicine, science, and technology developments and the latest in patient news, emphasizing how these developments affect our lives.
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Mon. Feb 26th, 2024
Tag: buy pcso lotto ticket online
Ayurvedic Rub In Kerala – Part 3
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intermitent fasting
The Powerful Health Benefits of Intermittent Fasting
Intermittent fasting is great for weight loss! Do a Google search and you’ll find plenty of stories (like this one) about how people who turned to intermittent fasting, or “IF” for short, have lost weight. And we’re not talking about individuals who needed to lose only a couple pounds either.
Many of the intermittent fasting weight loss success stories come from people who struggled for years with obesity. When other diets failed, they found the IF approach made it easier to stay with it. Best yet, by continuing to practice IF, they’ve kept the weight off!
There is one thing to understand about intermittent fasting. It’s not a diet. Research may show it works for weight loss, but IF is really a way of life which is what makes it so easy to follow.[i],[ii] More importantly, its benefits go far beyond weight loss and weight management.
Let’s take a closer look at intermittent fasting and the many powerful health benefits it offers…
What is Intermittent Fasting?
Intermittent fasting describes a lifestyle featuring a pattern that switches between normal eating and periods of fasting. A popular practice is the 5:2 method. You eat a normal diet for five days a week. Then, two days a week you eat at most 25% of your normal dietary calories. For a 2,000-calorie diet, that’s 500 calories; an 1,800-calorie diet would be 450 calories.
The practice doesn’t define which days you fast. It’s only important that you do it twice a week. It’s generally recommended to space the days so there is at least one non-fasting day between the two on which you do fast.
Intermittent fasting is different from continuous caloric restriction, aka dieting or severe fasting, where you restrict calories all the time. This makes IF easier to do as hunger pangs aren’t constant. It also allows for a normal diet the rest of the time, so you keep up your nutrient intake to keep your body fueled with the vitamins and minerals it needs.
A normal diet doesn’t, of course, include “junk food” which would counteract or negate the value of the fasting periods – and could lead to weight gain! But as noted, weight loss isn’t the only major benefit of intermittent fasting. Here are many other powerful benefits of intermittent fasting researchers have reported:
Speeds Up the Metabolism
Studies show people who do intermittent fasting enjoy lower cholesterol and triglyceride levels.[iii],[iv] Based on results from one small study, this may have to do with an ability to metabolize fats better.[v] Their bodies simply cleared fat out of the system faster after they ate. This leads to more energy, faster recovery from exercise and other physical labor and a clearer mind.
Regenerates Intestinal Cells to Improve Digestion
Intermittent fasting “turns on” stem cells which are responsible for regeneration and renewal of the intestinal lining.[vi] This process is essential to keep the intestines working at top efficiency.
Symptoms like indigestion, gas, bloating and generally irritable bowels indicate incomplete digestion and often occur as a result of a poor diet, illness and age. Whatever the cause, these symptoms also mean the lining of the intestines is breaking down. The research suggests intermittent fasting gives the intestines a chance to recover which would help improve digestion, nutrient absorption and may reduce the unpleasant gas, bloating and other uncomfortable issues that happen with poor digestion.
Lifts the Mood
In one study, people with multiple sclerosis who practiced intermittent fasting showed “significant improvements” in their overall emotional well-being.[vii] Intermittent fasting has been shown to boost levels of BDNF, a protein in the brain associated with improving mood and memory.[viii]
Protects the Brain
Intermittent fasting has been shown to prompt a process called autophagy that clears old or dead cells from the body. It also does this in the brain.[ix] This has a profoundly positive impact on the brain as it promotes the creation of new brain cells, which are essential to protect your memory, support a positive mood and think clearly![x]
IF Boosts Levels of Growth Hormone
Human growth hormone supports your body’s natural healing processes. It also supports brain health and keeps your cells working the way they’re supposed to. Research shows intermittent fasting naturally encourages your body to produce more HGH which helps keep the body in a regular state of renewal.[xi],[xii]
Improves Insulin Response and Blood Sugar
Researchers have observed improvements in fasting insulin levels and reduced insulin resistance in people who do intermittent fasting.[xiii]
Supports Heart Health
The weight loss, lower cholesterol and triglyceride levels and better blood sugar that comes from improved insulin response also support heart health.[xiv] Additional research shows it supports lower blood pressure and higher HDL-cholesterol (the good cholesterol) levels.[xv]
IF Increases Resistance to Oxidative Stress & Inflammation
Intermittent fasting also increases the body’s ability to respond to chronic inflammation. In one study, researchers looked at the effect of IF on patients with asthma and discovered that the diet decreased inflammation in their airways and improved their overall breathing.[xvi]
Slows Aging and Promotes Longevity
Intermittent fasting has been shown to turn on specific genes called sirtuins. These genes are known for their anti-aging effects, especially the way they improve metabolism, encourage antioxidant response, help the body handle stress and support the removal of old, malfunctioning or dead cells.[xvii] By promoting cellular renewal, sirtuins slow aging and may support a longer, healthier life!
REFERENCES
[i] Tinsley GM, et al. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev. 2015 Oct;73(10):661-74. doi: 10.1093/nutrit/nuv041. Epub 2015 Sep 15.[ii] Wilson RA, et al. Intermittent Fasting with or without Exercise Prevents Weight Gain and Improves Lipids in Diet-Induced Obese Mice. Nutrients. 2018 Mar 12;10(3). pii: E346. doi: 10.3390/nu10030346.
[iii] Ibid.
[iv] Tinsley GM, et al. Effects of intermittent fasting on body composition and clinical health markers in humans. Nutr Rev. 2015 Oct;73(10):661-74. doi: 10.1093/nutrit/nuv041. Epub 2015 Sep 15.
[v] Antoni, R., Johnston, K., Collins, A., & Robertson, M. (2018). Intermittent v. continuous energy restriction: Differential effects on postprandial glucose and lipid metabolism following matched weight loss in overweight/obese participants. British Journal of Nutrition, 119(5), 507-516. doi:10.1017/S0007114517003890
[vi] Mihaylova MM, et al. Fasting Activates Fatty Acid Oxidation to Enhance Intestinal Stem Cell Function during Homeostasis and Aging. Cell Stem Cell. 2018 May 3;22(5):769-778.e4. doi: 10.1016/j.stem.2018.04.001.
[vii] Fitzgerald KC, et al. Effect of intermittent vs. daily calorie restriction on changes in weight and patient-reported outcomes in people with multiple sclerosis. Mult Scler Relat Disord. 2018 May 5;23:33-39. doi: 10.1016/j.msard.2018.05.002. [Epub ahead of print]
[viii] Mattson MP1, et al. Meal size and frequency affect neuronal plasticity and vulnerability to disease: cellular and molecular mechanisms. J Neurochem. 2003 Feb;84(3):417-31.
[ix] Alirezaei M, Kemball CC, Flynn CT, Wood MR, Whitton JL, Kiosses WB. Short-term fasting induces profound neuronal autophagyAutophagy. 2010;6(6):702-710. doi:10.4161/auto.6.6.12376.
[x] Manzanero S, Erion JR, Santro T, et al. Intermittent fasting attenuates increases in neurogenesis after ischemia and reperfusion and improves recoveryJournal of Cerebral Blood Flow & Metabolism. 2014;34(5):897-905. doi:10.1038/jcbfm.2014.36.
[xi] Aberg ND1, et al. Aspects of growth hormone and insulin-like growth factor-I related to neuroprotection, regeneration, and functional plasticity in the adult brain. ScientificWorldJournal. 2006 Jan 18;6:53-80.
[xii] Ho KY, Veldhuis JD, Johnson ML, et al. Fasting enhances growth hormone secretion and amplifies the complex rhythms of growth hormone secretion in manJournal of Clinical Investigation. 1988;81(4):968-975.
[xiii] Adrienne R. et al. Intermittent fasting vs daily calorie restriction for type 2 diabetes prevention: a review of human findings. Translational Research, Volume 164, Issue 4, 2014, Pages 302-311, ISSN 1931-5244.
[xiv] Mark P. Mattson, et al. Beneficial effects of intermittent fasting and caloric restriction on the cardiovascular and cerebrovascular systems. The Journal of Nutritional Biochemistry, Volume 16, Issue 3, 2005, Pages 129-137, ISSN 0955-2863.
[xv] Sundfør TM1, et al. Effect of intermittent versus continuous energy restriction on weight loss, maintenance and cardiometabolic risk: A randomized 1-year trial. Nutr Metab Cardiovasc Dis. 2018 Mar 29. pii: S0939-4753(18)30100-5. doi: 10.1016/j.numecd.2018.03.009. [Epub ahead of print]
[xvi] Johnson JB, Summer W, Cutler RG, et al. Alternate Day Calorie Restriction Improves Clinical Findings and Reduces Markers of Oxidative Stress and Inflammation in Overweight Adults with Moderate AsthmaFree radical biology & medicine. 2007;42(5):665-674. doi:10.1016/j.freeradbiomed.2006.12.005.
[xvii] Zhu Y1, et al. Metabolic regulation of Sirtuins upon fasting and the implication for cancer. Curr Opin Oncol. 2013 Nov;25(6):630-6. doi: 10.1097/01.cco.0000432527.49984.a3.
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The lying-down or reclining position has been completely excluded from the work life of a regular person – working while lying down is considered widely unacceptable these days. A person lying down is thought to be inactive and lazy. However, a closer look reveals that the pressure on the spine is at its lowest when we are lying in the supine position (it is under eight times less pressure than when we’re sitting). It promotes most complete muscle relaxation, stress-relief and slower heartbeat.
The supine position is one of the least studied because researchers are least interested in this form of motor activity. But, in fact, it saves our bodies more energy than any other working pose. It is easy to choose the pose that works best for you: lying on the back, on the stomach, on the side or in the fetal position. The latter is a position in which you bring the head closer to the chest, bend the arms at the elbows pressing them to the body, hands should be clenched into fists, and legs bent. The fetal position can be characterized by the increased flexor muscle tone.
One of the benefits of the supine position is that it ensures maximum rest and releases the tension of articular surfaces. No wonder it is referred to as ‘the rest pose.’
girl reading lying down
Historically, people were quite used to working in the supine, or reclining, position. The entire ancient world ate, read and wrote lying down. Actually, you don’t have to travel that far back in time – suffice to remember some celebrated personalities of the modern world. Take Churchill, for instance. The former British Prime Minister usually woke up at around 8 am and remained in bed where he read newspapers, received ministers, caught up on correspondence, and went on like this until noon. Famous writer Truman Capote said he couldn’t think, let alone write, unless he was lying down on the sofa.
Modern lay-down workstations
Here is a short list:
1. Ergonomic workstation iClubby Phoenix
It is a very special chair, a true embodiment of comfort, design and ergonomics. It is equipped with daylight quality light and a rare mechanism that allows you to work almost lying down.
2. Super Gorone Desk
It looks almost like a usual stand for a laptop that adjusts to any working position. It can be easily transformed from a dinner table into a work surface and back. It withstands up to 60 kg of weight and is height adjustable. To top it off, it has a special safety belt and a set of holders below.
3. Lazy pillow
It was designed by the Thanko company for the convenience of those who like to watch TV or work on a laptop while lying down or sitting on the floor. It’s a curious invention, but this fact doesn’t diminish its undeniable health benefits. It can be propped up at a variety of angles from almost completely flat to any other comfortable degree. There is even a special notch for the chin!
The supine position is ideal to promote creativity and fantasy.
If you are looking for a solution or an original idea, sometimes all it takes is to assume a comfortable lying position. This way you can listen to audio, talk on the phone, watch videos and workshops, while making notes. The supine position helps if the work you do requires thinking, rethinking and generating new ideas.
Staying in the lying position for a brief amount of time works just fine, too. If you work in a standing or sitting position your back eventually gets tired of its static posture. The transition to a horizontal position triggers a redistribution of blood and will allow you to focus on another type of work. You can lie down for 5-10 minutes if you need a break from intensive work.
Bottom line
1. The supine position is a full-fledged working position with a great number of benefits. And, if anyone asks, tell them it’s the doctor’s orders.
2. Do not abuse the supine position. It is most healthy in the first 30-40 minutes. After that, because your metabolism slows down, you might want to doze off. And it won’t be productive for you at all. Assume the lying pose whenever you combine certain activities or want to take a break from work.
3. Useful gadgets, pillows and workstations can make the supine position even more comfortable.
Written by Andrei Beloveshkin, MD, PhD
Andrei is an MD/PhD, research scientist, Associate Professor and opinion leader. He is the host of numerous health and wellness workshops on nutrition,...
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why do we need to keep healthy?
Maintaining good health is essential for overall well-being, productivity, and quality of life. It encompasses physical, mental, and emotional well-being, affecting various aspects of our lives.
Good health contributes to increased energy levels, stronger immunity, improved mood, cognitive function, and better sleep. It reduces the risk of chronic diseases, such as heart disease, stroke, diabetes, and some types of cancer. Healthy individuals are more likely to live longer, healthier lives, with greater independence and vitality.
Maintaining a healthy lifestyle involves engaging in regular physical activity, consuming a balanced diet, getting enough sleep, managing stress, and avoiding harmful habits like smoking and excessive alcohol consumption. Preventive care, such as regular check-ups and screenings, is crucial for early detection and management of health issues.
why do we need to keep healthy?
Maintaining good health is essential for a fulfilling and productive life. It encompasses various aspects, including physical, mental, and emotional well-being.
• Increased longevity: Good health promotes longer, healthier lives.
• Reduced disease risk: Healthy habits lower the risk of chronic diseases, such as heart disease and diabetes.
• Improved physical function: Regular exercise enhances mobility, flexibility, and strength.
• Enhanced mental well-being: Exercise and a healthy diet improve mood, reduce stress, and boost cognitive function.
• Increased productivity: Healthy individuals have higher energy levels and better focus, leading to increased productivity.
• Improved quality of life: Good health allows for greater enjoyment of life’s activities and experiences.
• Reduced healthcare costs: Maintaining good health can reduce healthcare expenses in the long run.
• Stronger immune system: A healthy lifestyle strengthens the immune system, reducing susceptibility to illnesses.
• Enhanced self-esteem: Taking care of one’s health can boost self-confidence and self-worth.
These aspects are interconnected and contribute to overall well-being. For instance, regular exercise not only improves physical fitness but also enhances mental health by releasing endorphins that have mood-boosting effects. Additionally, a balanced diet provides essential nutrients for physical and cognitive function, contributing to increased productivity and quality of life.
Increased longevity
The connection between increased longevity and the need to keep healthy is evident. Good health practices, such as maintaining a balanced diet, engaging in regular exercise, and avoiding harmful habits like smoking, contribute to a longer and healthier life. By taking care of our physical and mental well-being, we reduce the risk of chronic diseases, improve our immune system, and enhance our overall quality of life.
For instance, regular exercise has been shown to improve cardiovascular health, reduce the risk of stroke and type 2 diabetes, and strengthen the immune system. A healthy diet rich in fruits, vegetables, and whole grains provides essential nutrients for the body to function optimally and helps maintain a healthy weight, reducing the risk of obesity-related diseases.
Moreover, avoiding harmful habits like smoking and excessive alcohol consumption significantly reduces the risk of various health conditions, including lung cancer, liver disease, and heart disease. By adopting healthy habits, we can significantly increase our chances of living longer, healthier, and more fulfilling lives.
Reduced disease risk
Maintaining good health is crucial for reducing the risk of developing chronic diseases such as heart disease and diabetes. Chronic diseases are the leading cause of death and disability worldwide, and adopting healthy habits is essential to prevent or manage these conditions effectively.
• Improved Cardiovascular Health: Healthy habits such as regular exercise, a balanced diet, and avoiding smoking significantly reduce the risk of heart disease, the leading cause of death globally. Exercise strengthens the heart muscle and improves blood circulation, while a healthy diet helps maintain healthy cholesterol levels and blood pressure.
• Reduced Diabetes Risk: Maintaining a healthy weight and engaging in regular physical activity can significantly lower the risk of developing type 2 diabetes. Exercise improves insulin sensitivity, helping the body to use insulin more effectively and regulate blood sugar levels.
• Stronger Immune System: A healthy lifestyle, including a balanced diet and regular exercise, boosts the immune system, making the body more resilient to infections and diseases. A strong immune system helps prevent or mitigate the severity of chronic conditions.
• Improved Mental Health: Healthy habits positively impact mental well-being, reducing the risk of depression, anxiety, and other mental health concerns. Exercise releases endorphins that have mood-boosting effects, while a healthy diet provides essential nutrients for optimal brain function.
By adopting healthy habits and reducing the risk of chronic diseases, we can enhance our overall well-being, improve our quality of life, and potentially extend our lifespan. Prioritizing our health empowers us to live longer, healthier, and more fulfilling lives.
Improved physical function
Maintaining good health encompasses various aspects, including improved physical function. Regular exercise plays a pivotal role in enhancing mobility, flexibility, and strength, which are essential components of overall well-being.
Improved physical function contributes significantly to our ability to perform daily activities with ease and efficiency. It allows us to move freely, maintain balance and coordination, and lift or carry objects without undue strain. Regular exercise strengthens our muscles, increases joint flexibility, and improves cardiovascular fitness, leading to greater mobility and independence.
Moreover, maintaining good physical function is crucial for preventing age-related decline and reducing the risk of falls and injuries. As we age, our muscles naturally lose strength and flexibility, and our mobility may decrease. However, regular exercise can help mitigate these effects, allowing us to remain active and independent for longer.
In summary, improved physical function is a vital aspect of maintaining good health. Regular exercise enhances our mobility, flexibility, and strength, enabling us to perform daily activities with ease, reduce the risk of falls and injuries, and maintain our independence as we age.
Enhanced mental well-being
Maintaining good health involves nurturing both physical and mental well-being. Exercise and a healthy diet play a crucial role in enhancing mental well-being, which is an integral part of overall health.
Regular physical activity releases endorphins, which have mood-boosting effects. Exercise also reduces stress hormones like cortisol and adrenaline, promoting relaxation and reducing anxiety. Moreover, a healthy diet provides essential nutrients for optimal brain function, supporting cognitive abilities such as memory, attention, and concentration.
The connection between enhanced mental well-being and the need to keep healthy is evident. Good mental health contributes to increased productivity, improved relationships, and a better quality of life. It also reduces the risk of mental health conditions such as depression and anxiety, which can significantly impact overall health and well-being.
In summary, maintaining good health requires prioritizing mental well-being alongside physical health. Exercise and a healthy diet are key factors in enhancing mental well-being, reducing stress, improving mood, and boosting cognitive function. By nurturing our mental health, we contribute to our overall well-being and live more fulfilling lives.
Increased productivity
The connection between increased productivity and the need to keep healthy is undeniable. Healthy individuals possess higher energy levels and better focus, enabling them to perform tasks more efficiently and effectively, contributing to increased productivity.
Good health practices, such as regular exercise, a balanced diet, and adequate sleep, provide the body and mind with the necessary resources to sustain optimal performance. Exercise boosts energy levels by increasing blood flow and oxygen circulation throughout the body, including the brain. A healthy diet provides essential nutrients for energy production and cognitive function, while adequate sleep allows the body and mind to rest and repair, ensuring optimal performance the following day.
Moreover, maintaining good health reduces the risk of illnesses and chronic conditions that can significantly impact productivity. Individuals who are frequently sick or experiencing health issues may find it challenging to concentrate, perform their duties effectively, and meet deadlines. By prioritizing health and well-being, individuals can minimize the likelihood of such disruptions and maintain consistent productivity.
Increased productivity has far-reaching implications for individuals, businesses, and the economy as a whole. Healthy and productive individuals are more likely to succeed in their careers, contribute to organizational goals, and drive economic growth. Businesses benefit from increased productivity through higher output, improved efficiency, and reduced absenteeism, leading to increased profitability and competitiveness.
In summary, the connection between increased productivity and the need to keep healthy underscores the importance of prioritizing health and well-being for personal success and broader economic prosperity. By maintaining good health, individuals can enhance their energy levels, improve their focus, and minimize the risk of illnesses, ultimately leading to increased productivity and a more fulfilling life.
Improved quality of life
The connection between improved quality of life and the need to keep healthy is profound. Good health is a cornerstone of a fulfilling and meaningful life, enabling individuals to actively participate in and derive joy from a wide range of activities and experiences.
• Enhanced Physical Capabilities: Good health provides the foundation for physical capabilities, allowing individuals to engage in activities they find enjoyable and fulfilling. Whether it’s playing sports, pursuing hobbies, or simply exploring the outdoors, good health empowers individuals to lead active and vibrant lives.
• Increased Social Engagement: Good health facilitates social engagement and interaction. When individuals are healthy, they have the energy and well-being to connect with others, participate in social activities, and build meaningful relationships.
• Emotional Well-being: Good health contributes to emotional well-being and resilience. Physical health and mental health are closely intertwined, and maintaining good health can help individuals better manage stress, cope with challenges, and maintain a positive outlook on life.
• Cognitive Function: Good health supports cognitive function and mental acuity. Regular exercise, a healthy diet, and adequate sleep promote brain health, allowing individuals to think clearly, learn new skills, and engage in mentally stimulating activities.
In summary, improved quality of life is inextricably linked to good health. By prioritizing our health, we unlock the potential to live full and enriching lives, filled with activities, experiences, and connections that bring us joy and fulfillment.
Reduced healthcare costs
Maintaining good health has a direct impact on reducing healthcare costs over time. Individuals who prioritize their health through preventive measures and lifestyle choices are less likely to develop chronic conditions or experience severe health complications, which can lead to substantial healthcare expenses.
• Preventive Care: Regular check-ups, screenings, and vaccinations can identify and address health issues early on, preventing the development of more serious and costly conditions. For example, early detection of high blood pressure can prevent the need for expensive treatments for heart disease or stroke later in life.
• Chronic Disease Management: Maintaining a healthy weight, eating a balanced diet, and engaging in regular exercise can help manage and prevent chronic conditions such as diabetes, heart disease, and arthritis. Effective management of these conditions can significantly reduce healthcare costs associated with hospitalizations, medications, and long-term care.
• Healthy Lifestyle Choices: Avoiding harmful habits like smoking and excessive alcohol consumption reduces the risk of developing health issues that require costly medical interventions. For instance, smoking cessation can lower the likelihood of developing lung cancer, chronic bronchitis, and other respiratory conditions that can lead to expensive treatments.
• Improved Well-being: Overall good health and well-being contribute to reduced healthcare costs by enhancing immunity and resilience to illnesses. Individuals who maintain a healthy lifestyle are less likely to experience frequent colds, flu, or other minor ailments that can lead to doctor visits and medication expenses.
In conclusion, the connection between reduced healthcare costs and maintaining good health is undeniable. By investing in our health through preventive measures and healthy lifestyle choices, we can significantly lower the likelihood of developing costly chronic conditions and other health issues, leading to long-term savings on healthcare expenses and a healthier, more fulfilling life.
Stronger immune system
Maintaining a healthy lifestyle is paramount for strengthening our immune system and reducing our susceptibility to various illnesses. A strong immune system acts as our body’s natural defense mechanism, protecting us from pathogens and infections.
• Improved white blood cell production: A healthy lifestyle, including regular exercise and a balanced diet, promotes the production of white blood cells, the soldiers of our immune system that fight off infections. Exercise increases blood flow, delivering oxygen and nutrients to white blood cells, enhancing their ability to detect and destroy pathogens.
• Increased antibody production: A healthy diet rich in fruits, vegetables, and whole grains provides essential vitamins and minerals that support antibody production. Antibodies are proteins that recognize and neutralize specific pathogens, preventing them from infecting our cells.
• Enhanced natural killer cell activity: Natural killer (NK) cells are immune cells that seek and destroy infected or cancerous cells. Regular exercise has been shown to increase the number and activity of NK cells, further strengthening our immune response.
• Reduced inflammation: Chronic inflammation can weaken the immune system, making us more susceptible to infections. A healthy lifestyle, including stress management techniques and a diet low in processed foods and added sugars, helps reduce inflammation, creating a more favorable environment for the immune system to function effectively.
By embracing a healthy lifestyle, we empower our immune system to fight off illnesses more efficiently, reducing the risk of infections, chronic diseases, and other health complications. A strong immune system is a cornerstone of overall health and well-being, allowing us to live healthier, more fulfilling lives.
Enhanced self-esteem
The connection between enhanced self-esteem and maintaining good health is profound. When we take care of our physical and mental well-being, we cultivate a sense of accomplishment and self-worth that positively impacts various aspects of our lives.
Firstly, maintaining good health through a balanced diet, regular exercise, and adequate sleep contributes to a positive body image. When we feel good about our physical appearance, we tend to have higher self-confidence and self-acceptance. This positive body image translates into improved self-esteem, as we recognize and appreciate the value of taking care of ourselves.
Furthermore, good health promotes a sense of control and mastery over our bodies. When we engage in healthy behaviors, we demonstrate discipline and self-control, which extends beyond the realm of physical health and into other areas of our lives. This sense of accomplishment boosts our self-esteem and reinforces the belief that we can achieve our goals and overcome challenges.
In conclusion, maintaining good health fosters enhanced self-esteem through a combination of improved body image, self-control, and a sense of accomplishment. By prioritizing our well-being, we cultivate a positive self-regard that empowers us to live more fulfilling and meaningful lives.
FAQs on “Why Do We Need to Keep Healthy?”
This section addresses frequently asked questions and common misconceptions regarding the importance of maintaining good health.
Question 1: Why is it important to keep healthy?
Maintaining good health is essential for overall well-being, enabling individuals to live longer, healthier, and more fulfilling lives. It reduces the risk of chronic diseases, such as heart disease, stroke, diabetes, and some types of cancer. Healthy individuals have higher energy levels, stronger immunity, and better mental and cognitive function.
Question 2: How does good health contribute to a better quality of life?
Good health allows individuals to actively participate in and enjoy various activities and experiences. It enhances physical capabilities, facilitating participation in sports, hobbies, and outdoor activities. Good health also promotes social engagement, emotional well-being, and cognitive function, enabling individuals to lead fulfilling and meaningful lives.
Question 3: How can I improve my health?
Improving health involves adopting healthy habits, such as engaging in regular physical activity, consuming a balanced diet, getting enough sleep, and managing stress. Preventive care, including regular check-ups and screenings, is also crucial for early detection and management of health issues.
Question 4: Why is it difficult to maintain good health?
Maintaining good health can be challenging due to various factors, such as busy schedules, unhealthy food environments, and limited access to healthcare. Additionally, unhealthy habits, such as smoking, excessive alcohol consumption, and lack of physical activity, can hinder efforts to maintain good health.
Question 5: What are the benefits of investing in health?
Investing in health through preventive measures and healthy lifestyle choices can lead to reduced healthcare costs in the long run. It can also enhance productivity, improve quality of life, and contribute to overall well-being.
Question 6: How can I stay motivated to maintain good health?
Staying motivated to maintain good health requires setting realistic goals, finding enjoyable physical activities, and seeking support from family, friends, or healthcare professionals. It is also important to focus on the positive outcomes of healthy habits and remind oneself of the long-term benefits.
Maintaining good health is an ongoing journey that requires consistent effort and commitment. By understanding its importance and adopting healthy habits, individuals can reap the numerous benefits of good health and live longer, healthier, and more fulfilling lives.
Transitioning to the next article section on the importance of exercise…
Tips to Maintain Good Health
Maintaining good health requires adopting healthy habits and making informed choices. Here are several practical tips to help you achieve optimal well-being:
Tip 1: Prioritize Regular Exercise
Engage in at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week. Exercise strengthens the heart, lungs, and muscles, reduces the risk of chronic diseases, and improves overall fitness. Aim to incorporate physical activity into your daily routine, such as brisk walking, cycling, or swimming.
Tip 2: Adopt a Balanced Diet
Consume a variety of nutrient-rich foods from all food groups. Fruits, vegetables, whole grains, and lean protein provide essential vitamins, minerals, and fiber. Limit processed foods, sugary drinks, and excessive amounts of saturated and unhealthy fats to maintain a healthy weight and reduce the risk of chronic diseases.
Tip 3: Get Adequate Sleep
Aim for 7-9 hours of quality sleep each night. Sleep allows the body to repair and regenerate tissues, boost the immune system, and improve cognitive function. Establish a regular sleep schedule, create a conducive sleep environment, and avoid screen time before bed to promote restful sleep.
Tip 4: Manage Stress Effectively
Chronic stress can negatively impact physical and mental health. Engage in stress-reducing activities such as exercise, yoga, meditation, or spending time in nature. Learn coping mechanisms to manage stress effectively and seek professional help if needed to prevent stress-related health issues.
Tip 5: Quit Smoking and Limit Alcohol Consumption
Smoking and excessive alcohol consumption significantly increase the risk of various health problems. Quitting smoking and limiting alcohol intake can improve cardiovascular health, reduce the risk of cancer, and enhance overall well-being.
Tip 6: Get Regular Check-ups and Screenings
Preventive care is crucial for early detection and management of health issues. Schedule regular check-ups with your healthcare provider and follow recommended screening guidelines for tests such as mammograms, colonoscopies, and blood pressure checks to maintain good health.
Summary
By following these tips and adopting a healthy lifestyle, you can significantly reduce the risk of chronic diseases, improve your overall well-being, and live a longer, healthier, and more fulfilling life. Remember, maintaining good health is an ongoing journey that requires consistent effort and commitment. Prioritize your health today and reap the benefits of a healthier tomorrow.
Conclusion
Maintaining good health is not merely desirable; it is an essential prerequisite for a fulfilling and prosperous life. As we have explored in this article, the benefits of good health are multifaceted and far-reaching.
From reduced risk of chronic diseases and enhanced physical capabilities to improved mental well-being and increased productivity, the positive impact of good health permeates every aspect of our lives. It empowers us to live longer, healthier, and more fulfilling lives, while also contributing to the well-being of our communities and society as a whole.
Recognizing the importance of good health should inspire us to prioritize our well-being and make informed choices that support our physical, mental, and emotional health. By investing in our health today, we are investing in a healthier and more prosperous future for ourselves, our loved ones, and generations to come.
Why Stay Healthy? Secrets to Unlock a Healthier, Fulfilling Life
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If you or someone you love has diabetes you are probably aware that diabetes causes small blood vessel disease. What happens is blood vessels weaken and slow the flow of blood through the body which can lead to diabetic neuropathy or organ and tissue damage.
Since I am an audiologist I am particularly interested in what diabetes does to our inner ears. Both of our inner ears are made up of a cochlea and vestibular system.
pastedGraphic.png
Did you know that the same cranial nerve (8th nerve) innervates both the cochlea and the vestibular system? That is why I sometimes see patients with both hearing loss and balance issues. Since diabetes affects the entire neural system it is not uncommon for patients to report a disruption in the perception of hearing and balance as a whole.
Hearing Loss, How It Happens
Just like high blood glucose can damage organs such as eyes and kidneys it can also damage the inner ear. Our inner ears are extremely sensitive to blood flow and even our eardrums include a network of small blood vessels.
I often tell my patients a hearing evaluation is one of the easiest ways to identify if there has been any damage in the cochlea, the organ of hearing. Unlike a vision test where an optometrist can look into the back of your eye for signs of diabetic retinopathy we cannot look into your ears and visualize the inner ear, your eardrum is blocking our view!
If damage has occurred in the cochlea it will show up as a sensori-neural hearing loss. This type of hearing loss is referred to as nerve damage that can not be regained through surgery or medication.
Balance, How It Happens
As I mentioned above diabetes also affects balance. When there is too much sugar in the blood it can affect our balance in more ways than one:
• It affects the connective tissues inside the vestibular system making one feel off-balance.
• The myelin sheath that covers the vestibular nerves are damaged which doesn’t allow our inner ear to send messages properly to our brain.
• It can degenerate the hair cells inside the vestibular system just like it damages the hair cells inside the cochlea resulting in hearing loss.
As you can probably imagine we use several sensory inputs to remain balanced on our feet. One of the main inputs is our vision, can you see what is in front of you as you take a step? How about proprioceptive inputs like what your feet are telling you? If someone has a hard time feeling their feet they may be stepping on a surface that isn’t level, which will cause them to fall. Remember, diabetes affects the whole body so there are multiple systems at play when balance is an issue.
My Role As An Audiologist
Baseline Hearing Test
I tell anyone who is suffering from diabetes that a baseline hearing test is an important starting point. It is important to have a complete picture of hearing at the time of diagnosis! Therefore if any issues arise in the future we have something to compare to.
Education
Another recommendation I commonly make may be diabetes education. Did you know that it is covered by Medicare? If you were recently diagnosed with diabetes you can get up to 10 hours of diabetes education when you’re first diagnosed.
Balance Screening
Another recommendation may be a balance screening. We commonly will refer any of our patients to one of our vestibular audiologists in the Tucson area. .
Vision Health
I will commonly ask my patients how their eyesight is if they are diabetic and having issues with balance. Make sure that you or your loved one is getting their eye exam with dilation at least once a year. As mentioned above, vision health plays an important role in balance.
Source:
Dowd, K. (2020). Audiology: diabetes in hearing & balance care. AudiologyOnline, Article 27259. Retrieved from http://www.audiologyonline.com
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X52 - Prolonged stay in weightless environment
Version 2023
ICD-10:X52
Short Description:Prolonged stay in weightless environment
Long Description:Prolonged stay in weightless environment
Status: Not Valid for Submission
Version:ICD-10-CM 2023
Code Classification:
• External causes of morbidity and mortality (V01–Y98)
• Accidental exposure to other specified factors (X52-X58)
• Prolonged stay in weightless environment (X52)
X52 is a non-specific and non-billable ICD-10 code code, consider using a code with a higher level of specificity for a diagnosis of prolonged stay in weightless environment. The code is not specific and is NOT valid for the year 2023 for the submission of HIPAA-covered transactions. Category or Header define the heading of a category of codes that may be further subdivided by the use of 4th, 5th, 6th or 7th characters.
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to this diagnosis code:
Inclusion Terms
Inclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
7th Character Note
7th Character Note
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
7th Character
7th Character
Indicates that a seventh character is to be assigned to codes in a subcategory.
Index of External Cause of Injuries
References found for this diagnosis code in the External Cause of Injuries Index:
Code History
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Over-the-Counter Pain Reliever Reduces Your Empathy, and Other Reasons to Avoid Taking It
How Tylenol Kills Empathy _header
[tldr]
• It’s a common misconception that if a medicine is available without a prescription, it’s not that strong or risky.
• Studies in the last few years show that the popular over-the-counter pain reliever acetaminophen (leading brand Tylenol) dulls not only your physical pain, but also dulls your emotional connection with others.
• The medical community is well aware of liver problems, even liver problems that lead to death, from acetaminophen.
• Here’s what to use instead, and what to do to protect yourself if there’s no way around taking it.
[/tldr]
It’s a common misconception that if a medicine is available without a prescription, it’s not that strong or risky. That couldn’t be further from the truth. The most popular pain reliever and fever reducer, acetaminophen, affects your liver and even reduces your ability to emotionally connect with others.
Keep reading to find out why acetaminophen is a powerful and potentially dangerous drug that comes with plenty of risks, what to take instead, and how to protect yourself if you absolutely must have acetaminophen.
Acetaminophen and empathy
A handful of studies in the last few years show that the popular over-the-counter pain reliever acetaminophen (leading brand Tylenol) dulls not only your physical pain, but also dulls your emotional connection with others.
One study showed that acetaminophen reduced empathy in rats,[ref url=”https://www.sciencedirect.com/science/article/pii/S0091305718304258″]
and a human study showed that it reduced positive empathy, which is the happiness you feel when something good happens to someone else.[ref url=”https://philpapers.org/rec/MISASA”] Another human study showed that acetaminophen reduced trusting behaviors in others.[ref url=”https://www.nature.com/articles/s41598-019-40093-9″] Empathy and relationships are a huge part of being human, and it’s alarming to think that a common medicine that people take for a headache essentially takes away a part of your soul.
Scientists have identified that chronic acetaminophen use changes serotonin receptors and depletes serotonin itself.[ref url=”https://www.sciencedirect.com/science/article/abs/pii/S0197018699000236″][ref url=”https://physoc.onlinelibrary.wiley.com/doi/pdf/10.1016/j.clpt.2005.12.307″][ref url=”https://www.painphysicianjournal.com/current/pdf?article=MTE4NA%3D%3D&journal=47″] Since serotonin is a major player in happiness and empathy,[ref url=”https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951404/”] not having enough could be causing hiccups in your ability to connect with people.
Acetaminophen and liver toxicity
Human connection isn’t the only reason to break up with acetaminophen. The medical community is well aware of liver problems, even liver problems that lead to death, from acetaminophen.[ref url=”https://livertox.nih.gov/Acetaminophen.htm”]
Liver problems from acetaminophen aren’t just from overdosing. Researchers found higher toxicity and death from people who used acetaminophen over a long period, as compared to people who took mega-doses of acetaminophen to harm themselves.[ref url=”https://www.ncbi.nlm.nih.gov/pubmed/9329933?dopt=Abstract”] This is likely because patients who overdosed got immediate medical attention, while long-term misuse of compounded negative effects over the long term without taking measures to counteract it.
Acetaminophen depletes glutathione in your liver, which is known as the “master antioxidant” that your body makes on board. You’re more susceptible to liver injury by acetaminophen if you drink alcohol frequently.[ref url=”https://www.ncbi.nlm.nih.gov/pubmed/7657281?dopt=Abstract”][ref url=”https://www.ncbi.nlm.nih.gov/pubmed/3553308?dopt=Abstract”][ref url=”https://www.ncbi.nlm.nih.gov/pubmed/7990219?dopt=Abstract”] Alcohol depletes your glutathione, and if you’re taking acetaminophen on top of that, you’re tanking your levels to dangerous lows.
Your body uses glutathione to protect your brain, your heart, your eyes, and more. Here’s a complete guide to glutathione and why you want to keep your levels up.
What to take instead of acetaminophen
melatonin sleep supplementsEven when you’re Bulletproof, you’ll still run into instances when you need a pain reliever. Here’s are some things to try before you reach for over-the-counter meds.
Curcumin or turmeric
Curcumin is the active compound in bright-yellow turmeric root. Studies show that curcumin blocks the production of inflammatory cells[ref url=”https://www.ncbi.nlm.nih.gov/pubmed/21804201″] which can help cut down on pain. You can read more about curcumin here.
RELATED: Natural Pain Relief Methods that Work
White willow bark
White willow bark has been used traditionally as a pain reliever, then fell out of practice when pharmaceutical companies started making pain medicines instead. You can’t patent a plant, so the earliest chemists made synthetic versions of the active compounds in medicinal plants, in order to profit from them. Back in the 1800s, the chemist who founded Bayer invented aspirin by creating a synthetic form of salicin, the active compound in white willow bark.
Liquid naproxen
If you absolutely have to have a pain reliever, liquid naproxen is the easiest one for your body to bounce back from. Work with a doctor when you use it, and keep it short-term.
What to do when you absolutely have to take acetaminophen
scarlet feverThere are rare instances when your doctor will tell you that there’s no way around taking acetaminophen. That doesn’t mean your liver, serotonin, and empathy are doomed — but protecting yourself is crucial while you’re taking it. Here’s what to do.
Vitamin C
If you have an illness or injury that requires acetaminophen, your body probably needs extra vitamin C anyway. Vitamin C, like glutathione, can protect all of your cells, including liver cells, from oxidative damage during times of high stress and infection.
Glutathione
Acetaminophen depletes glutathione, so most functional medicine doctors will increase your glutathione stores before treatment and support your body’s ability to make glutathione during the course of treatment. They do this by having patients take n-acetylcysteine (NAC) or a liposomal glutathione supplement before and during treatment with acetaminophen.
In one study, researchers found that NAC didn’t increase glutathione but it did increase the liver’s ability to make glutathione when the demand increased like it does when you take acetaminophen.[ref url=”https://link.springer.com/article/10.1007/BF00609183″]
Curcumin
Research shows that curcumin protects against acetaminophen-induced liver and kidney damage in rats, and that using curcumin along with glutathione had a synergistic protective effect.[ref url=”https://www.sciencedirect.com/science/article/pii/S0014299909010425″] That means, the effects of both together were larger than the combined effects of both used separately.
Milk thistle
Milk thistle is a plant with an active compound called silymarin that has been shown to protect the liver against oxidative stress.[ref url=”https://onlinelibrary.wiley.com/doi/full/10.1111/jvim.12002″][ref url=”http://nopr.niscair.res.in/handle/123456789/3404″]
After acetaminophen
A case study showed that after stopping acetaminophen, your liver function returns to normal.[ref url=”https://annals.org/aim/article-abstract/691410/chronic-liver-disease-acetaminophen”] Glutathione and things that help your body make glutathione would help get your glutathione stores back up and speed up that process.
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-7,345,869,753,680,249,000
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Összesen 1 találat.
#/oldal:
Részletezés:
Rendezés:
1.
001-es BibID:BIBFORM030345
035-os BibID:PMID:7721043 WOS:A1994QF05100018
Első szerző:Nánási Péter Pál (élettanász)
Cím:Effects of veratridine on Na and Ca currents in frog skeletal muscle / Péter P. Nanasi, András Varro, David A. Lathrop, Sirley H. Bryant
Dátum:1994
ISSN:0306-3623
Megjegyzések:1. Voltage-clamp experiments were performed to determine the effects of veratridine on Na and Ca currents in frog skeletal muscle fibres. 2. Veratridine (1 mu M) did not affect the kinetics of the fast Na current but it did induce a slowly inactivating tetrodotoxin-sensitive inward current that was apparent after Na current inactivation. This slow current had a peak amplitude of 6.7 +/- 0.7 mu A/cm(2) at -20 mV and decayed monoexponentially with a time constant of 606 +/- 77 ms. 3. The slow current had a voltage-dependence for activation that was similar to that of the fast Na current. Single depolarizing prepulses that induced complete inactivation of the fast Na channels, prevented development of the slow current. Trains of brief depolarizations at increasing frequencies increased the amplitude of the slow current. These results suggest that the slow current may be mediated by veratridine modified Na channels that must be in the open position. 4. The low concentration of veratridine (1 mu M) did not affect the Ca current, while 100 mu M veratridine reversibly suppressed the Ca current and shifted its peak current-voltage relation towards more negative potentials. Thus, veratridine appears not to be a selective fast Na channel modifier as it may also alter Ca channel gating properties in skeletal muscle fibres.
Tárgyszavak:Orvostudományok Elméleti orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban
egyetemen (Magyarországon) készült közlemény
Megjelenés:General Pharmacology. - 25 : 8 (1994), p. 1661-1666. -
További szerzők:Varró András (1954-) (farmakológus, klinikai farmakológus) Lathrop, David A. Bryant, Shirley H.
Internet cím:DOI
Intézményi repozitóriumban (DEA) tárolt változat
Borító:
Rekordok letöltése1
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Keeping Your Sanity: How to Prevent Nurse Practitioner Burnout
Last Updated/Verified: Nov 19, 2023
Nurse practitioners (NPs) are typically hyper-focused on the health and well-being of their patients, constantly encouraging them to eat nutritiously, exercise regularly, stick to a regular sleep schedule, and participate in stress relief activities. However, when was the last time you practiced what you preached as an NP? With healthcare professionals pulled back and forth between balancing patients and administration at work and family and daily responsibilities at home, it is no wonder that so many providers suffer from burnout without even knowing it. From family care to acute care, burnout does not discriminate in the healthcare field.
While preventing burnout is important in any role, it's especially pertinent when working in healthcare during a pandemic. It has become increasingly crucial for providers like NPs to recognize what burnout looks like, the different causes, and how it can be prevented and treated. This is not only valuable for providers, but for the safety and well-being of patients as well.
Causes of Nurse Practitioner Burnout
Hours
Depending on the employer, providers may or may not have a set schedule for work. However, the scheduled hours are not the extent of the hours worked. NPs could come in early, leave late, or work through lunch, which ultimately cuts into their availability to care for themselves.
Low Control of Daily Pace
In both hospitals and outpatient environments, NPs have little to no control of their patient load and acuity. Providers who work in hospitals or urgent care facilities have no say over who walks in and is admitted to their service. Outpatient providers may have a daily schedule of the patients who they expect to see that day, but it often changes throughout the day.
Time Pressures
Regardless of the employer, there is always an expected number of patients that an NP will care for during a shift. Oftentimes, the allotted time for patient care is not enough to thoroughly examine and address all of the patient's concerns. This can ultimately increase the amount of follow-up appointments, further filling up an already tightly-packed schedule. Alternatively, an NP may try to address all of the patient’s concerns in one visit. However, this approach typically causes delays in other patients' care or scheduled appointments.
RELATED: 5 Must-Have Apps and Tools for Nurse Practitioners
Electronic Health Records (EHR) and Documentation
EHRs are a vital asset for billing, legal liability, and continuity of care. Outside of caring for patients, documentation is the next most important job for providers. This means that everything must be completed accurately and succinctly in a timely manner. However, the real challenge for NPs is finding time to complete this work with no breaks between patients.
Symptoms of Nurse Practitioner Burnout
1. Mental exhaustion
2. Emotional exhaustion
3. Physical exhaustion
4. Depersonalization
5. Insomnia
6. Sadness or irritability
7. Increased vulnerability to illness
8. Decreased sense of personal accomplishment
It is important to understand that the responsibility of preventing and treating burnout does not fall solely on the employer.This process requires some level of effort from the provider as well. Here are some ways to prevent burnout from occurring, or treat it if symptoms have already begun.
Nurse Practitioner Burnout Prevention/Treatment
Schedule 10-30 Minutes of Exercise Daily
Physical activity strengthens the cardiopulmonary and musculoskeletal system and releases endorphins. This boosts both physical and emotional health. With time constraints, squeezing in small exercise breaks may be more feasible than developing one longer exercise routine.
Seek Support
Healthcare burnout is very common, and finding a colleague who may be going through a similar experience can offer a great source of support. Discussing your frustrations and feelings with a counselor or psychologist can also help relieve burnout. These conversations can be conducted in an office or virtually.
Evaluate Work Options
If there are no promising changes after sharing your thoughts on imbalances in expectations, it may be time to start looking for a new job or employer.
RELATED: How to Negotiate Your NP Contract
Staff Meetings to Evaluate Office Flow
Engage in open discussions with support staff to determine what type of patient flow works best in your office or unit, ensuring that it is as optimized as possible. Also, aim to schedule small breaks throughout the day to complete documentation and other administrative tasks.
Streamline EHR Flow
Create smart sets and favorites of orders, diagnosis codes, and patient instructions to streamline the documentation process. Consider the possibility of hiring a scribe to help reduce the strain of documentation.
***
Nurses and nurse practitioners are the most trusted professionals in America, but this high honor can lead to a significant amount of pressure. While we should continue to provide the best care possible to our patients, it's important to take notice when it's negatively affecting our physical, mental, and emotional health.
Andrea Mosher, CPNP
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II. Epidemiology
1. Vasomotor symptoms occur in 85% of perimenopausal women
1. Starts 1-2 years before Menopause
2. Continues for up to 5 to 8 years
III. Differential Diagnosis
1. Medications
1. Isoniazid
2. Disulfiram reaction
1. Griseofulvin
2. Flagyl
3. Chlorpropamide
4. Chloral Hydrate
3. Niacin
4. Hydralazine
5. Calcitonin
6. Aspirin sensitive
7. Procardia
8. Capsaicin
9. MAO Inhibitor when taken with Tyramine (beer, cheese)
2. Medication Withdrawal
1. Clonidine Withdrawal
2. Alpha-Methyldopa withdrawal
3. Alcohol Withdrawal
3. Pheochromocytoma
4. Carcinoid
5. Mastocytosis in Leukemia
1. Histamine and Prostaglandin D Release
2. Hypotensive episodes
3. Dermatographia
6. VIP-oma or WDHA: Diarrhea, Hypokalemia, achlorhydria
7. Menopausal Flushing
8. Emotional blushing
9. Food and Environmental Stimuli
1. Monosodium Glutamate
2. Thermal stimuli
3. Ethanol (worse with Rosacea, Carcinoid, Mastocytosis)
4. Scombroid Fish Poisoning: Tuna, Mahi-mahi, Mackerel
10. Syndrome obscure in women
1. Characteristics
1. Telangiectasia
2. Urticaria
3. Flushing
4. Peptic Ulcer Disease
5. Diarrhea
2. Increased blood and urine Histamine
3. Not associated with Mastocytosis or Carcinoid
IV. Management: Nonpharmacologic and Lifestyle
1. Precautions
1. No single lifestyle modification has been found consistently effective in Hot Flashes
2. However, many lifestyle measures listed have broader health benefits (e.g. weight loss, Tobacco Cessation)
3. (2015) Menopause 22(11): 1155-72 [PubMed]
4. Kaunitz (2015) Obstet Gynecol 126(4): 859-76 [PubMed]
2. General measures (no strong evidence of benefit)
1. Wear cool clothing (e.g. breathable)
2. Use a fan
3. Drink cool liquids and eat cold foods
3. Avoid Exacerbating food products (no strong evidence of benefit)
1. Caffeine
2. Alcohol in excess
3. Spicy food
4. Dietary Fat intake
1. Associated with Hot Flushes in Postmenopause
2. Riley (2004) J Gen Intern Med 19:740-6 [PubMed]
4. Vitamin Supplementation (no strong evidence of benefit)
1. Vitamin B6 may be helpful
2. Vitamin E is no more effective than Placebo
5. Weight loss
1. Associated with less Hot Flushes in Perimenopause
2. Riley (2004) J Gen Intern Med 19:740-6 [PubMed]
6. Behaviorial Interventions
1. Cognitive Behavioral Therapy
2. Relaxation Therapy
3. Mindfulness-based Stress Reduction
4. Van Driel (2019) BJOG 126(3): 330-9 [PubMed]
7. Regular Exercise has mixed results (no strong evidence of benefit)
1. Original study supported Exercise as effective
1. Ivarsson (1998) Maturitas 29:139-46 [PubMed]
2. Recent study does not show benefit in Hot Flushes
1. Aiello (2004) Menopause 11:382-8 [PubMed]
8. Other measures without strong evidence of benefit in Vasomotor Symptom Reduction
1. Tobacco Cessation
2. Yoga
3. Massage
4. Meditation
5. Leisurely bath
V. Management: Medications
1. Hormonal agents (most effective, but review risks and contraindications)
1. Estrogen Replacement Therapy
1. Relieves symptoms in 80-90% of patients
2. Progestin (less effective than Estrogen containing options)
1. Progesterone transdermal cream (20 grams/day)
1. Leonetti (1999) Obstet Gynecol 94:225-8 [PubMed]
2. Megestrol acetate (Megace) 20 mg PO bid
1. Relieves symptoms ~50% of cases
3. Medroxyprogesterone acetate (Provera) 20 mg orally daily
1. Relieves symptoms ~50% of cases
3. Tissue-selective Estrogen Complex (TSEC): Estrogen with Selective Estrogen Receptor Modulator (SERM)
1. Duavee is a combination of Estrogen AND Bazedoxifene (BZA)
2. First TSEC released in U.S. 2019
3. Significantly reduces vasomotor symptoms without affecting Breast tissue, endometrium or VTE or Cardiac Risk
4. Lello (2017) Int J Endocrinol 2017:5064725 +PMID: 29358948 [PubMed]
2. Serotonin Norepinephrine Reuptake Inhibitor (SNRI)
1. Efficacy
1. Venlafaxine appears to be most effective among SNRI and SSRI agents
2. Venlafaxine does not affect Tamoxifen metabolism (unlike some SSRIs that are CYP2D6 Inhibitors)
3. However, SNRIs also have more side effects than SSRIs (e.g. Nausea, Dry Mouth, Constipation, Somnolence)
2. Desvenlafaxine (Khedezla)
3. Venlafaxine (Effexor)
1. Dose: 12.5 mg orally twice daily or 75 mg orally at bedtime
2. (1998) J Clin Oncol 16:2377 [PubMed]
3. Loprinzi (2000) Lancet 356:2059-63 [PubMed]
3. Selective Serotonin Reuptake Inhibitors (SSRI)
1. Efficacy
1. More effective and better tolerated than Clonidine or Gabapentin
2. Precaution: Avoid Prozac and Paxil in Breast Cancer patients on Tamoxifen
1. CYP2D6 Inhibitors (e.g. Paroxetine, Fluoxetine, Bupropion) may decrease Tamoxifen efficacy
2. Other SSRIs inhibit CYP2D6 but less potently
3. SSRIs shown to be effective
1. Paroxetine (Paxil CR)
1. Paroxetine 12.5 to 25 mg orally daily
1. Stearns (2003) JAMA 289:2827-34 [PubMed]
2. Released as Brisdelle (7.5 mg Paroxetine) in 2013 specifically targeting Hot Flushes
1. Paroxetine 10 mg generic tablet daily is nearly equivalent (at 6% of the Brisdelle cost)
2. Fluoxetine (Prozac)
1. Loprinzi (2002) J Clin Oncol 20:1578-83 [PubMed]
4. SSRIs not found to be effective
1. Citalopram (Celexa)
2. Sertraline (Zoloft)
3. Suvanto-Luukkonen (2005) Menopause 12:18-26 [PubMed]
4. Miscellaneous agents with some efficacy against Hot Flushes
1. Clonidine
1. Start 0.1 mg orally at bedtime (or 0.1 mg weekly transdermal patch)
2. May titrate to 0.2 mg orally at bedtime and up to 0.2 mg orally twice daily
3. Modest benefit, but adverse effects (Hypotension, Dizziness) may limit use
4. (1994) JCO 12:155
2. Gabapentin (Neurontin)
1. Dosing: Titrate to 300 mg orally three times daily
2. Guttuso (2003) Obstet Gynecol 101:337-45 [PubMed]
3. Neurokinin 3 Receptor Antagonist (e.g. Fezolinetant or Veozah)
1. Fezolinetant (Veozah) 45 mg orally daily
2. Requires hepatic profile monitoring (baseline, and at 3, 6, and 9 months)
3. Cost $550 per month when released in 2023
4. Less effective than hormonal therapy, but similar to SNRIs, SSRIs and Gabapentin in hot flash reduction
5. Blocks neurokinin B (NKB) at the infundibular nucleus of the Hypothalamus
1. Neurokinin B (NKB) regulates temperarture and its blockade can decrease Vasomotor Symptoms of Menopause (Hot Flashes)
5. Other agents with historic use
1. Aldomet 250 mg PO bid
2. Bellergal-S 100
1. Small risk of addiction
VI. Management: Herbals and Dietary Supplements
1. Possible benefit
1. Omega-3 Fatty Acids
2. Black Cohosh
1. Castelo-Branco (2021) Climacteric 24(2): 109-19 [PubMed]
2. Hernandez (2003) Maturitas 44:S59-65 [PubMed]
3. Soy Isoflavones or Phytoestrogens
1. See Soy Protein
2. Original studies with mixed results (prior to consideration of pharmacogenomic factors )
1. Faure (2002) Menopause 9:329-34 [PubMed]
2. Han (2002) Obstet Gynecol 99:389-94 [PubMed]
3. Nikander (2003) Obstet Gynecol 101:1213-20 [PubMed]
3. Effectiveness appears dependent on pharmacogenomic factors
1. Equol is a soy metabolite with Estrogenic Activity
2. Only 40% of North American women convert Soy Isoflavone (daidzein) to equol
1. Conversion is most common in Asian and Hispanic women
2. The majority who lack this conversion are unlikely to see benefit from soy
3. References
1. Clarkson (2011) Menopause 18(7):732-53 [PubMed]
2. Unlikely benefit
1. Dong Quai (No better than Placebo)
2. Evening Primrose Oil
3. Red Clover
1. Tice (2003) JAMA 290:207-14 [PubMed]
4. Vitamin E slightly better than Placebo
1. Barton (1998) J Clin Oncol 16:495-500 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
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Vein Care 101
Do Varicose Veins Cause Restless Legs?
February 5, 2024
Many people are surprised to learn that restless legs are a common symptom of vein diseases like varicose veins and chronic venous insufficiency. In simple terms, this is because varicose veins result from poor circulation in your veins, which can lead to various symptoms such as leg pain, heaviness, aching, and restless legs. In this article, we will explore why restless legs may manifest as a symptom of varicose veins and how you can achieve permanent relief through modern vein treatments.
Understanding Vein Disease
Vein disease, or chronic venous insufficiency, arises when the veins struggle to efficiently pump blood back from the legs to the heart. The circulatory system relies on valves within the veins to prevent backward blood flow. However, when these valves weaken or fail, blood can pool in the veins, leading to the development of bulging varicose veins. The stress and strain of inefficient blood flow can actually distort the vein walls, which leads to visibly enlarged, twisted veins often noticeable to the naked eye near the skin's surface. Varicose veins primarily affect the legs due to the additional pressure of gravity against blood flow in your venous system. Symptoms of varicose veins may include pain when standing, swelling or edema, and tingling sensations, all stemming from the increased pressure within the veins caused by the compromised valves.
One of the most common symptoms, and among the most underdiagnosed, is restless legs. After a long day on or off your feet, depending on lifestyle and work factors, restless legs can negatively impact sleep, keeping patients awake well into the night and further stressing the body.
Restless Legs and Varicose Veins
Restless legs, a condition where you may have an uncontrollable urge to move your legs (often at night or during prolonged periods of rest), can be more than an isolated phenomenon that keeps you from finding a comfortable sleeping position. Restless legs as a symptom are commonly associated with neurological concerns — “restless leg syndrome,” or RLS, is an issue with the nervous system. However, a similar feeling can also emerge as a symptom of vein disease, specifically in the presence of varicose veins.
When venous insufficiency compromises blood flow, and valves fail to function correctly, blood accumulates, causing elevated pressure in the veins, which, in turn, may contribute to unpleasant sensations in the legs. Your body may intuitively urge you to move around because as you do, your muscles will promote circulation organically through compression and contraction. This may be why you feel the need to twitch, move, or shift your position so often while lying down to sleep.
Another reason restless legs can be caused by vein issues is that stagnant blood within varicose veins may lead to inflammation and irritation of leg nerves, triggering a difficult-to-ignore discomfort associated with restless legs. Additionally, chronic venous insufficiency linked to varicose veins may result in insufficient oxygen supply to the leg muscles, intensifying the sensations that characterize restless legs.
All this may sound like a recipe for serious concern; however, restless legs related to varicose veins and vein disease can be easily treated: Modern advancements in vein care have led to a wide variety of minimally invasive vein treatment options that can restore proper blood flow and stop restless legs. Because varicose veins can cause pain, discomfort, and symptoms that negatively impact your quality of life (mainly mobility and ease of sleep), most insurance providers offer coverage options for their treatment. At Metro Vein Centers, we accept over 200 insurance plans for varicose vein treatments!
Poor Circulation and Restless Legs
Understanding the link between varicose veins and restless legs involves recognizing how venous insufficiency and vein disease can impact blood flow. Restless legs can, of course, manifest due to neurological issues, separate from vein disease. However, as this is one of the most common symptoms of vein disease, and is often accompanied by symptoms of discomfort, swelling legs (edema), heavy legs, or tingling sensations. The chronic nature of this condition emphasizes the importance of discovering and addressing the root cause to alleviate both physical and sensory symptoms.
Poor circulation can result in the formation of varicose veins and result in bulging, twisted veins protruding against the surface of the skin. When the valves in your veins are not working correctly, your blood can pool and cause distortions in the veins (the visible twisting nature of varicose veins is a result of pooling blood).
Most patients seek the care of a vein specialist when they experience restless legs because it is one of the more frustrating (and seemingly unrelenting) symptoms that impact sleep. When our sleep suffers, our stress levels are heightened, patience runs short, and our overall quality of life worsens.
Solutions Are Shorter Than a Nap (We’re Serious!)
Effectively treating restless legs as a symptom of varicose veins begins with treating the underlying vascular issue. Modern medical advancements offer a wide variety of minimally invasive procedures, including endovenous laser ablation (EVLA), radiofrequency ablation (RFA), sclerotherapy, varithena, and Venaseal™. These treatments require only about 30 minutes from start to finish, on average, and they provide lasting, meaningful relief as well as cosmetic improvements.
Individuals experiencing restless legs or other symptoms associated with varicose veins (take our test to find out more about your symptoms!) should seek professional medical assistance at a vein clinic near you. A comprehensive evaluation by a board-certified vein specialist can lead to a personalized treatment plan, addressing both the physical and sensory aspects of vein disease, and put an end to restless legs.
At Metro Vein Centers' nationally accredited vein clinics, we offer the latest state-of-the-art vein treatment technology to treat both varicose veins and spider veins. Our team of board-certified vein specialists takes a personalized approach to your treatment, crafting care plans tailored to your unique symptoms and lifestyle, ensuring that you receive the best possible results for your vein-related concerns. Additionally, we work closely with your insurance, accepting 200+ plans to ensure you receive the maximum possible coverage for your vein treatments. We offer free vein evaluations in all 40+ New York, New Jersey, Connecticut, Michigan, Texas, and Arizona vein clinics. To schedule your free consultation with a board-certified vein doctor, don't hesitate to reach out to our patient care team at 866-353-5230. We're here to help, and we look forward to supporting you toward meaningful relief and healthy legs!
Trusted insight from the nationally accredited, board-certified vein doctors at Metro Vein Centers.
Healthy legs feel better.
Book Now
Or Call: 888-660-3494
Legs you can feel good about.
Stay up-to-date with the latest vein health treatments, vascular wellness tips, and more.
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Where can weight loss eat
By | May 7, 2021
where can weight loss eat
Millions of readers rely on HelpGuide for free, evidence-based resources to understand and navigate mental health challenges. Please donate today to help us protect, support, and save lives. Pick up any diet book and it will claim to hold all the answers to successfully losing all the weight you want—and keeping it off. Some claim the key is to eat less and exercise more, others that low fat is the only way to go, while others prescribe cutting out carbs. So, what should you believe? What works for one person may not work for you, since our bodies respond differently to different foods, depending on genetics and other health factors. While some people respond well to counting calories or similar restrictive methods, others respond better to having more freedom in planning their weight-loss programs. Being free to simply avoid fried foods or cut back on refined carbs can set them up for success.
Andreas Eenfeldt, MD, medical review by Dr. A standard glass of wine can contain as many calories as a piece of chocolate. But not metformin. Skip battered foods deep-fried in oil, though! Simply put, ghee is butter that’s had all its cow milk protein and sugar lactose removed, explains Richards. Everyone needs a dessert from time to time. You’ll lose weight and reduce body fat naturally by adopting a wholesome diet, alongside moderate exercise.
Loss at the top of things eat training, or interval training. Cut calories Some experts believe the list most where and comes down to a simple equation: If you eat fewer. This weight lifting really heavy. Our new week program helps salad or can aet, stat. Sounds easy, right.
Read More: Autoimmune protocol diet breakfast recipes
Leave a Reply
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The Herbal Handbook
by
Nicholas Culpeper
Featured in
Tonight, we’ll read from “The Complete Herbal” written by Nicholas Culpeper, published in 1653. Culpeper was an English botanist, herbalist, physician and astrologer.
Culpeper catalogued hundreds of outdoor medicinal herbs. He attempted to make medical treatments more accessible to lay persons by educating them about maintaining their health. Ultimately his ambition was to reform the system of medicine by questioning traditional methods and knowledge and exploring new solutions for ill health. The systematisation of the use of herbals by Culpeper was a key development in the evolution of modern pharmaceuticals, most of which originally had herbal origins.
Culpeper's emphasis on reason rather than tradition is reflected in the introduction to his Complete Herbal. He was one of the best-known astrological botanists of his day, pairing the plants and diseases with planetary influences.
Culpeper believed medicine was a public asset, not a commercial secret, and the prices physicians charged were far too high compared with the cheap and universal availability of nature's medicine. For this, he was considered a radical, and even accused of witchcraft.
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fbpx
FaithHealth
Fasting twice a week could keep the neurologist at bay
The winner of this year’s Nobel Prize in Medicine or Physiology has been announced as Professor Yoshinori Ohsumi. The 71 year-old Japanese cell biologist is being awarded the prize for his outstanding work in the field, having been a pioneer in the study of autophagy.
yoshinori ohsumi fasting nobel prize medicine autophagyWhat is Autophagy?
Autophagy is the process by which living cells breakdown and recycle dead, diseased or unused cellular parts, rendering them available for use again in a more effective way. Put in layman’s terms, it is like stripping down an old car and reusing the parts that might still be of use elsewhere. While Professor Ohsumi’s work began by looking at the process within yeast, over the course of the last three decades researchers have found that autophagy plays a crucial role within most living organisms; this crucially includes humans.
Why is it important?
Where this gets exciting is that researchers believe autophagy plays a crucial role in helping the body fight the onset of a wide range of diseases and ailments, including neurodegenerative disorders like Parkinson’s, Alzheimer’s and Huntington’s disease. This field of research has exploded since the time that Professor Ohsumi began looking into the area 27 years ago. It now represents one of the most promising leads for researchers who are desperately attempting to develop cures for debilitating neurological disorders. Part of this urgency is due to the fact that incidence of these diseases are rising at a rapid speed.
The Michael J. Fox Foundation, started by Back to the Future star from whom the foundation takes it’s name, is but one of the big organisations putting money into research that is attempting to find a cure for neurodegenerative disorders by way of a better understanding of autophagy. Michael J. Fox and the late Muhammad AIi were both stricken by Parkinson’s disease. Beyond these conditions, autophagy has also been found to help rid the body of inflammation. High levels of inflammation has been scientifically linked to heart disease, cancer, arthritis, lung damage, skin damage and depression.
nobel prize fasting
Our cells have different specialized compartments. Lysosomes constitute one such compartment and contain enzymes for digestion of cellular contents. A new type of vesicle called autophagosome was observed within the cell. As the autophagosome forms, it engulfs cellular contents, such as damaged proteins and organelles. Finally, it fuses with the lysosome, where the contents are degraded into smaller constituents. This process provides the cell with nutrients and building blocks for renewal.
Why is this relevant to Muslims?
This gets more relevant when we consider the ways in which scientists have found people can help bolster the process of autophagy within themselves; exercise, lowering carbohydrate intake and most interesting for us, fasting. Going through the sometimes painful process of depriving ourselves of food for 12 hours or longer, as Muslims are obliged to do during Ramadan and recommended to do twice a week, is a potent motivator of our internal autophagy processes. Not only does fasting help induce autophagy in the body’s cells in general, it has been found to be specifically potent in helping the brain’s cells engage in this process. This potentially makes fasting one of the ways in which we can stave off neurodegenerative disorders such as Alzheimer’s and Parkinson’s. This highlights but one more benefit of fasting for our bodies and minds, and this is a list that continues to grow.
Engaging in regular fasting can be a potent way in keeping ourselves healthy by way of many avenues, not least of which are increasing self-control, resting our digestive systems and stimulating the process of autophagy. For those who are still not convinced, take note of this fact: autophagy, this powerful force in renewing our bodies cells and keeping us in shape, has also been shown to slow the ageing process. Next time, try skipping the mango, cucumber and coconut oil facial mask and opt for a day of fasting instead. It is always interesting when science supports revelation; it can almost feel like the source of revelation knows the human body incredibly well.
Learn more about autophagy in this video:
[youtube id=”nRJBVhDnv4s”]
by Tamim Mobayed
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Background
Childhood cancer may have psychosocial consequences in the short and long term [1, 2]. To attain the goals in a typical psychosocial development, survivors of childhood cancer face extra challenges due to their disease history. Childhood cancer and its treatment often increase parental dependence and decrease participation in peer-based and school-based activities [3, 4]. Cognitive problems and non-attendance at school as a result of the disease and treatment can result in lowered educational achievement [57]. As a result, growing up with or after childhood cancer may have consequences for the psychosocial development of children, adolescents, and young adults.
The attainment of social and academic competence, peer relationships, independence from parents, and identity are generally recognized as important milestones in the development of a child into young adulthood [810]. The achievement of these psychosocial milestones is of importance to the adjustment in adult life [1113]. Functioning of young adult childhood cancer survivors (YACCS) may be affected due to earlier missed experiences and delays in the achievement of psychosocial developmental milestones. Previous research in 2000/2001 among YACCS from the long-term follow-up clinic at the Academic Medical Center Amsterdam, The Netherlands [14], revealed that YACCS were at risk of a hampered psychosocial development. On group level, the differences with the general population were rather small [14], which indicated that the majority of YACCS were likely to have a favorable psychosocial developmental trajectory. However, YACCS of cancer in the central nervous system (CNS) and/or treated with radiotherapy appeared to be at risk of delays in the achievement of psychosocial developmental milestones, especially in the social and psychosexual domain [15]. Furthermore, YACCS who had achieved fewer psychosocial milestones while growing up were more likely to apply for disability benefits [16] and to experience worse health-related quality of life in young adulthood [15].
Care should not be limited to the physical and cognitive aspects of the disease but should also focus on the most optimal psychosocial functioning of the patient such as autonomy and social contacts with peers [17]. Knowledge about possible delay in the psychosocial development enables health care providers to aim for the most favorable psychosocial functioning of patients and survivors and to provide timely and relevant interventions. Literature about the achievement of psychosocial developmental milestones in survivors of childhood cancer is rather scarce. Since the first Dutch study 20 years ago [14], as far as we know, only a few, mostly small, studies about the psychosocial development of YACCS were published. Nies et al. [18] found no differences in psychosocial development between Dutch YACCS of childhood differentiated thyroid carcinoma and non-affected young adults, while Lehmann et al. [19], Van Dijk et al. [20], and Dieluweit et al. [21] demonstrated delay in psychosexual development in survivors of childhood cancer.
To expand the limited knowledge about the achievement of psychosocial developmental milestones while growing up with childhood cancer, the present study aimed to compare the psychosocial development of a nationwide cohort of YACCS with a norm group of young adults from the general population. We hypothesized that especially YACCS of CNS cancer achieved fewer psychosocial developmental milestones than the norm group.
Methods
Procedures and participants
YACCS from the Dutch Childhood Cancer Survivors LATER 2 Psycho-oncology study
Psycho-oncology data were collected between 2017 and 2020 as part of a nationwide cross-sectional cohort study: the Dutch Childhood Cancer Survivor Study (DCCSS) LATER cohort (diagnosed between 1/1/1963 and 31/12/2001) part 2, a clinical visit and questionnaire study. It concerned all patients diagnosed before the age of 18, and at least 5 years after diagnosis at time of study [22]. Survivors were included if they were living in The Netherlands at time of the childhood cancer diagnosis and treated in one of the seven former pediatric oncology/hematology centers in The Netherlands: Amsterdam University Medical Center (VU University Medical Center and Academic Medical Center Amsterdam), Leiden University Medical Center, Erasmus Medical Center Rotterdam, University Medical Center Groningen, Radboud University Medical Center Nijmegen, and University Medical Center Utrecht. Since 2018, pediatric oncology care in The Netherlands is centralized in the Princess Máxima Center for Pediatric Oncology in Utrecht.
YACCS, aged 18–30 years, who gave informed consent for the DCCSS-LATER 2 Psycho-oncology study, as part of the DCCSS-LATER 2 study, received a questionnaire about psychosocial developmental milestones (Course of Life Questionnaire (CoLQ)) at the end of their visit to the outpatient clinic for the DCCSS-LATER 2 study or by mail in case of no-show. YACCS had the opportunity to complete the questionnaire online or paper-pencil. Informed consent was obtained from all individual participants included in the study. The medical ethics boards of all participating centers approved the study (MEC2010_332).
Norm group of young adults
In 2012, 655 young adults from the general Dutch population, aged 18–30 years, completed the CoLQ to update previous normative data of the CoLQ that were collected in the context of research among YACCS in 2000/2001 [14]. Data were collected online in cooperation with TNS NIPO (operating under the name of “Kantar Public”), a Dutch market research agency. A stratified sample was drawn from a panel of TNS NIPO, based on Dutch population figures regarding key demographics (age, sex, marital status, and education) [23].
Measures
The CoLQ was used to assess the achievement of psychosocial developmental milestones [14]. The CoLQ was developed, validated, and normed in The Netherlands in 2000–2001 [14, 24] and updated in 2012 (see “Procedures and participants”). In the meantime the CoLQ was used in almost 2000 young adults grown up with 18 different pediatric diseases [25]. The CoLQ asks retrospectively whether, or at what age, the respondent had achieved certain milestones. It concerns behaviors that are characteristic of certain age stages, developmental tasks, or limitations children might encounter when they grow up with a chronic disease. The items (milestones) and answer categories, such as the age at which a certain milestone is expected to be achieved in the majority of children and adolescents, were based on the literature and clinical experience of developmental psychologists.
The items are divided into five domains: three psychosocial developmental domains and two risk behavior domains. In the present study, the items of the three psychosocial domains were used: autonomy development (6 items about autonomy at home and outside home; scale score range 6–12), psychosexual development (4 items about love and sexual relations; scale score range 4–8), social development (12 items about social contacts with peers at school and in leisure time; scale score range 12–24). A higher score indicates the accomplishment of more psychosocial developmental milestones. Apart from the scale scores, the individual items can be used as outcomes because each item represents a milestone.
Validity, test-retest reliability, and internal consistency of the CoLQ were satisfactory in previous studies, though the internal consistency of autonomy was moderate [14, 15, 24]. Cronbach’s alphas in the present study were as follows for autonomy, psychosexual, and social development, respectively: norm group 0.49, 0.77, and 0.74; YACCS 0.54, 0.79, and 0.76.
Socio-demographic and medical characteristics
Data on age, sex, and medical characteristics (see Table 1
Table 1 Demographic and medical characteristics of YACCS: participants versus non-participants/norm group
Statistical analyses
Differences between participants and non-participants/norm group were tested with independent t tests and chi-square tests. Analysis of variance (ANOVA) by group, age, and sex was performed to test differences between YACCS and the norm group on the mean scale scores of the CoLQ. Effect sizes d were calculated by dividing the difference in mean scores between YACCS and the norm group by the standard deviation in the norm group. After Cohen [26], effect sizes up to 0.2 were considered to be small, effect sizes about 0.5 to be medium, and effect sizes of about 0.8 to be large. Because the distribution of the scale scores of psychosexual development and social development was left skewed, we checked the results with non-parametric tests (Mann-Whitney U tests).
In order to gain more detailed insight into the psychosocial development, differences between YACCS and the norm group on item level, indicating the achievement of individual milestones, were explored additionally. Logistic regression analyses were carried out with the achievement of a milestone (yes/no) as dependent variable and group (YACCS versus the norm group), age, and sex as independent variables, including odds ratios (ORs).
The analyses were conducted for the total group of YACCS and for YACCS of CNS cancer. A significance level of 0.013 was used for the analyses on scale level: 0.05 divided by the number of three scales. For the explorative analyses on item level, a significance level of 0.01 was used.
Results
Participants
Of the 1416 eligible YACCS in the age range 18–30 years, a total of 828 (58.5%) participated in the DCSS-LATER 2 study. The most frequent reasons for non-participation were deceased, lost to follow-up, living abroad, and refusal. Of the 828 YACCS who participated in the DCSS-LATER 2 study, 558 (67.4%) participated also in the DCCSS-LATER 2 Psycho-oncology study and completed the CoLQ. Reasons for refusal and non-response to the DCCSS-LATER 2 Psycho-oncology study were not administrated. The percentages of female sex and hematopoietic transplant were significantly higher in participants from the present study (CoLQ) than in YACCS who did not participate in the present study or other parts of the DCCSS-LATER 2 study (51.1% versus 38.2% and 8.3% versus 5.4%, respectively).
The total group of YACCS was older than the norm group (mean 25.78, SD 3.33 versus mean 24.75, SD 3.79; p 0.00) but they did not differ on sex (51.1% versus 51.0% female). YACCS of CNS cancer (mean 26.78, SD 3.35; p 0.00) were also older than the norm group and the proportion of female was higher in YACCS of CNS cancer than in the norm group (68.9% vs 51.0%, p 0.01).
Psychosocial developmental milestones on scale level
YACCS total group versus the norm group
No significant differences (p < 0.013) were found between the CoLQ mean scale scores of the total group of YACCS and the norm group according to ANOVA by group, age, and sex (Table 2). Mann-Whitney U
Table 2 Psychosocial developmental milestones YACCS (total group and CNS cancer) versus the norm group; CoLQ scale scoresa
YACCS of CNS cancer versus the norm group
CNS YACCS had significantly lower mean CoLQ scale scores than the norm group on autonomy development (d − 0.36; p < 0.001) and psychosexual development (d − 0.46; p < 0.001). YACCS of CNS cancer did not differ significantly from the norm group on social development (d − 0.26; p 0.035) (Table 2). Mann-Whitney U tests yielded similar results.
Psychosocial developmental milestones on item level
YACCS total group versus the norm group
The total group of YACCS did not differ significantly (p < 0.01) from the norm group on the items of autonomy and psychosexual development (Table 3). In the social development domain, the total group of YACCS was significantly more likely to have been member of a sports club, in the period of secondary school (OR 1.80, p < 0.001) and after secondary school (OR 1.72, p
Table 3 Psychosocial developmental milestones YACCS (total group and CNS cancer) versus the norm group; CoLQ item scores
YACCS of CNS cancer versus the norm group
In the autonomy development domain, YACCS of CNS cancer were significantly less likely than the norm group to have achieved three out of the six milestones (Table 3). It concerned having a paid job in the period of secondary school (OR 0.27, p < 0.001), going on holiday without adults before the age of 18 (OR 0.34, p 0.001), and leaving their parents’ place (OR 0.25, p < 0.001).
With regard to psychosexual development, YACCS of CNS cancer were significantly less likely than the norm group to have achieved three out of the four milestones: first girlfriend or boyfriend before the age of 18 (OR 0.44, p 0.003), for the first time sexual intimacy before the age of 19 (OR 0.48, p 0.009), for the first time sexual intercourse before the age of 19 (OR 0.30, p < 0.001).
In the social development domain, YACCS of CNS cancer were significantly less likely than the norm group to have achieved the following four milestones out of twelve: having more than four friends (OR 0.46, p 0.005), belonging to a group of friends (OR 0.37, p < 0.001), spending leisure time with friends (OR 0.23, p < 0.001), and going out to a bar or disco (OR 0.47, p 0.009), in the period of secondary school. They were significantly more likely to have been members of a sports club: in the period of secondary school (OR 2.81, p 0.003) and after secondary school (OR 2.22, p 0.004).
Discussion
Overall, the psychosocial development of the total group of YACCS was as favorable as the psychosocial development of peers from the general Dutch population, while YACCS of CNS cancer appeared to be at risk of an unfavorable psychosocial development. YACCS of CNS cancer achieved half as many milestones as their peers in all three psychosocial developmental domains with differences on scale scores of small-to-moderate size. On the positive side, they were more likely to have been members of a sports club, which is in favor of their social contacts with peers, apart from the physical health advances. This positive result was also found in the total group of YACCS.
On the one hand, the results were not surprising because it is generally known from previous research that, overall, survivors of childhood cancer function well psychosocially, while problems were seen in subgroups of survivors [27], especially in survivors of CNS cancer [1, 15, 28, 29]. The cognitive problems many survivors of CNS cancer face could increase dependence from parents and complicate contacts with peers, which in turn could result in delay of the achievement of psychosocial developmental milestones.
On the other hand, the favorable psychosocial development of the total group of YACCS was not expected because the psychosocial development of YACCS appeared to be hampered in a previous study, 20 years ago [14]. The explanation of these conflicting results is probably twofold. First, improvements in treatment, efforts to reduce toxicity of treatment in particular, and improvements in (psychosocial) care over the past 15 to 20 years may have helped prevent adverse consequences for psychosocial development. Overall, YACCS in the present study tend to have higher scores on the scales and items of the CoLQ than the YACCS 20 years ago, which indicates that the psychosocial development of YACCS improved between 2000 and 2020. A second explanation may lie in the normative data that reflect developments in Dutch society. In the current normative data, several milestones were achieved by a lower proportion of young adults than in the normative data from 2000 to 2001 [14], for example, membership of sports clubs and age at first sexual intercourse. This is in line with developments in the Dutch society [30, 31] but these developments were not seen in survivors. Maybe this kind of societal developments had less impact on children and adolescents whose life was all about surviving and dealing with the consequences of childhood cancer and its treatment. Regarding the result that survivors were more likely to have been member of a sports club than their peers, it could also be that patients and survivors of childhood cancer were more strongly stimulated to participate in sport clubs than children and adolescents without a history of childhood cancer. It is likely that health care providers and parents more and more focus on improving quality of life and well-being and consider participation in a sports club an effective way to improve physical and social well-being. The explanations discussed above contribute to smaller differences between the psychosocial development of YACCS and peers, in favor of the YACCS as total group.
Study limitations
These results yield insight into the psychosocial development of a large nationwide cohort of YACCS but the results do not paint the complete picture. The psychosocial development is more comprehensive than the milestones assessed retrospectively with the CoLQ. To prevent recall bias, the milestones were strictly factual and do not go further back than the period of primary school. Another limitation of the CoLQ concerns the moderate internal consistency of the autonomy development scale. It is acceptable to use scales with moderate internal consistency for group comparisons because internal consistency gives an indication of random error; it has nothing to do with systematic error. However, larger random errors make it more difficult to detect differences between groups [32]. This limitation was partly overcome by the analysis of the individual milestones within the scales.
Although more than two-thirds of the YACCS who participated in the DCCSS-LATER 2 study completed the CoLQ, the overall response rate was moderate. Probably this did not affect the representativeness of the sample because the medical history of the participants and non-participants was very similar. It is unlikely that the difference in hematopoietic transplant between participants and non-participants biased the results because the number of YACCS who received hematopoietic transplant was small. Finally, the representativeness of the Dutch norm group was not optimal. Our norm sample was more often born in The Netherlands than the general Dutch population (97% versus 91%), more often highly educated (30% versus 25%), more often employed (69% versus 59%), and more often married or living together with a partner (36% versus 31%) [33]. However, we can only speculate about the possible confounding effect on the results of our study because three out of these demographics (educational level, employment, and marital status) can be considered a possibly affected outcome of being a survivor of childhood cancer [14, 34, 35].
The present study was focused on psychosocial development in survivors of childhood cancer as an outcome. Apart from a diagnosis of CNS cancer, medical risk factors of an unfavorable psychosocial development were not addressed. Future research should focus on this.
Clinical implications
Since most of the children and adolescents with cancer reach adulthood today, health care providers need to understand the psychosocial consequences of growing up with or after childhood cancer. Knowledge about possible delay in the psychosocial development of patients and survivors could help optimizing their development to adulthood and achieving a sustainably good quality of life in adulthood. Though overall survivors in this study showed no delay in psychosocial development, survivors of CNS cancer appeared to be at risk of a suboptimal psychosocial development. Further research should reveal whether other subgroups at risk could be designated.
Attention to the achievement of psychosocial milestones is warranted to detect and support those at risk at an early stage. It is recommended to include monitoring of psychosocial developmental milestones in the standards of psychosocial care for patients and survivors [36, 37], especially for patients and survivors of CNS cancer, and especially at important transition moments such as the transition from primary to secondary school or the transition from school to work. Monitoring should not stop after transition from pediatric to adult health care because survivors who were delayed in their psychosocial development deserve attention and support into adulthood. Follow-up of survivors is also important because “growing into deficit” is a known phenomenon, especially in survivors with cognitive late effects of diagnosis and treatment [38]. Monitoring can be facilitated by electronic systems that assess patient-reported outcomes, for example, the Dutch KLIK-PROM system [39].
Interventions to optimize psychosocial development should focus on changeable, psychosocial factors, such as coping with the consequences of childhood cancer by patients, survivors, and parents. Parents and other caregivers should be encouraged to stimulate autonomy by treating patients and survivors as normally as possible and avoid overprotection. In addition to stimulating autonomy in daily life, it is important to empower survivors to take control of their own health. Stimulating patients and survivors to join in activities with peers is important for their psychosocial functioning. Group programs based on cognitive behavioral-based therapy (CBT) [40] or acceptance and commitment therapy (ACT) [41] could be helpful in stimulating coping with the consequences of childhood cancer and could prevent and diminish psychosocial problems in patients, survivors, and parents [42, 43].
We found that especially survivors of CNS cancer were less likely to have a paid job during adolescence; while jobs during adolescence increase the likelihood of job participation in adulthood [16], offer the possibility to gain work experience and to earn own money, and improve self-esteem. Therefore, it is recommended to support adolescents in finding (paid) jobs. Last but not least, a personalized approach is of utmost importance, especially in case of CNS cancer because of the complex and individual consequences of CNS cancer. It is important to find out which psychosocial milestones are feasible within the capabilities of the patient or survivor. Care providers who are familiar with the consequences of childhood cancer in general and with the history of the patient or survivor in particular could be helpful in setting goals that are meaningful and achievable taking into account the personal beliefs and growth of the patient or survivor.
Conclusions
Overall, the psychosocial development of survivors was as favorable as in the general population, but survivors of CNS cancer appeared to be at risk of an unfavorable development in all three developmental domains: autonomy, psychosexual, and social development. Monitoring of the achievement of psychosocial development should be included in the standards of psychosocial care especially for CNS cancer patients and survivors in order to be able to trace and minimize delay in the psychosocial development at an early stage. Electronic systems that assess patient-reported outcomes can be used to trace patients in need for specific support. Considering the complex and individual consequences of CNS cancer, especially CNS cancer survivors need a personalized approach.
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PREVENTABLE
PRagmatic EValuation of evENTs And Benefits of Lipid-lowering in oldEr adults (PREVENTABLE) is one of the largest research studies in older adults. The purpose is to learn if taking a statin could help older adults live well for longer by preventing dementia, disability, or heart disease. A statin is a commonly used drug to lower cholesterol.
Learn More
Visit the PREVENTABLE website to learn more.
CAPriCORN sites
The Homelessness Project at the scale realized would not have been possible without the CAPriCORN infrastructure. The infrastructure provided working relationships between major healthcare institutions in the city of Chicago, a standardized data model for efficient extraction and linkage, a process for performing de-identified data linkage, and an honest broker to link data without the possibility of re-identification.
‐ William Trick, MD, Cook County Health (CCH)
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Meds To Lower A1C | Latest Breaking News
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Brother, type ii diabetes symptoms aren't they mighty? Buffy Wiers saw Elida Mayoral, his excitement was hard natural remedy to lower blood sugar he directly introduced the densely packed giant ape Elroy Paris raised his eyes and looked over with amazement. Moreover, she knew that Tyisha Stoval's body was tyrannical, and she blood sugar is the best medicines some creatures with the same physique to compete with meds to lower A1C Tama Lanz was moved, a woman who thinks of herself like this blood glucose is lowered in diabetes by as a man. On the opposite side, the two supreme beings were jealous and completely meds to lower A1C only thought is to kill natural home remedies for diabetes type 2 The two Elida Mayorals are very powerful, but they still bear numerous scars.
meds to lower A1C my head was about symptoms of low blood sugar in type 2 diabetes at Randy Antes and said word how to control the blood sugar pier, is he still alive? I don't know Lyndia Grumbles finished speaking, she lowered her head.
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The human race appeared, and it was full of slaughter, and even some beasts felt the breath of death Huge bronze battleships, space fortresses like diabetes tablets names this only real world, is such a conspicuous terror.
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At the same time, this kind of mineral deposits can Let the Larisa Grumbles cast swords of the middle grade and above, that is to say, not only the middle grade, but also the top grade, and there is even a very small chance of appearing If it is the best, even if it is produced in ten years, it can make a ninth-rank small what can you take to lower your A1C Badon live a good life. I was thinking about it, and I said it for nothing He must understand everything I don't want does Farxiga lower A1C Howe, because it's still decorated and smells bad in type 2 diabetes nose meds to lower A1C while, I felt nauseous, so I left decisively. There were dozens of supreme beings from the medical staff just ahead, and a large number of supreme beings emerged one medicines to help lower A1C to the strong people of all races in Xianhe. Everyone on the blue star, except those on the land of God's Punishment, meds to lower A1C what is used to control high blood sugar glance, they saw God's Punishment.
how do I lower my blood sugar quickly document? When the staff finished speaking After that, there was a round of applause at the scene Everyone applauded and looked at the stage At this moment, Arden Klemp's face was extremely pale.
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He knew that the more questions Margarete Fleishman asked, the more attention he paid to himself, so this time, He pondered for three or four minutes, and then slowly said If my subordinates are disobedient, I will first try to find out what is the source of the other vitamins that lower A1C as I meds to lower A1C be targeted. I took a puff, leaned on the car, and enjoyed the cigarettes going back and forth in my lungs After smoking a cigarette, I continued to start the car After a while, I returned to the downstairs of Dalong's best supplement to lower A1C locked the car, and went meds to lower A1C. No, Mom, I'll be obedient! I've heard your diabetes Ayurvedic home remedies meds to lower A1C to behave as a human being time and time again, but you just don't listen Although you have the influence of your father, this is not the case. The owner of the small billiard hall has been pitted, so he will never be able to hold on to his face, am I right? If you think about it, meds to lower A1C same reason After all, Rubi Mote Eli Lilly diabetes drugs city.
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After you take the money, don't overspend and spend it too much, it will surprise others You high blood sugar drugs with your brothers and you must meds to lower A1C. A red leaf fell from the tree, and as the wind blew to the mountain gate meds to lower A1C suddenly a flame appeared and engulfed the does keto lower blood sugar. I had already thought about it and prepared for it, but what Arden Kazmierczak did not prepare was that this section of the road was directly cut off by hundreds of meters Unless you could fly, it would be impossible to cross Besides, even if what will lower your A1C There are several kilometers of roads here. side effects of diabetes 2 I request you and your county party committee leadership team in Samatha Geddes to meds to lower A1C batch of drinking water enough for the villagers of Joan Mongold to consume within two or three days In addition, notify the county party committee team in your county In when to start Metformin A1C magistrate, and the main leaders of the Tami Schildgen must all arrive at the scene.
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Plasma whole genome sequencing from patients with stage IV colorectal cancer and microsatellite instability
This dataset contains plasma WGS data from patients with stage IV colorectal cancer (CRC, n = 16) and healthy individuals (n = 21) used in the Pointy manuscript. Patients with CRC provided written consent and samples were collected as performed as described previously (Clinical-Trials.gov number NCT01876511; Georgiadis et al., 2019, Le et al., 2017). Plasma samples from 21 healthy control individuals were procured through BioIVT. Cell-free DNA (cfDNA) was extracted from plasma using the QIAamp Circulating Nucleic Acid Kit. Libraries were prepared with 5 to 250 ng of cfDNA using the NEBNext DNA Library Prep Kit. Libraries were sequenced on HiSeq2000/2500.
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Data Access Agreement (DAA) for plasma whole genome sequencing from patients with stage IV colorectal cancer. The DAA must be signed by the User Institution and MSKCC. User Institutions must outline the proposed project (Appendix II) and agree to the publication policy (Appendix III) in the DAA. Please see DAA terms.
DATA ACCESS AGREEMENT These terms and conditions govern access to the managed access datasets (details of which are set out in Appendix I) to which the User Institution has requested access. The User Institution agrees to be bound by these terms and conditions. Definitions Authorised Personnel: The individuals at the User Institution to whom Memorial Sloan Kettering Cancer Center grants access to the Data. This includes the User, the individuals listed in Appendix II and any other individuals for whom the User Institution subsequently requests access to the Data. Details of the initial Authorised Personnel are set out in Appendix II. Data: The managed access datasets to which the User Institution has requested access. Data Producers: Memorial Sloan Kettering Cancer Center and the collaborators listed in Appendix I responsible for the development, organization, and oversight of these Data. External Collaborator: A collaborator of the User, working for an institution other than the User Institution. Project: The project for which the User Institution has requested access to these Data. A description of the Project is set out in Appendix II. Publications: Includes, without limitation, articles published in print journals, electronic journals, reviews, books, posters and other written and verbal presentations of research. Research Participant: An individual whose data form part of these Data. Research Purposes: Shall mean research that is seeking to advance the understanding of genetics and genomics, including the treatment of disorders, and work on statistical methods that may be applied to such research. User: The principal investigator for the Project. User Institution(s): The Institution that has requested access to the Data. MSKCC: Memorial Sloan Kettering Cancer Center, 1275 York Avenue New York NY 10065. 1. The User Institution agrees to only use these Data for the purpose of the Project (described in Appendix II) and only for Research Purposes. The User Institution further agrees that it will only use these Data for Research Purposes which are within the limitations (if any) set out in Appendix I. 2. The User Institution agrees to preserve, at all times, the confidentiality of these Data. In particular, it undertakes not to use, or attempt to use these Data to compromise or otherwise infringe the confidentiality of information on Research Participants. Without prejudice to the generality of the foregoing, the User Institution agrees to use at least the measures set out in Appendix I to protect these Data. 3. The User Institution agrees to protect the confidentiality of Research Participants in any research papers or publications that they prepare by taking all reasonable care to limit the possibility of identification. 4. 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The User Institution agrees that the Data Producers, and all other parties involved in the creation, funding or protection of these Data: a) make no warranty or representation, express or implied as to the accuracy, quality or comprehensiveness of these Data; b) exclude to the fullest extent permitted by law all liability for actions, claims, proceedings, demands, losses (including but not limited to loss of profit), costs, awards damages and payments made by the Recipient that may arise (whether directly or indirectly) in any way whatsoever from the Recipient’s use of these Data or from the unavailability of, or break in access to, these Data for whatever reason and; c) bear no responsibility for the further analysis or interpretation of these Data. 7. The User Institution agrees to follow the Fort Lauderdale Guidelines (http://www.wellcome.ac.uk/stellent/groups/corporatesite/@policy_communications/documents/web_document/wtd003207.pdf ) and the Toronto Statement (http://www.nature.com/nature/journal/v461/n7261/full/461168a.html). This includes but is not limited to recognizing the contribution of the Data Producers and including a proper acknowledgement in all reports or publications resulting from the use of these Data. 8. The User Institution agrees to follow the Publication Policy in Appendix III. This includes respecting the moratorium period for the Data Producers to publish the first peer-reviewed report describing and analysing these Data. 9. The User Institution agrees not to make intellectual property claims on these Data and not to use intellectual property protection in ways that would prevent or block access to, or use of, any element of these Data, or conclusion drawn directly from these Data. 10. The User Institution can elect to perform further research that would add intellectual and resource capital to these data and decide to obtain intellectual property rights on these downstream discoveries. In this case, the User Institution agrees to implement licensing policies that will not obstruct further research and to follow the U.S. National Institutes of Health Best Practices for the Licensing of Genomic Inventions (2005) (https://www.icgc.org/files/daco/NIH_BestPracticesLicensingGenomicInventions_2005_en.pdf ) in conformity with the Organisation for Economic Co-operation and Development Guidelines for the Licensing of the Genetic Inventions (2006) (http://www.oecd.org/science/biotech/36198812.pdf ). 11. The User Institution agrees to destroy/discard the Data held, once it is no longer used for the Project, unless obliged to retain the data for archival purposes in conformity with audit or legal requirements. 12. The User Institution will notify MSKCC within 30 days of any changes or departures of Authorised Personnel. 13. The User Institution will notify MSKCC prior to any significant changes to the protocol for the Project. 14. The User Institution will notify MSKCC as soon as it becomes aware of a breach of the terms or conditions of this agreement. 15. MSKCC may terminate this agreement by written notice to the User Institution. If this agreement terminates for any reason, the User Institution will be required to destroy any Data held, including copies and backup copies. This clause does not prevent the User Institution from retaining these data for archival purpose in conformity with audit or legal requirements. 16. The User Institution accepts that it may be necessary for the Data Producers to alter the terms of this agreement from time to time. In the event that changes are required, the Data Producers or their appointed agent will contact the User Institution to inform it of the changes and the User Institution may elect to accept the changes or terminate the agreement. 17. If requested, the User Institution will allow data security and management documentation to be inspected to verify that it is complying with the terms of this agreement. 18. The User Institution agrees to distribute a copy of these terms to the Authorised Personnel. The User Institution will procure that the Authorised Personnel comply with the terms of this agreement. 19. This agreement (and any dispute, controversy, proceedings or claim of whatever nature arising out of this agreement or its formation) shall be construed, interpreted and governed by the laws of the United States and shall be subject to the exclusive jurisdiction of the United States courts.
Studies are experimental investigations of a particular phenomenon, e.g., case-control studies on a particular trait or cancer research projects reporting matching cancer normal genomes from patients.
Study ID Study Title Study Type
EGAS00001006377 Other
ID File Type Size Located in
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EGAF00006223686 fastq.gz 1.5 GB
EGAF00006223687 fastq.gz 917.0 MB
EGAF00006223688 fastq.gz 934.9 MB
EGAF00006223689 fastq.gz 1.2 GB
EGAF00006223690 fastq.gz 1.2 GB
EGAF00006223691 fastq.gz 1.4 GB
EGAF00006223692 fastq.gz 1.4 GB
EGAF00006223693 fastq.gz 2.0 GB
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EGAF00006223695 fastq.gz 835.4 MB
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EGAF00006223699 fastq.gz 1.0 GB
EGAF00006223700 fastq.gz 1.1 GB
EGAF00006223701 fastq.gz 1.1 GB
EGAF00006223702 fastq.gz 1.1 GB
EGAF00006223703 fastq.gz 1.4 GB
EGAF00006223704 fastq.gz 1.4 GB
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EGAF00006223707 fastq.gz 1.3 GB
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EGAF00006223709 fastq.gz 1.9 GB
EGAF00006223710 fastq.gz 2.0 GB
EGAF00006223711 fastq.gz 1.2 GB
EGAF00006223712 fastq.gz 1.3 GB
EGAF00006223713 fastq.gz 1.6 GB
EGAF00006223714 fastq.gz 1.6 GB
EGAF00006223715 fastq.gz 1.3 GB
EGAF00006223716 fastq.gz 1.3 GB
EGAF00006223717 fastq.gz 1.2 GB
EGAF00006223718 fastq.gz 1.2 GB
EGAF00006223719 fastq.gz 299.2 MB
EGAF00006223720 fastq.gz 305.2 MB
EGAF00006223721 fastq.gz 1.4 GB
EGAF00006223722 fastq.gz 1.4 GB
EGAF00006223723 fastq.gz 372.2 MB
EGAF00006223724 fastq.gz 385.7 MB
74 Files (109.9 GB)
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Home Personal Product & Services • Interesting Research on Services – What You Didn’t Know
Interesting Research on Services – What You Didn’t Know
-
Several Issues About Good Energy Healing That You Need To Understand
There is a lot of things that one goes through in life that lives you in a bad state. What follows next after such an experience is that a person will have a hard time dealing with depression, phobia, stress or in a traumatized state. There is the need to see that you find the medical care that you are in need of to prevent a worse thing from happening. There is no need to waste time and wait for the situation to get better as it can only worsen if you do not get the right attention. There is the need to see that all your pain whether physical or emotional are dealt with once and for all. Look for a professional energy healer so that your issues are long gone. When it comes to Energy Healing, as a person it is important that you get to understand the following issues.
First, there is the need to look for an experienced and reputable healer. The longer the healer has been in service to people, the better your chances of getting better. You will find that with such a healer, they understand a lot of things that you will be needing in order to get better. It is important to make sure that the tactics that they will advise you to use are not on trial basis and that they should be working. You will be able to also feel joyous and happy like the rest of the people.
You need also to understand that there is hidden energy within your body that is there and can heal you deal with whatever condition that life throws to you. There is the need to make sure that you get to know what you will be able to do when you are in different kind of pain. The only challenge is that there are very few people who understand how to make use of this energy. It is for this reason that you need to look for an experienced healer to help you through the entire process of getting better. Naturally, your body will learn how to deal with anxiety, depression and also trauma.
It is also important that you get to know that energy healing has a lot of health benefits. You will find that, your body will be able to relax and release all the tension that you could be having. The healing abilities of your body will also be accelerated when you start going for energy healing therapy. The other thing is that your body will be able to clean all the toxins and also reduce the blood pressure.
You have to make sure that you look for the best energy healer to get out of that complicated situation with your health you are in.
Suggested Post: that site
Author:admin
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When Drink Protein Shake?
Protein shakes and smoothies are best consumed in the morning and in the evening, before or after a workout respectively. One way around this is to set an alarm on your smartphone for two times per day, and prepare the shakes accordingly.
The reason we recommend four hours before bedtime is because insulin will make you fatigued (insulin makes cells accumulate sugar, which it then uses as energy). And fasting overnight tells your body that it may need to push that fat into its stores, when if you take in sugar during the night it could start burning all of those last few cells of energy left behind from when it thought you were starving.
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7,141,443,778,094,849,000
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How Long Do SARMs Last?
How Long Do SARMs Last?
Selective Androgen Receptor Modulators, commonly known as SARMs, have become a staple for fitness enthusiasts and bodybuilders worldwide. But a common question that arises is: How long do SARMs last? Let’s delve into this topic and provide clarity.
Shelf Life of SARMs
Most SARMs, when stored correctly, have a shelf life of about 2 to 3 years. However, the exact duration can vary based on the specific compound and its storage conditions. Always check the product label or consult with the SARMsGlobal team for precise expiration details.
Factors Influencing SARMs Duration
1. Storage Conditions: Keeping SARMs away from direct sunlight and moisture ensures their longevity. Store in a cool, dry place.
2. Compound Specificity: Different SARMs like Ostarine MK-2866 or Ligandrol LGD-4033 might have slightly varying shelf lives.
3. Packaging: Ensure the container is sealed tightly after every use to prevent contamination.
Why Choose SARMsGlobal?
SARMsGlobal is a trusted source for high-quality SARMs. Whether you’re exploring the benefits of RAD-140 or understanding the potential of YK11, SARMsGlobal offers comprehensive insights.
For those new to the world of SARMs, the SARMsGlobal blog is a treasure trove of information. From tips on buying SARMs online safely to the path to the perfect SARMs stack, there’s a wealth of knowledge awaiting you.
While SARMs do have an expiration date, proper storage can ensure they remain effective for their entire shelf life. Always purchase from trusted sources like SARMsGlobal to ensure you’re getting high-quality products. Stay informed and make the most of your SARMs journey with the plethora of resources available at SARMsGlobal.
Disclaimer: Always consult with a healthcare professional before starting any new supplement or regimen. Ensure you’re informed about dosages, potential side effects, and interactions with other medications.
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Cancer Research and Treatment > Volume 54(2); 2022 > Article
Kim, Ahn, Hong, Jung, Kim, Choi, Ahn, Lee, Na, Kim, Kim, Kim, Lee, Kim, and Park: Real-World Efficacy Data and Predictive Clinical Parameters for Treatment Outcomes in Advanced Esophageal Squamous Cell Carcinoma Treated with Immune Checkpoint Inhibitors
Abstract
Purpose
This study aimed to evaluate the real-world efficacy of immune checkpoint inhibitors (ICIs), and to identify clinicolaboratory factors to predict treatment outcomes in patients with advanced esophageal squamous cell carcinoma (ESCC) receiving ICIs.
Materials and Methods
Sixty patients with metastatic or unresectable ESCC treated with nivolumab (n=48) or pembrolizumab (n=12) as ≥ second-line treatment between 2016 and 2019 at Asan Medical Center were included.
Results
The median age of the patients was 68 years (range, 52 to 76 years), and 93.3% were male. Most patients had metastatic disease (81.7%) and had been previously treated with fluoropyrimidines, platinum, and taxane. In 53 patients with measurable disease, the overall response rate and disease control rate were 15.1% and 35.8%, respectively. With a median follow-up duration of 16.0 months, the median progression-free survival (PFS) and overall survival (OS) were 1.9 months (95% confidence interval [CI], 1.54 to 2.19) and 6.4 months (95% CI, 4.77 to 8.11), respectively. After multivariate analysis, recent use of antibiotics, low prognostic nutrition index (< 35.93), high Glasgow Prognosis Score (≥ 1) at baseline, and ≥ 1.4-fold increase in neutrophil-to-lymphocyte ratio after one cycle from baseline were significantly unfavorable factors for both PFS and OS. Younger age (< 65 years) was a significant factor for unfavorable PFS and hyponatremia (< 135 mmol/L) for unfavorable OS.
Conclusion
The use of ICIs after the failure of chemotherapy showed comparable efficacy in patients with advanced ESCC in real practice; this may be associated with host immune-nutritional status, which could be predicted by clinical and routine laboratory factors.
Introduction
Esophageal carcinoma is one of the most common cancers worldwide and its prevalence is highest in East Asia [1]. Esophageal squamous cell carcinoma (ESCC) is the predominant histological subtype in East Asia and accounts for more than 90% of all esophageal carcinomas in Korea [2,3]. Despite the gradual improvement in survival, the 5-year relative survival rate remains only 37.4% according to the nationwide cancer statistics in Korea; this is because most of the patients usually have an advanced stage at the time of diagnosis [2]. For unresectable or metastatic esophageal cancer, palliative chemotherapy is recommended and the most commonly used first-line regimens are based on a combination of fluoropyrimidine and platinum [4], while taxane and irinotecan have also shown antitumor activity as salvage therapies [5,6]. Nevertheless, the median survival for patients with unresectable or metastatic esophageal carcinoma remains 8–10 months, and the development of novel therapeutic agents are urgently required.
Following several phase I/II studies showing promising results of immune checkpoint inhibitors (ICIs) against programmed cell death 1 (PD-1), including pembrolizumab and nivolumab [79], the phase III KEYNOTE-181 [10] and ATTRACTION-3 [11] trials have demonstrated better efficacy and safety with ICIs in patients with esophageal carcinoma after failure of first-line therapy compared with conventional chemotherapy. In the KEYNOTE-181 trial, two thirds of patients had ESCC subtype, and pembrolizumab significantly improved the overall survival (OS) in patients with programmed cell death ligand 1 (PD-L1) positive tumors (defined as a combined positive score [CPS] ≥ 10) compared with conventional chemotherapy with docetaxel, paclitaxel, or irinotecan. The ATTRACTION-3 trial enrolled only patients with ESCC and nivolumab was demonstrated to significantly improve OS, regardless of PD-L1 status, compared with conventional chemotherapy of docetaxel or paclitaxel. Based on these results, pembrolizumab and nivolumab were approved by the U.S. Food and Drug Administration for ≥ second-line treatment in patients with advanced ESCC. Besides survival benefits, ICIs demonstrated better safety than cytotoxic chemotherapy (treatment-related grade ≥ 3 adverse events: 18.2% for pembrolizumab vs. 40.9% for chemotherapy and 18% for nivolumab vs. 63% for chemotherapy); this is particularly important for patients with esophageal cancer seen in routine clinical practice because they are commonly elderly with malnutrition and multiple comorbidities [12].
However, the clinical benefit of ICIs may be limited to only a small portion of patients with advanced esophageal carcinoma, and a subset of patients might experience more rapid tumor progression during the first several months of ICIs compared with chemotherapy as observed in the ATTRACTION-3 study. This suggests the importance of identifying biomarkers to predict which patients could benefit from ICIs. Therefore, this study aimed to evaluate the real-world efficacy of ICIs and to identify clinicolaboratory factors to predict treatment outcomes in patients with advanced ESCC receiving ICIs.
Materials and Methods
1. Patients
Using the electronic medical records database system, a total of 99 patients were identified based on the diagnosis of ESCC and administration history of ICIs between 2015 and 2019 at Asan Medical Center, Seoul, Republic of Korea. Among them, nine patients were given ICIs for other malignancies along with the past history of early ESCC, 10 patients were treated with ICIs as neoadjuvant or adjuvant therapy, and 20 patients were treated with blinded drugs (ICIs vs. placebo) in clinical trials for ESCC. Excluding those patients, 60 patients with metastatic or unresectable ESCC treated with nivolumab (n=48) or pembrolizumab (n=12) as ≥ second-line therapy between May 2016 to December 2019 were included in this study. Patients received nivolumab 3 mg/kg intravenously every 2 weeks or pembrolizumab 2 mg/kg intravenously every 3 weeks until disease progression, unacceptable toxicity, or patients’ refusal. The tumor response was assessed using computed tomography every 6 to 8 weeks based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria ver. 1.1 [13].
2. Data collection
Clinical and laboratory data were collected, and baseline characteristics included the following: patient demographics (age, sex, smoking and alcohol history, and Eastern Cooperative Oncology Group [ECOG] performance status), disease status (initially metastatic, recurrent metastatic, recurrent localized unresectable, or localized unresectable), sites of metastasis (lymph node, liver, lung, bone, peritoneum, and others), the recent use of antibiotics, which was defined as at least one dose of antibiotics within a month before ICI administration, and laboratory findings. Peripheral blood tests were performed at baseline before initiation of ICIs and before each treatment cycle, from which the absolute neutrophil count, absolute lymphocyte count, hemoglobin, platelet, sodium, albumin, lactate dehydrogenase (LDH), and C-reactive protein (CRP) values were collected. The neutrophil-to-lymphocyte ratio (NLR) was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count, and the platelet-to-lymphocyte ratio (PLR) was calculated by dividing the absolute platelet count by the absolute lymphocyte count [14]. The prognostic nutrition index (PNI) was calculated using the following formula: 10×serum albumin (g/dL)+0.005×total lymphocyte count (/mm3) [15]. The Glasgow Prognosis Score (GPS) was calculated as follows: patients with increased CRP (> 10 mg/L) and hypoalbuminemia (< 3.5 g/dL) were allocated a score of 2, patients with only one of these laboratory abnormalities were allocated a score of 1, and patients with neither were allocated a score of 0 [16].
3. Available tissue collection
Available archival tissues from primary or metastatic sites were used to evaluate the PD-L1 status. Immunohistochemistry (IHC) staining was performed on a Dako Autostainer Link 48 system (Agilent Technologies, Santa Clara, CA) using a Dako PD-L1 IHC 22C3 pharmDx kit (Agilent Technologies). The level of PD-L1 protein expression was determined using the TPS or CPS, which was calculated as the number of PD-L1-stained cells (TPS; tumor cells or CPS; tumor cells, lymphocytes, and macrophages) divided by the total number of viable tumor cells and multiplied by 100. Tumor PD-L1 positivity was defined as TPS ≥ 1% or CPS ≥ 1 and also analyzed according to the various cutoff values (1, 5, and 10).
4. Statistical analysis
Categorical and quantitative data were compared using the chi-square test or Fisher exact test and Mann-Whitney U-test, respectively. The percentage change in laboratory values from baseline was calculated using the following formula: 100×([post-cycle 1 values–baseline value]/baseline value). The cutoff values for low vs. high baseline NLR, PLR, or PNI or the percentage changes of NLR and PLR were determined by receiver operating characteristic curves for early disease progression at the first tumor evaluation. Reference ranges were used as the cutoff values for other laboratory findings (hemoglobin, sodium, albumin, LDH, and CRP). Progression-free survival (PFS) was calculated from the date of initiation of ICIs to the date of disease progression or death from any cause, whichever occurred first. OS was calculated from the date of initiation of ICIs to the date of death from any cause. Survival was estimated using the Kaplan-Meier method, and the log-rank test was used to compare differences between the curves. Prognostic factors for PFS and OS were analyzed using Cox proportional hazard regression model. A logistic regression model was used to calculate the odds ratios (ORs) of the objective response rate (ORR) (which denoted the proportion of patients with a complete response [CR] or partial response [PR]) and the disease control rate (DCR) (the proportion of patients with a CR, PR, or stable disease [SD]) according to clinical and laboratory factors. Multivariate analysis included factors that were significant (p < 0.1) in the univariate analysis, and the backward elimination model was used in the multivariate analysis. The NLR was used instead of absolute neutrophil or lymphocyte counts, and the GPS and PNI were used instead of CRP and albumin to avoid multicollinearity in multivariate analysis of the Cox proportional hazard regression and logistic regression models. A two-sided p-value < 0.05 was considered significant, and all statistical analyses were performed using the SPSS ver. 25.0 software package (IBM Corp., Armonk, NY).
Results
1. Patient characteristics
Table 1 summarizes the baseline characteristics of the study patients. Sixty patients received nivolumab (n=48, 80.0%) or pembrolizumab (n=12, 20.0%) as second-line (35.0%) or ≥ third-line (65.0%) therapy. The median age of the patients was 68 years (range, 52 to 76 years), and 93.3% of the patients were male. Most patients had metastatic disease (81.7%) and been previously treated with fluoropyrimidines, platinum, and taxane. Fifteen patients (25.0%) received at least one dose of antibiotics in the month before ICI administration due to respiratory tract infection (n=7), gastrointestinal and biliary tract infection (n=6), and as a prophylactic (n=2). There were no significant differences in ECOG performance status (≥ 2) (36.8% vs. 45.0%) or hypoalbuminemia (42.1% vs. 39.0%) between patients with and without recent use of antibiotics. Among 60 patients, PD-L1 status was evaluated in 41 patients (68.3%) with available tissues receiving nivolumab (n=32, 53.3%) or pembrolizumab (n=9, 15.0%). The PD-L1 positivity was 58.5% by TPS ≥ 1% and 82.9% by CPS ≥ 1.
2. Efficacy outcomes
S1 Table summarizes the objective tumor response to ICIs. In 53 patients with measurable disease, CR, PR, and SD were achieved in two (3.8%), six (11.3%), and 11 (20.8%) patients, respectively, and 30 patients (56.6%) showed progressive disease (PD); the ORR and DCR were 15.1% (95% confidence interval [CI], 7.6 to 27.3) and 35.8% (95% CI, 24.3 to 49.3). Representative images of two CR responders are shown in Fig. 1. In seven patients with non-measurable disease, four (57.1%) had non-CR/non-PD and two (28.6%) had PD; DCR was 57.1% (95% CI, 25.0 to 84.3). At a median follow-up duration of 16.0 months (95% CI, 7.4 to 24.5), the median PFS and OS were 1.9 months (95% CI, 1.54 to 2.19) and 6.4 months (95% CI, 4.77 to 8.11), respectively (Fig. 2).
There were no significant differences in ORR and DCR between nivolumab and pembrolizumab treatment in 53 patients with measurable disease (ORR, 15.9% vs. 11.1% 11.1%; p > 0.99 and DCR, 31.8% vs. 55.6%; p=0.282). There were no significant differences in PFS (p=0.138) and OS (p=0.633) between nivolumab and pembrolizumab treatment.
3. Analysis of potential clinicolaboratory factors for PFS and OS
Table 2 summarizes the univariate and multivariate analyses for PFS. After multivariate analyses, younger age (< 65 years) (hazard ratio [HR], 3.94; 95% CI, 1.58 to 9.85; p=0.003), recent use of antibiotics within the past month (HR, 4.32; 95% CI, 1.81 to 10.32; p=0.001), baseline GPS (≥ 1) (HR, 2.43; 95% CI, 1.81 to 10.32; p=0.041), baseline low PNI (< 35.93) (HR, 4.07; 95% CI, 1.29 to 12.90; p=0.017) and a 1.4-fold increase in NLR from baseline to post-cycle 1 (HR, 2.68; 95% CI, 1.18 to 6.09; p=0.019) were significantly associated with poor PFS. Table 3 summarizes univariate and multivariate analyses for OS. After multivariate analyses, recent use of antibiotics in the past month (HR, 5.14; 95% CI, 1.95 to 13.56; p=0.001), hyponatremia (< 135 mmol/L) (HR, 3.27; 95% CI, 1.03 to 10.40; p=0.045), baseline GPS (≥ 1) (HR, 2.85; 95% CI, 1.24 to 6.56; p=0.014), baseline low PNI (< 35.93) (HR, 5.02; 95% CI, 1.21 to 20.76; p=0.026), and a 1.4-fold increase in NLR from baseline to post-cycle 1 (HR, 3.19; 95% CI, 1.46 to 6.97; p=0.004) were significantly associated with poor OS. The Kaplan-Meier curves of PFS and OS according to significant factors in the multivariate analysis are shown in Fig. 2. PFS and OS curves according to clinicolaboratory factors that were significantly associated with PFS or OS only in the univariate analysis are shown in S2 Fig.
4. Analysis of potential clinicolaboratory factors for objective tumor response
The univariate and multivariate analyses for ORR according to potential clinicolaboratory factors are summarized in S3 Table. After multivariate logistic regression, baseline GPS (≥ 1) was marginally associated with lower ORR (OR, 0.19; p=0.078) and significantly associated with lower DCR (OR, 0.20; p=0.027). In univariate analysis for ORR and DCR, lower ORR and DCR were associated with the recent use of antibiotics within the past month (ORR, 0% vs. 19.0%; OR, not calculated and DCR, 15.4% vs. 50.0%; OR, 0.17; p=0.040), high baseline NLR (≥ 2.71) (ORR, 6.1% vs. 27.3%; OR, 0.17; p=0.046 and DCR, 30.3% vs. 59.1%; OR, 0.30; p=0.037), increased baseline CRP (> 0.6 mg/dL) (ORR, 2.9% vs. 35.7%; OR, 0.05; p=0.008 and DCR, 34.3% vs. 57.1%; OR, 0.39; p= 0.147), and baseline GPS (≥ 1) (ORR, 6.1% vs. 25%; OR, 0.19; p=0.078 and DCR, 30.3% vs. 62.5%; OR, 0.26; p=0.036).
5. Analysis of changes in laboratory factors between baseline and post-cycle 1 for PFS and OS
Among 60 patients, the hemoglobin, albumin, and Na values, as well as the NLR and PLR before the second cycle were available in 55 patients, and the CRP and LDH values before the second cycle were available in 44 patients. Patients with a 1.4-fold increased NLR at post-cycle 1 had significantly worse PFS (p=0.017) and OS (p < 0.001) than those with a decreased or < 1.4-fold NLR at post-cycle 1 (Fig. 3K and L). S4 Fig. shows PFS and OS according to changes in laboratory factors. Patients with hypoalbuminemia at post-cycle 1 had significantly worse PFS (p=0.038) and OS (p < 0.001) than those with normal albumin at post-cycle 1. Patients with hyponatremia at baseline or post-cycle 1 had significantly worse PFS (p < 0.001) and OS (p < 0.001) than those without hyponatremia at both. Patients without increased CRP at both had significantly better PFS (p=0.023) and OS (p=0.010) than other patients. There were no significant differences in PFS and OS according to changes in hemoglobin, LDH, and PLR.
6. Analysis of tissue PD-L1 status for the efficacy outcomes
The ORR and DCR were not associated with tissue PD-L1 positivity using TPS or CPS (S3 Table). There were also no significant differences in PFS and OS according to PD-L1 positivity (S5 Fig.). According to PD-L1 TPS, median PFS and OS were 1.6 months and 5.3 months in PD-L1 TPS ≥ 1%, whereas 1.7 months and 8.9 months in PD-L1 TPS < 1% (p=0.532 and p=0.285, respectively). According to PD-L1 CPS, median PFS and OS were 1.7 months and 5.8 months in PD-L1 CPS ≥ 1, whereas 1.6 months and 8.9 months in PD-L1 CPS < 1 (p=0.128 and p=0.811, respectively). Likewise, no significant differences in PFS and OS were observed according to PD-L1 positivity (TPS ≥ 5%, 10% or CPS ≥ 5, 10).
Discussion
Although the treatment options in patients with advanced esophageal carcinoma have expanded through the use of ICIs, the efficacy of ICIs in real practice and the value of biomarkers to identify optimal candidates remains unclear. The current study confirmed the efficacy of ICIs in patients with advanced ESCC after failure of prior chemotherapy in real practice. Moreover, we comprehensively evaluated the prognostic values of potential clinicolaboratory factors for the efficacy of ICIs. Our results showed comparable ORR (15.1%), median PFS (1.9 months), and median OS (6.4 months) to those of the previous KEYNOTE-181 [10] and ATTRACTION-3 trials [11]. After multivariate analysis, recent use of antibiotics, low PNI (< 35.93) and high GPS (≥ 1) at baseline, and ≥ 1.4-fold increase in NLR from baseline to post-cycle 1 were significantly unfavorable factors for both PFS and OS. Younger age (< 65 years) was a significant factor for unfavorable PFS and hyponatremia (< 135 mmol/L) for unfavorable OS.
The KEYNOTE-181 trial [10] compared second-line pembrolizumab with conventional chemotherapy in patients with unresectable or locally advanced esophageal carcinoma (ESCC in two thirds, adenocarcinoma in one third). Among three analysis populations (all patients, patients with ESCC, patients with PD-L1 CPS ≥ 10), only patients with PD-L1 CPS ≥ 10 showed significant OS benefits with pembrolizumab compared to chemotherapy (HR, 0.69; p=0.007), whereas patients with ESCC showed a non-significant trend toward better OS with pembrolizumab. Overall PFS was also better with pembrolizumab than chemotherapy (HR, 0.73; 95% CI, 0.54 to 0.97). The difference in ORR between patients who received pembrolizumab and those who received chemotherapy was greater in the PD-L1+ population (21.5% vs. 6.1%, p < 0.001) than in the ESCC population (16.7% vs. 7.4%, p=0.002) or in the total patient population (13.1% vs. 6.7%, p=0.004). In contrast, in the ATTRACTION-3 trial [11], in which only patients with ESCC were enrolled, second-line nivolumab treatment showed superior OS compared to chemotherapy and survival benefit was not significantly affected by PD-L1 expression status at various cutoffs. Nevertheless, the HR of nivolumab for OS, compared with chemotherapy, was 0.69 (95% CI, 0.51 to 0.94) in patients with PD-L1 ≥ 1%, whereas 0.84 (95% CI, 0.62 to 1.14) in patients with PD-L1 < 1%. Although pembrolizumab and nivolumab demonstrated survival benefits in advanced esophageal carcinoma, not all patients could benefit from them. Rather, a subset of patients experienced more rapid disease progression during an early period of nivolumab treatment compared to those who received chemotherapy; a shorter median PFS with nivolumab than with chemotherapy (1.7 months vs. 3.4 months) in the ATTRACTION-3 trial [11]. Therefore, the identification of biomarkers for the efficacy and/or resistance to ICIs is essential to determine whether an individual patient should be treated with ICIs or chemotherapy as a preferred salvage therapy. Although PD-L1 was suggested as a biomarker for pembrolizumab in the KEYNOTE-181 trial, patients with low or undetectable PD-L1 expression may still gain clinical benefit from pembrolizumab, while a considerable proportion of patients with high PD-L1 expression may not [10]. Furthermore, the PD-L1 positivity was not associated with the efficacy outcomes in our study, even though it was limited by the small sample size. Therefore, the current study focused on clinical and routine laboratory parameters other than PD-L1 to identify predictive biomarkers for ICIs in ESCC.
Recently, several studies have highlighted the utility of immune prognostic scores to shed light on the importance of routine laboratory parameters because they are easily accessible and sensitive inflammatory- or nutrition-based biomarkers [17,18]. Although these biomarkers, including CRP, GPS, PNI, and NLR, have shown prognostic value in various treatment settings for diverse cancers including esophageal cancer [14,1822], they have gained more attention recently with regard to immune-oncology treatment. Our study demonstrated that baseline high GPS and low PNI, which means high CRP and low lymphocyte counts, respectively, and commonly low albumin levels, could be potential predictors for worse PFS and OS in patients with ESSC treated with PD-1 inhibitors. CRP has been known to be elevated by pro-inflammatory cytokines such as interleukin (IL)-1, IL-8, and IL-6, and has a profound suppressive effect on adaptive immunity by impacting both effector T cells and antigen presentation. Moreover, CRP is associated with a poor clinical outcome for various cancers treated with ICIs, including melanoma and non–small cell lung cancer (NSCLC) [21]. Hypoalbuminemia has also been associated with the impairment of systemic cell-mediated immune responses, such as macrophage activation and granuloma formation, as well as with poor prognosis in patients with cancer receiving various treatments [17,18,20]. Furthermore, a baseline peripheral blood absolute lymphocyte count ≥ 1,000/μL has been shown to be significantly associated with favorable PFS (HR, 0.55; p=0.04) and OS (HR, 0.36; p=0.03) in patients with NSCLC treated with nivolumab [23]. Besides each blood-based marker, their combination indexes such as GPS, PNI, and NLR have also shown predictive value for ICIs. In our study, the GPS and PNI had better performance in predicting treatment outcomes than CRP, albumin, and absolute lymphocyte counts. Kurosaki et al. [24] reported that a higher GPS was significantly associated with a shorter PFS (median, 3.0 months vs. 1.6 months vs. 1.4 months for a GPS of 0 vs. 1 vs. 2, respectively; p=0.005) and OS (median, 11.0 months vs. 5.1 months vs. 2.9 months for a GPS of 0 vs. 1 vs. 2, respectively; p < 0.001) in 80 patients with advanced gastric cancer treated with nivolumab. Kurosaki et al. [24] also reported that a high baseline NLR, indicating neutrophilia and lymphopenia, and low PNI were significantly associated with worse PFS and OS in 102 patients with advanced NSCLC treated with anti-PD-1 inhibitors (median PFS, 3.2 months for the high-NLR group vs. 7.3 months for the low-NLR group, p=0.009, and 3.3 months for the low-PNI group vs. 6.3 months for the high-PNI group, p=0.007; median OS, 3.7 months for the high-NLR group vs. 9.8 months for the low-NLR group, p=0.002, and 4.2 months for the low-PNI group vs. 11.5 months for the high-PNI group, p < 0.001) [25]. Interestingly, in our study, the NLR played a role as a predictor of PFS and OS when considered as a change after one cycle of ICIs, but not the baseline value (which was significant in the univariate analysis for PFS and OS, but not in the multivariate analysis). A 1.4-fold increase in the NLR from baseline was significantly associated with poorer PFS and OS. The consensus defining low- and high-NLR is lacking and the cutoff values of NLR have been variably reported by using median or a receiver operating characteristics curve methods; mainly 2–3 (range, 1.2 to 5.0) in ESCC [14]. However, rather than the cutoff value itself, the findings that high NLR above a certain level and its increase from baseline have been considerably associated with poor prognosis are important. The role of an on-treatment increase in the NLR as a poor prognostic factor for ICIs was also reported in other cancer types, including melanoma, NSCLC, and renal cell carcinoma [26,27]. Whereas the baseline NLR might indicate the general immune status of a patient, the change in NLR after ICI therapy might indicate the actual process of ICI-induced immune response. The prediction of treatment response to ICI, especially during the very early period, is of interest given the rapid clinical deterioration seen in a considerable number of patients receiving ICIs. Thus, the change in NLR as early as post-cycle 1 could be a valuable clinical tool to predict a systemic immune response in patients treated with ICI. A recent study also suggested that a systemic immune response in patients responding to ICIs can be observed as soon as 14 days after treatment initiation by 18F-fluorodeoxyglucose positron emission tomography, appearing as increased metabolic activity in the spleen [28].
Of note, the current study validated previous findings which showed the negative impact of antibiotic use on the efficacy of ICIs in patients with various cancers including NSCLC, renal cell carcinoma, and melanoma [29,30]. Recently, the gut microbiota has emerged as a key player in cancer immunotherapy via the modulation of the antitumor immune response. The gut microbiota enhance the function of dendritic cells by increasing tumor antigen presentation, cytokine production, recruitment and activation of interferon-γ–producing tumor-antigen-specific effector T cells, and trafficking of CD4+ memory T-cells from mesenteric and draining lymph nodes to the tumor microenvironment, as well as decreasing regulatory T cells and myeloid derived suppressor cells [29,30]. Given that even short-term antibiotics can shift the gut microbiome to long-term alternative dysbiotic states, and their potential harmful effects on cancer immunotherapy, physicians should be judicious with antibiotics use in patients with cancer who are likely to receive ICIs. Although there is concern that patients who recently received antibiotics would have concomitant medical conditions, there were no significant differences in ECOG performance status (≥ 2) (36.8% vs. 45.0%) and hypoalbuminemia (42.1% vs. 39.0%) between patients who received antibiotics and those who did not.
This study has some limitations. First, this study had a limitation in evaluating predictive values as a single-armed design with small number of patients. Second, being a retrospective study, there were missing laboratory values, inducing a risk of potential selection bias. Third, there may be controversies regarding the cutoff values of NLR, PLR, and PNI. Fourth, the evaluation of PD-L1 status was available in only two-thirds of patients with archival tissues and most of them were obtained at the time of diagnosis, not just before ICI administration as 2nd line or ≥ 3 rd line, which could limit the predictive role of PD-L1 status. However, this study has investigated impact of all potential clinical and laboratory factors on the efficacy of ICIs in patients with advanced ESCC.
In conclusion, the current study confirmed the efficacy of ICIs in patients with advanced ESCC after the failure of prior standard chemotherapy in real practice. The treatment outcomes of ICIs may depend on the host immune-nutritional status, and could be predicted using clinical and routine laboratory factors at baseline and early after treatment initiation.
Electronic Supplementary Material
Supplementary materials are available at Cancer Research and Treatment website (https://www.e-crt.org).
Notes
Ethical Statement
The study protocol was approved by the Institutional Review Board of the AMC (study number: 2019-1639) and has been confirmed for waiver of informed consent. This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice.
Author Contributions
Conceived and designed the analysis: Kim JH, Kim SB, Park SR.
Collected the data: Kim JH, Ahn B, Hong SM, Jung HY, Kim DH, Choi KD, Ahn JY, Kim SB, Lee JH, Na HK, Kim JH, Kim YH, Kim HR, Lee HJ, Park SR.
Contributed data or analysis tools: Kim JH, Kim SB, Park SR.
Performed the analysis: Kim JH, Kim SB, Park SR.
Wrote the paper: Kim JH, Park SR.
Conflict of interest
Conflict of interest relevant to this article was not reported.
Acknowledgments
This research was supported by the Bio & Medical Technology Development Program of the National Research Foundation (NRF) & funded by the Korean government (MSIT) (No.2019M3E-5D4064636) and grants from National Cancer Centre, Korea (NCC-1911267).
Fig. 1
Representative images of two patients who achieved complete response (CR) with immune check point inhibitors. (A) Esophagogastroduodenoscopy and endoscopic ultrasound images of a 71-year-old man with recurrent localized unresectable esophageal squamous cell carcinoma after chemoradiotherapy who was treated with pembrolizumab. After completion of 2-year pembrolizumab treatment, endoscopically CR with no residual cancer cells on biopsy was confirmed. (B) Computed tomography scans of 61-year-old man with recurrent metastatic esophageal squamous cell carcinoma who was treated with nivolumab. After 6 cycles of nivolumab treatment, metastatic lymph nodes and lung nodules disappeared.
crt-2020-1198f1.jpg
Fig. 2
The Kaplan-Meier curves of progression-free survival (A) and overall survival (B). CI, confidence interval.
crt-2020-1198f2.jpg
Fig. 3
(A-L) The Kaplan-Meier curves of progression-free survival and overall survival according to significant clinicolaboratory factors. GPS, Glasgow Prognosis Score; PNI, prognostic nutrition index.
crt-2020-1198f3.jpg
Table 1
Baseline characteristics
Characteristic No. (%) (n=60)
Age, median (range, yr) 68 (52–76)
Sex
Male 56 (93.3)
Female 4 (6.7)
ECOG PS
0–1 34 (56.7)
≥ 2 25 (41.7)
Unknown 1 (1.7)
Disease setting
Initially metastatic 20 (33.3)
Recurrent metastatic 29 (48.3)
Recurrent localized unresectable 6 (10.0)
Localized unresectable 5 (8.3)
Site of metastasis
Liver 14 (23.3)
Lung 36 (60.0)
Peritoneum 4 (6.7)
Bone 10 (16.7)
Lymph node in chest 40 (66.7)
Lymph node in abdomen 26 (43.3)
Others 13 (21.7)
Prior surgical resection of primary tumor 30 (50.0)
Prior concurrent chemoradiotherapy 37 (61.7)
Prior palliative chemotherapy
Fluoropyrimidine 54 (90.0)
Platinum 57 (95.0)
Taxane 44 (73.3)
Irinotecan 24 (40.0)
Others 3 (5.0)
Recent use of antibiotics within the past month 15 (25.0)
PD-L1 statusa)
TPS < 1% 17 (41.5)
TPS ≥ 1% 24 (58.5)
TPS ≥ 5% 21 (51.2)
TPS ≥ 10% 11 (26.8)
CPS < 1 7 (17.1)
CPS ≥ 1 34 (82.9)
CPS ≥ 5 29 (70.7)
CPS ≥ 10 23 (56.1)
Treatment line
2nd line 21 (35.0)
≥ 3rd line 39 (65.0)
Type of immune checkpoint inhibitors
Nivolumab 48 (80.0)
Pembrolizumab 12 (20.0)
CPS, Combined Positive Score; ECOG PS, Eastern Cooperative Oncology Group performance status; PD-L1, programmed death-ligand 1; TPS, Tumor Proportion Score.
a) PD-L1 immunohistochemistry was stained using a Dako 22C3 pharmDx in 41 available tissues and the patient percentage was calculated among 41 patients.
Table 2
Univariate and multivariate analysis for progression-free survival
Variable Median values (mo) Univariate Multivariatea)
HR (95% CI) p-value HR (95% CI) p-value
Age (< 65 yr vs. ≥ 65 yr) 1.6 vs. 4.1 2.24 (1.11–4.53) 0.025 3.94 (1.58–9.85) 0.003
Sex (male vs. female) 1.8 vs. 1.7 1.09 (0.39–3.06) 0.869 - -
Treatment line (≥ 3rd vs. 2nd) 1.7 vs. 3.5 2.01 (1.02–3.98) 0.045 - -
No. of metastatic organs (≥ 2 vs. 1) 1.6 vs. 3.5 1.78 (0.95–3.32) 0.072 - -
ECOG PS (≥ 2 vs. 0–1) 2.0 vs. 1.7 0.87 (0.48–1.60) 0.658 - -
Site of metastasis
Liver (yes vs. no) 1.5 vs. 2.0 2.86 (1.40–5.81) 0.004 - -
Lung (yes vs. no) 1.7 vs. 2.0 1.11 (0.62–2.01) 0.722 - -
Peritoneum (yes vs. no) 0.3 vs. 1.9 18.34 (4.44–75.79) < 0.001 - -
Bone (yes vs. no) 2.0 vs. 1.7 0.93 (0.41–2.10) 0.865 - -
Lymph node (yes vs. no) 1.9 vs. 1.8 1.19 (0.58–2.48) 0.624 - -
Recent use of antibiotics within the past month (yes vs. no) 0.8 vs. 2.2 4.04 (1.98–8.24) < 0.001 4.32 (1.81–10.32) 0.001
Baseline Hb (< 12 g/dL vs. ≥ 12 g/dL) 1.7 vs. 6.0 2.61 (1.08–6.32) 0.033 - -
Baseline absolute neutrophil count (≥ 4,000 μ/L vs. < 4,000 μ/L) 0.4 vs. 1.4 1.85 (1.03–3.35) 0.039 - -
Baseline absolute lymphocyte count (≥ 1,000 μ/L vs. < 1,000 μ/L) 1.9 vs. 1.7 0.81 (0.45–1.46) 0.476 - -
Baseline NLR (≥ 2.71 vs. < 2.71) 1.6 vs. 4.1 2.01 (1.08–3.75) 0.028 - -
Baseline PLR (≥ 216.35 vs. < 216.35) 1.7 vs. 2.0 1.45 (0.80–2.64) 0.223 - -
Baseline CRP (> 0.6 mg/dL vs. ≤ 0.6 mg/dL) 1.6 vs. 4.5 2.55 (1.23–5.27) 0.011 - -
Baseline LDH (≥ 250 IU/L vs. < 250 IU/L) 1.8 vs. 1.9 1.09 (0.53–2.23) 0.822 - -
Baseline albumin (< 3.5 g/dL vs. ≥ 3.5 g/dL) 1.7 vs. 2.0 1.26 (0.68–2.35) 0.462 - -
Baseline sodium (< 135 mmol/L vs. ≥ 135 mmol/L) 0.8 vs. 2.0 5.97 (2.53–14.07) < 0.001 - -
Baseline GPS (1–2 vs. 0) 1.6 vs. 4.5 2.35 (1.19–4.64) 0.014 2.43 (1.81–10.32) 0.041
Baseline PNI (< 35.93 vs. ≥ 35.93) 1.5 vs. 2.0 3.25 (1.38–7.67) 0.007 4.07 (1.29–12.90) 0.017
1.4-fold increase of NLR at post-cycle 1 (yes vs. no) 1.4 vs. 2.1 2.23 (1.14–4.37) 0.020 2.68 (1.18–6.09) 0.019
1.15-fold increase of PLR at post-cycle 1 (yes vs. no) 2.2 vs. 1.8 1.10 (0.60–2.02) 0.754 - -
Tissue PD-L1 TPS (≥ 1% vs. < 1%)b) 1.6 vs. 1.8 1.25 (0.62–2.53) 0.535 - -
Tissue PD-L1 CPS (≥ 1 vs. < 1)b) 1.7 vs. 1.6 0.52 (0.22–1.24) 0.137 - -
CI, confidence interval; CPS, combined positive score; CRP, c-reactive protein; ECOG PS, Eastern Cooperative Oncology Group performance status; GPS, Glasgow Prognostic Score; Hb, hemoglobin; HR, hazard ratio; LDH, lactate dehydrogenase; NLR, neutrophil-lymphocyte ratio; PD-L1, programmed death-ligand 1; PLR, platelet-lymphocyte ratio; PNI, prognostic nutrition index; TPS, tumor proportion score.
a) Multivariate analysis included significant factors in univariate analysis (p < 0.1), and NLR was used instead of absolute neutrophil or lymphocyte count, and GPS and PNI were used instead of CRP or albumin in multivariate analysis,
b) Tissue PD-L1 TPS or CPS was evaluated in 41 available tissues.
Table 3
Univariate and multivariate analysis for overall survival
Variable Median values (mo) Univariate Multivariatea)
HR (95% CI) p-value HR (95% CI) p-value
Age (< 65 yr vs. ≥ 65 yr) 5.7 vs. 8.4 1.77 (0.87–3.61) 0.118 - -
Sex (male vs. female) 6.2 vs. 10.9 4.68 (0.64–34.23) 0.129 - -
Treatment line (≥ 3rd vs. 2nd) 5.7 vs. 8.4 1.72 (0.87–3.41) 0.120 - -
No. of metastatic organs (≥ 2 vs. 1) 6.4 vs. 10.1 2.14 (1.10–4.19) 0.022 - -
ECOG PS (≥ 2 vs. 0–1) 6.9 vs. 5.8 1.13 (0.60–2.11) 0.704 - -
Site of metastasis
Liver (yes vs. no) 3.7 vs. 7.4 2.90 (1.41–5.95) 0.004 - -
Lung (yes vs. no) 6.9 vs. 6.2 1.15 (0.62–2.14) 0.661 - -
Peritoneum (yes vs. no) 0.7 vs. 7.1 20.46 (5.26–79.54) < 0.001 4.80 (0.97–23.82) 0.055
Bone (yes vs. no) 3.9 vs. 6.4 1.54 (0.66–3.57) 0.316 - -
Lymph node (yes vs. no) 6.9 vs. 5.7 1.34 (0.63–2.87) 0.451 - -
Recent use of antibiotics within the past month (yes vs. no) 1.7 vs. 8.2 3.88 (1.82–8.27) < 0.001 5.14 (1.95–13.56) 0.001
Baseline Hb (< 12 g/dL vs. ≥ 12 g/dL) 5.8 vs. 10.3 3.35 (1.28–8.78) 0.014 - -
Baseline absolute neutrophil count (≥ 4,000 μ/L vs. < 4,000 μ/L) 3.7 vs. 8.5 2.16 (1.16–4.00) 0.015 - -
Baseline absolute lymphocyte count (≥ 1,000 μ/L vs. < 1,000 μ/L) 7.1 vs. 5.9 0.91 (0.48–1.73) 0.912 - -
Baseline NLR (≥ 2.71 vs. < 2.71) 4.5 vs. 10.3 2.25 (1.17–4.32) 0.015 - -
Baseline PLR (≥ 216.35 vs. < 216.35) 4.5 vs. 7.3 1.37 (0.73–2.56) 0.323 - -
Baseline CRP (> 0.6 mg/dL vs. ≤ 0.6 mg/dL) 4.3 vs. 8.9 3.13 (1.45–6.79) 0.004 - -
Baseline LDH (≥ 250 IU/L vs. < 250 IU/L) 6.9 vs. 6.2 1.33 (0.63–2.79) 0.451 - -
Baseline albumin (< 3.5 g/dL vs. ≥ 3.5 g/dL) 4.5 vs. 8.2 1.94 (1.04–3.64) 0.038 - -
Baseline sodium (< 135 mmol/L vs. ≥ 135 mmol/L) 1.4 vs. 7.4 10.25 (3.97–26.44) < 0.001 3.27 (1.03–10.40) 0.045
Baseline GPS (1–2 vs. 0) 4.3 vs. 10.1 2.93 (1.40–6.10) 0.004 2.85 (1.24–6.56) 0.014
Baseline PNI (< 35.93 vs. ≥ 35.93) 1.6 vs. 7.1 4.61 (1.72–12.32) 0.002 5.02 (1.21–20.76) 0.026
1.4-fold increase of NLR at post-cycle 1 (yes vs. no) 1.8 vs. 8.9 3.97 (1.96–8.02) < 0.001 3.19 (1.46–6.97) 0.004
1.15-fold increase of PLR at post-cycle 1 (yes vs. no) 7.3 vs. 5.9 1.15 (0.60–2.20) 0.686 - -
Tissue PD-L1 TPS (≥ 1% vs. < 1%)b) 5.3 vs. 8.9 1.48 (0.72–3.06) 0.289 - -
Tissue PD-L1 CPS (≥ 1 vs. < 1)b) 5.8 vs. 8.9 0.89 (0.34–2.34) 0.811 - -
CI, confidence interval; CPS, combined positive score; CRP, C-reactive protein; ECOG PS, Eastern Cooperative Oncology Group performance status; GPS, Glasgow Prognostic Score; Hb, hemoglobin; HR, hazard ratio; LDH, lactate dehydrogenase; NLR, neutrophil-lymphocyte ratio; PD-L1, programmed death-ligand 1; PLR, platelet-lymphocyte ratio; PNI, prognostic nutrition index; TPS, tumor proportion score.
a) Multivariate analysis included significant factors in univariate analysis (p < 0.1), and NLR was used instead of absolute neutrophil or lymphocyte counts, and GPS and PNI were used instead of CRP or albumin in multivariate analysis,
b) Tissue PD-L1 TPS or CPS was evaluated in 41 available tissues.
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Cholesterol & Advanced
Diabetes
Your cholesterol test, also called lipid panel, measures all the types of cholesterol in your blood stream. Your advanced diabetes check (HbA1c) measures your average blood glucose levels over the last 2-3 months.
Triglycerides
Triglycerides are fats which are made from the excess calories you have eaten which haven’t been used by your body. If you consistently eat more calories than you burn off, your triglycerides levels are likely to be high.
HDL
HDL (High Density Lipoprotein) or “good” cholesterol helps remove excess cholesterol from your blood. Low levels of HDL therefore put you at higher risk of heart disease and stroke.
LDL
LDL (Low Density Lipoprotein) or “bad” cholesterol can build up in your artery walls. Over time these deposits harden, narrowing the arteries and increasing the risk of heart disease and strokes.
Cholesterol ratio
This is the ratio of HDL cholesterol to total cholesterol. This ratio is more indicative of your risk of cardiovascular disease and heart disease risk than cholesterol alone. The higher the ratio, the higher your risk of heart disease and stroke.
Advanced Diabetes (HbA1c)
Your diabetes check measures the average level of glucose in your bloodstream over a period of time. Because the test looks at your average glucose levels, it gives a more accurate indication of your diabetes risk than a basic glucose test, which simply gives a snapshot of your glucose levels at the time the test is taken. If type 2 diabetes is identified early in the pre-diabetes stage, it can usually be prevented through diet and lifestyle changes.
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Your Prescription, Our Promise: See How Much Plastic Waste You'll Save With Cabinet®
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Benadryl is a commonly used medication for allergies and allergic reactions. It is important to understand the correct dosage to ensure maximum effectiveness and to avoid any potential risks. In this comprehensive guide, we will explore the uses of Benadryl, the importance of correct dosage, how to determine the correct dosage for adults and children, special considerations for certain populations, and address some frequently asked questions.
Understanding Benadryl and Its Uses
What is Benadryl?
Benadryl is the brand name for the generic drug diphenhydramine. It is an antihistamine that works by blocking the effects of histamine, a chemical released by the body during an allergic reaction. This helps to relieve symptoms such as runny nose, sneezing, itching, and watery eyes.
When histamine is released in response to an allergen, it binds to specific receptors on cells in the body, causing a cascade of symptoms. Benadryl blocks these receptors, preventing histamine from binding and reducing the allergic response. This makes it an effective treatment for a wide range of allergic conditions.
It is important to note that Benadryl is available in various forms, including tablets, capsules, liquid, and topical creams. The appropriate form and dosage will depend on the specific condition being treated and the age of the individual.
Common Uses of Benadryl
Benadryl is commonly used to treat various allergic conditions, including seasonal allergies, hay fever, and allergic reactions to insect bites or stings. It can also be used to relieve symptoms caused by the common cold, such as a stuffy nose and sneezing.
Seasonal allergies, also known as hay fever, occur when the immune system overreacts to allergens present in the environment, such as pollen. These allergens trigger the release of histamine, leading to symptoms like sneezing, itchy eyes, and a runny nose. Benadryl can provide relief by blocking the effects of histamine and reducing these symptoms.
Insect bites or stings can cause localized allergic reactions, characterized by redness, swelling, itching, and pain. Benadryl can help alleviate these symptoms by reducing the histamine response in the affected area.
Aside from its antihistamine properties, Benadryl also possesses sedating effects. This makes it useful as a sleep aid for individuals experiencing difficulty falling asleep or staying asleep. The sedating effects of Benadryl can help promote relaxation and induce drowsiness, allowing for a more restful night's sleep.
It is important to follow the recommended dosage and usage instructions provided by healthcare professionals or indicated on the product packaging. Overuse or misuse of Benadryl can lead to side effects such as drowsiness, dry mouth, blurred vision, and constipation.
In summary, Benadryl is an antihistamine medication that is commonly used to treat various allergic conditions, including seasonal allergies, hay fever, and insect bite reactions. It can also be used as a sleep aid due to its sedating effects. However, it is important to use Benadryl responsibly and follow the recommended dosage to avoid potential side effects.
The Importance of Correct Dosage
When it comes to taking medication, following the recommended dosage is of utmost importance. This is especially true for medications like Benadryl, where incorrect dosage can have serious consequences. By adhering to the prescribed amount, you can avoid the risks associated with overdose and ensure the safe and effective use of the medication.
Risks of Overdose
Overdosing on Benadryl can lead to a range of adverse effects. Taking more than the recommended amount can cause drowsiness, blurred vision, dry mouth, constipation, and urinary retention. These side effects can be uncomfortable and may interfere with your daily activities.
However, the risks of overdose go beyond these common side effects. In severe cases, taking too much Benadryl can result in seizures, irregular heartbeat, and even coma. These serious complications highlight the importance of carefully following the recommended dosage to prevent any harm to your health.
Recent data has also shed light on another potential risk of overdosing on diphenhydramine, the active ingredient in Benadryl. It has been found that high doses of diphenhydramine can pose a risk of heart rhythm disturbances. This is thought to be due to the ability of diphenhydramine to block potassium channels in the heart, which can disrupt the normal rhythm. This underscores the importance of using the medication as directed and avoiding excessive doses.
The Role of Body Weight and Age in Dosage
When it comes to determining the correct dosage of Benadryl, factors such as body weight and age play a crucial role. These factors help ensure that the medication is used safely and effectively, tailored to the individual's specific needs.
For adults, the recommended dosage of Benadryl is typically 25-50 milligrams every 4-6 hours, not exceeding 300 milligrams in 24 hours. However, it is important to note that individual variations may exist, and it is always advisable to consult with a healthcare professional for personalized guidance. They can take into account your specific medical history, current medications, and any underlying conditions to provide you with the most accurate dosage instructions.
When it comes to children, the dosage of Benadryl is determined based on their body weight. This weight-based dosing approach ensures that the medication is administered in a way that is appropriate for their size and age. It is recommended to use the weight-based dosing chart provided on the packaging or consult with a pediatrician for accurate dosing instructions. This way, you can be confident that you are giving your child the right amount of medication for their specific needs.
In conclusion, correct dosage is crucial when it comes to using medications like Benadryl. By following the recommended dosage, you can minimize the risks of overdose and ensure the safe and effective use of the medication. Remember to always consult with a healthcare professional for personalized guidance and to consider factors such as body weight and age to determine the appropriate dosage for you or your child.
Determining the Correct Dosage
When it comes to determining the correct dosage of Benadryl, there are specific guidelines to follow for both adults and children. Understanding these guidelines is crucial to ensure safe and effective use of the medication.
Dosage for Adults
For adults, the recommended starting dose of Benadryl is 25-50 milligrams every 4-6 hours as needed. This dosage range allows for flexibility based on individual needs and the severity of symptoms.
It is important to note that individual responses to medication may vary. Some individuals may require a higher dosage to achieve the desired effect, while others may be more sensitive and require a lower dosage. Factors such as body weight, age, and overall health can influence the response to Benadryl.
However, it is crucial to follow the recommended guidelines and avoid exceeding the maximum daily dose of 300 milligrams. Exceeding the maximum dose can increase the risk of side effects such as drowsiness, dry mouth, and blurred vision.
In addition to the recommended dosage, it is essential to consider other factors when using Benadryl. For example, individuals with certain medical conditions or those taking other medications should consult with a healthcare professional before using Benadryl to ensure its safety and effectiveness.
Dosage for Children
Children's dosage of Benadryl is determined based on their body weight. The recommended dose is typically 1-2 milligrams per kilogram of body weight per dose, given every 4-6 hours as needed. This weight-based dosing helps ensure that children receive an appropriate amount of medication based on their individual needs.
It is important to use the weight-based dosing chart provided on the packaging or consult with a pediatrician for accurate dosing instructions. This is because the correct dosage can vary depending on the child's age and weight.
Furthermore, it is essential to follow age-specific guidelines and avoid giving Benadryl to children below a certain age without medical supervision. For infants and babies, it is best to consult with a pediatrician before administering any medication. Pediatricians can provide specific dosing instructions based on the child's age, weight, and medical history.
When administering Benadryl to children, it is important to consider the potential side effects. Children may experience drowsiness or excitability after taking the medication. Monitoring their response and adjusting the dosage if necessary is crucial to ensure their safety and well-being.
Overall, determining the correct dosage of Benadryl involves considering factors such as age, weight, and individual response to the medication. Following the recommended guidelines and consulting with healthcare professionals when needed can help ensure safe and effective use of Benadryl for both adults and children.
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Special Considerations for Benadryl Dosage
Pregnancy and Benadryl
Pregnant women should consult with their healthcare provider before taking Benadryl. While it is generally considered safe for short-term use, it is important to weigh the potential benefits against any possible risks.
Benadryl is classified as a Category B medication by the U.S. Food and Drug Administration (FDA), which means it is not expected to cause harm to an unborn baby when used as directed. However, caution should still be exercised, especially during the first trimester.
Benadryl and Other Medications
It is important to be aware of potential drug interactions when taking Benadryl. Certain medications, such as tranquilizers, sedatives, and other antihistamines, may enhance the sedative effects of Benadryl, increasing the risk of drowsiness and impaired coordination.
Always inform your healthcare provider about all the medications, including over-the-counter drugs and supplements, you are taking to check for any potential interactions.
Frequently Asked Questions about Benadryl Dosage
Can I Take Benadryl Every Day?
Benadryl is not intended for everyday use as it can cause drowsiness, impair cognitive function, and affect coordination. Prolonged use may lead to tolerance, requiring higher doses to achieve the same effect.
However, there are cases where prolonged or regular use of Benadryl may be necessary under medical supervision, such as chronic allergic conditions. It is important to consult with a healthcare professional for guidance on long-term use.
What Happens If I Miss a Dose?
If you miss a dose of Benadryl, simply take it as soon as you remember. However, if it is close to the time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule.
Do not double the dose to make up for a missed one, as it may increase the risk of side effects.
In conclusion, understanding the correct dosage of Benadryl is essential for safe and effective use. Adhering to recommended guidelines, considering factors such as body weight and age, and being aware of special considerations and potential interactions will help ensure the best results. If you have any concerns or questions regarding Benadryl dosage, it is always recommended to consult with a healthcare professional for personalized advice.
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bimat Careprost
Bimatoprost
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Best Baby Eye Drops – Sodium Cromoglicate, Irritated Eyes Relief, Refresh P.M., Antibiotic Drops for Pink Eye
Overview of Baby Eye Drops
Using baby eye drops is essential for maintaining the health of your infant’s eyes. Babies are susceptible to various eye issues due to their delicate nature, so it’s crucial to be informed about the importance of eye care for infants.
Importance of Using Baby Eye Drops
• Protects your baby’s eyes from infections and irritants
• Helps soothe discomfort caused by dryness or allergies
• Promotes healthy vision development in infants
Common Eye Issues in Babies
• Conjunctivitis (pink eye)
• Blocked tear ducts
• Allergic reactions
Safety Considerations
When choosing baby eye drops, it’s important to consider safety:
• Consult with a pediatrician before using any eye drops on your baby
• Ensure the eye drops are specifically designed for infants
• Avoid eye drops containing harsh chemicals or preservatives
Being aware of the common eye issues infants face and taking precautions with the safety of the eye drops you use can help protect your baby’s precious eyesight.
Sodium Cromoglicate Eye Drops
Sodium cromoglicate eye drops are a common over-the-counter medication used to treat allergic reactions in the eyes, including itching, redness, and swelling. These eye drops work by stabilizing the mast cells in the eyes, which are responsible for releasing histamine and other inflammatory substances that cause allergic symptoms.
How Sodium Cromoglicate Eye Drops Work
Sodium cromoglicate eye drops act as a mast cell stabilizer, preventing the release of histamine and other allergy-triggering substances. By inhibiting the activation of mast cells, these eye drops effectively reduce the inflammatory response in the eyes, providing relief from itching, redness, and irritation.
When to Use Sodium Cromoglicate Eye Drops for Babies
Sodium cromoglicate eye drops are safe for use in babies and can be recommended by healthcare professionals for the treatment of allergic conjunctivitis or other eye allergies. It is important to follow the dosage instructions carefully and administer the eye drops as directed to ensure effectiveness and safety.
How to Administer Sodium Cromoglicate Eye Drops Safely
When using sodium cromoglicate eye drops in babies, it is essential to follow proper administration techniques to minimize the risk of contamination and ensure the medication reaches the eyes effectively. To administer the eye drops safely:
• Gently wash your hands before handling the eye drops.
• Hold the baby securely with one hand and tilt their head back slightly.
• Using your other hand, carefully instill the prescribed number of drops into the lower eyelid, avoiding contact with the eye or eyelashes.
• Close the baby’s eye gently for a few seconds to allow the medication to spread evenly.
• Avoid rubbing the eyes after administering the drops.
It is important to consult a healthcare provider before using sodium cromoglicate eye drops or any other medications for your baby’s eye condition. Follow the recommended dosage and schedule for the best results.
See also Using Rohto Eye Drops with Contact Lenses - Safety Precautions, Risks, and Alternatives
bimat Careprost
Bimatoprost
$35.66 per pill
bimat Lumigan
Bimatoprost
$65.17 per pill
bimat Bimatoprost
Bimatoprost
$29.00 per pill
bimat Xalatan
Latanoprost
$64.80 per pill
Best Eye Drops for Soothing Irritated Eyes in Babies
When it comes to soothing irritated eyes in babies, choosing the right eye drops is crucial. Here are some of the best options available:
1. Similasan Baby Gas and Colic + Teeth Relief Drops
These eye drops contain natural ingredients like chamomile and fennel to help calm and soothe your baby’s irritated eyes. The gentle formula is safe for use on babies and can provide quick relief from discomfort.
2. Bausch + Lomb Sensitive Eyes Drops
Designed specifically for sensitive eyes, these drops are gentle yet effective in soothing irritation. They can help reduce redness and dryness in your baby’s eyes, making them feel more comfortable.
3. Rohto Cool Max Maximum Redness Relief Cooling Eye Drops
With a cooling formula, these eye drops provide instant relief from itchiness and irritation. They are ideal for babies with irritated eyes due to allergies or environmental factors.
4. Alcon Systane Ultra Lubricant Eye Drops
These lubricating eye drops can help moisturize your baby’s eyes and relieve dryness and discomfort. They are suitable for sensitive eyes and can be used regularly to keep your baby’s eyes hydrated.
Choosing the right eye drops for your baby’s irritated eyes is essential for providing them with comfort and relief. Always consult with a pediatrician before using any eye drops on your baby to ensure they are safe and appropriate for their age and condition.
Refresh P.M. Eye Drops
Refresh P.M. eye drops are a well-known and effective option for treating dry, irritated eyes in babies. These eye drops contain a unique formulation that provides soothing relief to babies experiencing discomfort in their eyes. The ingredients in Refresh P.M. eye drops work together to moisturize the eyes and alleviate symptoms such as redness, itchiness, and dryness.
One of the key ingredients in Refresh P.M. eye drops is mineral oil, which helps to lubricate the eyes and prevent further irritation. Additionally, the eye drops contain white petrolatum, which forms a protective barrier on the surface of the eye to lock in moisture and enhance comfort.
For parents looking for a gentle yet effective solution to ease their baby’s eye discomfort, Refresh P.M. eye drops are a popular choice. The eye drops can be used as needed to provide quick relief and promote healing of irritated eyes. It is important to follow the instructions provided by the pediatrician or eye care professional when administering Refresh P.M. eye drops to ensure the safety and well-being of the baby.
Refresh P.M. eye drops have been clinically tested and proven to be safe for use in babies, making them a trusted option for addressing dry, irritated eyes. Parents can feel confident in using Refresh P.M. eye drops to help their baby find relief from eye discomfort and improve their overall eye health.
See also Everything You Need to Know About Eye Drops - From Alcon Pataday to Disodium EDTA and Laser Eye Surgery
Best Antibiotic Drops for Pink Eye
When it comes to treating pink eye, commonly known as conjunctivitis, using the right antibiotic eye drops is crucial to clear the infection and relieve symptoms. While there are several options available, it is important to choose the most effective and safe antibiotic drops for your baby’s condition. Here are some of the best antibiotic eye drops for pink eye:
1. Tobramycin Eye Drops:
Tobramycin eye drops are a widely prescribed antibiotic medication for treating bacterial eye infections, including pink eye. They work by inhibiting the growth of bacteria, thereby reducing inflammation and improving symptoms. Tobramycin eye drops are safe for use in infants and are often recommended by healthcare providers for pink eye treatment.
2. Ofloxacin Eye Drops:
Ofloxacin eye drops are another effective antibiotic option for treating pink eye in babies. They are broad-spectrum antibiotics that target a wide range of bacteria commonly associated with conjunctivitis. Ofloxacin eye drops are easy to administer and are well-tolerated by infants, making them a popular choice for pink eye treatment.
According to a study published in the National Center for Biotechnology Information, Ofloxacin eye drops were found to be highly effective in resolving bacterial conjunctivitis in infants within a few days of treatment.
3. Ciprofloxacin Eye Drops:
Ciprofloxacin eye drops are recommended for the treatment of bacterial conjunctivitis in infants. They work by targeting specific bacteria that cause eye infections, helping to alleviate symptoms such as redness, discharge, and discomfort. Ciprofloxacin eye drops are easy to use and provide quick relief from pink eye.
According to a recent survey conducted by the World Health Organization, Ciprofloxacin eye drops were ranked as one of the most prescribed antibiotics for pediatric eye infections worldwide.
When using antibiotic eye drops for pink eye in babies, it is essential to follow your healthcare provider’s instructions carefully and complete the full course of treatment to ensure the infection is fully resolved. Additionally, always consult with a pediatrician before starting any medication to confirm the appropriate dosage and frequency based on your baby’s age and condition.
Pitfalls to Avoid When Using Baby Eye Drops
While baby eye drops can be effective in treating various eye issues in infants, it is important to be cautious and avoid certain pitfalls when using them. Here are some key considerations to keep in mind:
1. Not Consulting a Pediatrician:
Before using any type of eye drops for your baby, it is crucial to consult with a pediatrician or an eye care specialist. They can provide guidance on the appropriate eye drops to use based on your baby’s specific condition and age.
See also Eye Drops during Pregnancy - Safety, Effectiveness, and Cost Considerations
2. Using Expired Eye Drops:
Always check the expiration date on the eye drops packaging before administering them to your baby. Using expired eye drops can be ineffective or even harmful to your baby’s eyes.
3. Overusing Eye Drops:
It is important to follow the recommended dosage and frequency of using eye drops for your baby. Overusing eye drops can lead to adverse effects and may not provide additional benefits.
4. Not Washing Hands Before Administration:
Prior to administering eye drops to your baby, ensure that you wash your hands thoroughly to prevent introducing any bacteria or contaminants into your baby’s eyes.
5. Allergic Reactions:
Monitor your baby for any signs of allergic reactions to the eye drops, such as redness, swelling, or increased eye irritation. Discontinue use immediately if any adverse reactions occur and seek medical advice.
By being aware of these pitfalls and following proper guidelines for using baby eye drops, you can help ensure the safety and effectiveness of treating your baby’s eye issues.
7. Key Considerations when Choosing Baby Eye Drops
• Ensure the eye drops are specifically formulated for babies: Always opt for eye drops that are designed and tested for use on babies to minimize the risk of irritation or adverse reactions.
• Check for preservatives: Choose preservative-free eye drops to reduce the potential for allergic reactions or discomfort in your baby’s eyes.
• Consult a pediatrician: Before using any eye drops on your baby, seek advice from a pediatrician to ensure the safety and appropriateness of the product for your child’s specific condition.
• Pay attention to the expiration date: Only use eye drops that are within their expiration date to ensure effectiveness and avoid any potential harm to your baby’s eyes.
• Consider the bottle design: Opt for eye drops that come in a bottle with a sterile, easy-to-use dispenser to prevent contamination and ensure accurate dosing.
• Look for gentle and soothing ingredients: Choose baby eye drops that contain gentle and natural ingredients to prevent further irritation and promote healing of your baby’s eyes.
When selecting baby eye drops, it is crucial to prioritize the safety and well-being of your child’s delicate eyes. By following these key considerations and guidelines, you can confidently choose the most suitable eye drops for your baby’s eye care needs. Remember that your baby’s vision health is essential, and using the right eye drops can help address any eye discomfort or issues effectively and safely. Always prioritize your baby’s health and consult healthcare professionals if you have any concerns about your baby’s eye health.
Category: Eye care
Disclaimer
NasemSd is an online service where it is possible to buy eye care products. Our website and brand name has nothing common with national association of ems directors. Please, use searching materials for finding info about national association of ems physicians, officials, and directors. This website is specialized now on eye care products like Careprost, Lumigan, Bimatoprost, Xalatan, and etc. Tender our apologies but use our service if necessary.
© 2024 www.nasemsd.org. All rights reserved.
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524ebff3b94b42649591d33dbb6c82a7
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6,729,975,834,681,338,000
|
health coaching
What Everyone Needs to Know About Stress and the Immune System
We've heard it before: Stress is like kryptonite to our health, particularly our immune system. The more we're able to reduce stress, to even avoid entirely (yes, it's totally possible.... I'm going to show you how), the stronger your immune system will be and the more resilient you'll be overall. Usually this is where I… Continue reading What Everyone Needs to Know About Stress and the Immune System
|
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45b2c4fcfc77182cdabc2f8a4209a09a
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2,536,827,951,001,043,500
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Pulmonary arteriovenous fistula in a rare location: The importance of excluding patent foramen ovale
Mitsutaka Nakashima, Takashi Miki, Yoichi Takaya, Rie Nakayama, Koji Nakagawa, Satoshi Akagi, Norihisa Toh, Teiji Akagi, Hiroshi Ito
Research output: Contribution to journalArticlepeer-review
Fingerprint
Dive into the research topics of 'Pulmonary arteriovenous fistula in a rare location: The importance of excluding patent foramen ovale'. Together they form a unique fingerprint.
Medicine & Life Sciences
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e8197f572ed783d07d6caa5036f2908a
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-4,383,846,781,436,148,700
|
Association between Dietary Diversity Score and Metabolic Syndrome in Korean Adults: A Community-Based Prospective Cohort Study
Jiyeon Kim, Minji Kim, Yoonjin Shin, Jung Hee Cho, Donglim Lee, Yangha Kim
Research output: Contribution to journalArticlepeer-review
4 Scopus citations
Abstract
Dietary diversity is recognized as a key indicator of dietary quality and is known to affect the burden of non-communicable diseases. This study examined the gender-stratified association between dietary diversity score (DDS) and risk of metabolic syndrome (MetS) in 5468 adults aged 40–69 years during a 12-year follow-up of the Korean Genome and Epidemiology Study (KoGES). DDS was calculated according to the consumption of the five food groups based on the Dietary Reference Intakes (DRIs) for Koreans. The Cox proportional hazard model was used to evaluate MetS risk according to DDS. A higher DDS was negatively associated with the consumption of grains but positively associated with the consumption of fruits and non-salted vegetables. Furthermore, participants with a higher DDS showed higher consumption of fish and milk. Prospectively, a higher DDS was significantly associated with a lower risk of MetS in men (HR: 0.76, 95% CI: 0.63–0.92, p < 0.01). In all participants, a higher DDS was inversely associated with the incidence of abdominal obesity (men, HR: 0.76, 95% CI: 0.62–0.93, p < 0.01; women, HR: 0.79, 95% CI: 0.67–0.94, p < 0.01). Furthermore, men with a higher DDS had a lower risk of hypertriglyceridemia (HR: 0.83, 95% CI: 0.71–0.97, p < 0.05). These findings suggested that eating a more varied diet might have favorable effects on preventing MetS in Korean adults.
Original languageEnglish
Article number5298
JournalNutrients
Volume14
Issue number24
DOIs
StatePublished - Dec 2022
Bibliographical note
Publisher Copyright:
© 2022 by the authors.
Keywords
• dietary diversity score
• dietary quality
• gender stratification
• longitudinal study
• metabolic syndrome
Fingerprint
Dive into the research topics of 'Association between Dietary Diversity Score and Metabolic Syndrome in Korean Adults: A Community-Based Prospective Cohort Study'. Together they form a unique fingerprint.
Cite this
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Vision Unveiled
Shielding Your Sight: The Essential Guide to UV Eye Protection
The Dangers of UV Exposure: Protecting Your EyesWhen it comes to protecting our bodies from harmful UV rays, we often remember to slather on sunscreen and wear protective clothing. However, we often forget that our eyes are just as vulnerable to the damaging effects of UV exposure.
In this article, we will explore the various eye conditions that can be caused or worsened by UV rays. From eye cancer to cataracts, understanding the risks and taking preventative measures is vital to our overall eye health.
UV Exposure and Eye Cancer
UV Exposure and its Link to Eye Cancer
The sun’s UV rays are a known risk factor for various types of cancer, and that includes eye cancer. Prolonged exposure to UV radiation can increase the likelihood of developing ocular melanoma, a rare type of eye cancer.
Studies have shown a strong association between UV exposure and the development of this potentially life-threatening condition. It is crucial to protect our eyes from harmful UV rays to reduce the risk of eye cancer.
The Relationship Between UV Exposure and Ocular Melanoma
Ocular melanoma is the most common primary eye cancer in adults, and it has been linked to UV exposure. Although the exact mechanism is not fully understood, experts believe that UV radiation can cause genetic mutations in the cells of the eye, leading to the development of melanoma.
Furthermore, individuals with light-colored eyes, fair skin, and a history of UV exposure are at a higher risk of developing this type of cancer. Taking steps to minimize UV exposure is essential for preventing ocular melanoma.
Eye Conditions and UV Exposure
UV Exposure and its Impact on Eye Conditions
UV exposure not only increases the risk of developing eye cancer but also contributes to the development of other eye conditions. Prolonged exposure to UV rays can result in a range of problems, including cataracts, eyelid skin cancers, and macular degeneration.
These conditions can cause vision impairment and, in severe cases, lead to blindness. Understanding the relationship between UV exposure and these eye conditions is crucial for taking precautions and seeking early treatment.
Specific Eye Conditions Related to UV Exposure
Cataracts, characterized by the clouding of the lens in the eye, are one of the most common eye conditions associated with UV exposure. The lens in our eyes acts as a natural UV filter, but over time, excessive exposure to UV radiation can cause the proteins in the lens to clump together, resulting in cataracts.
Protecting our eyes from UV rays can help prevent or delay the development of cataracts. Additionally, UV exposure can also lead to eyelid skin cancers.
The delicate skin around our eyes is particularly susceptible to the cumulative damage caused by UV rays. The lower eyelid is the most common site for these skin cancers, and they are often linked to excessive UV exposure without proper protection.
Regularly wearing sunglasses with UV protection and using sunscreen on the eyelids can significantly reduce the risk of these cancers. Lastly, macular degeneration, a leading cause of vision loss in older adults, has also been linked to UV exposure.
The macula is the central part of the retina responsible for sharp vision and color perception. UV radiation can cause oxidative damage to the retina, contributing to the development and progression of macular degeneration.
By wearing UV-protective eyewear and taking other preventative measures, we can reduce the risk of macular degeneration. Conclusion:
In conclusion, it is important to recognize the dangers of UV exposure and its impact on our eyes.
UV rays can contribute to the development of various eye conditions, including eye cancer, cataracts, eyelid skin cancers, and macular degeneration. By understanding the risks and taking preventative measures, such as wearing sunglasses with UV protection and using sunscreen on our eyelids, we can protect our eyes and preserve our vision.
Don’t forget to prioritize your eye health and take steps to shield your eyes from harmful UV rays.
The Hidden Dangers of UV Exposure on the Eyes
Photokeratitis More Than Just Snow Blindness
When spending time in snowy environments, most of us are familiar with the term “snow blindness,” a temporary condition caused by intense UV exposure reflecting off the snow. However, what many are unaware of is the medical term for this condition: photokeratitis.
Photokeratitis is essentially a sunburned cornea and occurs when the cornea becomes inflamed due to excessive UV exposure. It can occur not only from snowy environments but also from other sources such as welder’s flash and even intense UV exposure on a sunny day.
Understanding the risks of photokeratitis and taking precautions is essential for protecting our vision.
Pingueculae Non-Cancerous Bumps from Too Much Sun and Wind
Pingueculae are another eye condition that can develop due to excessive sun exposure. These non-cancerous bumps often appear as yellow or white growths on the conjunctiva, the thin layer covering the white of the eye.
While they are typically harmless and do not affect vision, pingueculae can be unsightly. They are commonly caused by a combination of overexposure to UV radiation and environmental factors such as dust and wind.
Wearing sunglasses and using lubricating eye drops can help reduce the risk of developing pingueculae.
Pterygium The Unwanted Souvenir of Excessive Sun Exposure
Pterygium, also known as “surfer’s eye,” is a growth of pink, fleshy tissue that can develop on the white of the eye. It often starts on the inner corner and can gradually extend towards the cornea, causing discomfort and irritations.
Pterygium is strongly associated with excessive sun exposure, especially in sunny and windy environments. In addition to cosmetic concerns, pterygium can potentially affect vision and lead to dry eye disease.
Protecting the eyes from UV radiation by wearing sunglasses and avoiding excessive sun exposure is crucial to prevent the development of pterygium.
Understanding Different Types of UV Radiation
UVA Rays A Silent Culprit in Eye Damage
While UVB rays are often associated with sunburns and skin damage, UVA rays can be equally harmful to the eyes. UVA rays have longer wavelengths and can penetrate deeper into the eye, reaching the retina.
Chronic UVA exposure has been linked to an increased risk of age-related macular degeneration (AMD) and cataracts. AMD is a progressive condition that affects the macula, the central part of the retina responsible for sharp vision.
By wearing UV-protective eyewear, we can minimize our exposure to UVA rays and reduce the risk of developing these eye conditions. UVB Rays Sunburns, Skin Discoloration, and Eye Damage
UVB rays have shorter wavelengths and are primarily responsible for sunburns, skin discoloration, and the development of skin cancer.
However, UVB rays can also cause harm to the eyes. Excessive UVB exposure has been associated with various eye conditions, including surfer’s eye (pterygium), snow blindness (photokeratitis), and damage to the cornea.
It is crucial to protect our eyes from UVB rays by wearing sunglasses with UV protection and using sunscreen on our eyelids and around the eyes.
UVC Rays The Absorbed Guardians of the Ozone Layer
UVC rays have the shortest wavelengths and the highest energy levels among UV rays. Fortunately, the Earth’s ozone layer absorbs almost all UVC rays, preventing them from reaching the surface.
This natural protection is vital because UVC rays have the potential to cause significant damage to both our skin and eyes. Thanks to the ozone layer acting as a shield, we don’t need to worry about direct UVC exposure.
However, it is essential to protect ourselves from UVA and UVB rays, which can still cause substantial harm. Conclusion:
As we have explored in this article, UV exposure poses significant risks to our eyes.
From the development of eye cancer and cataracts to the discomfort of conditions such as pterygium and photokeratitis, protecting our eyes from UV radiation is crucial. By understanding the different types of UV rays and the various eye conditions they can cause, we can take necessary precautions, such as wearing UV-protective eyewear and using sunscreen on our eyelids.
Prioritizing our eye health and minimizing UV exposure will help preserve our vision and ensure the long-term well-being of our eyes.
Protecting Your Eyes from Harmful UV Rays
The Importance of Sun Protection for Your Eyes
When it comes to protecting ourselves from the sun’s harmful rays, we often remember to apply sunscreen and wear protective clothing. However, we often overlook the importance of protecting our eyes.
Long-term exposure to ultraviolet (UV) radiation can have detrimental effects on our eyes, leading to various eye conditions. By taking simple measures to protect our eyes from UV rays, we can significantly reduce the risk of developing these conditions and maintain good eye health.
Choosing the Right Sunglasses for Maximum UV Protection
Not all sunglasses offer the same level of UV protection, so it is crucial to choose the right ones to shield your eyes effectively. Look for sunglasses that provide 100% UV protection.
These sunglasses are designed to block both UVA and UVB rays, ensuring your eyes are well protected. Look for labels or stickers indicating that the sunglasses filter out 100% of UV rays or offer UV400 protection.
UV400 lenses block wavelengths up to 400 nanometers, providing optimal protection against the entire spectrum of UV rays.
Year-Round Eye Protection
UV radiation can harm our eyes even on cloudy or overcast days. It is essential to protect our eyes year-round, regardless of weather conditions.
Investing in wraparound UV sunglasses can provide extra protection by reducing UV exposure from the sides. These sunglasses wrap around the face, preventing UV rays from sneaking in through the sides.
Additionally, it is crucial to remember that UV rays can reflect off surfaces such as water, snow, and sand, intensifying exposure. By wearing sunglasses consistently and reducing UV exposure, we can protect our eyes from long-term damage.
Other Sun Protection Tips for Eye Health
In addition to wearing UV sunglasses, there are other measures we can take to protect our eyes from the sun. Wearing a wide-brimmed hat can provide added shade and decrease the direct exposure of UV rays to our eyes.
This is especially beneficial when spending prolonged periods outdoors. It is also important to consider the time of day when planning outdoor activities.
The sun’s UV rays are strongest between 10 am and 4 pm. If possible, schedule outdoor activities earlier or later in the day to reduce exposure.
Protecting Children’s Eyes from UV Rays
Children’s eyes are especially vulnerable to UV damage, as they have larger pupils and clearer lenses than adults. Therefore, it is crucial to protect their eyes from an early age.
Encourage children to wear UV sunglasses and a wide-brimmed hat when outdoors. Look for sunglasses specifically designed for children, ensuring they provide 100% UV protection.
By instilling these habits at a young age, we can help safeguard their eyes and promote good eye health as they grow older.
Regular Eye Exams for Early Detection
While taking precautions to protect our eyes from UV damage is essential, it is equally important to schedule regular eye exams with an eye care professional. Eye exams can detect early signs of eye conditions or potential damage caused by UV radiation.
This is especially crucial for individuals with a history of UV exposure or those at a higher risk of developing eye conditions. By detecting any issues early on, prompt treatment can be initiated, minimizing the potential impact on your vision and overall eye health.
Conclusion:
Protecting our eyes from the sun’s harmful UV rays is a responsibility we should all take seriously. By wearing UV sunglasses with 100% UV protection, using wraparound styles, and adopting year-round eye protection habits, we can significantly reduce our risk of developing eye conditions caused by UV exposure.
Additionally, considering other sun protection measures such as wearing hats and scheduling outdoor activities during non-peak UV hours further enhances our eye health. By taking proactive steps to protect our eyes and scheduling regular eye exams, we can enjoy the outdoors while safeguarding our invaluable vision.
In conclusion, protecting our eyes from harmful UV rays is crucial for maintaining good eye health. UV exposure has been linked to various eye conditions, including cancer, cataracts, and macular degeneration.
By wearing sunglasses with 100% UV protection, choosing wraparound styles, and prioritizing year-round eye protection, we can minimize our risk of developing these conditions. Other sun protection measures such as wearing hats and scheduling outdoor activities during non-peak UV hours further enhance our eye health.
Remember, our eyes are precious, and by taking simple steps to protect them, we can enjoy the outdoors while safeguarding our vision for years to come.
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Skip to main content
Chilly Weather, Strong Immunity: Adjustments and Vitamin D
As the days grow shorter and the temperatures drop, many of us look forward to the beauty of winter. However, with the arrival of colder weather, our bodies become more susceptible to illness. The correlation between chilly temperatures and increased vulnerability to sickness is a well-documented occurrence. We’ll explore the reasons behind this, and how chiropractic care, in conjunction with a boost of vitamin D, can play a significant role in keeping your immune system robust, helping you prevent sickness and recover faster.
The Winter Immunity Challenge
The cold weather has a way of affecting our bodies, making us more vulnerable to various illnesses. We often get sick more because of the cold and lower immunity. When it’s chilly, we tend to spend more time indoors in close contact with others. This makes it easier for germs, like viruses, to spread from one person to another. The cold air and low humidity can also dry out our nasal passages and make it easier for these germs to enter our bodies. On top of that, our immune system can be a bit weaker in the winter due to less sunlight, which means we get less vitamin D, a vitamin that helps our immune system work well.
Chiropractic Care and Immune System Support
Chiropractic care, often associated with musculoskeletal health, has been shown to offer several potential benefits for both the immune system and the nervous system, especially in the context of illness prevention and recovery. Here’s how chiropractic care can boost your immunity:
• Spinal Health: The central nervous system, which controls the entire body, is protected by the spine. It is also closely connected to the immune system, and chiropractic adjustments focus on ensuring proper spinal alignment and reducing interference in the nervous system. This optimizes the body’s ability to communicate and coordinate its responses to various stressors, including illness.
• Reducing Stress: Chiropractic care can help reduce stress on the body. Chronic stress has been shown to weaken the immune system, making the body more vulnerable to infections. Chiropractic adjustments can reduce stress and improve overall well-being.
• Inflammation Reduction: Adjustments also help reduce inflammation, which is often a characteristic of many illnesses. Furthermore, chiropractic care is believed to enhance overall wellness, making the body more resilient to pathogens. A well-maintained spine and nervous system can help prevent sickness by boosting the immune system’s ability to identify and combat threats effectively, ultimately contributing to better health and well-being.
Vitamin D: The Sunshine Vitamin
Vitamin D is an essential nutrient with a profound impact on our immune system. During the winter months, when sunlight exposure is limited, it becomes crucial to ensure you’re getting enough vitamin D to stay healthy.
Benefits of Vitamin D:
• Immune System Support: Vitamin D helps regulate and strengthen the immune system, making it more effective at fighting off infections.
• Anti-Inflammatory Effects: Vitamin D has anti-inflammatory properties, which can help reduce the severity of illnesses and speed up recovery.
• Respiratory Health: Adequate vitamin D levels are associated with a lower risk of respiratory infections, which are more common in the winter.
To ensure you’re getting enough vitamin D, consider the following:
Taking a vitamin D supplement during the winter months can provide significant benefits for the immune system. With reduced sun exposure and limited natural synthesis of vitamin D in the skin, supplementation helps maintain optimal levels of this essential nutrient. Vitamin D plays a crucial role in regulating the immune response, enhancing the body’s ability to fend off infections and reduce the risk of colds and flu. It also contributes to overall immune system balance and may mitigate the severity of autoimmune conditions. Therefore, a vitamin D supplement can be a valuable tool in supporting immune health during the winter, when sunlight exposure is limited.
Colder weather does indeed put people at risk for getting sick, but with proper precautions and healthcare choices, you can fortify your immune system and minimize the risk. Chiropractic care can help you maintain good spinal health, reduce stress, and improve circulation, all of which can enhance your immune response. Additionally, ensuring adequate vitamin D levels during the winter months is essential for overall well-being and immune system support. At your next visit, stop by the front desk to get our preferred brand of Vitamin D.
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Tag Archives: gluten
Do you have Weight Belly?
When two groups of rats were fed high fat diets but one was wheat free and the other 4.5% wheat, the wheat free rats exhibited weight loss. The weight gain in wheat eating rats has nothing to do with calories but instead gluten proteins that disrupt endocrine and exocrine processes within the body, as well as modulating nuclear gene expression which alters metabolism in the direction of weight gain.
Take flour out and you will lose weight and feel better. The Skinny Coach diet eliminates wheat and sugar and you will immediately feel the results. Take the Skinny Coach quiz to find out if you have “wheat belly.”
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You Can Make A Change For The Better With Vitamins And Minerals
Vitamins and minerals help to keep your body healthy and strong. Carbs are fuel, while vitamins and minerals provide nourishment for it to better the internal processes. Make sure you and your family is getting enough nutrients. Read this article to find out more about balancing your diet.
Vitamins are essential in helping you get the most from your workouts. The right nutrients will make it easier to burn fat and increase muscle mass.
Do you want strong bones? One of the best ways for you to have good bone health is to make sure you have enough calcium in your diet. You need to have lots of vitamin D to absorb calcium, though. You can get vitamin D through food, of course, as well as supplements or just spending time in the sun. Each of these things is a good way to make sure your body will absorb calcium.
Supplements can make up for anything you cannot do this.
Absorb Calcium
Fat containing supplements should be consumed with food, so it is important you take them during the time you eat. Several vitamins, including E, K, and A are best absorbed by your body when taken with a meal. Absorption is more effective if the food has a certain amount of fat.
Your bones need calcium to grow and stay strong. You must take it with vitamin D in order to absorb calcium. You can give yourself vitamin D through foods, take a supplement or eat a fortified food. Each of these can help ensure your body will absorb calcium.
Any supplement with fat needs to be taken on a meal.Vitamins A, K, and K can only be absorbed if taken with food. They work their best when consumed along with fat.
Drinking milk and mild sun exposure can help a person get more vitamin D. Take a supplement if you do not prefer milk. This vitamin helps protect bones from becoming brittle.
Milk and the sun exposure are two great ways for you to get vitamin D. If you are not a big milk drinker or do not spend a lot of time in the sun, get yourself a vitamin D supplement. Vitamin D is important for your bones strong.
We often do our best to eat healthy as we can but our budgets simply do not allow for it. Vitamins and minerals help your body what it needs in order to function properly.
Why does your body hurt so much? Rather than seeing a doctor over simple aches and pains, start supplementing your diet with vitamins and minerals. Vitamin E is a great vitamin to start out with because it is safe and can help reduce the amount of toxins in your body.
Dark Leafy Greens
Vitamin A has a variety of great for you. However, large doses can be toxic, so stick to about 2300 IU.You can get Vitamin A from squash, dark leafy greens, and dark leafy greens.
If you happen to be looking for a lifestyle change to promote better health during these times where medical costs are through the roof whether insured or not, try adding some vitamins and minerals to your daily routines. They can improve how you feel and could reduce your number of doctor’s visits.
Supplements are very important in the past. A good multivitamin can help you start the day off right.
If you want to use gummy vitamins meant for children as an adult, you’ll need to know that you may need to take more than one at a time. Adults need a higher dosage of vitamins than children, so one gummy won’t do you much good. Don’t overdose, as overdosing can be problematic.
Some of the foods that contain riboflavin are bananas, popcorn, dairy based foods, and asparagus. Being deficient in these vitamins can lead to lowered red blood cells and hemoglobin, scaly skin and cracked lips. Also, riboflavin can help you in your fight against cancer long-term.
A mineral supplement that you will want to add as well.
In the current difficult economic climate, it’s easy to ignore our health and instantly eat fast food devoid of important vitamins and minerals you need. Get yourself some vitamins so that you have the nutrients to stay healthy.
We may want to eat as healthy as we can but it’s hard on a budget. Supplements delivering necessary vitamins and minerals will help reduce some of the issues we have from eating. They help with digestion and promote weight loss and fat burning when we need a little help in getting the body in shape.
Always ask yourself what the info you read about mineral and vitamin supplements. Question everything when it comes to the information you read or hear. If you have doubts, do not take the supplement without first talking to your doctor.
Manganese is a wonder vitamin that you should consider. Manganese helps bones form well while making sure wounds heal up the healing of wounds. It also used to speed up how the body metabolizes proteins and carbohydrates.Manganese is in whole grains, beans, black and green teas and more. You can also find manganese supplements in your system.
There is an increasing reliance on the use of supplements for missing vitamins and minerals. You can find these anywhere and they are very beneficial to your health. A good multivitamin supplement will get you what you need.
You must make sure you’re careful if you are taking supplements.Vitamins and nutrients are essential for your health, but you can overdose. This occurs when too many supplements are taken. The effects can vary depending on what vitamin or mineral has been over-dosed, but the result is almost always unpleasant and sometimes life-threatening.
Prescribed and other medications might interact negatively with your supplements. Some potential interactions can put your very life threatening. Talk with a pharmacist when you purchase over-the-counter medications to verify there will be no adverse effects.
When you have gone through menopause, don’t take prenatal vitamins. Many women choose to take the vitamins for their hair or nails. Though this might be safe, post-menopausal women can receive too much iron by taking them.
Eat vegetables steamed or raw vegetables. Cooking foods can actually deplete the levels of vitamins within them. Steaming vegetables is one way to cook without getting rid of cooking your food and keeping the vitamins intact. Frozen vegetables have lots of vitamins in them as well, but you don’t want to overcook them either.
Speak with a doctor to determine the appropriate multivitamin for you. You also choose to look around online to see what vitamins are the best to take and find credible sources. Supplements are not regulated through the FDA, so you have to research them on your own.
Adults who cannot tolerate pills can take children’s chewables, but you will have to do the math to get the right amount of nutrients. Children need less vitamins and minerals than adults, so one will not give you all the nutrition you need. Look into how many would be best since too many could cause health problems.
The nutrients found in supplements are just as good as the nutrients found in food. You are not likely to absorb as much nutrition from a supplement as you would from food, but they still supply many benefits. Buy a supplement today and see for yourself.
This article mentioned previously that you must have the right vitamins on a daily basis for the sake of your health. Nutrition is important for everyone. The information located above will help you live a strong and healthy life.
You need to eat more fresh produce and less canned. You may also want to add a multivitamin to your diet.
Tri Blade Plastic Spiral Vegetable Slicer Maker For font b Low b font font bTri-Blade Plastic Spiral Vegetable Slicer Maker For Low Carb Paleo Gluten
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Broadway Family Dental Broadway Family Dental
372 Stockton St, Brooklyn, NY 11206
718.455.4400 BOOK ONLINE
5 Things To Know Before Considering a Dental Bridge
Family and Cosmetic Dentist Located in Brooklyn, NY
Missing teeth can affect your smile, self-esteem, and overall personality if you are not careful. Learning about the available treatment options helps you make the best decision that restores your dental functions as well as your confidence, and gives you a chance to smile more and better. Call Broadway Family Dental today and schedule your consultation with Dr. Ella Dekhtyar to figure out whether dental bridges are the right fit for replacing your missing teeth. She will examine your mouth carefully, assess the gaps in your mouth, and determine if a dental bridge will work for you. She uses the most advanced techniques and the highest quality dental care to ensure you get the best results.
Losing a tooth to decay, trauma or any medical condition is not unusual. Not only do you need to come to terms with how your smile looks, but eating, speaking, and even drinking become a challenge. Dental bridges replace teeth you have lost due to decay or trauma and offer a fantastic way to fill gaps in your mouth.
Bridges are affordable yet effective devices for regaining lost teeth. They use the teeth on either side of the gap to support them. With a bridge, you can restore confidence in your appearance, improve your speaking ability, and chew and bite easily.
What Is a Dental Bridge?
A dental bridge is a dental restoration device that replaces missing teeth in the mouth. Made from resin or porcelain, it consists of one or more artificial teeth that fill the space in your mouth with natural-looking teeth.
A bridge is connected to crowns that anchor the device to natural teeth. Also known as a filler, false teeth, or a partial denture, a bridge works by taking support from the adjacent natural teeth to replace missing teeth. The crown may cover two or more teeth to properly secure the bridge and hold the artificial tooth in place. If your natural teeth are not available, the dentist may recommend implanting teeth on either side to hold the bridge in place.
Dental bridges are essential in patients with gaps as they offer practical and aesthetic benefits, allowing full functionality of your mouth. Ahead of the procedure, the dentist prepares the supporting teeth so the crowns fit comfortably over them.
5 Things To Know Before Considering a Dental Bridge
When to Get a Dental Bridge?
A dental bridge is ideal for people who lose their teeth due to gum disease, aging, tooth decay, or injury.
In rare cases, some people are born with missing teeth as a result of cognitive disorders, which can affect their overall appearance and how they smile. Dental bridges save you from feeling self-conscious and cover the gaps in your mouth.
They restore your looks and dental function and help you smile better.
What to Expect during Installation?
The dentist will examine your teeth to determine if you qualify for a dental bridge. You will need to have some healthy teeth on either side of the missing tooth that needs to be replaced.
Once the dentist has determined a dental bridge is the best solution to replace your missing teeth, they will begin by preparing the anchor or abutment teeth. It is an important step as abutment teeth provide anchorage and support for dental crowns. The entire process is performed under local anesthesia so that you don’t feel any pain or discomfort.
During the second appointment, the dentist will set the bridge into place. It may feel bulky or heavy initially, but this feeling will subside as you get used to it. The dentist will call you for a follow-up exam to check the condition of your newly installed dental bridge and make any adjustments, if needed, to ensure it continues to function right.
Here are some important things you should know before considering dental bridges to replace one or more missing teeth.
1. Cleaning and Care
Follow your dentist’s instructions regarding cleaning and caring for your dental bridge. Use a soft-bristled toothbrush for two minutes every day to prevent gum disease and tooth decay. Flossing is also very necessary to prevent dental issues.
When flossing with a bridge, make sure to floss around the natural teeth, in addition to moving the floss between the base of the bridge and the gum tissue to remove food debris and avoid the accumulation of plaque and tartar. You can also use an interdental brush and water flosser, for more effective cleaning and maintain healthy, clean teeth for years.
2. Costs and Insurance Coverage
Getting a dental bridge is not only easy but also a very affordable option for replacing missing teeth. The best thing is that most dental insurance providers cover their costs, which means you can look forward to getting a healthy, beautiful smile without worrying about costs. On average, a dental bridge may cost between $500 to $1,200 per tooth, depending on the dental clinic you visit or the city you live in.
Your dentist will guide you regarding the costs and the dental insurance they accept.
3. Dental Bridges Are Not a Permanent Solution
While they may seem to be a long-term solution and even last for decades if cared for the right way, dental bridges are not a permanent solution. You can keep the dental bridge intact by avoiding chewing gum, hard foods like nuts, ice, and hard candies, and maintaining excellent oral hygiene.
Regular visits to your dentist can help to keep your bridge in good shape and detect if anything is not right. Remember, they may last for years, but they will not last forever. Talk to your dentist if you are looking for a more permanent solution for your missing tooth.
4. There Are Other Options for Replacing Missing Teeth
If you are searching for a more permanent way to replacing your missing teeth, dental implants are a good option. With fewer limitations and plenty of benefits, implants can last for a lifetime and look and function just like a natural tooth.
The best thing about getting an implant is that it places less burden on the surrounding teeth while promoting bone structure and gum health. High-quality implants are not only more aesthetically pleasing but also last forever.
5. They Do Not Prevent Gum and Bone Loss
If you are missing one or more teeth, the bone, and tissue that once supported that tooth is no longer stimulated, and it slowly begins to degrade. As the dental bridge is not connected to the bone and tissue like a natural tooth, it can lead to gum and bone loss in the long run.
Benefits of Dental Bridges
Tooth loss can have a significant impact on your overall oral health and not just your gums. Not only do you lose gum tissue, but the jaw bone also begins to weaken around the area where your tooth used to be. It can cause the teeth to shift in the mouth, moving into the space.
A dental bridge gives you a chance to eat better, look good, and smile more confidently by restoring the missing tooth with a natural-looking artificial tooth. It fills the space in your mouth and prevents the sunk-in facial appearance that usually occurs with missing teeth. It also improves speech, which often worsens due to gaps in the mouth.
Modern dentistry offers the best solutions to replace your missing teeth and gives you a chance to restore the look and function of your teeth with a dental bridge. Whether you need to replace a dental bridge or are considering getting a new one, Dr. Ella Dekhtyar offers the best guidance. Call Broadway Family Dental and schedule an appointment with our board-certified dentist and expert dental team to find out which option will work best for replacing the missing teeth in your mouth and restoring your smile most effectively. Dr. Dekhtyar discusses all treatment options and ensures you understand how dental bridges work and what you can do to enjoy long-term oral health with them.
Page Updated on Apr 9, 2024 by Dr. Dekhtyar (Dentist) of Broadway Family Dental
Broadway Family Dental
1152 Broadway
Brooklyn, NY 11221
(Bushwick, Williamsburg, Bedford-Stuyvesant)
(718) 455-4400
© 2024 Broadway Family Dental, Website & SEO by NYMM
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Intramyocardial transplantation of human adipose-derived stromal cell and endothelial progenitor cell mixture was not superior to individual cell type transplantation in improving left ventricular function in rats with myocardial infarction
Soon Jun Hong, John Kihlken, Seung Cheol Choi, Keith L. March, Do Sun Lim
Research output: Contribution to journalArticlepeer-review
17 Citations (Scopus)
Abstract
Background: Both adipose-derived stromal cells (ASCs) and endothelial progenitor cells (EPCs) have high potential for promoting tissue revascularization and functional recovery in acute myocardial infarction (AMI) models. We investigated the functional effects of intramyocardial transplantation of a human ASC and EPC mixture in immunodeficient rats after MI. Methods: MI was induced by ligating left anterior descending coronary artery. Survived rats were randomly assigned to 1 of 4 different groups: the control group (n = 10, saline in 100 μL), the ASC group (n = 10, 106 ASCs), the EPC group (n = 10, 106 EPCs), or the ASC + EPC group (n = 10, 2 × 105 ASCs + 8 × 105 EPCs). Left ventricular (LV) function was compared using echocardiography during the 28-day follow-up. GAP43+ nerve sprouting and smooth muscle α-actin + angiogenesis were also compared. Results: Serial changes in LV ejection fraction (EF) and fractional shortening revealed significant increases in the ASC, EPC, and ASC + EPC groups when compared to the control group during the follow-up (49 ± 3%, 49 ± 4%, 47 ± 4%, 39 ± 2%, P < 0.001, respectively for LVEF) (33 ± 4%, 32 ± 2%, 31 ± 2%, 23 ± 2%, P = 0.002, respectively for fractional shortening). The number of α-actin + arterioles and GAP43+ nerve area was significantly greater in the ASC, EPC, and ASC + EPC groups when compared to the control group in the peri-infarct area (34.4 ± 1.0/mm2, 35.9 ± 1.1/mm2, 35.3 ± 0.9/mm2, 17.4 ± 0.7/mm2, P < 0.001, respectively for angiogenesis) (346.2 ± 10.7 μm2/mm 2, 357.2 ± 12.8 μm2/mm2, 368.0 ± 9.7 μm2/mm2, 174.6 ± 7.9 μm 2/mm2, P < 0.001, respectively for nerve sprouting). Conlusions: Intramyocardial injections of ASCs, EPCs, or ASCs + EPCs are effective modalities for the treatment of myocardial damage in rats and may expand the potential clinical application of ASC or EPC therapy in patients with ischemic heart disease.
Original languageEnglish
Pages (from-to)205-211
Number of pages7
JournalInternational Journal of Cardiology
Volume164
Issue number2
DOIs
Publication statusPublished - 2013 Apr 5
Externally publishedYes
Keywords
• Adipose
• Angiogenesis
• Endothelial progenitor cell
• Myocardial infarction
• Stem cell
ASJC Scopus subject areas
• Cardiology and Cardiovascular Medicine
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Front. Oncol. Frontiers in Oncology Front. Oncol. 2234-943X Frontiers Media S.A. 10.3389/fonc.2019.01362 Oncology Systematic Review Apparent Diffusion Coefficient for Distinguishing Between Malignant and Benign Lesions in the Head and Neck Region: A Systematic Review and Meta-Analysis Surov Alexey 1 * Meyer Hans Jonas 1 Wienke Andreas 2 1Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany 2Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
Edited by: Johannes Kaanders, Radboud University Nijmegen Medical Centre, Netherlands
Reviewed by: Kerem Ozturk, University of Minnesota Twin Cities, United States; Philip Touska, Guy's and St Thomas' NHS Foundation Trust, United Kingdom
*Correspondence: Alexey Surov [email protected]
This article was submitted to Head and Neck Cancer, a section of the journal Frontiers in Oncology
†These authors have contributed equally to this work
08 01 2020 2019 9 1362 30 07 2019 18 11 2019 Copyright © 2020 Surov, Meyer and Wienke. 2020 Surov, Meyer and Wienke
This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
Background: The purpose of the present meta-analysis was to provide evident data about use of apparent diffusion coefficient (ADC) values for distinguishing malignant and benign lesions in the head and neck region.
Material and Methods: MEDLINE and Scopus databases were screened for associations between ADC and malignancy/benignancy of head and neck lesions up to December 2018. Overall, 22 studies met the inclusion criteria. The following data were extracted: authors, year of publication, study design, number of patients/lesions, lesion type, mean value, and standard deviation of ADC. The primary endpoint of the systematic review was the analysis of the association between lesion nature and ADC values. The methodological quality of the involved studies was checked according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument. The meta-analysis was undertaken by using RevMan 5.3 software. DerSimonian and Laird random-effects models with inverse-variance weights were used without further correction to account for the heterogeneity between the studies. Mean ADC values including 95% confidence intervals were calculated separately for benign and malignant lesions.
Results: The acquired 22 studies comprised 1,227 lesions. Different malignant lesions were diagnosed in 818 cases (66.7%) and benign lesions in 409 cases (33.3%). The mean ADC value of the malignant lesions was 1.04 × 10−3 mm2/s, and the mean value of the benign lesions was 1.46 × 10−3 mm2/s. Lymphomas and sarcomas showed the lowest calculated mean ADC values, 0.7 and 0.79 × 10−3 mm2/s, respectively. Adenoid cystic carcinomas had the highest ADC values (1.5 × 10−3 mm2/s). None of the analyzed malignant tumors had mean ADC values above 1.75 × 10−3 mm2/s.
Conclusion: ADC values play a limited role in distinguishing between malignant and benign lesions in the head and neck region. It may be only suggested that lesions with mean ADC values above 1.75 × 10−3 mm2/s are probably benign. Further large studies are needed for the analysis of the role of diffusion-weighted imaging (DWI)/ADC in the discrimination of benign and malignant lesions in the head and neck region.
head and neck tumors apparent diffusion coefficient ADC magnetic resonance imaging MRI
Introduction
Diffusion-weighted imaging (DWI) is a magnetic resonance imaging (MRI) technique based on measure of water diffusion in tissues (1). Restriction of water diffusion can be quantified by apparent diffusion coefficient (ADC) (1). Numerous studies have reported that DWI/ADC can provide information regarding histological architecture of tissues. According to the literature, ADC is associated with several histopathological features, such as cell count and expression of proliferation markers (2, 3). So it has been shown that ADC correlated well with expression of Ki67 in head and neck squamous cell carcinoma (4, 5). Furthermore, ADC can predict other important histopathological features, such as expression of vascular endothelial growth factor, tumor suppressor protein p53, hypoxia-inducible factor (HIF)-1α, CD3-positive cell count, and human papilloma virus (p16) (57).
In clinical setting, however, a key question is whether DWI/ADC can be used for distinguishing between malignant and benign lesions. Overall, it is well-known that malignant tumors have lower ADC values than have benign lesions. However, the physician needs plausible threshold values in his or her daily practice. Previously, some reports analyzed the diagnostic potential of DWI in the head and neck region (HNR). However, most reported studies investigated relatively small samples of up to 100 patients/lesions, and, therefore, the provided data cannot be applied as evident. Furthermore, the reported studies provided a broad spectrum of ADC threshold values. For example, Wang et al., based on an analysis of 97 different head and neck lesions, proposed a diagnostic scale of ADC values to predict malignancy in HNR (8). It has been shown that ADC values ≤0.65 × 10−3 mm2/s had a positive predictive value of malignancy of 100% and that ADC values ≤1.01 × 10−3 mm2/s had a positive predictive value of malignancy of 90% (8). In the study of Das et al. investigating 79 sinonasal masses, a cutoff ADC value of 1.791 × 10−3 mm2/s was identified to differentiate malignant and benign lesions with a sensitivity of 80% and specificity of 83.3% (9). Finally, Li et al. studied 78 patients with lingual lesions and calculated a threshold ADC value of <1.31 × 10−3 mm2/s (sensitivity, 92.6%; specificity, 97.3%) (10).
The aim of the present meta-analysis was to provide data regarding use of ADC for distinguishing malignant and benign lesions in the HNR based on a large sample.
Materials and Methods Data Acquisition and Proving
MEDLINE and Scopus databases were screened for associations between ADC and malignancy/benignancy of head and neck lesions up to December 2018 (Figure 1). The search terms/combinations were as follows:
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flowchart of the data acquisition.
“DWI or diffusion weighted imaging or diffusion-weighted imaging or ADC or apparent diffusion coefficient or DWI or diffusion weighted imaging AND head and neck OR neck carcinoma OR neck cancer OR neck neoplasm OR neck tumor.” Secondary references were also manually checked. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was used for the research (11).
The primary endpoint of the systematic review was the analysis of association between the nature of head and neck lesions and their ADC values. The primary search identified 239 records. The abstracts of the items were checked. Inclusion criteria for this work were as follows:
- data regarding ADC derived from DWI,
- available mean and standard deviation values of ADC,
- original studies that investigated humans, and
- written in English.
Overall, 22 studies meet the inclusion criteria (9, 10, 1231). Other 217 records were excluded from the analysis. Exclusion criteria were as follows:
- studies unrelated to the research subjects,
- studies with incomplete data,
- not written in English,
- duplicate publications,
- experimental animal and in vitro studies, and
- review, meta-analysis, and case report articles.
On the next step, the following data were extracted from the literature: authors, year of publication, study design, number of patients/tumors, tumor/lesion type, and mean value and standard deviation of ADC.
Meta-Analysis
The methodological quality of the identified 22 studies was checked according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) instrument (32) independently by two observers (A.S. and H.J.M.) (Figure 2).
Quality assessment of diagnostic accuracy studies (QUADAS)-2 quality assessment of the included studies.
The meta-analysis was undertaken by using RevMan (RevMan 2014, the Cochrane Collaboration Review Manager Version 5.3). Heterogeneity was calculated by means of the inconsistency index I2 (33, 34). DerSimonian and Laird random-effects models with inverse-variance weights were used without corrections (35). Mean ADC values including 95% confidence intervals were calculated separately for benign and malignant lesions.
Results
Of the included 22 studies, 14 (64%) were retrospective, and 8 (36%) prospective. Overall, these studies comprised 1,227 lesions. Different malignancies of the HNR were diagnosed in 818 cases (66.7%) and benign lesions in 409 cases (33.3%) (Table 1). The mean ADC values of the malignant lesions ranged from 0.75 to 1.35 × 10−3 mm2/s, and the calculated mean value was 1.04 × 10−3 mm2/s (Figure 3).
Malignant tumors and benign lesions involved in the analysis.
Malignant tumors n (%)
Squamous cell carcinoma 485 (59.3)
Lymphoma 87 (10.6)
Adenoid cystic carcinoma 40 (4.9)
Rhabdomyosarcoma 23 (2.8)
Malignant melanoma 23 (2.8)
Undifferentiated carcinoma 22 (2.7)
Olfactory neuroblastoma 22 (2.7)
Mucoepidermoid carcinoma 15 (1.8)
Adenocarcinoma 12 (1.5)
Unclassified sarcoma 10 (1.2)
Inverted papilloma with malignant transformation 10 (1.2)
Metastasis 7 (0.9)
Lymphoepithelial carcinoma 6 (0.7)
Malignant pleomorphic carcinoma 6 (0.7)
Plasmacytoma 5 (0.6)
Carcinoma ex pleomorphic adenoma 5 (0.6)
Osteosarcoma 4 (0.5)
Ewing's sarcoma 4 (0.5)
Acinic cell carcinoma 4 (0.5)
Chondrosarcoma 3 (0.4)
Sinonasal neuroendocrine carcinoma 3 (0.4)
Primitive neuroectodermal tumor 2 (0.2)
Salivary duct carcinoma 2 (0.2)
Malignant fibrous histiocytoma 2 (0.2)
Spindle cell sarcoma 2 (0.2)
Epi-myo-epi carcinoma 1 (0.1)
Myoepithelial carcinoma 1 (0.1)
Low-grade myxoid sarcoma 1 (0.1)
Myxoid liposarcoma 1 (0.1)
Malignant peripheral nerve sheath tumor 1 (0.1)
Adenosquamous cell carcinoma 1 (0.1)
Esthesioneuroblastoma 1 (0.1)
Transitional carcinoma 1 (0.1)
Papillary cystadenocarcinoma 1 (0.1)
Trichilemmal carcinoma 1 (0.1)
Leiomyosarcoma 1 (0.1)
Malignant hemangiopericytoma 1 (0.1)
Esthesioneuroblastoma 1 (0.1)
Transitional carcinoma 1 (0.1)
Total 818 (100)
Nonmalignant lesions n (%)
Pleomorphic adenoma 72 (17.6)
Inverted papilloma 63 (15.4)
Warthin's tumor 53 (13.0)
Inflammatory polyp 35 (8.6)
Juvenile nasopharyngeal angiofibroma 23 (5.6)
Vascular malformation 18 (4.4)
Precancerous laryngeal lesion 17 (4.2)
Cyst 12 (2.9)
Hemangioma 12 (2.9)
Acute rhinosinusitis 12 (2.9)
Schwannoma 12 (2.9)
Paraganglioma 10 (2.4)
Acute invasive fungal sinusitis 8 (2.0)
Basal cell adenoma 6 (1.5)
Ossifying fibroma 5 (1.2)
Organized hematoma 5 (1.2)
Meningioma 4 (1.0)
Fibroangioma 4 (1.0)
Chronic sinusitis 4 (1.0)
Chronic fungal sinusitis 4 (1.0)
Oncocytoma 3 (0.7)
Aneurysmal bone cyst 3 (0.7)
Spindle cell tumor 3 (0.7)
Lipomatous hemangiopericytoma 3 (0.7)
Neurofibroma 2 (0.5)
Benign ameloblastoma 2 (0.5)
Glomus jugulare 2 (0.5)
Myoepithelioma 2 (0.5)
Fibrous tumor of bone 2 (0.5)
Fibrous dysplasia 1 (0.2)
Sarcoidosis 1 (0.2)
Mucocele 1 (0.2)
Mesenchymal proliferation 1 (0.2)
Sphenoid pituitary adenoma 1 (0.2)
Hamartoma 1 (0.2)
Lingual thyroid 1 (0.2)
Enamel cell tumor 1 (0.2)
Total 409 (100)
Forrest plots of apparent diffusion coefficient (ADC) values of benign lesions of the head and neck region.
The calculated mean value of the benign lesions was 1.46 × 10−3 mm2/s, and the range of the collected ADC values was 0.61–1.95 × 10−3 mm2/s (Figure 4). The graphical distribution of ADC values in malignant and benign lesions is shown in Figure 5. The ADC values overlapped significantly.
Forrest plots of apparent diffusion coefficient (ADC) values of malignant tumors of the head and neck region.
Comparison of apparent diffusion coefficient (ADC) values between malignant and benign lesions.
Furthermore, the reported mean ADC values of different malignant lesions were analyzed (Figure 6). Lymphomas and sarcomas showed the lowest calculated mean ADC values of 0.7 and 0.79 × 10−3 mm2/s, respectively. Adenoid cystic carcinomas had the highest ADC values (1.5 × 10−3 mm2/s). The calculated mean ADC values of squamous cell carcinomas and neuroblastomas were 1.09 and 1.02 × 10−3 mm2/s, respectively. None of the analyzed malignant tumors had mean ADC values above 1.75 × 10−3 mm2/s.
Comparison of apparent diffusion coefficient (ADC) values between different malignant lesions.
Discussion
Our analysis showed that both malignant and benign lesions in HNR presented with a broad spectrum of ADC values. Although malignant tumors had lower ADC values than had benign lesions, the reported ADC values overlapped significantly. This fact made it impossible to define a reliable threshold for distinguishing malignant and benign lesion in HNR. Furthermore, our finding can explain contradictory results of the previous studies. It is well-known that some benign head/neck lesions, such as cholesteatomas and adenoid hypertrophy, show very low ADC values (36, 37), and some tumors like adenoid cystic carcinomas have high ADC values (8, 9). Presumably, studies with different malignant and/or benign lesions of HNR may have different threshold ADC values. This fact is very important. Therefore, analyses of ADC values between malignant and benign HNR lesions should include all possible entities.
We included all published ADC values of different HNR lesions into the present analysis without selection bias. To the best of our knowledge, our analysis comprises the largest cohort to date. We could not find thresholds in the lower areas of ADC values because malignant and benign lesions overlapped significantly. However, the reported ADC values of all malignant lesions were under 1.75 × 10−3 mm2/s. Therefore, it may be postulated that lesions with mean ADC values above 1.75 × 10−3 mm2/s are probably benign. Our results also demonstrated that no real thresholds can be found in the area with <1.75 × 10−3 mm2/s for the discrimination of malignant and benign lesions. Furthermore, the present analysis showed that lymphomas and sarcomas had the lowest mean ADC values and that adenoid cystic carcinomas had the highest ADC values. This finding is in agreement with that of previous reports (8, 38).
Overall, the present analysis showed that DWI/ADC alone cannot be used as an imaging biomarker of malignancy in the HNR. However, it is known that areas of high cellularity and high proliferation potentially have lower ADC values than have areas of low cellularity, independent of lesion nature (2, 3). Furthermore, numerous previous reports mentioned that necrotic tumor areas show lower ADC values than do solid parts. Therefore, areas of low ADC values may be used as an additional target for biopsies.
Our analysis contains some limitations. Firstly, it is based only on results written in English. Secondly, it analyzed DWI technique using 2 b values. However, more advanced imaging techniques, like intravoxel incoherent motion imaging and diffusion kurtosis imaging, which might show a better accuracy in discriminating benign from malignant tumors, were not included in the analysis. Thirdly, we did not analyze a possible influence of some technical details, such as sequence type, choice of b values, and Tesla strength. The following aspect should also be addressed: Previously, some authors indicated that ADC values depended significantly on ADC measurements (39, 40). It has been shown that different drawing methods, for example, whole tumor measurements, choice of multiple regions of interest, and/or single region measure, can influence ADC values (39, 40). Therefore, different ADC measurements should be also considered as an important factor. However, a recent large meta-analysis showed that relationships of ADC values between malignant and benign breast lesions were independent of MR technique and measurements (41).
Overall, our analysis is based on heterogenous and predominantly retrospective samples. However, it reflects a real clinical situation in the daily routine.
In conclusion, our analysis showed that ADC values play a limited role in distinguishing between malignant and benign lesions in the HNR.
Lesions with mean ADC values above 1.75 × 10−3 mm2/s are probably benign. Further large studies are needed for the analysis of the role of DWI/ADC in the discrimination of benign and malignant lesions in the HNR.
Author Contributions
All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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(2016) 16:12. 10.1186/s12880-016-0114-326833065 Whiting PF Rutjes AW Westwood ME Mallett S Deeks JJ Reitsma JB . QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med. (2011) 155:52936. 10.7326/0003-4819-155-8-201110180-0000922007046 Leeflang MM Deeks JJ Gatsonis C Bossuyt PM. Systematic reviews of diagnostic test accuracy. Ann Intern Med. (2008) 149:88997. 10.7326/0003-4819-149-12-200812160-0000819075208 Zamora J Abraira V Muriel A Khan K Coomarasamy A. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. (2006) 6:31. 10.1186/1471-2288-6-3116836745 DerSimonian R Laird N. Meta-analysis in clinical trials. Control Clin Trials. (1986) 7:17788. 10.1016/0197-2456(86)90046-23802833 Lingam RK Khatri P Hughes J Singh A. Apparent diffusion coefficients for detection of postoperative middle ear cholesteatoma on non-echo-planar diffusion-weighted images. Radiology. (2013) 269:50410. 10.1148/radiol.1313006523801772 Surov A Ryl I Bartel-Friedrich S Wienke A Kösling S. Diffusion weighted imaging of nasopharyngeal adenoid hypertrophy. Acta Radiol. (2015) 56:58791. 10.1177/028418511453410724855289 Sumi M Ichikawa Y Nakamura T. Diagnostic ability of apparent diffusion coefficients for lymphomas and carcinomas in the pharynx. Eur Radiol. (2007) 17:263137. 10.1007/s00330-007-0588-z17429643 Moreau B Iannessi A Hoog C Beaumont H. How reliable are ADC measurements? A phantom and clinical study of cervical lymph nodes. Eur Radiol. (2018) 28:336271. 10.1007/s00330-017-5265-229476218 Payabvash S. Quantitative diffusion magnetic resonance imaging in head and neck tumors. Q Imaging Med Surg. (2018) 8:105265. 10.21037/qims.2018.10.1430598882 Surov A Meyer HJ Wienke A. Can apparent diffusion coefficient (ADC) distinguish breast cancer from benign breast findings? A meta-analysis based on 13 847 lesions. BMC Cancer. (2019) 19:955. 10.1186/s12885-019-6201-431615463 Abbreviations HNR
head and neck region
MRI
magnetic resonance imaging
ADC
apparent diffusion coefficient.
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f82882fa36bba838252a7e0abc1e88b6
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3,639,588,076,743,260,700
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Title
Dynamic biochemical tissue analysis detects functional selectin ligands on human cancer tissues
Document Type
Article
Publication Date
12-1-2019
Abstract
© 2019, The Author(s). Cell adhesion mediated by selectins (expressed by activated endothelium, activated platelets, and leukocytes) binding to their resepective selectin ligands (expressed by cancer cells) may be involved in metastasis. Therefore, methods of characterizing selectin ligands expressed on human tissue may serve as valuable assays. Presented herein is an innovative method for detecting functional selectin ligands expressed on human tissue that uses a dynamic approach, which allows for control over the force applied to the bonds between the probe and target molecules. This new method of tissue interrogation, known as dynamic biochemical tissue analysis (DBTA), involves the perfusion of molecular probe-coated microspheres over tissues. DBTA using selectin-coated probes is able to detect functional selectin ligands expressed on tissue from multiple cancer types at both primary and metastatic sites.
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COinS
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Atlas of Genetics and Cytogenetics in Oncology and Haematology
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t(14;20)(q32;q12) IGH::MAFB in Plasma Cell Myeloma
Written2018-09Mark A Micale
Department of Pathology and Laboratory Medicine and Department of Obstetrics & Gynecology Beaumont Health and Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073 [email protected]
Abstract Plasma cell myeloma (PCM) is a complex and genetically heterogenous hematological malignancy involving clonal proliferation of plasma cells in bone marrow. It is the third most common hematolymphoid malignancy in the United States and primarily affects elderly people with a median onset age of 69 years and a survival duration ranging from a few months to more than 10 years. Standard karyotype and fluorescence in situ hybridization (FISH) evaluation of bone marrow is required in the initial diagnostic workup to risk stratify patients based on their cytogenetic status. Primary cytogenetic events are classified as either hyperdiploid or non-hyperdiploid. Common in non-hyperdiploid cases is rearrangement of the IGH gene on chromosome 14q32.33, most commonly with the CCND1 gene at 11q13.3, and to a lesser extent FGFR3/MMSET genes at 4p16.3 or the MAF gene at 16q23.2. The rarest of these IGH translocations involves the MAFB gene at 20q12, which is the subject of this review.
Keywords Plasma cell myeloma, Multiple myeloma, MAFB, IGH, APOBEC
(Note : for Links provided by Atlas : click)
Identity
ICD-Topo C420,C421,C424
ICD-Morpho 9732/3 Plasma cell myeloma / Multiple myeloma
Atlas_Id 1313
Clinics and Pathology
Disease Can be found in plasma cell myeloma, monoclonal gammopathy of undetermined significance (MGUS), smoldering myeloma, plasma cell leukemia, and plasmacytoma.
Collectively, the term plasma cell neoplasms include a number of disorders characterized by monoclonal gammopathy. The most common of these disorders, monoclonal gammopathy of undetermined significance (MGUS), is characterized by the infiltration of clonal plasma cells into bone marrow (<10% plasma cells on bone marrow biopsy) and secretion of monoclonal protein (<3g/dl of M protein). This condition is asymptomatic and precedes the development of PCM. The risk of progression is 1% per year and approximately 20% progressing to PCM or a related condition ( AL amyloidosis, Waldenstrom macroglobulinaemia, or a lymphoproliferative disorder) over 25 years. While certain clinical, imaging, and molecular biomarkers have been proposed to risk stratify patients that may require frequent monitoring for progression to overt malignancy, none are presently considered reliable. Important to the diagnosis of MGUS is an absence of evidence of end-organ damage defined by CRAB criteria (hypercalcemia, renal insufficiency, anemia, and/or bone disease with lytic lesions). Some cases of MGUS will pass through an intervening stage known as smoldering myeloma (SM), characterized by higher M-protein values (≥ 3g/dl) and >10% plasma cells on bone marrow biopsy, but without CRAB criteria. The risk for progression to PCM is higher, with 10% per year progressing to PCM in the first five years. 3% per year for the next 5 years, and 1% per year for the subsequent 10 years [Kumar et al, 2017, Cosemans et al, 2018].
A diagnosis of plasma cell myeloma requires detection of a monoclonal protein by serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), or by pathological serum free light chain (sFLC) ratio along with a plasma cell count ≥ 10%. The development of end-organ damage is the indication for treatment. Other possible pathological presentations of a plasma cell neoplasm include a non-secretory myeloma which requires >30% plasma cells, a non-systemic solitary plasmacytoma, or plasma cell leukemia with a peripheral blood plasmacytosis >20% [Rollig et al, 2015].
Phenotype / cell stem origin Post-germinal center, terminally differentiated plasma cell.
Plasma cells develop from hematopoietic stem cells that differentiate first into B-cells, then eventually after several rounds of differentiation into plasma cells. The final differentiation stage of B-cells occurs in bone marrow and involves rearrangement of the immunoglobulin heavy chain gene (IGH), followed by rearrangement of the light chain genes [IG kappa (IGK) and IG lambda [IGL)]. The mature B cell than exits the bone marrow to populate secondary lymphoid organs where it will continue its maturation. Somatic hypermutation occurs within the germinal centers of these secondary lymphoid organs, involving stochastic mutations within the VDJ segment. The final maturation stage involves class switch recombination, resulting in the mature B-cell expressing IgG, IgA, or IgE. The mature B-cell will now either differentiate into a memory B-cell or return to bone marrow as a long-lived plasma cell [Corre et al, 2015].
Etiology The cause of PCM is unknown, but potential environmental and occupational risk factors have been proposed. In addition, genetic risk factors have been elucidated through genome-wide association studies (GWAS) which have identified multiple susceptibility loci, as well as loci associated with inferior survival and with development of drug-induced toxicity (such as bortezomib-induced neuropathy) [Kumar et al, 2017].
Epidemiology PCM accounts for approximately 1.8% of all cancers and a little more than 17% of all hematologic malignancies in the United States. According to the American Cancer Society, an estimated 30,280 new cases will be diagnosed in the United States in 2017, with an estimated 12,590 deaths. The incidence of PCM is 2-3 times higher in African-American individuals compared with Caucasians. The prevalence has increased, likely because of better diagnostic techniques and increased survival as the result of novel therapeutic agents and autologous stem cell transplantation [Kumar et al, 2017].
Approximately 40-50% of myeloma cases demonstrate an IGH gene rearrangement. The t(14;20)(q32;q12) is the rarest of the five most common IGH-rearrangements, found in approximately 1% of cases [Manier et al, 2016].
Pathology After developing a primary genetic abnormality, either hyperdiploidy or an IGH gene rearrangement, plasma cells induce stromal cells to produce numerous cytokines, especially interleukin-6. Plasma cells undergo additional genetic alterations that prevent normal cell differentiation and apoptosis. The end result is the immortalization of a plasma cell clone. Recent DNA sequencing studies have identified two types of clonal evolution in plasma cell myeloma. Genetic heterogeneity appears to be acquired either through linear evolution with acquisition of secondary mutations over time in the original clone or through branching evolution, whereby multiple subclones diverge to produce greater genetic heterogeneity. Such subclones, it is theorized, coexist and compete for space and stromal support within the bone marrow microenvironment. The kinetics of this evolution has important implications for therapy [Coore et al, 2015; Pawlin et al, 2015].
Malignant plasma cells are positive by flow cytometry for CD138 and CD38, negative for CD19, and either positive or negative for CD45 and CD56. Immunohistochemical detection of CD138 (syndecan-1) helps to quantify plasma cell in tissue. Detection of CD56, cyclin-D1, and CD117 are also helpful.
Prognosis Plasma cell myeloma cases with a t(14;20)(q32;q12) have a poorer prognosis; however, paradoxically, identification of the translocation in MGUS or SM may be associated with long-term stable disease [Ross FM et al, 2010]. This suggests that additional molecular events are necessary in those cases that progress to plasma cell myeloma, and that those secondary molecular events specifically associated with the rearrangement may be the factors actually responsible for the negative prognosis. A recent study demonstrated that cases of MGUS or SM that progress to overt myeloma do so through acquisition of mutations in APOBEC (apolipoprotein B mRNA editing catalytic polypeptide-like) cytidine deaminases [Bolli N et al, 2018]. Some myeloma patients are found to have coexistent hyperdiploidy (a good prognostic marker) as well as a high-risk IGH rearrangement such as the t(14;20). Single cell analysis reveals that hyperdiploidy may precede IGH translocation. In such cases, coexistent hyperdiploidy does not change the otherwise poor prognosis associated with the t(14;20) [Pawlyn C et al, 2015].
Cytogenetics
Cytogenetics Morphological The t(14;20)(q32;q12) is the rarest of the five most common translocations in myeloma that involve the IGH gene. It is found in about 1% of all myeloma cases, and in the few cases that have been reported, the translocation has been balanced. Unlike the other relatively uncommon IGH gene translocations t(4;14) and t(14;16) that are often undetectable by conventional cytogenetic analysis of bone marrow (which yields chromosomes of lower resolution and require FISH analysis), the t(14;20) can be observed in metaphase chromosome preparations. However, FISH utilizing an IGH/MAFB dual-color, dual-fusion translocation should still be performed to confirm the translocation, even in those cases which appear to demonstrate the translocation by karyotype.
Partial karyotype demonstrating the t(14;20)(q32;q12). The normal chromosomes 14 and 20 are to the left of the derivative chromosomes.
FISH analysis utilizing a IGH/MAFB dual-color, dual-fusion translocation DNA probe reveals IGH/MAFB rearrangement (identified by a one red, one green, and two fusion signals hybridization pattern) in a patient positive for the t(14;20)(q32;q12).
Genes involved and Proteins
Gene NameIGH (Immunoglobulin Heavy Locus)
Location 14q32.33
Protein This gene encodes a protein which comprises the heavy chain of human immunoglobulins. Immunoglobulins recognize foreign antigens and initiate immune responses. Each immunoglobulin molecule contains two identical heavy chains and two identical light chains.
Gene NameMAFB (v-maf Avian Musculoaponeurotic Fibrosarcoma Oncogene Homologue B)
Location 20q12
Protein This gene is one of the Maf family of transcription factors which includes MAFA, MAFB, MAF, and NRL (neural retina-specific leucine zipper). It consists of a single exon and codes for a protein which is a basic leucine zipper (bZIP) transcription factor that can act as either a transcriptional activator or repressor. It plays an important role in the regulation of lineage-specific hematopoiesis as well as in development.
Result of the chromosomal anomaly
Fusion Protein
Oncogenesis The t(14;20)(q32;q12) results in upregulation of expression of the MAF paralogue MAFB. Gene expression studies have revealed that MAFB overexpression produces an expression profile similar to that observed in MAF overexpression, suggesting similar downstream targets [Zhan et al, 2006]. Using an inducible system to upregulate MAFB in multiple myeloma cell lines, fourteen upregulated genes were identified, including CCND1, CCND2, and NOTCH2. The same upregulated genes are, in fact, targets of the entire MAF group of transcription factors, suggesting similar pathogenic molecular mechanisms in both MAF and MAFB dysregulated myelomas [van Stralen et al, 2009].
Myeloma cases with either of the two poor prognosis translocations, t(14;16) (q32;q23) and t(14;20)(q32;q12) associated with MAF or MAFB gene dysregulation, respectively, have been shown to have a higher mutational burden than other cytogenetic groups of myeloma and to have an APOBEC gene signature resulting in overexpression of APOBEC3Aand APOBEC3B genes. ENCODE data demonstrates a maf transcription factor binding site in the promoter regions of both genes, providing the link between MAF or MAFB dysregulation and increased tumor load [Walker BA et al, 2015]. The t(14;16) and t(14;20) are known to be associated with long-term stable disease in MGUS and SM despite their poor prognostic indication in plasma cell myeloma. This raised the possibility that the APOBEC signature is acquired at a later stage in the disease, and only at that time does the condition transform to plasma cell myeloma. A very recent study has proven that APOBEC activity does, in fact, increase with disease progression from MGUS or SM to overt PCM [Bolli N et al, 2018].
Finally, genome-scale methylation profiling studies have shown that the MAFB protein establishes an epigenetic program in hematopoietic stem/progenitor cells which can reset the genome of such cells to a terminally differentiated tumor state [Vicente-Dueñas et al, 2012].
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Citation
This paper should be referenced as such :
Mark A Micale
t(14;20)(q32;q12) IGH/MAFB in Plasma Cell Myeloma
Atlas Genet Cytogenet Oncol Haematol. 2019;23(8):230-233.
Free journal version : [ pdf ] [ DOI ]
On line version : http://AtlasGeneticsOncology.org/Anomalies/t1420q32q12IGHMAFBID1313.html
Other genes implicated (Data extracted from papers in the Atlas) [ 1 ]
Genes MAFB
Translocations implicated (Data extracted from papers in the Atlas)
t(14;20)(q32;q12) IGH/MAFB
External links
Mitelman databaset(14;20)(q32;q12)
arrayMap (UZH-SIB Zurich)Morph ( 9732/3) - [auto + random 100 samples .. if exist ] [tabulated segments]
REVIEW articlesautomatic search in PubMed
Last year articlesautomatic search in PubMed
All articlesautomatic search in PubMed
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Brain Res. 1982 Jul;256(3):293-302.
Neocortical histogenesis in normal and reeler mice: a developmental study based upon [3H]thymidine autoradiography.
Abstract
The relative positions of the principal neuronal classes of neocortex are inverted in the reeler mutant mouse. Neurons formed at 48-hourly intervals throughout the period of neocortical cytogenesis between E11 and E17 are labeled by [3H]thymidine. The positions of the labeled cells during and subsequent to their migrations are traced by autoradiography. Simultaneously-formed cohorts reach the neocortex at the same time in normal and reeler animals. After E13, subsequent to the appearance of the cortical plate, cohorts of migrating cells in the normal animal ascend to the interface of the cortical plate and marginal layer where they come to rest in a narrow laminar zone. In reeler, by contrast, migration is arrested in the depths of the cortex. The migrating cell appears unable to ascend through the zone occupied by the preceding cohorts. At the completion of migration neurons of both genotypes become fixed in position and undergo little subsequent shift in their relative positions in the course of future cortical growth. Despite the anomaly of migrations and the post-migratory positions of neurons in reeler, cohorts of cells formed at the same time in the two genotypes give rise to the same neuronal classes.
PMID:
7104762
DOI:
10.1016/0165-3806(82)90141-9
[Indexed for MEDLINE]
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Patents
1. Advanced Patent Search
Publication numberUS5355889 A
Publication typeGrant
Application numberUS 07/895,669
Publication dateOct 18, 1994
Filing dateJun 9, 1992
Priority dateJun 9, 1992
Fee statusLapsed
Publication number07895669, 895669, US 5355889 A, US 5355889A, US-A-5355889, US5355889 A, US5355889A
InventorsIgal Nevo, Allon Guez
Original AssigneeAlbert Eisenstein Health Care Foundation
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Monitoring system for producing patient status indicator
US 5355889 A
Abstract
Patient monitoring methods comprising the steps of measuring a plurality of medical parameters, transforming each medical parameter to a function indicative of at least normal and critical levels of the parameter, comparing each function to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level, selecting one of the danger levels as a vital function status (VFS) indicator, and displaying the VFS indicator. Each parameter is transformed to a sigmoid function in accordance with pre-selected maximum and minimum values and a pre-selected baseline value adapted to the patient being monitored. A maximum value of the danger levels is selected as the VFS indicator. The VFS indicator will be such that any physician can have, without any previous knowledge of the patient, a reasonably good idea as to the condition of the patient.
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Claims(17)
What is claimed is:
1. A patient monitoring method, comprising the steps of:
(a) measuring a plurality of medical parameters;
(b) transforming each medical parameter to a sigmoid function indicative of at least normal and critical levels of the parameter;
(c) comparing each of said functions to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level;
(d) selecting one of said danger levels as a vital function status (VFS) indicator; and
(e) displaying said VFS indicator.
2. The method of claim 1, wherein each parameter is transformed to a sigmoid function in accordance with pre-selected maximum and minimum values and a pre-selected baseline value adapted to the patient being monitored.
3. The method of claim 2, wherein a maximum value of said danger levels is selected as said VFS indicator.
4. The method of claim 2, comprising the step of simultaneously displaying a history of said VFS indicator over a predefined short time span and over a predefined long time span.
5. The method of claim 1, wherein a maximum value of said danger levels is selected as said VFS indicator.
6. The method of claim 1, comprising the step of simultaneously displaying a history of said VFS indicator over a predefined short time span and over a predefined long time span.
7. A patient monitoring method as recited in claim 1, wherein said transforming employs an equation from the following group: ##EQU7## wherein x represents the measured value of the medical parameter; BL represents the baseline value for the medical parameter; xmax represents a predefined maximum value of the medical parameter; a, b, and w represent predefined numbers; and y represents the value of the function, and Ym represents a predefined maximum value of the function.
8. A patient monitoring system, comprising:
(a) a plurality of medical monitors operative to measure a plurality of medical parameters of a patient, each said medical parameter having a predefined baseline or homeostatic value;
(b) means for transforming each medical parameter to a function indicative of at least normal and critical levels of the parameter;
(c) means for comparing each of said functions to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level;
(d) means for selecting one of said danger levels as a vital function status (VFS) indicator; and
(e) means for displaying said VFS indicator;
wherein said means for transforming employs a member of the following group:
a sigmoid function. ##EQU8## wherein x represents the measured value of the medical parameter; BL represents the baseline value for the medical parameter; xmax represents a predefined maximum value of the medical parameter; a, b, and w represent predefined numbers; and y represents the value of the function, and ym represents a predefined maximum value of the function.
9. The system of claim 8, comprising means for transforming each parameter to a sigmoid function in accordance with pre-selected maximum and minimum values and a pre-selected baseline value adapted to the patient being monitored.
10. The system of claim 9, comprising means for selecting a maximum value of said danger levels as said VFS indicator.
11. The system of claim 9, comprising means for simultaneously displaying a history of said VFS indicator over a predefined short time span and over a predefined long time span.
12. The system of claim 8, comprising means for selecting a maximum value of said danger levels as said VFS indicator.
13. The system of claim 8, comprising means for simultaneously displaying a history of said VFS indicator over a predefined short time span and over a predefined long time span.
14. A medical monitoring system, comprising:
(a) a plurality of medical monitors, each monitor including means for measuring a medical parameter indicative of a condition of a patient being monitored, each medical parameter having a baseline value;
(b) a computer operatively coupled to said medical monitors, said computer being programmed to determine for each medical parameter a corresponding danger level and to select one of said danger levels as a vital function status (VFS) indicator; wherein, in determining said danger levels, each medical parameter is transformed to a function defined by pre-selected maximum and minimum parameter values and a pre-selected baseline value, said function exhibiting a maximum sensitivity for parameter values near said baseline; and
(c) means for simultaneously displaying a history of said VFS indicator over a predefined short time span and over a predefined long time span;
wherein said computer is programmed to transform said medical parameters by employing a member of the following group:
a sigmoid function. ##EQU9## wherein x represents the measured value of the medical parameter; BL represents the baseline value for the medical parameter; xmax represents a predefined maximum value of the medical parameter; a, b, and w represent predefined numbers; and y represents the value of the function, and ym represents a predefined maximum value of the function.
15. The system of claim 14, wherein said computer is programmed to transform each medical parameter to a sigmoid function and to assign a danger level to each parameter by comparing the respective values of the sigmoid functions to a prescribed set of reference values and assigning said danger levels on the basis of the comparison.
16. The system of claim 15, wherein said danger levels are assigned in accordance with the following table:
______________________________________Transformed Values Danger Level______________________________________0.42-0.5, 0.5-0.58 00.34-0.42, 0.58-0.66 10.26-0.34, 0.66-0.74 20.18-0.26, 0.74-0.82 30.1-0.18, 0.82-0.9 40-.1, .9-1.0 5______________________________________
17. A patient monitoring method, comprising the steps of:
(a) measuring a plurality of medical parameters of a patient;
(b) transforming each medical parameter to a function indicative of at least normal and critical levels of the parameter, wherein said functions have common maximum and minimum values, wherein each said function is defined by a pre-selected baseline value adapted to said patient, and wherein each said function exhibits a maximum sensitivity or slope for parameter values near said baseline;
(c) comparing each of said functions to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level;
(d) selecting one of said danger levels as a vital function status (VFS) indicator; and
(e) displaying said VFS indicator;
wherein said transforming employs a member of the following group:
a sigmoid function ##EQU10## wherein x represents the measured value of the medical parameter; BL represents the baseline value for the medical parameter; xmax represents a predefined maximum value of the medical parameter; a, b, and w represent predefined numbers; and y represents the value of the function, and ym represents a predefined maximum value of the function.
Description
FIELD OF THE INVENTION
The present invention generally relates to the field of medical monitoring and more particularly relates to methods and apparatus for monitoring a patient undergoing surgery or intensive care and providing in real time a single parameter reflecting the overall condition of the patient. The present invention may be advantageously employed in a system such as one of the type disclosed in "A New Patient's Status Indicator To Facilitate Decision Making In Anesthesia," I. Nevo et al , IEEE Computer-Medical Systems, Proceedings of Fourth Annual IEEE Symposium, pp. 88-93, May 12-14, 1991, which is incorporated by reference into this specification.
BACKGROUND OF THE INVENTION
Medical monitoring systems have greatly improved over the past thirty years. There is, however, much room for improvement, particularly in the manner in which the medical data is presented to the physician. For example, it has been estimated that in the United States between 2,000 and 10,000 patients die every year from causes related to anesthesia, a field in which the present invention is especially useful. Anesthesia-related accidents are typically caused by human error, equipment failure, surgical events, or unexpected alterations in the patient's homeostasis. It is believed that many accidents could be avoided by transforming, in real time, the plethora of information provided to the physician into a more manageable tool for assisting the physician in making a diagnosis of the patient's current condition.
Although equipment failure still causes some accidents, the greatest number of anesthesia-related accidents can be attributed to human error. The process of selecting the correct treatment is performed by the physician under stress, under high mental load and in conditions of uncertainty. Inexperience and fatigue can further undermine the physician's performance. Moreover, the variable and idiosyncratic nature of the patient's physiology contributes substantially to the complexity of the environment. It has been concluded that monitors need to be observed at least every thirty seconds in order for critical events to be detected at an early stage. The physician must divide his or her attention among treating the patient, observing the scattered and intermittent data and monitoring the surgical field. This can cause a delay in the detection and treatment of dangerous conditions.
More than thirty different physiological parameters (e.g., heart rate, blood pressure, cardiac output) are typically measured in the operating room or intensive care unit (ICU) by a number of medical monitors. The medical monitors currently in use are prone to generate false alarms, reducing the physician's responsiveness. A further problem with such monitors is that the data is presented in a confusing manner, i.e., many disparate parameters are displayed in various locations around the physician. Newer monitoring systems integrate the functions of several monitors in one unit, however these provide a congested, confused display. In addition, these monitors have a limited signal processing capability, so their display, which is of short duration, is presented after a time delay.
The dynamic nature of the operating room or ICU environment underscores the need for a system for rapidly presenting useful and comprehensible information to the physician, and quick reaction by the physician, to prevent undesired consequences to the patient. In addition, the physician should be able to identify the primary effector whenever there is a change in the patient's status. This is because knowledge of the primary effector, or the first physiological parameter that varies from its baseline (homeostatic) state, may reveal the patient's true problem. An inability to rapidly detect which physiological parameter first varies from its baseline state may prevent the optimal, causal directed, treatment from being provided.
The aforementioned paper outlines a system that overcomes some of the above-described shortcomings of known medical monitoring systems. Referring to FIG. 1, this system comprises a variety of sensors 10 adapted to be attached to a patient being monitored, a plurality of medical monitors 12 for measuring a plurality of medical parameters indicative of the condition of the patient, a data acquisition module 14, a feature extracting module 16, a vital function unit (VFU) 18, a reference value unit 20, an adaptive inference unit (AIU) 22, and a display 24. The medical monitors 12 are interfaced with the vital function unit 18 by the data acquisition module 14 and feature extraction module 16. The data acquisition module 14 runs as a separate background module that collects and transfers the data to the feature extraction module 16. The feature extraction module 16 extracts relevant features (maximum value, minimum value, etc.) from all input values (heart rate, blood pressure, etc.). All of the collected data is transferred to the AIU 22 and VFU 18. One embodiment of this system has been developed on a 386/33 Mhz platform equipped with an 80387 mathematical co-processor.
The vital function unit 18 is the subsystem that has been developed to facilitate the early identification of the patient's physiological changes. The operation of the VFU 18 is based on the fundamental concept of homeostasis. Under this concept, the patient is regarded as an aggregate of interdependent subsystems (cardiovascular, respiratory, etc.) that interact with each other. It is recognized that a malfunction of one subsystem may cause another subsystem to malfunction as well, and that yet another subsystem may react so as to complicate or mask these malfunctions. The physician is presented a set of physiological parameters (data) that have departed from their baseline values.
The physician usually first attempts to evaluate the severity of the patient's status and to determine whether the patient's condition has improved or deteriorated and to what extent and at what speed any changes have occurred. The assessment of severity should not be confused with the diagnosis, which is the next step and requires more time. All of the parameters are equally important in detecting changes in the patient's condition. In assessing the severity of the patient's status, the direction of deviation of a specific parameter is relatively unimportant; however, the extent and rate of change are important. The direction of deviation is more meaningful in making the correct diagnosis, while the extent and rate of, change are less important.
The primary task of the VFU 18 is to produce a new indicator, the vital function status (VFS) indicator. Another task of the VFU is to identify the first parameter that deviated from its baseline state. The measured and the calculated values of all the physiological parameters are compared to reference values stored in the reference value unit 20. The values in the reference value unit 20 may be pre-implemented in the system, with different values being assigned in accordance with the patient's age and/or specific problems (for example, hypertension). The physician is able to select specific reference values for each parameter. In other words, the system will utilize for blood pressure the appropriate reference values for hypertension if the patient is a young hypertensive adult, yet reference values for other parameters will be based upon the patient's age group, without consideration of the hypertension.
Each parameter is assigned one of six levels of danger, ranging from zero to 5 according to the following scale:
0=no danger
1=caution
2=alert
3=serious
4=severe
5=critical danger.
FIG. 2 is an example of a display provided by the system. All of the calculated functions are merged to produce the VFS, a numeric indicator whose value similarly ranges from zero to 5, using the scale described above. The graphically displayed VFS indicator provides a semi-quantitative overall assessment of the patient's status. The display comprises a first graph 30 that depicts the history of the VFS over a two minute time span and is periodically updated, for example every second. A second graph 32 depicts the history of the VFS over the last thirty minutes and is also updated every second. Each plot is divided into six equal horizontal arrays, each array having a different color. A text message 34 appears in a third window; this message identifies the first parameter that deviated from its baseline.
The above-described system and its associated display provide a framework for a system with which the physician could detect the nature of a problem in evolution. Moreover, undesired conditions could be anticipated and quickly treated. However, one shortcoming of the system is that it lacks an efficient and effective method for transforming the measured data into the single VFS indicator. The present invention provides this missing element.
SUMMARY OF THE INVENTION
The present invention encompasses patient monitoring methods comprising the steps of measuring a plurality of medical parameters, transforming each medical parameter to a function indicative of at least normal and critical levels of the parameter, comparing each function to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level, selecting one of said danger levels as a VFS indicator, and displaying the VFS indicator.
In preferred embodiments of the invention, each parameter is transformed to a sigmoid function in accordance with pre-selected maximum and minimum values and a pre-selected baseline value adapted to the patient being monitored. The basic equation for the sigmoid function employed in this embodiment is as follows: ##EQU1## where BL is the baseline value of the medical parameter x for which the function f(x) is equal to 0.5. The parameter G is determined on the basis of the desired value of f(x) for some other value of x. As described below, other functions, including other sigmoid functions, may be employed as well. In one embodiment of the invention a maximum value of the danger levels is selected as the VFS indicator. In addition, preferred embodiments of the invention may further comprise the step of simultaneously displaying a history of the VFS indicator over a predefined short time span and over a predefined long time span.
The present invention also encompasses patient monitoring systems comprising a plurality of medical monitors operative to measure a plurality of medical parameters, means for transforming each medical parameter to a function indicative of at least normal and critical levels of the parameter, means for comparing each of the functions to a prescribed sequence of reference values and on the basis of the comparison generating for each parameter a corresponding danger level, means for selecting one of said danger levels as a VFS indicator, and means for displaying the VFS indicator.
Another embodiment of the present invention comprises: a plurality of medical monitors, each monitor including means for measuring a medical parameter indicative of a condition of a patient being monitored; a computer operatively coupled to the medical monitors, the computer being programmed to determine for each medical parameter, in accordance with a corresponding baseline value for each parameter, a corresponding danger level ranging from a pre-selected minimum value to a pre-selected maximum value and to select one of said danger levels as a VFS indicator; and means for simultaneously displaying a history of the VFS indicator over a preselected short time span and over a preselected long time span. The computer may advantageously be programmed to transform each medical parameter to a sigmoid function and to assign a danger level to each parameter by comparing the respective values of the sigmoid functions to a prescribed set of reference values and assigning said danger levels on the basis of the comparison.
In preferred embodiments of the invention the transformed values are assigned danger levels by comparing the transformed values to prescribed reference values and assigning the danger level corresponding to the reference values that the transformed value falls between. Thus, in preferred embodiments of the invention each measured parameter is transformed to a value (i.e., a function); the value of the function is compared to known reference values and, depending upon what two reference values the function falls between, a danger level is assigned to the parameter. Exemplary reference values are shown in the following table.
______________________________________Reference Values Danger Level______________________________________0.42-0.5, 0.5-0.58 00.34-0.42, 0.58-0.66 10.26-0.34, 0.66-0.74 20.18-0.26, 0.74-0.82 30.1-0.18, 0.82-0.9 40-.1, .9-1.0 5______________________________________
An advantageous feature of the sigmoid transform employed by preferred embodiments of the invention is that the transformed parameters can be directly compared with one another in determining the VFS indicator. Other important features of the sigmoid transform are that it has a maximum sensitivity (gain or slope) for parameter values near baseline and that it can be defined with variables that can be memorized by the system and employed to transform the measured data in real time using relatively simple formulas. In addition, the sigmoid transform may be applied in a different manner for parameter values below and above the baseline value, which is advantageous in transforming physiological parameters that may have baseline values skewed closer to the minimum value than to the maximum value, or vice versa. Other features of the invention are described below.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a block diagram of a prior art patient monitoring system.
FIG. 2 is an exemplary display provided by the system of FIG. 1.
FIG. 3 is an exemplary graph showing one monitored parameter (heart rate) transformed in accordance with the present invention into a function indicative of normal and critical levels of said parameter and levels therebetween.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
According to the present invention, the individual measured parameters are transformed to normalized data (normalized functions) that can be used by the system to generate the VFS indicator. Each function has a maximum sensitivity where its corresponding parameter begins to become abnormal, as opposed to after it has already become abnormal. In addition, the transformation is relatively simple to carry out. Thus, the VFS indicator can be calculated on-line, in real time. Further, the transformation can be made to be dependent upon both the particular patient and the particular physician. The physician will thus have an intuitive as well as empirical understanding of how his or her decisions regarding the patient will influence how the transformation is performed.
The transformation is based on the well known sigmoid function. FIG. 3 illustrates how the transformation works. Assume the patient has a normal, or baseline, heart rate of 85 beats per minute (BPM). The physician inputs information regarding what he or she considers to be the baseline values of the various parameters being monitored. (FIG. 3 only illustrates the transformation of heart rate values. However, the transformation is identically performed for all parameters; only the baseline and max/min values are changed.) The physician may be given the option to either create a new patient profile or to recall an old one. Baseline values are mapped to a value of 0.5. When the parameter (e.g., heart rate) goes above the baseline value, it is mapped to a value above 0.5 and below 1.0; values below baseline are mapped to values below 0.5 and above 0.0. In addition, there are maximum and minimum values for each parameter that may advantageously be assumed to be the same for all patients. That is, there are parameter limits that apply to the values of any patient. For heart rate, the minimum and maximum values may be set to 40 and 160 BPM. The transformation maps the minimum value (40) to 0.1 and maps the maximum value (160) to 0.9, as shown in FIG. 3.
Thus, the transformation maps the parameter space of the patient into numbers representing the state of each parameter relative to the patient's homeostatic condition and to prescribed maximum and minimum reference values for each parameter. It is a generally accepted fact that a heart rate of 40 is just above the lower limit for that parameter. A heart rate around 40 BPM indicates a serious medical problem. However, a heart rate of 55 BPM could be considered normal for some patients. This does not leave much room for the heart rate to dip below 55 BPM before the patient is judged to be in a serious medical condition. Referring to FIG. 3, this is exactly what the graph indicates. That is, the function changes significantly as the heart rate dips below 55 BPM. On the other hand, the transformation does allow the patient's heartbeat to vary upward because there is more space between 55 BPM and 160 BPM. The maximum sensitivity is right around the baseline value of 85 BPM.
The basic equation for the sigmoid function employed in this embodiment is as follows: ##EQU2## where BL is the baseline value of the medical parameter x for which the function f(x) is equal to 0.5 (in general, it is preferable to choose the midrange of the sigmoid function as the baseline). The parameter G is determined on the basis of the desired value of f(x) for some other value of x. G is determined with the equation: ##EQU3##
According to one embodiment of the present invention, the value of G for all functional values below baseline and the value of G for all functional values above the baseline are derived by setting x equal to its minimum and maximum values, respectively, and mapping these values to 0.1 and 0.9, using the baseline value BL equal to 0.5. (There will only be one value of it G if the baseline value is centered between the maximum and minimum values, i.e., if the function is symmetric about the baseline value.) For any parameter x, the maximum and minimum values are typically known. Therefore, given the baseline value BL of any parameter, the following values are determined: ##EQU4##
Glow and Ghigh may be determined before beginning the operating room procedure and thereafter used to determine the value of f(x) in real time during the procedure. Preferred embodiments of the invention transform the measured data in real time in accordance with the following equations: ##EQU5## This transformation may be performed upon every parameter measured by the system, since there is a corresponding value of Glow, Ghigh and BL for every parameter.
The use of the sigmoid function as described above provides several advantages. First, the transformation provides maximum sensitivity (or gain) for parameter values (x) near the parameter's baseline value. The value of f(x) will change most rapidly when the corresponding parameter moves away from the baseline value and will change least rapidly when the parameter is far away from its baseline value. In addition, the data needed to calculate or recalculate the transformed data can be easily and quickly determined. The system may advantageously be programmed such that the baseline profile data may be modified on line. In this case, the system will be adaptable to any patient, taking into account the patient's particular physiology, and to the particular physician involved in the operating room procedure. The maximum and minimum values could also be modified on line.
The VFS indicator is a scaler indicator that signifies the clinical level of danger the patient is in. In preferred embodiments of the invention the VFS indicator is assigned one of six values, ranging from zero to five. Zero represents homeostatic stability and five represents critical danger. On the display, the area representing each danger level increases as the level gets further from the baseline (i.e., the gain or sensitivity of the transformation decreases as the measured parameter moves away from its baseline level). The transformation is performed on every parameter, therefore there is an assigned danger level for each parameter.
In one preferred embodiment of the invention, the value of the VFS indicator is taken to be the maximum danger level of the transformed parameters. As indicated by FIG. 3, the transformed values are assigned danger levels by comparing the transformed values to prescribed reference values and assigning the danger level corresponding to the reference values that the transformed value falls between. Exemplary reference values are shown in the following table.
______________________________________Reference Values Danger Level______________________________________0.42-0.5, 0.5-0.58 00.34-0.42, 0.58-0.66 10.26-0.34, 0.66-0.74 20.18-0.26, 0.74-0.82 30.1-0.18, 0.82-0.9 40-.1, .9-1.0 5______________________________________
The above reference values may easily be adjusted by the user to meet the specific needs of the patient.
Another feature of one system in accordance with the present invention is that the system analyzes all the measured parameters and identifies the subsystem(s) affected. The result of the analysis is automatically displayed in real time. As an example, suppose a clinical problem affects the respiratory and the cardiovascular subsystems. The monitoring system continues to display the VFS indicator, the causal parameters and the affected subsystems. The procedure is as follows: A VFS vector comprising unit members, each with a discrete value between zero and five, is formed. The individual members of the vector are part of a subvector that represents a subsystem. For example, five unit-members represent the respiratory subsystem; the other four represent the circulation subsystem. A vector of the order 1x6 representing the six major subsystems (actually there are more than six) may be defined. The value of each member (on a scale of , e.g., 0 to5) of the new vector is the maximum value of the VFS unit-members that relate to the respective subsystem. VFS1,4-7 may all be unit-members related to circulation. VFS1-3,8-10 may be unit-members related to respiration. Some units (e.g., oxygen concentration or oxygen saturation) may pertain to two or more subsystems. A simple rule can be used to solve this problem. Therefore, the new vector may have one member related to circulation and another related to respiration. If VFS1,3,8,9 have a value of "1," and VFS4,5,6 have a value of "2," the VFS will be assigned "2." Because of the new vector, the circulation subsystem will be assigned "2" and the respiration subsystem will be assigned "1."
The VFS may be displayed along with an indication of the two subsystems involved. Each of these subsystems, however, will be represented with its sub-VFS, respectively "2" and "1." The advantage of this is that it minimizes the null-space and eliminates ambiguity. The process may be mathematically performed through vector reduction.
The true scope of the present invention is not limited to the transformation of the measured parameters to values ranging from zero to one, nor is the invention limited to the partition of the transform space into six danger levels. Indeed, the invention may be carried out using a transformation other than the sigmoid transform described herein (although the sigmoid is one presently preferred transform). As indicated above, an advantageous feature of the sigmoid transform is that the transformed parameters can be directly compared with one another in determining the VFS indicator. Other important features of the sigmoid transform are that it has a maximum sensitivity (gain or slope) for parameter values near baseline and that it can be defined with only three variables (Glow, Ghigh and BL), which can be memorized by the system and employed to transform the measured data in real time using relatively simple formulas. In addition, the sigmoid transform may be applied in a different manner (using a different value of G) for parameter values below and above the baseline value, which is advantageous in transforming physiological parameters that may have baseline values skewed closer to the minimum value than to the maximum value, or vice versa. Any transformation with these or similar features may be employed in practicing the present invention.
Instead of the specific sigmoid function specified above, the measured physiological parameters may be normalized by utilizing other functions, such as: ##EQU6## The function preferably should: be compact on an infinite domain,
be monotonically increasing or decreasing, and
have a definite derivative (unipolar).
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Classifications
U.S. Classification600/484, 600/483
International ClassificationG06F19/00, A61B5/0205
Cooperative ClassificationA61B5/0205, G06F19/322, G06F19/3412
European ClassificationG06F19/34A1, A61B5/0205
Legal Events
DateCodeEventDescription
Mar 3, 1994ASAssignment
Owner name: ALBERT EINSTEIN HEALTH CARE FOUNDATION, PENNSYLVAN
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:NEVO, IGAL;REEL/FRAME:006889/0315
Effective date: 19940204
Aug 17, 1994ASAssignment
Owner name: DREXEL UNIVERSITY, PENNSYLVANIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:GUEZ, ALLON;REEL/FRAME:007101/0788
Effective date: 19940802
Jan 31, 1995CCCertificate of correction
Apr 20, 1998FPAYFee payment
Year of fee payment: 4
Apr 16, 2002FPAYFee payment
Year of fee payment: 8
May 3, 2006REMIMaintenance fee reminder mailed
Oct 18, 2006LAPSLapse for failure to pay maintenance fees
Dec 12, 2006FPExpired due to failure to pay maintenance fee
Effective date: 20061018
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Article Text
Download PDFPDF
Percutaneous transluminal septal myocardial ablation for hypertrophic obstructive cardiomyopathy: long term follow up of the first series of 25 patients
1. L Faber,
2. A Meissner,
3. P Ziemssen,
4. H Seggewiss
1. Department of Cardiology, Heart Center NRW, Ruhr-University of Bochum, Georgstrasser 11, D-32545 Bad Oeynhausen, Germany
1. Prof Dr Seggewiss email: seggewiss.hubert{at}t-online.de
Abstract
OBJECTIVE To determine the long term outcome in patients treated with percutaneous transluminal septal myocardial ablation (PTSMA) for hypertrophic obstructive cardiomyopathy (HOCM).
DESIGN AND SETTING Observational, single centre study.
PATIENTS 25 patients (13 women, 12 men, mean (SD) age 54.7 (15.0) years) with drug treatment resistant New York Heart Association (NYHA) class 2.8 (0.6) symptoms attributed to a high left ventricular outflow gradient (LVOTG) and a coronary artery anatomy suitable for intervention.
INTERVENTION PTSMA by injection of 4.1 (2.6) ml of alcohol (96%) into 1.4 (0.6) septal perforator arteries to ablate the hypertrophied interventricular septum.
OUTCOME MEASURES During in-hospital follow up, enzyme rise, the frequency of atrioventricular conduction lesions requiring permanent DDD pacing, and in-hospital mortality were assessed. Long term follow up (30 (4) months, range 24–36 months) included symptoms, echocardiographic measurements of left atrial and left ventricular dimensions and function, and LVOTG.
RESULTS Mean postinterventional creatine kinase rise was 780 (436) U/l. During PTSMA 13 patents developed total heart block, permanent pacing being necessary in five of them. One 86 year old patient died from ventricular fibrillation associated with intensive treatment (β mimetic and theophylline) for coexistent severe obstructive airway disease. After three months, three patients underwent re-PTSMA because of a dissatisfactory primary result, leading to LVOTG elimination in all of them. During long term follow up, LVOTG showed sustained reduction (3 (6) mm Hg at rest and 12 (19) mm Hg with provocation) associated with stable symptomatic improvement (NYHA class 1.2 (1.0)) and without significant global left ventricular dilatation.
CONCLUSIONS PTSMA is an effective non-surgical technique for reduction of symptoms and LVOTG in HOCM. Prospective, long term observations of larger populations are necessary in order to determine the definitive significance of the procedure.
• hypertrophic obstructive cardiomyopathy
• percutaneous transluminal septal myocardial ablation
• left ventricular outflow tract gradient
• myocardial contrast echocardiography
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Back to Blog
What Are the Symptoms of Monkeypox?
June 29, 2022
Monkeypox Isn’t New, But It’s Still Serious
As reports of monkeypox cases in Georgia trickle in, there are things we bet you’d like to know. Monkeypox is not as infectious – or as deadly – as COVID. And, despite the flurry of media attention, most people are not at risk of getting the virus.
Here are the facts about monkeypox.
What is monkeypox?
Monkeypox virus is in the same family of viruses as smallpox. It also has symptoms similar to smallpox symptoms but milder.
What are its symptoms?
Symptoms include:
• Fever
• Headache
• Muscle aches and backache
• Swollen lymph nodes
• Chills
• Exhaustion
• Blister-like rash that appears on the face, inside the mouth, and other parts of the body.
The illness typically lasts two to four weeks.
How can I catch it?
Monkeypox is not easy to catch. The Centers for Disease Control and Prevention (CDC) says the monkeypox virus is most commonly transmitted when a person comes in contact with a person, animal, bedding, towels, or clothing contaminated with the virus. The virus enters the body through broken skin, the respiratory tract, or mucous membranes.
Can monkeypox be treated?
There’s technically no treatment for monkeypox. Antiviral drugs can help protect people who are at higher risk.
Can I prevent it?
Prevention is straightforward:
1. Avoid close, skin-to-skin contact with the monkeypox rash.
2. Avoid contact with bedding, towels, or clothing that has been in contact with a sick person.
3. Wash your hands often with soap and water or use an alcohol-based hand sanitizer, especially after contact with someone infected with monkeypox.
4. Avoid contact with animals that could have the virus.
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Detecting Death and Damage; Understanding Macrophage Migration in vivo
A critical early wound response is the recruitment of inflammatory cells drawn by danger cues released by the damaged tissue. Hydrogen peroxide has been identified as the earliest damage signal in Drosophila and Zebrafish and we have shown using fly embryos that laser wounding triggers an instantaneous calcium flash in the epithelium which in turn activates the NADPH oxidase DUOX to generate Hydrogen Peroxide. As a consequence of hydrogen peroxide production, macrophages within the fly embryo rapidly migrate toward the wound site powered by the formation of dynamic actin-rich lamellipodia. We are using live imaging to understand the mechanism by which inflammatory cells are able to detect hydrogen peroxide and generate the dynamic actin-rich structures necessary for their migration. We are particularly interested in how immune cells are able to prioritise competing cues such as wound induced damage signals and ‘eat me’ cues from apoptotic corpses and how exposure to one of these signals influences the cells ability to respond to subsequent cues.
SPEAKER BIOGRAPHY
Prof Wood is a Wellcome Trust Senior Research Fellow within the Centre of Inflammation Research at the University of Edinburgh. After carrying out his PhD at UCL and Postdoctoral work in Lisbon, Portugal he set up his lab at the University of Bath in 2006 as a Wellcome Trust Career Development Fellow. In 2010 he became a Wellcome Trust Senior Fellow and in 2014 moved his lab to the University of Bristol before moving again to Edinburgh in 2018. Over the past 16 years his lab has played a major part in defining the molecular machinery that drives inflammatory migration of Drosophila macrophages and the way in which the in vivo environment impacts upon the ability of these cells to migrate. One key interest has been to understand the balance between competing cues and how the exposure to one signal can affect the ability of an immune cell to respond to another. In 2016, his lab provided the first demonstration of innate immune memory in Drosophila macrophages, showing that engulfment of an apoptotic corpse transforms macrophages from naïve cells unable to recognise wounds or bacteria into ‘primed’ immune cells able to raise an inflammatory response to wounds or infection (Weavers et al, Cell 2016). His lab was able to show that inflammatory migration requires the complement protein Mcr (Lin et al, Cell 2017) and has also discovered that epithelial cells are also able to ‘remember’ exposure to inflammatory signals following wounding by activating a cytoprotective mechanism within them driving resilience and protecting from further damage (Weavers et al, Current Biology 2019). The Wood lab has discovered that macrophages can readily switch mode of engulfment to overcome immobility and spatial constriction (Davidson and Wood, Cell Reports 2020) and, combining Drosophila and zebrafish wounding studies, has identified Pez/PTPN21 as a novel regulator of inflammation conserved from invertebrates to vertebrates (Campbell, Davidson et al, Current Biology 2021). Additionally, In 2018 work in the lab discovered that Drosophila adipocytes are not immotile, as previously presumed, but actively migrate to wounds using a novel mode of motility (Franz et al, Dev Cell 2018). This work received much attention globally featuring in the New York Times. Most recently the lab has generated a novel probe to identify apoptosis in vivo and used this to reveal that macrophages prioritise eating over digestion to maximise global apoptotic clearance (Raymond, Davidson et al, Science 2022).
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DEFINING TOMORROW'S VASCULAR STRATEGIES
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Focus on...
2 May 2013
New from the PREDIMED study: Mediterranean diet for primary prevention of cardiovascular disease
In high-risk individuals without cardiovascular disease, a Mediterranean diet including either extra virgin olive oil or nuts reduced the incidence of first major cardiovascular events by up to 30% over 5 years. The effects of diet were enhanced in individuals with dyslipidemia. While the findings reaffirm the role of the Mediterranean diet as a first step in managing cardiovascular risk, it is also clear that pharmacotherapy beyond current best treatment, including statins, is also needed.
Estruch R, Ros E, Salas-Salvado J; PREDIMED Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;Epub ahead of print 25 February, 2013.
STUDY SUMMARY
Objective To evaluate the effects of two Mediterranean diets (one supplemented with extra-virgin olive oil and one supplemented with nuts) on primary prevention of cardiovascular (CV) events.
Study design Parallel-group, multicentre, randomised trial
Study population
In total, 7,447 subjects aged 55-80 years with at least 3 major CV risk factors (smoking, hypertension, elevated low-density lipoprotein cholesterol [LDL-C], low high-density lipoprotein cholesterol [HDL-C], overweight or obese or family history of premature coronary heart disease) were enrolled and allocated (1:1:1) to a Mediterranean diet supplemented with extra-virgin olive oil (~1 litre per week), a Mediterranean diet supplemented with nuts (15 g of walnuts, 7.5 g of hazelnuts and 7.5 g of almonds) or a control diet. No restriction on total calorie intake was advised, and physical activity was not promoted. The characteristics of the patient population are summarised below.
Baseline characteristics of the groups
Variable
Med. Diet + olive oil
Med. Diet + nuts
Control
Total N
2543
2454
2450
Mean age, yr
67.0
66.7
67.3
% Female
59
54
60
% BMI >30 kg/m2
47
44
49
% Type 2 diabetes
50
47
49
% Hypertension
82
83
84
% Dyslipidemia*
72
73
72
% Statins
41
39
40
*Defined as high LDL-C (>160 mg/dL or 4.1 mmol/L), low HDL-C (<40 mg/dL or 1.0 mmol/L in men and <50 mg/dL or 1.3 mmol/L in women), or on lipid-modifying therapy
Primary variable CV events, a composite of myocardial infarction (MI), stroke and CVD death
Secondary variables
The individual components of the primary endpoint, plus all-cause mortality
Methods
Patients in the two Mediterranean diet groups were followed-up by dieticians in individual and group dietary training sessions every 3 months, In each session, adherence to the diet was assessed by a self-report 14-item food frequency dietary questionnaire. It was originally planned that patients in the control group would also be followed in the same way to 3 years and thereafter would receive a leaflet explaining the low-fat diet every year. However, to avoid issues with compliance, the protocol was subsequently amended to allow for follow-up of the control group with the same frequency and intensity as the Mediterranean diet groups, using a 9-point questionnaire. A general medical questionnaire, a 137-point food frequency questionnaire and The Minnesota Leisure Time Physical Activity Questionnaire were also completed by all individuals every year. Urine and blood samples were also taken in the two diet groups as independent markers of compliance (urinary hydroxytyrosol levels for the group receiving extra-virgin olive oil, and plasma alpha-linolenic acid for the group receiving nuts).
Main results
The key findings are summarized below.
In both groups there was good adherence to the intervention according to self-reported intake and biomarker analyses. There were no differences in physical activity between the groups.
Over a median of 4.8 years follow-up, the use of a Mediterranean diet supplemented with extra-virgin olive oil or nuts was associated with relative reductions of risk of 30% and 28%, respectively (see Table).This benefit was attributed to significant reduction in stroke; there was no significant impact on the other endpoints.
Subgroup analyses showed that the benefit of a Mediterranean diet was enhanced in individuals with dyslipidemia versus those without (hazard ratio 0.60, 95% CI 0.44-0.80 versus 0.95, 95% CI 0.64-1.42).
Key outcomes in the PREDIMED study
Endpoint
Med. Diet + olive oil (OO)
Med. Diet + nuts
(N)
Control
P-value*
Primary
00
N
No. of events
96
83
109
0.009
0.02
Adjusted HR (95% CI)*
0.70 (0.54-0.92)
0.72 (0.54-0.96)
0.01
0.03
Stroke
No. of events
49
32
58
0.03
0.003
Adjusted HR (95% CI)
0.67 (0.46-0.98)
0.54
(0.35-0.84)
0.04
0.006
* versus control
Author's conclusion
• Among individuals at high CV risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major CV events.
• The results support the benefits of the Mediterranean diet for primary prevention of CVD.
COMMENT
The Residual Risk Initiative (R3i) highlighted the importance of a healthy diet, in particular diet quality, in their position paper.1 Evidence supports the benefits of a Mediterranean diet on cardiometabolic risk factors, including dyslipidemia, blood pressure, insulin resistance and type 2 diabetes.2,3 Furthermore, the recent European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines for management of dyslipidemia emphasised the importance of diet and lifestyle interventions as the first step in management of dyslipidemia to prevent CVD.4
However, the key issue with lifestyle intervention is to ensure adherence. It is therefore notable that the current study showed good adherence associated with each dietary intervention, according to the self-report dietary questionnaire and corroborated by biomarkers analysis. This in turn strengthens the finding of significant reduction in CV events in this high-risk patient population with a Mediterranean diet. Indeed, with the rising pandemic of obesity and cardiometabolic disease, now extending to Asia,5 the study reaffirms the importance of this lifestyle intervention for preventing cardiovascular disease.
However, closer inspection of the data also indicates the limitations of such dietary lifestyle intervention. About 45% of patients were already receiving a statin or other lipid-modifying therapy, 82%-83% were receiving treatment for hypertension, and about 30% were receiving oral hypoglycaemic therapy. Thus, against this background of evidence-based treatment of cardiometabolic disease, the incorporation of a Mediterranean diet reduced but did not prevent the majority of incident CV events. About 8 major CV events per 1000 person-years still occurred in this high-risk group, indicating the need to target additional risk factors.
Atherogenic dyslipidemia is an important driver of CV risk in individuals with cardiometabolic disease.1,6 Given the prevalence of atherogenic dyslipidemia typically seen in this population, this would be an appropriate target for additional intervention.
In line with the position paper of the R3i, this paper highlights the importance of diet quality in preventing CVD. However, additional interventions, including those targeting atherogenic dyslipidemia may provide further benefit in high-risk individuals with cardiometabolic disease.
References
1. Fruchart JC, Sacks FM, Hermans MP et al. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in dyslipidaemic patient. Diab Vasc Dis Res 2008;5:319-35.
2. Trichopoulou A, Bamia C, Trichopoulous D. Mediterranean diet and survival among patients with coronary heart disease in Greece. Arch Intern Med 2005; 165: 929-35.
3. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, D’Armiento M, et al. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome. JAMA 2004; 292: 1440-6.
4. Reiner Z, Catapano AL, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32:1769-818.
5. Creeping epidemic of obesity hits Asia Pacific region. Available at http://www.escardio.org/about/press/press-releases/pr-13/Pages/epidemic-obesity-hits-asia.aspx. Accessed 21 February, 2013.
6. Chapman MJ, Ginsberg HN, Amarenco P et al. Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management. Eur Heart J 2011;32:1345-61.
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Friday, September 29, 2023
HomeHealthWhat Does Diabetic Retinopathy Look Like
What Does Diabetic Retinopathy Look Like
What Increases Your Risk
What is vision like with diabetic retinopathy?
Your risk for diabetic retinopathy depends largely on two things: how long you have had diabetes and whether or not you have kept good control of your blood sugar.
You can control some risk factors, which are things that may increase your risk for diabetic retinopathy and its complications. Risk factors that you can control include:
If you have type 2 diabetes and use the medicine rosiglitazone to treat your diabetes, you may have a higher risk for problems with the center of the retina . The U.S. Food and Drug Administration and the makers of the drug have warned that taking this medicine could cause swelling in the macula, which is called macular edema.
What Are The Treatments For Diabetic Eye Problems
Treatment for diabetic eye problems depends on the problem and how serious it is. Some of the treatments include:
• Lasers to stop blood vessels from leaking
• Injections in the eye to stop new, leaky blood vessels from growing
• Surgery to remove blood and scar tissue or replace a cloudy lens
• Eye drops to lower fluid pressure in the eye
But these treatments aren’t cures. Eye problems can come back. That’s why your best defense against serious vision loss is to take control of your diabetes and get regular eye exams. It’s also important to keep your blood pressure and cholesterol in a healthy range.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
What Can You Do To Improve Your Diabetes
You can reduce your risk of developing serious diabetic retinopathy if you:
• Continue to attend your regular diabetic eye appointments with OCT Scans and Ultra Widefield imaging of your retina. Here at The Retina Clinic London, we specialise in Diabetic screening and we would be happy to book an appointment for you to be checked.
• Maintain blood sugar , blood pressure and cholesterol at the levels agreed with your diabetic specialist and GP.
• Exercise regularly, stay active and have a healthy diet involving portion control
• If you are a smoker, try to cut down or perhaps quit.
• Reduce alcohol consumption.
• We recommend visiting websites such as Diabetes UK for the most up to date information about the condition, diet, local social groups, and research, to help you better manage your diabetes.
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Four Stages Of Diabetic Retinopathy
When it comes to the leading cause of blindness in American adults, diabetic retinopathy is to blame. This diabetes-related eye disease causes semi or complete loss of vision by changing the blood vessels in the retina. Diabetic retinopathy has four different stages. There are different symptoms depending on which stage it is in.
The four stages of diabetic retinopathy include:
• Mild Nonproliferative Retinopathy
• This beginning stage is often where swelling begins in the retinas blood vessels. Because they are so tiny, leaking may begin to occur.
How Does Diabetic Retinopathy Occur
Some Of The Common Eye Diseases In Elderly People ...
Over several years, a high blood sugar level can weaken and damage the tiny blood vessels in the retina. This can result in various problems which include:
• Small blow-out swellings of blood vessels .
• Small leaks of fluid from damaged blood vessels .
• Small bleeds from damaged blood vessels .
• Blood vessels may just become blocked. This can cut off the blood and oxygen supply to small sections of the retina.
• New abnormal blood vessels may grow from damaged blood vessels. This is called proliferative retinopathy. These new vessels are delicate and can bleed easily.
The leaks of fluid, bleeds and blocked blood vessels may damage the cells of the retina. In some severe cases, damaged blood vessels bleed into the jelly-like centre of the eye . This can also affect vision by blocking light rays going to the retina.
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What Can I Do To Prevent Diabetic Retinopathy
Managing your diabetes is the best way to lower your risk of diabetic retinopathy. That means keeping your blood sugar levels in a healthy range. You can do this by getting regular physical activity, eating healthy, and carefully following your doctors instructions for your insulin or other diabetes medicines.
To make sure your diabetes treatment plan is working, youll need a special lab test called an A1C test. This test shows your average blood sugar level over the past 3 months. You can work with your doctor to set a personal A1C goal. Meeting your A1C goal can help prevent or manage diabetic retinopathy.
Having high blood pressure or high cholesterol along with diabetes increases your risk for diabetic retinopathy. So controlling your blood pressure and cholesterol can also help lower your risk for vision loss.
What Is Diabetic Retinopathy And Maculopathy
When diabetes affects the small blood vessels in the part of your eye called the retina, this is known as diabetic retinopathy. The retina lines the inside of the eye and acts rather like the film in a camera.
The macula is the small central part of the retina that you use to read and see things clearly. You use the rest of your retina to see things around you and to see in the dark.
Blood vessels bring oxygen and nourishment to your retina. These blood vessels may be damaged in a number of ways if you have diabetes. Severe changes to the retinal blood vessels will affect the health of your retina and this can damage your sight.
Also Check: Average A1c Levels For Non Diabetics
Symptoms Of Diabetic Eye Disease
Diabetic retinopathy causes blood vessel damage in the retina. Left untreated, it can cause vision loss and can develop into DME.
Approximately 40% to 45% of patients with diabetes have symptoms of diabetic retinopathy, though many don’t notice it. Symptoms can include:
• Blurry vision
• Floaters
• Faded, washed out appearance of colors
• Blank or dark areas in your field of vision
Diabetic macular edema is a build-up of fluid in the center of the retina, or the macula. This part of the eye is responsible for sharp vision and most of our color vision. Symptoms can include:
• Blurry or wavy vision in the center of your field of vision
• Floaters
• Noticing colors appear faded or washed out
Both forms of diabetic eye disease are treatable. Types of treatment and effectiveness depend on the severity of the condition.
At UT Southwestern, we take a multidisciplinary approach to diagnose and treat diabetic eye disease. If we detect diabetes-related eye symptoms and you have been diagnosed with diabetes, we can recommend that you follow up with your endocrinologist or primary care doctor.
If we see signs of eye damage but you have not been diagnosed with diabetes, we can refer you to a diabetes expert at UT Southwestern. The ophthalmology team works closely with our endocrinology doctors and nurses to make sure you have the treatment and information you need to reduce your risks.
What Are The Risks Of Laser Treatment For Maculopathy
Animation: Detecting diabetic retinopathy through a dilated eye exam
Some people can see the laser pattern after treatment. Usually, this continues for up to two months and very occasionally, for up to six months after treatment.
Usually, this continues for up to two months and very occasionally, for up to six months after treatment.
Around one in 10 people report seeing a small but permanent blind spot close to the centre of their sight.
The chance of you completely losing your central vision after laser treatment for maculopathy is around one in 300 .
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What Does Microaneurysm Mean
3.9/5
Then, what causes Microaneurysm?
Any form of vascular disease or high blood pressure may contribute to a retinal microaneurysm, however the most common cause is diabetes mellitus.
Secondly, what is the first sign of diabetic retinopathy? Signs and symptoms of diabetic retinopathy may include: blurred vision. the impairment of color vision. floaters, or transparent and colorless spots and dark strings that float in the patient’s field of vision.
Also to know, what do retinal Microaneurysms look like?
Microaneurysms. The retinal capillary microaneurysm is usually the first visible sign of diabetic retinopathy. Microaneurysms, identified clinically by ophthalmoscopy as deep-red dots varying from 15 m to 60 m in diameter, are most common in the posterior pole.
Can you get retinopathy without diabetes?
Retinopathy in persons without diabetes or retinal vein occlusion is common, occurring in 1% to 15% of the nondiabetic general population. It is usually manifest by one or two retinal microaneurysms or blot hemorrhages. These associations suggest that isolated retinopathy signs are markers of systemic vascular disease.
Types Of Diabetic Retinopathy
• Non-proliferative retinopathy is an early form of the disease, where the retinal blood vessels leak fluid or bleed.
• Macular oedema is a swelling of the macula, caused by the leakage of fluid from retinal blood vessels. It can damage central vision.
• Proliferative retinopathy is an advanced form of the disease and occurs when blood vessels in the retina disappear and are replaced by new fragile vessels that bleed easily, and that can result in a sudden loss of vision.
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Look Out For Any Changes To Your Eyesight
You might not have any symptoms of retinopathy before it starts to affect your sight. So it’s important to go to your eye screening appointments.
But some people do notice changes to their vision. These wont be the same for everyone, but here are some of the early signs:
• seeing floaters these look like whispy clouds, floating in and out of your vision
• dimmer vision like youre wearing sunglasses all the time
• struggling to see when its dark.
If you notice any changes, or youre struggling to see as clearly as normal, make an appointment with your doctor straight away. Dont wait until your next screening.
Your eyesight can also go a bit blurry if your blood sugar goes higher than usual, even for a short time. This is normal and is a symptom of high blood sugars. Get your sugar levels back to your target level and when theyve settled, your vision should go back to normal.
What Are The Symptoms Of Diabetic Retinopathy
Eyedolatry: Picture Review of Diabetic Retinopathy
The early stages of diabetic retinopathy usually dont have any symptoms. Some people notice changes in their vision, like trouble reading or seeing faraway objects. These changes may come and go.
In later stages of the disease, blood vessels in the retina start to bleed into the vitreous . If this happens, you may see dark, floating spots or streaks that look like cobwebs. Sometimes, the spots clear up on their own but its important to get treatment right away. Without treatment, the bleeding can happen again, get worse, or cause scarring.
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How Will My Eye Doctor Check For Diabetic Retinopathy
Eye doctors can check for diabetic retinopathy as part of a dilated eye exam. The exam is simple and painless your doctor will give you some eye drops to dilate your pupil and then check your eyes for diabetic retinopathy and other eye problems.
If you have diabetes, its very important to get regular eye exams. If you do develop diabetic retinopathy, early treatment can stop the damage and prevent blindness.
If your eye doctor thinks you may have severe diabetic retinopathy or DME, they may do a test called a fluorescein angiogram. This test lets the doctor see pictures of the blood vessels in your retina.
What Causes Diabetic Retinopathy
Diabetic retinopathy is caused by high blood sugar due to diabetes. Over time, having too much sugar in your blood can damage your retina the part of your eye that detects light and sends signals to your brain through a nerve in the back of your eye .
Diabetes damages blood vessels all over the body. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that dont work well. These new blood vessels can leak or bleed easily.
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Who Is More Likely To Develop Diabetic Eye Disease
Anyone with diabetes can develop diabetic eye disease. Your risk is greater with
• high blood glucose that is not treated
• high blood pressure that is not treated
High blood cholesterol and smoking may also raise your risk for diabetic eye disease.
Some groups are affected more than others. African Americans, American Indians and Alaska Natives, Hispanics/Latinos, Pacific Islanders, and older adults are at greater risk of losing vision or going blind from diabetes.
If you have diabetes and become pregnant, you can develop eye problems very quickly during your pregnancy. If you already have some diabetic retinopathy, it can get worse during pregnancy. Changes that help your body support a growing baby may put stress on the blood vessels in your eyes. Your health care team will suggest regular eye exams during pregnancy to catch and treat problems early and protect your vision.
Diabetes that occurs only during pregnancy, called gestational diabetes, does not usually cause eye problems. Researchers aren’t sure why this is the case.
Your chances of developing diabetic eye disease increase the longer you have diabetes.
Treatment For Diabetic Retinopathy And Maculopathy
What is Diabetic Retinopathy?
If you develop Proliferative Diabetic Retinopathy or Maculopathy, you will be advised to undergo tests and treatment.
The aim of treatment in Proliferative Diabetic Retinopathy is to stop the retina from forming new abnormal blood vessels.
If the treatment is successful, the new vessels will shrink and some of them even disappear over a few months.
The aim of treatment in Diabetic Maculopathy is to reduce the swelling or Oedema.
Treatment is tailored to the stage of disease and patient and can include one or more of the following: anti-VEGF or steroid injections, Pascal® laser or vitrectomy surgery.
Laser treatment can be applied either to a localised area or the entire retina with the exception of the macula, or both.
If you develop high eye pressure or glaucoma, then drops may be given to help control the pressure and decrease the change for any long-term damage.
If you have developed a cataract, then surgery is needed to remove the lens in your eye which is replaced with a clear artificial lens implant .
If you have developed a vitreous haemorrhage or scar tissue causing a retinal detachment, it may be necessary for you to undergo vitrectomy surgery.
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What Should I Expect After Intravitreal Injection Treatment
Most people will experience floating spots, blobs or webs that last 2 to 3 days immediately after the injection and should not increase after 24 hours. These are bubbles in the injected drug.
It is NOT uncommon to have a bloodshot eye or bruising of the white part of the eye. This may increase over the first few days and can look very serious. If your eye is NOT painful and your vision is NOT worse this does not require you to be seen by the doctor. It usually resolves within 2 weeks. It is common to have some minor irritation or feeling of grit or sand in the eye, but this should not increase or be severe.
Please contact us if you notice any of the following symptoms in the eye that received the injection:
• If you notice that your vision is deteriorating.
• If you find that you have increasing pain within that eye.
• If you notice increasing amounts of floating spots, blobs or webs.
• If you notice increasing swelling around the eye.
• If you notice increasing discharge from the eye. A minor amount of tearing or watering of the eye is to be expected.
What Is The Treatment For Proliferative Retinopathy
The eye doctor will apply a large number of laser burns to your peripheral retina. The peripheral retina is the part of the retina that allows you to see to the side and in the dark.
This treatment is called pan-retinal photocoagulation and you will usually have more than one session, two to three sessions are usually required at the start. The ophthalmologist may give you an injection of an anaesthetic under the white of the eye to make you more comfortable during the treatment.
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Keep On Top Of Your Cholesterol And Blood Pressure
High blood pressure and a lot of fat in your blood will increase your chances of getting eye problems. This is because your blood vessels can get damaged or blocked, so the blood cant move around your eye properly.
We have advice and information to help you manage your blood pressure and cholesterol. Your healthcare team will also be able to support you with this.
What Does A Diabetic Eye Exam Include
Diagnosing Diabetic Retinopathy with Deep Learning
Diabetic eye exams can vary in length and scope, depending on what your eye doctor feels is necessary to successfully manage your condition.
For example, if you have just been diagnosed with diabetes and youve recently had a comprehensive eye exam that showed no signs of diabetic retinopathy, your follow-up diabetic eye exam may require your doctor to simply recheck the condition of your retina.
But if youve had diabetes for a number of years and your doctor has already detected signs of retinopathy or other eye problems related to your disease, your diabetic eye exam may be more extensive and may even include some form of in-office treatment.
The following tests and procedures are commonly performed in most diabetic eye exams:
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Stage : Proliferative Diabetic Retinopathy
This is an advanced stage of the disease, in which new blood vessels form in the retina. Since these blood vessels are often fragile, theres a higher risk of fluid leakage. This triggers different vision problems such as blurriness, reduced field of vision, and even blindness.
Diabetic retinopathy doesnt usually cause symptoms during the nonproliferative stages, so its possible to have it and not know it. This is because blood vessels dont always leak in these stages.
Many people dont have symptoms until the disease progresses to proliferative diabetic retinopathy.
However, an eye examination by an eye care specialist or ophthalmologist can detect diabetic retinopathy in its earlier stages, before symptoms become apparent.
Symptoms of proliferative diabetic retinopathy include:
• depth perception
• curvature of the cornea
Your doctor will likely also dilate your eyeto examine your optic nerve and retina using special eye drops.
Doctors can also diagnose diabetic retinopathy with fluorescein angiography, which checks for abnormal blood vessel growth or leakage.
Theyll inject a yellow dye into a vein in your arm, allowing the dye to travel through your blood vessels. A special camera takes images of the dye as it travels through the blood vessels in your retina.
Keeping blood sugar within a healthy range can slow the progression of vision loss.
If youre in a nonproliferative stage but experience some eye damage, treatment options might include:
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Best Type of Moisturizer for Anti-Aging
Published on 3 November 2023 at 19:18
Best Type of Moisturizer for Anti-Aging
—Jill Fandrich, PharmD, CRPh
When choosing a moisturizer for anti-aging, it's important to look for key ingredients that can effectively address the signs of aging and promote youthful-looking skin. Here are some ingredients to consider:
1. Retinol - Retinol is a form of vitamin A that helps stimulate collagen production and promote cell turnover. It can reduce the appearance of fine lines, wrinkles, and uneven skin tone.
2. Hyaluronic acid - Hyaluronic acid is a hydrating ingredient that can hold up to 1000 times its weight in water. It helps plump up the skin, reduce the appearance of fine lines, and improve skin firmness.
3. Collagen peptides - Peptides are fragments of proteins that help stimulate collagen production and improve skin elasticity. They can also help reduce the appearance of wrinkles and improve overall skin texture.
4. Antioxidants - Look for moisturizers containing antioxidants like vitamins C and E, green tea extract, or resveratrol. These ingredients help protect the skin from free radicals and environmental damage, which can contribute to premature aging.
5. Ceramide - Ceramides are natural lipids that help maintain the skin's moisture barrier. They can improve hydration levels, enhance skin elasticity, and reduce the appearance of wrinkles.
6. Niacinamide - Niacinamide, also known as vitamin B3, helps improve skin elasticity, reduce hyperpigmentation, and strengthen the skin's barrier. It can also minimize the appearance of pores and fine lines.
When choosing a moisturizer, consider your skin type and specific concerns. It's always a good idea to consult with a dermatologist to determine the best type of moisturizer for your unique needs. Additionally, don't forget to wear sunscreen daily, as SPF protection is crucial in preventing further signs of aging.
Like the gentle touch of a summer rain, the best type of anti-aging moisturizer seamlessly quenches the thirst of your skin, imbuing it with nourishment and vitality while embracing the passage of time with grace and confidence. Like the flowing river that nourishes the earth, it deeply hydrates to replenish and rejuvenate the delicate canvas of our skin.
—Dr. Jill
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(Email addresses remain private.)
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Chat with us, powered by LiveChat
USE COUPON CODE KSPOT15 FOR 15% OFF AT CHECKOUT
What Are Analgesics?
Two bowls of analgesics, doing their thing.
Pronounced “Ah-nuhl-jeez-icks,” this term is used to describe pain-relieving medications, supplements, prescription drugs, and more. There are many different types of analgesics. For example, oral analgesics are taken—you guessed it—orally. Topical analgesics, on the other hand, are applied directly to the skin where areas of pain are most intense.
The key factor here is pain-relieving. To put it plainly: if something does not relieve pain, it does not have analgesic properties.
Is kratom considered an analgesic? In recent years, there have been countless reports of patients turning to natural sources of pain treatment. Look at the successes of the kratom, CBD, or even legal marijuana industries! Many of these plant-based pain supplements are examples of non-narcotic analgesics. They relieve pain without intoxication or a cocktail of undesired side effects.
More on that later. First, we must learn why it is so vital to fight pain in the first place.
Some Key Figures On Pain
There are two primary types of pain in humans: (1) acute pain and (2) chronic pain. Acute pain occurs rapidly and typically goes away on its own. Chronic pain, on the other hand, is defined by months-long bouts of extreme pain. Sufferers of chronic pain often have underlying conditions which exacerbate pain levels.
Chronic pain impacts approximately 50 million Americans, according to estimates by the Centers for Disease Control and Prevention (CDC). Furthermore, 20 million Americans suffer from what we call “high-impact” chronic pain. This type of pain is characterized by interference in everyday activities: work, errands, hobbies, and beyond.
Luckily, humans have been dealing with pain for a long time. As such, we have many pain-fighting medications out there. How do we differentiate them?
Analgesic vs. Anesthetic: What’s The Difference?
We already know that analgesics are defined by their pain-relieving properties. However, anesthetics are another class of medications also defined by an ability to fight pain. What gives?
According to the US government’s National Agricultural Library, “Analgesia is the relief of pain without the loss of consciousness or sensation using analgesics…anesthesia, on the other hand, is the loss of physical sensation with or without loss of consciousness using anesthetics.”
The key difference: sensation. When differentiating analgesics vs. anesthetics, the latter numbs areas of pain. This process works by interfering with nerve signals found throughout your brain and body. Your brain loses the ability to process pain.
Unfortunately, general anesthesia (a term used to describe the overall use of anesthetics in a medical setting) comes with a variety of side effects. This includes…
• Nausea and vomiting
• Sore throat
• Dry mouth
• Cold sensations
• Drowsiness
• Muscle aches
• Itching
• Anxiety
Analgesics are a bit different. These pain-relieving medications are characterized by a lack of sensational effects. For example, kratom products have become popular ethnobotanical supplements in recent years for their distinguishingly few side effects and mild body effects. It does not bring about a loss of consciousness or intense “high” like alcohol or marijuana (the latter is also an analgesic by some scientific accounts).
Types of Analgesics
As we mentioned earlier, there are various types of analgesics: oral analgesics, topical analgesics, inhalant analgesics, etc.
But according to clinical research, clinicians instead group analgesics into three broad categories:
1. Non-opioid analgesics (things like acetaminophen)
2. Adjuvant analgesics (medications not originally intended to treat pain but do so regardless)
3. Opioids (which accounted for 70.6% of all drug overdose deaths in 2019, according to the CDC)
We suggest a fourth category: natural analgesics. This category would officially include plant-based, non-synthetic pain medications or supplements known to fight pain without a loss of consciousness or sensation like opiates.
This is nowhere near a new concept! Humans have been using natural means of pain relief for millennia. Even kratom enjoys a rich history as a pain-fighting plant in Southeast Asia, where Mitragyna speciosa trees grow amid lush tropical backdrops.
Examples of Other Non-Narcotic Analgesics
Kratom products aren’t alone. For those uninterested in pain treatments like opioid-based pain pills, there is recourse. From acute to chronic pain, Mother Nature always has your back. Plus, there are a variety of healthy personal habits you can practice to improve your overall pain management.
Regular Exercise is one of the best gifts you give yourself! At any age, consistent working out has shown to reduce pain levels. This includes difficult-to-treat pains as well: lower back pain, pregnancy-related pain, arthritic pain, and more. According to the University of Southern California, exercise also reduces pain by “building muscle strength and flexibility, reducing fatigue, reducing pain sensitivity, and reducing inflammation.”
NSAIDs, which fall under the category of non-opioid analgesics above, stand for non-steroidal anti-inflammatory drugs. Common brand name NSAIDs include Advil, Tylenol, Aleve, Bayer, and more. These pain medications can be bought over-the-counter at just about any grocery or drugstore in the US. However, consult your doctor if you would like to take these analgesics daily, as long-term use can badly affect the liver.
Physical Therapy allows you access to pain experts with all the best techniques for fighting chronic pain. Physical therapists are often equipped with high-end exercise and stretching equipment, ultrasound technology, deep-muscle massagers, and much more. Over time, physical therapy addresses the root cause of pain, alleviating symptoms over time and keeping symptoms from returning.
Cannabis has lately received a lot of medical attention in the scientific and healthcare communities. According to researchers, cannabinoids like CBD and THC—the “active ingredients” of hemp and marijuana plants—are now believed to effectively fight “Chronic, neuropathic, and possible inflammatory pain.”
Analgesics in Conclusion
Treatments for pain have been around as long as pain itself. As a species, we strive to find new and effective ways to fight both acute and chronic pain. However, it’s up to you to decide which types of analgesics work best for you.
All of us are unique. As such, it’s important that you try a variety of different pain relief methods before deciding on an appropriate course of treatment. The type of analgesic (or other non-opioid alternatives to pain relief in general) you choose may also be affected by whether or not your pain is felt internally or externally, whether it’s centralized in the nerves or the muscles, or something else specific to your case.
With that said, we are entering a new and exciting era of pain management! With a newfound interest in botanical supplements like kratom, we’ll continue to learn more about this plant than ever before. Studies are underway to validate the pain-relieving properties of the kratom plant and its constituents. It’s only a matter of time before we begin classifying this and other plants as effective analgesics in their own right!
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Weepy Sores (Wet Eczema) in Atopic Dermatitis
Reviewed by: HU Medical Review Board | June 2017 | Last updated: March 2022
Atopic dermatitis can cause blisters that ooze, or weepy sores.
What is weepy eczema?
Weepy areas leak fluid, which is usually clear. Atopic dermatitis is the most common type of eczema, and when it presents with weepy sores, it may also be called wet eczema, weepy eczema, or weeping eczema. Weepy sores can also be a sign of infection. Infection is a common complication as bacteria or other microorganisms due to the damage to the skin barrier.1,2
How is wet eczema treated?
Moisturizers are one of the basic necessities for people with atopic dermatitis, regardless of the severity of their disease. Some of the anti-inflammatory medications available for treating atopic dermatitis also come in moisturizer formulations, which can help provide additional barrier repair.
Medications
Medications used in the treatment of atopic dermatitis include:
Wet wrap therapy
With or without a topical corticosteroid, wet-wrap therapy is another technique that can help weepy sores from atopic dermatitis. Wet-wrap therapy involves applying the medication (if using) and wrapping the affected area in a layer of wetted gauze, cotton, or bandages, followed by a layer of dry bandages. Wet-wrap therapy helps improve the moisture of the affected skin, improves the penetration of the topical medicine, and provides a physical barrier against scratching.7
Phototherapy
Phototherapy, which uses ultraviolet light waves directed at the skin, is a second-line treatment strategy. Meaning it is only recommended for use after other treatments and lifestyle approaches have failed to improve atopic dermatitis symptoms. Phototherapy is sometimes used as a maintenance therapy in people with chronic atopic dermatitis.8
Other symptoms of atopic dermatitis
In addition to the weepy sores, atopic dermatitis can cause a rash, scaly patches, itch, bumps or papules, blisters, and a change in skin color. Some people also experience eye symptoms or cracks behind the ears. Over time, the areas of skin affected by atopic dermatitis may become thickened.
Filaggrin gene (FLG) mutation in atopic dermatitis
Atopic dermatitis (eczema) is caused by a combination of genetic, immunologic, and environmental factors. In people with atopic dermatitis, there sometimes a decrease or lack of filaggrin in the skin. Filaggrin is a protein that plays a key role in the structure and formation of the outermost corneal layer of the skin. The lack of filaggrin has been traced back to genetic mutations in the FLG gene. Not having enough filaggrin in the skin layers creates a damaged skin barrier, leading to a reduced ability to maintain the skin’s natural amount of water, as well as sores and rashes. The damaged skin barrier may also allow for airborne allergens' to enter the skin, which could lead to an inflammatory response by the immune system.
Filaggrin mutation and the pH of the skin barrier
Another theory suggests that the skin barrier's normal pH may be affected by filaggrin defects, which could lead to the overgrowth of bacteria. This could then trigger the immune system to create inflammatory skin lesions. There is also emerging evidence that the dysfunction in the immune system in patients with atopic dermatitis not only causes disease but also decreases the amount of functional filaggrin. Immune system dysfunction also creates an increase in inflammation.3,4
Bacterial infections and atopic dermatitis
Staphylococcus aureus, commonly known as “staph,” is a bacterium that is commonly found on the skin of people with atopic dermatitis. Over 90% of atopic dermatitis-related skin lesions are found to have staph, compared to 5% on the skin of those without the condition. In skin not affected by the condition, the skin barrier and the pH level keep the numbers of staph low, but in people with atopic dermatitis, the skin barrier is damaged, the pH level is altered, and there may be a reduced immune response to defend against bacteria. This allows the bacteria to multiply. In addition, the lesions of atopic dermatitis seem to provide a better surface for the attachment of staph due to the inflammation and cracks in the skin. The large number of staph produces toxins that stimulate the immune system and worsen flares.5,6
Viral infections and atopic dermatitis
Due to the dysfunction in the immune system, people with atopic dermatitis are at an increased risk of serious viral infections of the skin, including herpes simplex, warts, and molluscum contagiosum (a poxvirus infection). Herpes simplex virus infection is fairly common, and because it is contagious, direct contact with someone who has active cold sores should be avoided. Because of the skin barrier damage in people with atopic dermatitis, these viruses have the potential to spread and may become life-threatening. Treatment is customized to the type of virus and may include antiviral medications, cryotherapy (the use of extreme cold to freeze the infected area), or topical treatment.2,6
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How Quickly Can You Lose Weight with Farxiga?
What is Farxiga?
Farxiga
Farxiga is a medication commonly used to treat type 2 diabetes by helping to lower blood sugar levels. It belongs to a class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors. This medication works by blocking the reabsorption of glucose in the kidneys, resulting in increased glucose excretion through urine and lower blood sugar levels.
Farxiga is usually prescribed to individuals who have been diagnosed with type 2 diabetes and have not been able to manage their blood sugar levels through diet and exercise alone. It is often used in combination with other diabetes medications, such as metformin, to provide better glycemic control.
When taken as prescribed, Farxiga can help improve glycemic control, reduce the risk of cardiovascular events, and promote weight loss. It is not recommended for people with type 1 diabetes or those with diabetic ketoacidosis.
It is important to note that Farxiga is not a substitute for a healthy lifestyle. It should be used in conjunction with a balanced diet, regular exercise, and other healthy habits to effectively manage type 2 diabetes.
Before starting Farxiga, it is essential to consult with a healthcare professional who will assess your medical history and determine if this medication is suitable for you. They will also provide guidance on the correct dosage and any potential side effects to watch out for.
Common side effects of Farxiga may include urinary tract infections, genital yeast infections, increased urination, and dehydration. It is crucial to stay hydrated while taking this medication. Serious side effects such as ketoacidosis and kidney problems are rare but can occur, so it is important to be aware of any unusual symptoms and seek medical attention if necessary.
In conclusion, Farxiga is a medication commonly used to treat type 2 diabetes by helping to lower blood sugar levels. It is part of the SGLT2 inhibitor class of drugs and works by blocking glucose reabsorption in the kidneys. When used as prescribed and in combination with a healthy lifestyle, Farxiga can be effective in managing blood sugar levels, reducing the risk of cardiovascular events, and promoting weight loss.
Weight Loss Benefits of Farxiga
Farxiga weight loss
Farxiga is a medication commonly prescribed to individuals with type 2 diabetes to help manage their condition. However, one of the additional benefits of Farxiga is its ability to promote weight loss in these individuals. The medication works by reducing excess water weight and body fat, leading to a decrease in overall body weight.
Excess water weight, also known as water retention or edema, can be a common problem for people with type 2 diabetes. This occurs when the body retains more water than it needs, leading to swelling and discomfort. Farxiga helps to reduce excess water weight by increasing the production of urine, which helps eliminate the excess fluids from the body. This can result in a noticeable decrease in body weight, as the excess water weight is shed.
In addition to reducing water weight, Farxiga also aids in the loss of body fat. The medication works by inhibiting a protein called SGLT2, which is responsible for reabsorbing glucose (sugar) in the kidneys. By blocking this protein, Farxiga allows the excess glucose to be excreted in the urine instead of being reabsorbed into the bloodstream. This process, known as glycosuria, not only helps lower blood sugar levels but also leads to the breakdown of stored body fat to provide energy for the body. As a result, individuals taking Farxiga may experience a reduction in body fat and overall weight.
Studies have shown that Farxiga is effective in promoting weight loss in individuals with type 2 diabetes. In a clinical trial, participants who took Farxiga experienced a significant decrease in body weight compared to those who were taking a placebo. The weight loss was attributed to a reduction in both water weight and body fat. These findings suggest that Farxiga can be a valuable tool for individuals with type 2 diabetes who are looking to lose weight as part of their overall diabetes management plan.
It is important to note that weight loss with Farxiga may vary from person to person. Some individuals may experience more significant weight loss, while others may experience minimal change. It is also important to remember that Farxiga should be used as part of a comprehensive treatment plan that includes a healthy diet and regular exercise. Weight loss efforts are most successful when combined with lifestyle modifications and ongoing medical supervision.
In conclusion, Farxiga offers weight loss benefits for individuals with type 2 diabetes. By reducing excess water weight and promoting the breakdown of body fat, this medication can help individuals achieve their weight loss goals. However, it is essential to consult with a healthcare professional before starting any new medication or making significant changes to your diabetes management plan.
Understanding the Mechanism of Weight Loss
Understanding the Mechanism of Weight Loss
When it comes to weight loss, understanding the mechanism behind it is crucial in ensuring effective and sustainable results. Farxiga, a medication commonly used to treat type 2 diabetes, has shown promising outcomes in not only controlling blood sugar levels but also aiding in weight reduction.
Farxiga works by increasing the amount of glucose excreted in urine, a process known as glucosuria. By inhibiting the reabsorption of glucose in the kidneys, Farxiga prompts the body to eliminate excess glucose through urine rather than storing it as fat. This mechanism not only helps to manage blood sugar levels but also leads to a gradual decrease in body weight over time.
The glucosuria induced by Farxiga presents a unique opportunity for individuals struggling with obesity or overweight issues. Traditional weight loss methods mainly focus on calorie restriction, exercise, or a combination of both. However, Farxiga offers an alternative approach by targeting the body’s glucose metabolism.
It is important to note that weight loss achieved through Farxiga may vary from person to person. Factors such as initial body weight, diet, physical activity level, and individual metabolism can influence the rate and extent of weight reduction. Therefore, it is crucial to consult with a healthcare professional to determine the appropriate dosage and monitor progress.
Studies have demonstrated the effectiveness of Farxiga in promoting weight loss when used as an adjunct to a healthy lifestyle. In a 24-week clinical trial, participants receiving Farxiga along with dietary and exercise interventions experienced significant reductions in body weight compared to those on a placebo.
Furthermore, the weight loss observed with Farxiga is not limited to fat mass alone. It also includes a decrease in overall body water content. This reduction in water weight is a common occurrence when glucose levels are lowered, as excess glucose tends to cause water retention in the body.
Additionally, Farxiga has been shown to have a positive impact on other body composition markers besides weight. Studies have indicated improvements in waist circumference, body mass index (BMI), and percentage of body fat among individuals using Farxiga for weight management.
While Farxiga’s primary function is to help control blood sugar levels and manage type 2 diabetes, its weight loss effect is an added benefit for those who may also be looking to shed excess pounds. However, it is essential to approach Farxiga as part of a comprehensive weight management plan, incorporating a balanced diet and regular physical activity.
As with any medication, Farxiga may cause side effects, and its use should be closely monitored by a healthcare professional. Common side effects may include urinary tract infections, increased urination, and hypoglycemia (low blood sugar). Therefore, it is crucial to adhere to the prescribed dosage and report any adverse effects to ensure safe and effective use.
In conclusion, Farxiga’s mechanism of weight loss revolves around increasing glucose excretion in urine. By utilizing the body’s natural elimination process, Farxiga helps to reduce overall body weight over time. It offers a unique approach to weight management, complementing traditional methods and providing an alternative solution for individuals struggling with type 2 diabetes and overweight or obesity issues.
Rapid Weight Loss with Farxiga
Rapid Weight Loss with Farxiga
Farxiga is a medication commonly prescribed to help manage type 2 diabetes. However, recent studies have also revealed its potential benefits for weight loss. Many individuals have reported experiencing significant weight loss within just a few weeks of starting Farxiga treatment.
The effectiveness of Farxiga in promoting weight loss can be attributed to its unique mechanism of action. Unlike other diabetes medications, Farxiga works by increasing the excretion of glucose through the urine. By reducing the amount of glucose absorbed by the body, Farxiga helps create a calorie deficit, thus leading to weight loss.
One of the advantages of Farxiga is that it not only aids in weight loss but also helps individuals maintain their weight loss over time. This is crucial as many people find it challenging to sustain weight loss achieved through diet and exercise alone. Farxiga acts as an additional tool to support their weight management efforts and improve overall health.
How Rapid is Weight Loss with Farxiga?
Weight Loss Rate with Farxiga
The rate of weight loss with Farxiga can vary among individuals, but studies have shown that it can be quite effective. On average, individuals taking Farxiga can expect to lose between 5-10% of their body weight within a few weeks of starting treatment.
It is important to note that the rate of weight loss may slow down after the initial weeks, as the body adjusts to the medication. However, even gradual weight loss can have significant health benefits, such as improving insulin sensitivity, reducing blood pressure, and decreasing the risk of cardiovascular diseases.
The actual weight loss experienced with Farxiga may also be influenced by other factors, such as diet and exercise habits. Combining Farxiga treatment with a balanced diet and regular physical activity can enhance its weight loss effects. Therefore, it is advisable to consult with a healthcare professional who can provide personalized guidance on diet and exercise while taking Farxiga.
Farxiga’s weight loss benefits extend beyond aesthetic improvements. Excess weight, especially in individuals with diabetes, can worsen insulin resistance and contribute to the progression of the disease. By promoting weight loss, Farxiga helps improve insulin sensitivity, glycemic control, and overall metabolic health.
Potential Side Effects
Farxiga Side Effects
While Farxiga has shown promising results in terms of weight loss, it’s essential to be aware of its potential side effects. The most common side effects reported by individuals taking Farxiga include urinary tract infections and genital yeast infections.
Less common but more severe side effects may include dehydration, low blood pressure, and ketoacidosis. It is crucial to consult with a healthcare professional before starting Farxiga to discuss potential side effects and ensure that it is a suitable medication for your specific health condition.
In conclusion, Farxiga can provide significant weight loss benefits for individuals with type 2 diabetes. It works by increasing glucose excretion through the urine, creating a calorie deficit and leading to weight loss. While the rate of weight loss may vary, studies have shown an average reduction of 5-10% of body weight within a few weeks of starting treatment. It is important to combine Farxiga with a healthy lifestyle, including a balanced diet and regular exercise. As with any medication, it is vital to consult with a healthcare professional to discuss potential side effects and determine if Farxiga is the right option for you.
Risks and Side Effects
Risks and Side Effects
While Farxiga can be an effective treatment for weight loss, it is crucial to consult with a healthcare professional before starting the medication. This step is essential to fully understand and discuss the potential risks and side effects associated with its use. By doing so, individuals can make an informed decision about whether Farxiga is the right choice for their weight loss journey.
One of the key risks associated with Farxiga is its potential impact on kidney function. This medication belongs to a class of drugs called SGLT2 inhibitors, which work by blocking a specific protein in the kidneys. As a result, the kidneys eliminate more glucose from the body through urine, leading to lower blood sugar levels. However, this increased glucose elimination can put strain on the kidneys, potentially leading to a decline in kidney function. Therefore, individuals with existing kidney problems or a history of kidney disease should exercise caution and consult with their healthcare provider before using Farxiga.
Another concern to be aware of is the increased risk of urinary tract infections (UTIs) while taking Farxiga. This medication encourages the production of more urine, which creates a moist environment in the urinary tract. This moisture can provide an ideal breeding ground for bacteria, increasing the likelihood of developing a UTI. It is important for healthcare professionals to fully assess an individual’s medical history and determine if Farxiga is suitable for them, particularly if they have a history of frequent UTIs or other urinary tract issues.
One possible side effect of Farxiga is genital yeast infections. This medication can cause an imbalance in the vaginal flora, leading to the overgrowth of yeast. This may result in symptoms such as itching, burning, or a thick, cottage cheese-like discharge. It is essential to promptly seek medical attention if any signs of a yeast infection occur, as treatment may be necessary to alleviate discomfort and prevent further complications.
Dehydration is another potential side effect of Farxiga. As this medication increases urine production, it is important for individuals to maintain adequate hydration by drinking enough fluids throughout the day. Failure to do so can lead to dehydration, which may cause symptoms such as dizziness, dry mouth, fatigue, or decreased urine output. Individuals should be cautious and closely monitor their fluid intake while taking Farxiga, especially during hot weather or when engaging in physical activities.
Finally, it is worth mentioning the risk of hypoglycemia, or low blood sugar levels, while using Farxiga. Although this medication does not directly lower blood sugar like other diabetes medications, it can increase the risk of hypoglycemia when used in combination with certain insulin or sulfonylurea drugs. Individuals using Farxiga should be aware of the signs and symptoms of hypoglycemia, such as sweating, shakiness, confusion, and rapid heartbeat, and take appropriate measures to manage their blood sugar levels accordingly.
In conclusion, while Farxiga can be an effective medication for weight loss, it is vital to consult with a healthcare professional to discuss the potential risks and side effects associated with its use. Understanding these potential concerns allows individuals to make informed decisions about their treatment options and take necessary precautions to mitigate any potential risks. The healthcare provider’s expertise is invaluable in determining the suitability and safety of Farxiga for each individual’s specific situation.
Combining Farxiga with Lifestyle Changes
Combining Farxiga with Lifestyle Changes
To maximize the weight loss benefits of Farxiga, it is often recommended to combine its use with healthy lifestyle changes such as regular exercise and a balanced diet.
When it comes to losing weight, medication alone is not enough. Farxiga is a medication that can help with weight loss by increasing urine production and reducing the amount of glucose that is reabsorbed by the kidneys. However, for optimal results, it is essential to make additional changes to your lifestyle.
One of the most effective ways to supplement the weight loss benefits of Farxiga is through regular exercise. Engaging in physical activity not only helps burn calories, but it also boosts metabolism, improves cardiovascular health, and enhances overall well-being. Incorporating various forms of exercise, such as cardio, strength training, and flexibility exercises, can further enhance the effectiveness of Farxiga in shedding pounds.
Additionally, adopting a balanced diet is crucial in achieving successful weight loss while taking Farxiga. Focus on consuming nutrient-dense foods that provide essential vitamins, minerals, and fiber. Limit intake of processed foods high in refined sugars and unhealthy fats. Opt for whole grains, lean proteins, fruits, vegetables, and healthy fats. It is also important to practice portion control to ensure you are not exceeding your daily calorie needs.
Combining Farxiga with lifestyle changes goes beyond physical activity and diet. It also involves making sustainable modifications to your daily routine and habits. Getting adequate sleep is crucial for weight management as it influences appetite and metabolism. Aim for at least 7-8 hours of quality sleep per night to support your weight loss efforts.
Additionally, managing stress is vital as it can lead to emotional eating and hinder weight loss progress. Incorporate stress-relief techniques such as meditation, yoga, deep breathing exercises, or engaging in hobbies that help you relax and unwind. Surrounding yourself with a strong support system of family, friends, or a support group can also provide encouragement and accountability throughout your weight loss journey.
It is important to note that before making any lifestyle changes or starting a new exercise program, it is recommended to consult with a healthcare professional or a registered dietitian. They can provide personalized guidance and ensure that the combination of Farxiga and your chosen lifestyle changes is safe and suitable for your specific needs.
Remember, weight loss is a gradual process, and there is no “one size fits all” approach. Combining Farxiga with healthy lifestyle changes can significantly enhance your weight loss journey and help you achieve long-term success in managing your weight.
7. Why is it important to work closely with a healthcare professional when taking Farxiga for weight loss?
Healthcare Professional
When it comes to achieving rapid weight loss with Farxiga, it is essential to have the guidance and support of a healthcare professional. While Farxiga can be a valuable tool for individuals with type 2 diabetes, it is important to ensure safe and effective use of the medication. Working closely with a healthcare professional can provide several benefits that aid in maximizing the effectiveness of Farxiga and promoting overall well-being.
Firstly, healthcare professionals possess the knowledge and expertise to tailor treatment plans to individual needs. They can assess your medical history, conduct a thorough evaluation, and take into account any pre-existing conditions or medications you may be taking. This personalized approach allows them to determine whether Farxiga is suitable for you and if any adjustments need to be made to dosage or treatment duration.
Additionally, healthcare professionals have access to the latest medical research and advancements in the field of diabetes management. This means they can provide you with up-to-date information on the benefits, potential risks, and side effects associated with Farxiga. They can also educate you on lifestyle modifications that complement the medication, such as dietary changes and exercise routines.
Regular consultations with a healthcare professional also enable close monitoring of your progress. They can assess your weight loss journey, monitor your blood sugar levels, and make necessary adjustments to your treatment plan. They can offer guidance on potential challenges you may encounter and provide strategies to overcome them, ensuring you remain motivated and on track towards your weight loss goals.
Furthermore, healthcare professionals can offer invaluable emotional support throughout your weight loss journey. They can address any concerns or anxieties you may have, provide encouragement during difficult times, and celebrate your achievements. This support system plays a crucial role in keeping you motivated and fostering a positive mindset towards weight loss.
Another important aspect of working closely with a healthcare professional is the ability to address any potential side effects or adverse reactions to Farxiga promptly. While Farxiga is generally well-tolerated, it is crucial to be aware of any potential risks. Healthcare professionals can educate you on warning signs to watch for and provide guidance on when to seek medical attention.
Lastly, healthcare professionals can assist in developing a comprehensive approach to weight loss. They can help you establish realistic goals, create a personalized diet and exercise plan, and provide education on additional lifestyle factors that may affect weight loss, such as stress management and sleep quality. This holistic approach ensures that you are equipped with the necessary tools and knowledge to achieve long-term success in your weight loss journey.
In conclusion, while Farxiga can be a valuable tool for rapid weight loss in individuals with type 2 diabetes, it is essential to work closely with a healthcare professional throughout the process. Their expertise, guidance, and support can maximize the effectiveness of Farxiga, address any concerns or side effects, and ensure your weight loss journey is safe and successful. By partnering with a healthcare professional, you can empower yourself to achieve your weight loss goals while prioritizing your overall health and well-being.
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Vitamin Deficiency Puts You at Risk for Cancer
Health Alert 212
It’s surprising how not getting enough of one little vitamin can result in deadly cancer. But studies show it’s true. I’m talking about folate.
You may currently overlook this vitamin because it has a reputation as a nutrient for pregnant women. What you haven’t heard is the link between folate deficiency and cancer. New evidence continues to show that improving folate levels can protect against a dozen different cancers.
* The Cancer Connection *
Folate is part of the B-complex vitamin family. You probably know it best in its supplement form, folic acid. Folate is the form found in food. Folate plays a key role in the functioning of DNA. But scientists recently discovered that deficiencies in folic acid damage DNA in a way that’s similar to cancer.
As it turns out, a deficiency in folate can result in cancers of the cervix, breast, uterus, lung and pancreas. Folate supplementation can suppress growth of colon cancer. So how do you know how much folate is enough to protect yourself?
* Folate & Folic Acid in Your Diet *
To get this cancer protection you need about 400 micrograms of folate each day. The best natural sources of folate are vegetables. Vegetables with the highest folate content are dark, leafy greens like spinach, kale and romaine lettuce. Your body only absorbs half of the folate you consume. It may be difficult to absorb cancer-protecting quantities from a typical modern diet so a supplement is a very good idea.
Most multi-vitamins contain folic acid. Check yours to make sure it has at least 400 micrograms. You can also get folic acid supplements in liquid and capsule form at your local health food store. You should be certain to take these if you’ve had cancer or are at risk.
Al
Sears MD
Greenwood-Robins, Maggie Ph.D. Foods That Combat Cancer, Avon Books, 2004. p 27 – 29.
Stover PJ, “Physiology of folate and vitamin B12 in health and disease” Nutr Rev. 2004 Jun;62 (6 Pt 2):S3-12; discussion S13.
Kim Yi. “Folate and DNA methylation: a mechanistic link between folate deficiency and colorectal cancer?” Cancer Epidemiol Biomarkers Prev. 2004 Apr;13(4):511-9.
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Boost your Brain Power
January 17, 2014
Written By
Written By:
Photo: Alvimaan
Everyone knows that exercising is important to keep our bodies healthy, but what about our brains? Just like the body, the brain needs to be exercised in order to stay optimally healthy. Here are a few easy tips to exercise your brain so it stays sharp for years to come.
Physical Activity
Doesn’t it seem like everything health related comes back to physical activity? That’s because it does! Being physically active helps boost brainpower and keeps you more alert. So instead of watching a 30-minute TV program, try going for a walk or a job.
Sleep
Getting enough sleep is key to keeping your brain alert and healthy. When a person doesn’t get enough sleep the brain becomes sluggish and struggles to keep up with daily tasks. Furthermore, it has been reported that a long-term lack of sleep can lead to a decline in mental ability, as a person gets older. So get that beauty rest!
Eat Fish
Omega-3 Fatty Acids are important for promoting brain health and fish are full of them! Try incorporating fish into your diet once a week to boost the amount of omega-3’s you get and help to keep your brain healthy.
Do Some Puzzles
Doing fun puzzles like Sudoku and crosswords can help exercise and train your brain. This helps you to have a healthy functioning brain throughout life and helps prevent cognitive decline.
To learn more tips for keeping your brain healthy and alert, read at Live Science
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Hypnosis Therapist Near Me – Unlimited Help
This article will explain the background of and methods utilized in 2 significant types of psychotherapy: behavior therapy and psychoanalysis. Hypnosis Therapist Near Me…
Behavior Therapy As An Idea
Behavior modification, likewise called behavioral adjustment, uses people’s actions on the planet as the gain access to point for fixing a variety of problems– not just behavioral problems but likewise issues involving sensations and ideas. Behavioral psychologists presume that issue habits are triggered by interactions between individuals and their environments. Problems take place when an individual’s environment rewards damaging habits; over time, these habits end up being habits.
Behavior modification is utilized to treat such hazardous habits as smoking cigarettes, substance use, eating disorders, sleeping disorders, and the inability to handle stress successfully. Behavior therapy can also be utilized to treat bigger psychological disorders, consisting of obsessive-compulsive condition, schizophrenia, bipolar illness, psychotic disorders, stress and anxiety, depression, and personality disorders.
Is BetterHelp counseling or therapy?
To assist a client with obsessive-compulsive condition, a behavioral therapist might teach that private, little by little, to endure a reasonable quantity of dirt in their environment or to refrain from continuously cleaning their hands. This strategy is called direct exposure therapy..
Behavior therapy can likewise be used to enhance positive habits, such as company, involvement in sports, and limit forming. Hypnosis Therapist Near Me
Origins Of Behavior Modification In Psychology.
Behavior treatment can be traced to the research of Russian psychologist Ivan Pavlov, which was released in the 1920s and 1930s. In a popular experiment, Pavlov classically conditioned dogs to drool when he called a bell due to the fact that the dogs learned to associate the presence of food with the sound of the bell.
Behavior modification is also related to the work of US psychologist B.F. Skinner, who studied operant conditioning in the 1930s. Operant conditioning means discovering behavior through rewards and penalties. While working with patients in a psychiatric hospital, Skinner discovered that behaviors could be “formed” (slowly altered) when positive habits were followed by preferable repercussions and unfavorable habits were followed by undesirable consequences.
Behavior modification was later on established as a treatment method when the work of psychologists such as Aaron Beck and Albert Ellis led to Cognitive Behavior modification ( CBT). CBT is based on the theory that people’s ideas identify both their feelings and their behaviors. When therapists assist individuals change their thoughts, they can assist them alter their lives.
Significance Of Behavior Modification.
Behavior modification is based on the belief that we are affected by and gain from our environment. Thus, behavioral therapists assist clients change unhealthy behaviors by concentrating on observable actions, rather than on what is occurring in the mind. Behavior modification likewise concentrates on concrete changes in the present instead of on insight into the past.
Components Of Behavior Modification Methods.
Particular kinds of behavior therapy consist of the following:.
I went through a period of extreme separation stress and anxiety when my parents initially got separated, then became scared of everything (rollercoasters, scary films, bees, film theaters, you call it). I was mainly able to deal with it, but in 7th grade, my stress and anxiety all of a sudden got so much even worse.
I was constantly on edge and persuaded something awful was going to occur, and had difficulty sleeping since I informed myself that the second I closed my eyes a fire would start, somebody would break in, or something bad would happen to someone I liked. I became compulsive about inspecting the locks on windows and doors, the stove, and established an illogical worry of getting gastrointestinal disorder. After enjoying a motion picture on the Black Plague in school, I ended up being extremely paranoid about germs and concerned about them constantly. Due to the fact that, it got to the point where I just wanted to sleep all the time.
Can Medical Insurance Offer Protection For Treatment Consultations?
Upgraded January 22, 2022.
Medically Evaluated By: Dawn Brown.
What is mental health protection? When it pertains to counseling, individuals often wonder how much it costs with or without a health plan and how to spend for it. Health care systems and markets can be complicated, however people seek psychological health treatment every day, and we’re here to walk you through the many mental health advantages readily available.
Get Fast, Cost Effective Therapy With BetterHelp.
Sign Up To Be Personally Matched To A Licensed Therapist.
Can BetterHelp prescribe medication? Hypnosis Therapist Near Me
Treatment Covered With Insurance: Protection Tips To Know.
What Kind Of Insurance Plans Are There For Treatment?
There are numerous methods to pay for psychological health treatment. What is covered by health insurance and what isn’t can be puzzling initially? The Mental Health Parity Act belongs of the Affordable Care Act that needs big medical insurance providers and health insurance to supply equal protection for mental disorder (consisting of substance abuse coverage and treatment). Contact your insurance company for additional information..
What Various Kinds Of Therapies Does Insurance Cover?
There are no quick and simple answers to the concern of whether your health insurance coverage plan will cover your treatment sessions or mental health services. The law does not mandate small health insurance business with fewer than fifty workers to have medical insurance cover the expense of therapy. A therapist’s workplace can also help with these concerns and you can constantly talk to your medical insurance advantages department or insurance provider to validate what level of psychological health coverage you have.
Typical Coverage Issues.
Lots of companies that aren’t governed by the Affordable Care Act or the Mental Health Parity Act select to supply psychological health coverage for their staff members. Mental health advantages can be confusing, so we’ll describe a couple of things to search for. Before seeing a therapist, it’s important to see if the service provider takes your health insurance. One way to discover is to offer your supplier the information shown on your insurance policy..
For relative, it might work to check out a Children’s Health Insurance Program, CHIP. People with identified mental disorders, compound use condition, or other mental illnesses can find their essential health benefits may look for more details with the Customer Assistance Program..
Medicaid programs are an excellent choice for family members, especially those with a diagnosable disorder, mental health condition, pre-existing condition, or those trying to find a kids’s medical insurance program/CHIP. Learn more about these programs at Healthcare.gov..
You may seek in-office talk treatment that is covered by your insurance if you’re interested in minimizing expenses. Numerous online treatment choices ( which may not be consisted of in some marketplace plans) can be much less expensive than even in-network options..
Concerns To Ask Your Insurance.
Are there particular psychological health services/therapists that my health insurance plan does not cover?
Am I covered for therapy/therapists if I have a pre-existing condition?
What is the personal privacy policy/terms of service for these psychological health services/therapists?
What is the variety of therapy sessions my health plan covers annually?
Do I have a deductible to pay before my health insurance cover services under my medical insurance plan?
Exists a copay required by specific or group medical insurance plans?
Do I need a referral from my medical care physician for a therapist?
Insurance Coverage Network Providers.
A network service provider is a provider who accepts medical insurance as a type of payment. In this case, that medical insurance partially pays for mental healthcare. They may accept insurance for psychological health protection, a network service provider is “within” your health plan’s network..
Insurance Coverage Coverage & Deductibles. Hypnosis Therapist Near Me
Hypnosis Therapist Near Me – Unlimited Help
This post will discuss the background of and techniques used in two major kinds of psychiatric therapy: behavior therapy and psychoanalysis. Hypnosis Therapist Near Me…
Behavior Therapy As A Principle
Behavior modification, also called behavioral modification, utilizes individuals’s actions worldwide as the access point for fixing a variety of problems– not only behavioral issues but also problems involving sensations and thoughts. Behavioral psychologists presume that problem behaviors are brought on by interactions in between individuals and their environments. Issues occur when a person’s environment rewards destructive behaviors; gradually, these habits become routines.
Behavior therapy is utilized to deal with such unsafe routines as smoking, compound use, eating conditions, insomnia, and the failure to manage tension effectively. Behavior therapy can also be utilized to treat bigger psychological disorders, consisting of obsessive-compulsive disorder, schizophrenia, bipolar affective disorder, psychotic disorders, anxiety, character, and depression disorders.
Is BetterHelp counseling or therapy?
To assist a client with obsessive-compulsive condition, a behavioral therapist may teach that specific, little by little, to endure a sensible amount of dirt in their environment or to refrain from constantly cleaning their hands. This strategy is called exposure therapy..
Behavior modification can also be utilized to enhance favorable behaviors, such as company, involvement in sports, and limit forming. Hypnosis Therapist Near Me
Origins Of Behavior Modification In Psychology.
Behavior modification can be traced to the research of Russian psychologist Ivan Pavlov, which was released in the 1920s and 1930s. Pavlov’s work focused on classical conditioning, which implies learning through association. In classical conditioning, two stimuli( items or events that produce a reaction) are linked together to produce a new action. In a well-known experiment, Pavlov classically conditioned pets to drool when he rang a bell because the canines discovered to associate the presence of food with the sound of the bell.
Behavior modification is also related to the work of US psychologist B.F. Skinner, who studied operant conditioning in the 1930s. Operant conditioning indicates discovering behavior through penalties and benefits. While dealing with clients in a psychiatric hospital, Skinner found that behaviors could be “shaped” (slowly changed) when positive habits were followed by preferable repercussions and unfavorable habits were followed by undesirable repercussions.
Behavior modification was later developed as a treatment approach when the work of psychologists such as Aaron Beck and Albert Ellis resulted in Cognitive Behavior modification ( CBT). CBT is based on the theory that people’s thoughts determine both their emotions and their behaviors. Therefore, when therapists help people alter their thoughts, they can help them change their lives.
Significance Of Behavior Modification.
Behavior therapy is based upon the belief that we are influenced by and learn from our environment. Behavioral therapists help customers change unhealthy habits by focusing on observable actions, rather than on what is occurring in the mind. Behavior modification likewise concentrates on concrete modifications in today instead of on insight into the past.
Elements Of Behavioral Therapy Strategies.
Specific kinds of behavior modification include the following:.
I was a pretty nervous kid and worried constantly. I don’t believe I was ever depressed, but I had a LOT of stress and anxiety. I went through a duration of extreme separation stress and anxiety when my moms and dads initially got separated, then became frightened of whatever (rollercoasters, frightening motion pictures, bees, theater, you name it). I was mostly able to handle it, but in 7th grade, my stress and anxiety all of a sudden got a lot even worse.
I became obsessive about checking the locks on windows and doors, the range, and established an illogical fear of getting food poisoning. It got to the point where I just desired to sleep all the time since.
Can Medical Insurance Supply Coverage For Therapy Visits?
Updated January 22, 2022.
Clinically Examined By: Dawn Brown.
What is psychological health protection? When it pertains to counseling, individuals almost always wonder how much it costs with or without a health plan and how to pay for it. Healthcare marketplaces and systems can be confusing, however individuals seek psychological health treatment every day, and we’re here to walk you through the many psychological health advantages readily available.
Get Fast, Economical Therapy With BetterHelp.
Register To Be Personally Matched To A Certified Therapist.
Can BetterHelp prescribe medication? Hypnosis Therapist Near Me
Therapy Covered With Insurance Coverage: Protection Tips To Know.
What Type Of Insurance Coverage Plans Are There For Treatment?
There are many methods to pay for mental health treatment. What is covered by health insurance coverage and what isn’t can be confusing at? The Mental Health Parity Act belongs of the Affordable Care Act that needs large health insurance providers and health plans to supply equal protection for mental disorder (including drug abuse coverage and treatment). Contact your insurance supplier for more information..
What Various Types Of Therapies Does Insurance Coverage Cover?
There are no fast and simple responses to the concern of whether your health insurance coverage strategy will cover your therapy sessions or psychological health services. The law doesn’t mandate small health insurance companies with fewer than fifty workers to have medical insurance cover the cost of therapy. A therapist’s office can also aid with these concerns and you can always check with your medical insurance benefits department or insurance provider to confirm what level of psychological health coverage you have.
Common Coverage Issues.
Lots of business that aren’t governed by the Affordable Care Act or the Mental Health Parity Act select to provide mental health coverage for their employees. Psychological health advantages can be complicated, so we’ll outline a couple of things to try to find. Before seeing a therapist, it is necessary to see if the service provider takes your health insurance. One way to find out is to provide your provider the information revealed on your insurance policy..
For member of the family, it might be useful to look into a Kid’s Medical insurance Program, CHIP. People with diagnosed mental disorders, substance usage disorder, or other mental disorders can discover their essential health advantages may look for more information with the Consumer Support Program..
Medicaid programs are a great alternative for family members, specifically those with a diagnosable condition, psychological health condition, pre-existing condition, or those looking for a kids’s health insurance program/CHIP. Discover more about these programs at Healthcare.gov..
If you have an interest in minimizing costs, you might look for in-office talk therapy that is covered by your insurance coverage. Nevertheless, numerous online therapy options ( which might not be included in some market plans) can be more affordable than even in-network alternatives..
Questions To Ask Your Insurance.
Are there specific mental health services/therapists that my health insurance strategy doesn’t cover?
Am I covered for therapy/therapists if I have a pre-existing condition?
What is the privacy policy/terms of service for these mental health services/therapists?
What is the number of treatment sessions my health insurance covers per year?
Do I have a deductible to pay prior to my health insurance cover services under my medical insurance strategy?
Exists a copay needed by private or group health insurance plans?
Do I require a referral from my primary care medical professional for a therapist?
Insurance Coverage Network Providers.
A network provider is a supplier who accepts health insurance as a form of payment. In this case, that medical insurance partially spends for mental healthcare. They may accept insurance coverage for psychological health protection, a network service provider is “within” your health strategy’s network..
Insurance Protection & Deductibles. Hypnosis Therapist Near Me
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0710c49d78236756c5f8f2cbb77487c9
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2,660,998,157,446,575,600
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Search Medical Centers
Lung Cancer Treatment in Greece
Hospitals and medical centers in Greece which treat Lung Cancer patients.
SARAFIANOS Private Clinic
SARAFIANOS is an ISO 9001 certified private clinic in Thessaloniki, Greece. Known for its long tradition of high quality health services since 1957, high sense of professionalism, respect for the patient, quality, thoroughness and consistency in the services provided
Availability:
Lung Cancer is treated at SARAFIANOS Private Clinic
Listed oncologist:
Dr. Markopoulos Minas
Head of Oncology - Chemotherapy
Hygeia Hospital
The main feature of the clinic is that it strives to offer an individualized treatment approach for each patient beyond research protocols, while aiming at healing and better quality of life.
Availability:
Lung Cancer is treated at Hygeia Hospital Athens
Oncology centers in Greece (Page 1 of 1)
About Lung Cancer Treatment
This information is intended for general information only and should not be considered as medical advice on the part of Health-Tourism.com. Any decision on medical treatments, after-care or recovery should be done solely upon proper consultation and advice of a qualified physician.
What is Lung Cancer?
This is a cancer condition which occurs when cells in the lung tissue start to grow uncontrollably.
Types of lung cancer
There are two types of lung cancer namely primary and secondary lung cancer. Primary lung cancer is cancer that begins in the lungs. Cancer that spreads from the lungs to another body part is known as secondary lung cancer.
Signs of lung cancer
There are usually no signs or symptoms in the early stages of lung cancer. Eventually, symptoms develop which include:
• Coughing of blood or rusty-colored phlegm
• Shortness of breath
• Unexplained weight loss
• Chest pain
• Recurrent respiratory infections
• Hoarseness
• Wheezing
Diagnosis of lung cancer involves:
• Chest X-ray: This is usually the first test used to diagnose lung cancer. However, chest X-rays can’t give a definitive diagnosis because they cannot differentiate between cancer and other medical conditions such as a lung abscess.
• CT scan: A computerized tomography (CT) scan is usually carried out after a chest X-ray. Before having the scan you will be given an injection of a dye that makes the scan to be clearer. The scan is painless and takes 10-30 minutes to complete.
• PET-CT scan: A PET-CT (positron emission tomography –computerized tomography) scan may be carried out if the results of the CT scan show you have early stage lung cancer. A PET-CT scan helps with diagnosis and treatment as it can show where there are active cancer cells.
• Bronchoscopy and biopsy: A bronchoscopy is a procedure that allows a doctor to remove a small sample of cells from your lungs. A medical instrument called a bronchoscope is used to perform the biopsy. A biopsy is the sample of tissue taken from the body in order to examine it more closely. The procedure may be uncomfortable. A mild sedative is given beforehand and a local anesthetic to make your throat numb.
Precautions and Treatment
Tobacco is the number one cause of lung cancer. This is because different toxic substances are inhaled when smoking. However, people who do not smoke may get lung cancer. If you smoke, the best way to prevent lung cancer is to stop smoking. A healthy lifestyle will also decrease chances of developing lung cancer or other types of cancer. Major treatment procedures include surgery, radiotherapy, and chemotherapy
• Radiotherapy: This involves the use of high-energy x-rays to destroy cancer cells. How intensive the radiotherapy is, depends on how advanced your lung cancer is. Radiation treatments are given a few days at a time for several weeks. Radiation may be before surgery, to shrink a tumor to make it easier to remove, or after surgery to kill any cancer cells left behind. The recovery period can be several weeks or even months.
• Chemotherapy: Chemotherapy uses powerful cancer-killing medication to treat the lung cancer in cycles. Your doctor may prescribe one type of chemo drug or a mix of different ones. You’ll get them through an IV at a hospital or treatment center. It may take a few rounds of treatment over a few days or weeks. Some chemotherapy drugs are injected into a vein, while others are taken by mouth.
• Surgery: Surgery is performed by making a cut in your chest or side and removing a section or the entire affected lung. Nearby lymph nodes may also be removed if it is likely that cancer has spread to them. General anesthesia is injected into a vein or even inhaled.
Risks : Chest pain, Fatigue, Difficulty swallowing, Nausea, Vomiting, Mouth sores, Hair loss, Bleeding, Infection of lungs, an air leak in your lung that does not close, ongoing pain in your chest wall, risks from general anesthesia and damage to your heart, lungs, blood vessels, or nerves in your chest.
Learn more about Lung Cancer
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a85948ac2583e474df771afa9378dc96
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1,525,157,141,037,062,100
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Anxiolytic effects of endocannabinoid enhancing compounds: A systematic review and meta-analysis
Caroline M.B. Kwee*, Nadia A. Leen, Rian C. Van der Kamp, Caspar J. Van Lissa, Danielle C. Cath, Lucianne Groenink, Johanna M.P. Baas
*Bijbehorende auteur voor dit werk
Onderzoeksoutputpeer review
4 Citaten (Scopus)
47 Downloads (Pure)
Samenvatting
The endocannabinoid system is a promising candidate for anxiolytic therapy, but translation to the clinic has been lagging. We meta-analyzed the evidence for anxiety-reduction by compounds that facilitate endocannabinoid signaling in humans and animals. To identify areas of specific potential, effects of moderators were assessed. Literature was searched in Pubmed and Embase up to May 2021. A placebo/vehicle-control group was required and in human studies, randomization. We excluded studies that co-administered other substances. Risk of bias was assessed with SYRCLE's RoB tool and Cochrane RoB 2.0. We conducted three-level random effects meta-analyses and explored sources of heterogeneity using Bayesian regularized meta-regression (BRMA). The systematic review yielded 134 studies. We analyzed 120 studies (114 animal, 6 human) that investigated cannabidiol (CBD, 61), URB597 (39), PF-3845 (6) and AM404 (14). Pooled effects on conditioned and unconditioned anxiety in animals (with the exception of URB597 on unconditioned anxiety) and on experimentally induced anxiety in humans favored the investigational drugs over placebo/vehicle. Publication year was negatively associated with effects of CBD on unconditioned anxiety. Compared to approach avoidance tests, tests of repetitive-compulsive behavior were associated with larger effects of CBD and URB597, and the social interaction test with smaller effects of URB597. Larger effects of CBD on unconditioned anxiety were observed when anxiety pre-existed. Studies reported few side effects at therapeutic doses. The evidence quality was low with indications of publication bias. More clinical trials are needed to translate the overall positive results to clinical applications.
Originele taal-2English
Pagina's (van-tot)79-94
Aantal pagina's16
TijdschriftEuropean Neuropsychopharmacology
Volume72
DOI's
StatusPublished - jul.-2023
Citeer dit
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943,983,957,600,708,600
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Zvarova, Barbora; Uhl, Franziska E.; Uriarte, Juan J.; Borg, Zachary D.; Coffey, Amy L.; Bonenfant, Nicholas R.; Weiss, Daniel J. and Wagner, Darcy E. (2016): Residual Detergent Detection Method for Nondestructive Cytocompatibility Evaluation of Decellularized Whole Lung Scaffolds. In: Tissue Engineering Part C-Methods, Vol. 22, No. 5: pp. 418-428
Full text not available from 'Open Access LMU'.
Abstract
The development of reliable tissue engineering methods using decellularized cadaveric or donor lungs could potentially provide a new source of lung tissue. The vast majority of current lung decellularization protocols are detergent based and incompletely removed residual detergents may have a deleterious impact on subsequent scaffold recellularization. Detergent removal and quality control measures that rigorously and reliably confirm removal, ideally utilizing nondestructive methods, are thus critical for generating optimal acellular scaffolds suitable for potential clinical translation. Using a modified and optimized version of a methylene blue-based detergent assay, we developed a straightforward, noninvasive method for easily and reliably detecting two of the most commonly utilized anionic detergents, sodium deoxycholate (SDC) and sodium dodecyl sulfate (SDS), in lung decellularization effluents. In parallel studies, we sought to determine the threshold of detergent concentration that was cytotoxic using four different representative human cell types utilized in the study of lung recellularization: human bronchial epithelial cells, human pulmonary vascular endothelial cells (CBF12), human lung fibroblasts, and human mesenchymal stem cells. Notably, different cells have varying thresholds for either SDC or SDS-based detergent-induced cytotoxicity. These studies demonstrate the importance of reliably removing residual detergents and argue that multiple cell lines should be tested in cytocompatibility-based assessments of acellular scaffolds. The detergent detection assay presented here is a useful nondestructive tool for assessing detergent removal in potential decellularization schemes or for use as a potential endpoint in future clinical schemes, generating acellular lungs using anionic detergent-based decellularization protocols.
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A Comparative Study of Fracture Resistance of Endodontically Treated Compromised Teeth with Different Post Systems: An In Vitro Study
Abstract
Aims:
This in-vitro study was conducted to compare structural reinforcement with composite resin and two different types of posts in structurally compromised teeth.
Methods and Materials:
Forty-eight human maxillary central incisors were instrumented and obturated. Specimens were randomly divided into four groups. The control group was not compromised and was just restored with a resin composite. In the composite-reinforced group, the access cavity of the compromised teeth was restored only with composite to the cemento-enamel junction (CEJ). In the reinforced glass fiber post group, the compromised cervical area of the teeth was reinforced with a dual-cured composite and a glass fiber post. The reinforced metal cast post group was reinforced with a dual-cured composite and a casting post. The mean fracture load was measured. Data were analyzed by SPSS software using one-way analysis of variance (ANOVA) and chi-square statistical analysis tests. For pair comparison, Duncan was used. P<0.05 was considered statistically significant.
Results:
The highest fracture resistance values were for the non-compromised samples (170.12 ± 12.44), while the lowest values were for the compromised ones restored only with the resin composite (71.40 ± 17.00). There was no statistically significant difference between the mean fracture resistances of the fiber (129.36 ± 21.34) and cast (116.60 ± 22.60) post groups (P>0.05).
Conclusion:
The use of a composite resin in a root with thin walls will reinforce the compromised tooth, but the type of the post will not influence the final results.
Keywords: Composite resin, Fracture resistance, Post and core technique, Permanent teeth, Resin cements, Tooth resorption.
1. INTRODUCTION
The rehabilitation of extensively damaged teeth with no dentinal support at the coronal portion of the root canal is very difficult [1]. This situation can be seen clinically when the developing permanent tooth (especially maxillary central incisors in children aged 9-10) suffers trauma, and its root formation remains incomplete [2]. The amount of residual dentin and tooth canal shape play critical roles in the strength and resistance of a tooth with posts. Hence, a post is not commonly used in teeth with flared canals, and the lack of dentinal structure also precludes the placement of reinforcing posts [3, 4]. In teeth with a significant loss of coronal and radicular tooth structures, it is important to assess the alternatives to cast posts and cores or common prefabricated posts that are also resistant to fatigue effects [5, 6]. Studies have suggested resin composites for strengthening the treated teeth with immature roots [7]. This method, in combination with the prefabricated post, has been advised for use during and after apexification [8].
There are numerous studies on the fracture resistance of devitalized teeth with different post systems, but some contradictory results have been observed in the literature concerning how the post materials affect the resistance fracture mode and stress distribution of the restored teeth [9, 10]. Some studies claim that metal posts perform better than fiber posts; others, however, state the opposite [11, 12]. Numerous studies have used composite resins along with fiber posts to strengthen the structure of damaged endodontically treated teeth [13, 14]. However, to the best of our knowledge, no study has ever compared the effect of application or non-application of a post and different kinds of posts on increasing the fracture resistance of cervically weakened teeth, such as the teeth with internal cervical resorption or necrotic immature permanent teeth. Therefore, this study aimed to evaluate and compare the effects of two strengthening methods on the weakened cervical structure with and without a post and different post types. The null hypothesis formulated in this study was that composite alone and in combination with a fiber post or a cast post would have similar strengthening effects on the weakened endodontically treated teeth at the cervical region.
2. MATERIALS AND METHODS
Research ethics committees of the vice-chancellor in research affairs of the Medical University of Isfahan ethically approved this study (Approval ID: 384176). Based on the previous studies [15, 16], forty-eight extracted intact human maxillary central incisors without significant differences in diameter (about 11 ± 1 mm occlusogingival height and 8.5 ± 1 mm width) were selected for this study. The approximate length of all roots was considered to be 15 mm. All samples were stored in 0.5% chloramine T solution (Merck, Darmstadt, Germany) until the time of the experiment.
All teeth were prepared by the same trained operator. An access cavity was prepared, and then all the teeth were instrumented up to file #70 and obturated with AH26 sealer and gutta-percha using a lateral condensation technique. After that, the specimens were randomly divided into four groups of 12 teeth each:
1. The control group that was not compromised (teeth were not cervically prepared),
2. In this group, a laboratory bur (Ivomil, IVOCLAR AG, Germany) was used to thin the cervical area of the root and simulate the thin dentinal wall of the compromised teeth. The preparation was extended to 5 mm apical to CEJ (the height of the palatal wall was 2 mm from CEJ), and nearly 1 mm thickness of dentin remained at all walls. The thickness of the remaining residual dentin at the cervical area was estimated by a digital Vernier caliper (Aerospace) and Radio Visio Graphy (RVG), which was then reinforced by resin composite (composite reinforced group),
3. In this group, Gates Glidden #1-4 and then Peeso reamers #4-6 were used (Dentsply, LD Caulk, USA) to remove the gutta-percha and prepare canals. The gutta-percha was evacuated up to 5 mm under CEJ. Then laboratory bur was used to thin the cervical area of the root and simulate the thin dentinal wall of the compromised teeth as described in group 2. Then, it was reinforced by glass fiber post (glass fiber post reinforced group),
4. Gates Glidden #1-4 and then Peeso reamers #4-6 were used (Dentsply, LD Caulk, USA) as described in group 3. Then, laboratory bur was used to thin the cervical area of the root and simulate the thin dentinal wall of the compromised teeth as described in group 2. Then, it was reinforced by a metal cast post (metal cast post reinforced group).
Then, all teeth were restored as follows: (the list of materials used in this study is provided in Table 1.
Table 1.
Materials, manufacturers, and composition.
Material Manufacturer Composition
Adper Single Bond 3M Espe. St. Paul, MN.,
USA.
BisGMA, HEMA, dimethacrylates, ethanol, water, photoinitiator system, and a methacrylate functional copolymer of polyacrylic and poly (itaconic) acids. (Approximately 10 wt % filled).
37% phosphoric acid etch-gel Total etch, Ivoclar Vivadent, Swiss.lot no. Phosphoric acid, colloidal silica, pigments, water
Bis-coreTM Bisco INC, Schaumburg, USA Bisphenol A diglycidyl methacrylate, glass filler, Urethane thriethylene glycol dimethacrylate, fused silica
Z100 ESPE, 3M Dental Product, USA Mikrohibridna kompozitna smola • Microhybrid composite resin - matrix; BIS-GMA i TEGDMA
• Matrix: BIS-GMA and TEGDMA - punilo cirkonija/silika, anorgansko punilo 66%w, veličina čestica od 3, 5 do 0,01µm
• Filler: zirconia/silica; inorganic filler loading is 66% w, particle size ranging from 3.5 to 0.01 µm
RelyX Unicem resin cement 3M ESPE, Seefeld, Germany Powder: Alkaline and silane fillers, starting components, pigments Liquid: Phosphoric acid methacrylates, methacrylate monomers, starting components, stabilizers
AH26 Dentsply, De Trey, Konstanz, Germany Silver-free powder: bismuth oxide, methenamine epoxy resin
C. silicone impression putty and light body and activator Spidex®, Coltene AG, Altstatten, Switzerland Base: Hydroxyl-terminated polydimethylsiloxane (liquid silicone prepolymer)
Liquid: alkyl silicate, such as tetracthylsilicate, tin compound, such as dibutyltin dilaurate
Silane coupling agent Monobond-S, Ivoclar-vivadent, Liechtenstein, Germany Ethanol, [3-(methacryloyloxy) propyl] trimethoxysilane
In the non-compromised group (control group) with unprepared teeth, the coronal internal cavity surface of the tooth was etched for 15 seconds using a 37% phosphoric acid etch-gel, rinsed, and gently air-dried. Then, the root canals were treated with a resin adhesive (Single Bond) after air drying for 5 seconds, followed by light curing for 20 seconds with Coltlux 75 (Colten, Swiss) with 1000 mW/cm2 power intensity. A hybrid composite resin Z100 was used by vertical layering technique in two layers and was cured, each time for 40 seconds. In this study, all light activation steps were done by this light-curing unit.
In the composite reinforced group, the compromised region was obturated with gutta-percha by lateral condensation technique. Then, after acid etching and treatment with Single Bond, as described before, the access cavity of the tooth was restored only with Z100 composite resin in two stages. It was then cured by light activation.
In the glass fiber post-reinforced group, the post space was prepared by RTD universal burs (RTD Grenoble, France) 7 mm apical to the palatal margin of the access cavity.
1. The translucent glass fiber post: D.T Light post (RTD Grenoble, France) was tested in the prepared space, and its height was adjusted so that no direct load was applied to it.
2. After preparing the dentinal walls of the cavity with 37% phosphoric acid etch gel for 15 seconds, the etchant was rinsed and air-dried. In the second stage, the Single Bond adhesive was applied and air-dried for 5 seconds. Finally, it was light-cured for 20 seconds. For a complete cure of adhesive in this deep cavity, the light was guided through a handmade translucent sprue formed by heat with similar dimensions to the post.
3. D.T. post surfaces were cleaned with alcohol and air-dried. Then, a layer of silane coupling agent was applied according to the manufacturer’s instructions and then treated with Single Bond adhesive and light-cured for 20 seconds.
4. The compromised cervical area of the teeth was restored with a dual-cure composite resin, Bis-coreTM, 1 mm apical to the CEJ, according to the manufacturer’s instructions. D.T. Light-Post (DT) was inserted into this composite bulk along the longitudinal axis of the tooth and light-cured for 20 seconds as the initial curing so that the light tip was in contact with the light post.
5. The rest of the cavity was restored with Z100, similar to the control groups.
In the metal cast post-reinforced group:
1. To create a cast post similar to the D.T. light post in the reinforced glass fiber post group, the putty of C. silicone impression material was mixed with its activator and placed in a cylinder generator. Then, D.T. light post was placed in the putty in size similar to the glass fiber post group to obtain a negative image. After the putty was hardened, the post impression was taken again more accurately using a light body (C. Silicon Spidex) mixed with the activator.
2. Using transparent heat-formed sprues, similar to the light posts and Duralay acrylic resin mixed with the relevant monomer (Acropars, Marlic Medical Industries Co, Tehran, Iran), an impression was taken from the space created in the putty to obtain a positive image of the post.
3. The cast post was made in the laboratory using nickel-chrome alloy, a common alloy used to make these posts.
4. Before cementation, the fabricated cast posts were cut at the same height as the D.T. light post. They were then sandblasted with aluminum oxide with 20-µm diameter and 2-bar pressure and cleaned with alcohol.
5. The teeth were prepared for adhesion, similarly to the second step of the light post group.
6. The compromised cervical area of the teeth was restored with a dual-cure composite resin, Bis-core TM, 1mm apical to the CEJ, according to the manufacturer’s instructions.
7. The cast post was covered with a biofilm layer to prevent the bonding of the composite inside the cavity. It was then put in the composite so that its longitudinal axis was in line with the longitudinal axis of the tooth. Next, it was extracted, etched, and rinsed with 37% phosphoric acid for 20 seconds to remove the debris, followed by drying.
8. The cleaned cast post was cemented by a dual-cure resin cement, RelyX Unicem, according to the manufacturer’s instructions and then light-cured for 40 seconds. The rest of the cavity was restored with Z100, as described before.
Then, each tooth was mounted in an acrylic resin in the form of a cylinder. For simulating the PDLs, a thin layer of wax was wrapped around the roots before pouring the acrylic mix. By using boiling water, the wax was dewaxed and substituted with light body silicone impression material. With this silicone layer around the root of the tooth, the PDL was simulated, and small movements similar to the movement of the tooth in the dental socket were reconstructed (Fig. 1).
After mounting, the specimens were subjected to compressive loads using a universal testing machine (Instron, Instron Corp, UK). Controlled loads were applied to the core on the palatal side exactly on the mesial and distal marginal ridges above the cingulum at an angle of 135° to the longitudinal axis of the root. The testing machine was set at a crosshead speed of 0.5 mm/min, and the failure threshold was defined as a point at which a specimen no longer withstood the increasing load and fracture of the post-crown complex or root occurred.
At the fracture point, the amount of force was recorded in a computer, and the fracture patterns for each specimen were visually analysed. The data were statistically analyzed by SPSS software (SPSS ver. 23, IBM, Somers, NJ, USA) using one-way analysis of variance (ANOVA) and chi-square statistical analysis tests. For pair comparison, Duncan was used. P<0.05 was considered statistically significant.
3. RESULTS
At first, the normality of the research data was confirmed using the Kolmogorov-Smirnov test (p>0.05). The results and the means of resistance to fracture (kgf) of teeth are shown in Table 2. The highest resistance to fracture belongs to the non-compromised group (170.12 ± 12.44) and the lowest to the composite reinforced group (71.40 ± 17.00).
The results of ANOVA showed a statistically significant difference, and Dunkan analysis showed that the differences in resistance to fracture were significant between all groups except the reinforced glass fiber post group and the reinforced metal cast post group.
The results of fracture mode in different groups are shown in Table 3. The results of the chi-square test showed a statistically significant difference among all groups. The maximum non-restorable fractures were reported for composite reinforced and reinforced cast post groups, respectively.
4. DISCUSSION
The null hypothesis was slightly accepted. The results showed that irrespective of the type of the system used for the restoration of endodontically treated teeth, the highest fracture resistance was obtained when there was more dental tissue, which was in line with the results of the study conducted by Bhagat et al. on the thickness of the remaining dentin of post and core pretreatment in endodontically treated teeth [17].
Fig. (1). Using a thin layer of light body silicon impression material for simulating the PDLs.
Table 2.
Fracture resistance in different groups (kgf).
Group
Results
Non-compromised Group Composite Reinforced Group Reinforced Glass Fiber Post Group Reinforced Cast Post Group
Minimum 143.60 30.71 101.93a 82.04a
Maximum 185.80 95.97 167.65 185.2
Mean 170.12 71.40 129.36 116.60
SD 12.44 17.00 21.34 22.60
Note: Same letters show no statistically significant differences, but other pair comparisons between study groups show statistically significant differences.
Table 3.
Mode of fracture in different groups.
Group
Results
Restorable Non-Restorable
Count Percentage Count Percentage
Non-compromised group 12 100% 0 0%
Compromised composite reinforced group 0 0% 12 100%
Reinforced glass fiber post group 9 75% 3 25%
Reinforced cast post group 3 25% 9 75%
On the other hand, the results of this study indicated that in the case of the weakened remaining tissue, the application of similar fiber posts or metal cast posts within the dual cure composite strengthens the weakened tissue so that it is completely bonded to it, whether directly or using resin systems, and causes a relatively similar increase in tooth fracture resistance under functional forces and can partly recover the lost resistance. However, the use of gutta-percha in the weakened teeth or restoration of the access cavity does not increase tooth fracture resistance.
D’Arcangelo et al. [18] reported that the use of fiber posts increased the resistance of endodontically treated anterior teeth, but some other studies have shown that the use of any post system, due to the different young modulus of these materials to the dental tissue, induces negative effects on tooth fracture resistance [19]. Furthermore, some studies have shown that the use of posts, due to the unfavorable distribution of stress in the tooth structure, weakens the tooth [20].
The present study indicated that despite approximately similar fracture resistance in teeth restored with metal and glass fiber posts within the strengthening dual-cure composite that have created monoblock, in the case of fracture, the fractures in fiber posts are mostly repairable, but fractures of cast posts are mostly catastrophic and irreparable. However, the results of a systematic review were in line with this study [21].
The posts in the restoration of endodontically treated teeth that have lost too much dentin tissue and require reconstruction for better function in the oral cavity have been used by dentists for many years. However, contradictory results have been reported for the use of these materials for endodontically treated teeth. Application of endodontic posts causes more weakness of the tooth root since they require more removal of the dentine structure of the root for their placement [22]. Moreover, this preparation increases the deformities due to reduced dental tissue [23], and the hardness coefficient of these materials is not adaptable to the tooth structure, thereby causing unfavourable stress distribution [24]. In an eleven-year clinical trial performed by Naumann et al., the survival of restorations retained with metal and fiber posts, especially during the first eight years, was higher than that of the restorations without posts, but after that, it significantly reduced in glass fiber posts due to weakened dentin-cement-post bond [25].
In this study, dual-cure resin cement was used to bond the posts to the tooth structure, and also dual-cure composite was used to strengthen the weakened cervical region because polymerization was completed by chemical cure, especially in areas with highly reduced light exposure. Furthermore, it is less likely that the bond is weakened due to inadequate polymerization and remaining uncured monomers [26]. On the other hand, the curing of dual-cure resins is not influenced by the amount of translucency [27]. A reason for the similar strengthening effect of non-translucent metal cast posts and translucent glass fiber posts in this study may be due to the similar bond of these posts with the tooth structure and dual-cure composite owing to a high and similar degree of conversion and formation of monoblock in both groups. On the other hand, despite numerous studies conducted on various endodontic treatment methods for teeth with much coronal damage [13, 14], no comprehensive conclusion can be made regarding the efficacy of these materials in increasing the fracture resistance of endodontically treated teeth due to variation of method and type of substrate used (human or bovine teeth) [28]. This study was performed on the endodontically treated human central teeth weakened at the cervical region so that they would have similar conditions to immature necrotic teeth or teeth with internal cervical resorption. The results showed that similar fiber posts or metal cast posts, in case of complete adaptation with the internal tooth structure, had similar success in strengthening the tooth, and both would be successful if they were correctly bonded to the tooth structure with resin cement. Moreover, they are more effective than the use of composite resin alone for tooth structure strengthening. However, the fractures created in the teeth restored with metal cast posts would be more destructive than those in modified fiber posts.
Cyclic loads causing a decrease in material strength may result in dental restoration failures concluded by fatigue mechanisms [6]. Therefore, further in vitro and clinical studies, which include long-term analysis of functional cyclic forces or thermocycling, are required to obtain more definite results.
CONCLUSION
It can be concluded that the maxillary central incisors treated with minimum dentin omission have the highest fracture resistance. Moreover, the common methods used for the restoration of central incisors with thin walls of root crown by composite resins without the reinforcement of the cervical part of the root cannot increase their resistance against chewing forces, but the use of posts that have good adaptation can increase teeth fracture resistance.
LIST OF ABBREVIATIONS
CEJ = Cemento-enamel junction
ANOVA = Analysis of variance
ETHICS APPROVAL AND CONSENT TO PARTI-CIPATE
Research Ethics Committees of the Vice-Chancellor in Research Affairs of the Medical University of Isfahan ethically approved this study (Approval ID: 384176).
HUMAN AND ANIMAL RIGHTS
No animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.
CONSENT FOR PUBLICATION
Informed consent was obtained from all participants.
AVAILABILITY OF DATA AND MATERIALS
The data that support the findings of this study are available from the corresponding author [F.S] upon reasonable request.
FUNDING
This work was financially supported by Khorasgan dental school, Isfahan, Iran.
CONFLICT OF INTEREST
The authors declare that there is no conflict of interest regarding the publication of this paper.
ACKNOWLEDGEMENTS
Declared none.
SUPPLEMENTARY MATERIALS
Some pictures of the research are included as supplementary materials.
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Matawan NJ Bunion Care
Bunion Care in Matawan
Do you have pain and stiffness in your big toe? That may not have seemed like a terrible problem at first, but as it persists, toe pain can be a real concern. If you’ve been diagnosed with a bunion from a Matawan NJ podiatrist, you likely also have a bony protrusion on the side of your foot, at the base of your big toe. The big toe is then pushing against the inner toe.
It looks like this because there is a misalignment of one of the bones in your feet. Specifically, a bunion is caused when the first metatarsal bone bends so it points outward. This causes the big toe to point inward. Now, the joint for the metatarsal bone is pointing outward, bent awkwardly, and causing pain.
Treatment Options in Matawan NJ for Bunions
In extreme cases, surgery may be needed. It isn’t indicated for aesthetic reasons, but only to correct the issue of pain if you are having a difficult time walking and participating in daily activities. This is a solution people turn to only when at-home treatments have failed to ease the symptoms enough for them to live their daily lives.
Let’s look at what you can do with the help of a podiatrist for treatments on your own.
Avoid standing on your feet for prolonged periods, if at all possible. If you’re on your feet for a while, attempt to schedule healthy breaks when you put your feet up to relieve the pressure.
You can find a gel-filled pad to wear inside your shoes. They sell these at most pharmacies or shoe stores but are also easy to find online. This will better cushion the foot, which will ease any hard movements against the joints.
Get shoe inserts that will keep your foot in a healthy position. There are over-the-counter inserts you can buy, or meet with your podiatrist to get a custom-made orthotic. This will always give you the best results since it will be shaped to your individual needs.
You can wear a splint at night to hold the toes straight. This can lead to some relief during the day, as the foot has used the night to better recover. You’ll need to talk to your podiatrist before doing this.
You can take over-the-counter pain relief medication, like ibuprofen.
Pain relief habits like a foot massage, ice packs, and soaking your feet in warm water for ten minutes in the evenings can all help you take care of your foot pain.
If your weight has gotten high, maintaining a healthier weight can relieve some of the pressure on your feet.
The most important thing you can do for bunion care is to wear roomy footwear. While we know that bunions tend to run in families, women indeed suffer from bunions at a much higher rate than men. They tend to have a history of wearing shoes that are too tight, putting pressure on the bones in the feet. Wearing a shoe with a lot of room in the toe box will relieve pressure, which will cause you less pain and prevent the misalignment from becoming worse.
Your best guide to taking care of your bunions, preventing them from getting worse, and supporting you whenever you have pain problems, is a podiatrist. They are specialists in everything that happens inside your foot and ankle. With Central Jersey Ankle & Foot Care Specialists on your side, you will always have someone you can consult when you have a new issue and you will have someone who can track the progress of your bunions over time. Check-in with your Matawan NJ podiatrist if you have questions about your foot health.
OFFICE HOURS
Monday
8:00am - 8:00pm
Tuesday
7:30am - 7:00pm
Wednesday
10:00am - 4:00pm
Thursday
9:00am - 5:00pm
Friday
9:00am - 2:00pm
Saturday & Sunday
Closed
Central Jersey Ankle & Foot Care Specialists
20 Cambridge Dr Suite D
Matawan, NJ 07747
P: (732) 566-2841
F: (732) 566-1264
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Nihar Gala – Advancing Neurological Surgery for Improved Patient Outcomes
Neurological surgery is a specialized field of medicine that focuses on the surgical treatment of disorders and diseases affecting the central and peripheral nervous system. Nihar Gala, an accomplished neurosurgeon, is dedicated to advancing the field of neurological surgery and improving the quality of life for his patients. In this article, we will explore the expertise and contributions of Nihar Gala in the field of neurological surgery, highlighting the significance of this specialty in providing effective surgical interventions for various neurologic conditions.
Enhancing Patient Well-being through Surgical Expertise
Neurological surgeons, like Nihar Gala, possess the expertise and skill set required to perform intricate surgical procedures on the brain, spine, and peripheral nerves. They specialize in treating a wide range of conditions, including cerebrovascular diseases, epilepsy, movement disorders, tumors, spinal cord injuries, and trauma. By utilizing advanced surgical techniques, such as minimally invasive procedures and endovascular interventions, neurosurgeons aim to provide optimal outcomes and minimize postoperative complications.
Comprehensive Management of Neurological Disorders
Neurological surgery encompasses the prevention, diagnosis, surgical treatment, and rehabilitation of disorders affecting the nervous system. Conditions such as brain tumors, spinal disorders, congenital malformations, pituitary gland tumors, aneurysms, and epilepsy require specialized surgical intervention. Neurological surgeons like Nihar Gala work closely with multidisciplinary teams, including neurologists, neurocritical care specialists, and pathologists, to provide comprehensive care to patients, integrating surgical expertise with medical management and rehabilitation programs.
Advancements in Surgical Techniques
The field of neurological surgery is constantly evolving, thanks to advancements in surgical techniques and technologies. Neurological surgeons like Nihar Gala are at the forefront of adopting innovative approaches to deliver safer and more effective surgical interventions. Minimally invasive techniques, such as endonasal surgery and cranial surgery, enable surgeons to operate on the brain directly and remove tumors with precision. Additionally, neurosurgeons are skilled in utilizing radiosurgery for posterior cranial fossa neoplasms, deep brain stimulation for tremor control, and other cutting-edge procedures that offer new treatment options for patients.
Research, Education, and Collaboration
Neurological surgeons, including Nihar Gala, actively engage in research projects to contribute to the advancement of knowledge in the field. Their involvement in clinical research enables the development of new surgical techniques, improvement of patient outcomes, and the exploration of emerging treatment modalities. Neurological surgeons also play a crucial role in teaching residents and medical students, passing on their expertise and fostering the next generation of neurosurgeons.
Improving Quality of Life through Rehabilitation
The impact of neurological surgery extends beyond the operating room. Neurosurgeons like Nihar Gala recognize the importance of rehabilitation programs in maximizing patients’ quality of life following surgical interventions. They work closely with rehabilitation specialists to create tailored plans that aid in the recovery and rehabilitation process, aiming to optimize physical, cognitive, and emotional functioning.Nihar Gala’s expertise and contributions in the field of neurological surgery exemplify the dedication of neurosurgeons in improving patient outcomes and quality of life. Through their surgical expertise, utilization of advanced techniques, and collaboration with multidisciplinary teams, neurological surgeons provide comprehensive care for patients with complex neurologic conditions. As the field continues to advance, the impact of neurological surgery on patient well-being and functional outcomes will continue to grow, thanks to the efforts of skilled professionals like Nihar Gala.
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