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However generic malegra dxt 130 mg on line, in the triiodothyronine assay malegra dxt 130 mg with mastercard, the detergent markedly reduced the binding of triiodo­ thyronine to the primary antibody and could therefore not be used in this assay generic malegra dxt 130 mg on-line. All preparations showed a binding capacity to the ligand-primary anti­ body complex that was proportional to the IgG binding capacity safe 130 mg malegra dxt, determined with rabbit IgG. The latter value could therefore be applied to calculate the optimal amount of immobilized antibody to be used in the various immunoassays. No variation in non-specific binding of the labelled ligand to the immunospheres was observed and the separation step in the assays was not influenced by lipemia. They exhibit low physical adsorption of protein, which favours covalent coupling of antibody and gives products with low non-specific binding of labelled ligands. The particles tested give semi-stable suspensions in water solutions for 1 to 2 h, allowing the reaction of immobilized second antibody with rabbit IgG to proceed without agitation. On the other hand, low-speed centrifugation formed a firm particle pellet so that the separation could be easily performed by décantation. The immobilized antibody could be stored for several months at 4°C without any noticeable loss of its IgG binding capacity. The use of sulfonyl chlorides as coupling agents gave the best solid-phase second antibody. This was also the preferred method for coupling of the primary antibody to these particles in an immunoradiometric analysis for rat glandular kallikrein [16]. However, in this assay coupling with cabonyl-di-imidazole and sulfonyl chlorides both, preserved the biological activity of the antibody equally well. Nustad enlarged on the advantages deriving from the monodisperse polymer particle product described — a uniform suspension in buffer semi-stable for a period which could be varied by changing particle density or size, uniform distribution of solid-phase linked Ab and, finally, a minimum of trapped fluid in the solid-phase pellet. The polymer was cross-linked and the particles had excellent mechanical properties. No swelling was observed in buffer; there was a two-fold reversible swelling in acetone/ dioxane. The product was closely related to that used in immunocytochemistry and marketed by the Dow Chemical Co. Its eventual price was not known, but would be similar to those of alternatives on the market. Brief reference was made to the possible use of such particulate material in particle counting assays. Antigens and/or antibodies have been coupled covalently to, or adsorbed on to, five different solid phases. These were polypropylene tubes, polystyrene balls and tubes, nylon balls, activated Teflon discs and microcrystalline cellulose. The different methods of chemical activation of the solid supports, together with applications and examples, are given for different immunoassays. Adsorptive techniques are described for the immobilization of antisera, together with the effects of varying pH and ionic strength upon the amounts of antibody bound per given surface area. Consideration has been made for the application of these techniques for both radio- and non-radioisotopic assays, where the nature of the support may play an important role (for example, in luminescence techniques). The advantages and disadvantages of adsorptive and covalent binding are discussed with regard to their application and limitation. Points often taken for granted when using or preparing solid-phase antigens or antibodies are examined critically. Many immunoassays and enzyme-activity measurements are performed using an immobilized reaction partner. This study presents results from experiments performed to examine adsorptive and covalent coupling of proteins and haptens to different matrices, and gives examples of the application of some of the methods described. Although adsorptive techniques are often easier to perform than covalent chemical binding, they are frequently more difficult to control and optimize. The nature of the support often plays a crucial role in the limitations of its use as an immobilized reaction phase. The solid phases here examined are: Polystyrene tubes and balls (adsorption/covalent); Polypropylene tubes (adsorption only); Nylon balls (covalent only); Teflon discs (covalent only); Cellulose —20 jum particles (covalent only). The experiments have been carried out with respect to the immobilization of antibodies and antigens for radio- and luminescent immunoassays. Buffer chemicals, metallic sodium and ammonia were obtained from Merck, Darmstadt; all other reagents were purchased from Sigma, Munich. Adsorptive techniques Since Catt and Tregear [1 ] described the adsorption of antibodies to plastic tubes, this method of immobilizing antibodies has been used both commercially and on a laboratory scale with varying success. Here, the effect of varying the pH and molarity of the adsorption solution has been investigated, the results being documented for both isolated IgG fractions as well as for unfractionated antisera. The immobilized antisera were tested in radio- and chemiluminescent immunoassays [2]. Coating time was 16—20 h (overnight) at 4°C, using a volume of 200 ¿uLin the case of the tubes. The antibody dilution used for coating the balls was 1:1000 and the coating buffer was 0. A = binding after tracer incubation, without washing; В = the unspecific binding under the same conditions. In wash steps 4c and 4d, the balls which had been washed three times with water were washed with detergent. The addition of sodium chloride to the assay buffer in a 17ß-oestradiol coated ball radioimmunoassay to measure the effect on the maximum tracer binding. The unspecific binding remained relatively constant between 350 and 400 counts/min when using a total activity of 16 000 counts/min. This may be an antigen-specific effect, as no fewer than six transferrin antisera from rabbits or sheep gave a binding greater than 0. The same antisera bound the same radioactive tracer in a conventional liquid-phase radioimmunoassay in excess of 0. The effect of washing the solid phases with detergents after the antigen- antibody reaction is shown in Fig. Here an extreme case has been chosen, where almost all the tracer was adsorbed on to the support, in this case a polystyrene ball, although identical effects were seen in the case of both polystyrene and poly­ propylene tubes using this antiserum (anti-17|3-oestradiol) and tracer. The effect of increasing the ionic strength of the assay buffer, in this case using sodium chloride, is shown for the maximum binding in Fig. Again, the anti-17/3-oestradiol antiserum was used in an assay buffer basically consisting of a phosphate buffer, 0. It was interesting to note that the best adsorption of antibody took place not in buffer, but in double distilled water. This effect has been seen in other antisera raised against cortisol, as well as in antisera raised against the amino­ glycosides gentamicin and tobramycin. If this coating procedure is to be used, it is important that the vessels used are previously saturated with bovine serum albumin solution, if balls are to be coated, in order to minimize loss of antiserum on to the vessel walls. The assay here presented has a total incubation time o f 48 h and uses a sample o f 50 ßL serum. The assay working range is 10-200 mU/L and utilizes a pyruvate kinase-labelled second antibody as "tracer". After reaction, the solid phases were washed free of unreacted material using a high molar sodium chloride solution (1. Polystyrene balls and tubes It is possible to introduce amino groups into polystyrene by nitration followed by reduction. The difficulties encountered were that if the amine-polystyrene coat was too thick, it became brittle on drying and cracked and peeled off, leaving an unreacted polystyrene surface. In six controlled experiments, only one resulted in a stable ‘aminated’ layer which did not crack. For these reasons, and also because the polystyrene balls often shrank in size or became visibly distorted during the reaction, further attempts to activate polystyrene were abandoned. Nylon balls Six-millimetre-diameter nylon balls were activated by O-methylation using dimethyl sulphate in dry dioxane, (20% vol/vol) using methods already published [5, 6]. An alternative method of activation was made by partial hydrolysis with sodium hydroxide followed by reaction with dicyclohexyl carbodiimide and N-hydroxysuccinimide in dry dimethyl formamide [8].

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If no date of publication can be found 130mg malegra dxt with mastercard, but the publication contains a date of copyright malegra dxt 130 mg mastercard, use the date of copyright preceded by the letter "c"; for example c2005 malegra dxt 130mg low price. Book with unknown place order discount malegra dxt line, publisher, and date of publication Books 165 Pagination for Entire Books (optional) General Rules for Pagination • Provide the total number of pages on which the text of the book appears • Do not count pages for such items as introductory material, appendixes, and indexes unless they are included in the pagination of the text • Follow the page total with a space and the letter p • For books published in more than one physical volume, cite the total number of volumes instead of the number of pages, such as 4 vol. If all of the pages (not just the introductory pages) of a book have roman numerals instead of the usual arabic numbers: • Convert the roman numeral on the last page of the text to an arabic number • Follow the number by "p. If the entire publication has no page numbers: • Count the total number of pages of the text • Express the total as leaves, not pages • End with a period Examples: Howell E. Book with no numbers on the pages Physical Description for Entire Books (optional) General Rules for Physical Description • Give information on the physical characteristics if a book is published in a microform (microflm, microfche, etc. Such information helps the reader select the appropriate equipment with which to view the microform. Specific Rules for Physical Description • Language for describing physical characteristics Box 51. If a book is published on microfche, microflm, or microcards: • Begin with information on the number and type of physical pieces, followed by a colon and a space 5 microfche: 3 reels: [of microflm] 2 microcards: • Enter information on the physical characteristics, such as color and size. Book in a microform with type of medium given Series for Entire Books (optional) General Rules for Series • Begin with the name of the series • Capitalize only the frst word and proper nouns • Follow the name with any numbers provided. As an option, the name of the overall series editor may be included with the series information. If a book is a part of more than one series, include information on all series if desired. Book published also as a journal issue Language for Entire Books (required) General Rules for Language • Give the language of publication if not English • Capitalize the language name 170 Citing Medicine • Follow the language name with a period Specific Rules for Language • Books appearing in more than one language Box 55. Le genome: avancees scientifques et therapeutiques et consequences sociales = Te genome: scientifc and therapeutic developments and social consequences. La lengua cientifca griega: origenes, desarrollo e infuencia en las lenguas modernas europeas [Te Greek scientifc language: origins, development and infuence on modern European languages]. Some examples of notes are: • If the book is available from a distributor rather than the publisher, give the name of the distributor, its location, and any accession or fnding number. Informed decisions: the complete book of cancer diagnosis, treatment, and recovery. Book authors/editors with compound last names having a hyphen Lopez-Goni I, Moriyon I, editors. Book authors/editors with compound last names without a hyphen Garcia y Griego M, Verea Campos M. Mexico City: Universidad Nacional Autonoma de Mexico, Coordinacion de Humanidades; 1988. Book with organization as author and subsidiary department/ division named American Occupational Terapy Association, Ad Hoc Committee on Occupational Terapy Manpower. Book with organization as author which is also the publisher Virginia Law Foundation, Committee on Continuing Legal Education. Book with organization as author and an editor(s) American Association of Neuroscience Nursing. Diagnostika i kompleksnoe lechenie osnovnykh gastroenterologicheskikh zabolevanii: klinicheskie ocherki. Base molecular de la expresion del mensaje genetico [Molecular basis of gene expression]. Diagnostika i kompleksnoe lechenie osnovnykh gastroenterologicheskikh zabolevanii: klinicheskie ocherki [Diagnosis and complex treatment of basic gastrointestinal diseases: clinical studies]. Book published with equal text in two languages Chemically-defned favouring substances = Substances aromatisantes chimiquement defnies. Le genome: avancees scientifques et therapeutiques et consequences sociales = Te genome: scientifc and therapeutic developments and social consequences. La lengua cientifca griega: origenes, desarrollo e infuencia en las lenguas modernas europeas. Evolucionismo y cultura: darwinismo en Europa e Iberoamerica [Evolution and culture: Darwinism in Europe and Latin America]. La lengua cientifca griega: origenes, desarrollo e infuencia en las lenguas modernas europeas [Te Greek scientifc language: origins, development and infuence on modern European languages]. Studies of fall risk and bone morphology in older women with low bone mass [dissertation]. Women and medicine: remedy books, 1533-1865, from the Wellcome Library for the History and Understanding of Medicine, London [microflm]. Dance/movement therapy with frail older adults: a controlled experiment to demonstrate efect on mood, social interaction, and physical functioning of nursing home residents and adult day health clients [microfche]. Boston: Hebrew Rehabilitation Center for Aged, Research and Training Institute; 1996. Manuale di psichiatria: per studenti, medici, assistenti sociali, operatori psichiatrici. Studies of fall risk and bone morphology in older women with low bone mass [dissertation]. Self-image pattern and treatment outcome in severely disturbed psychiatric patients. Stockholm: Statens Beredning for Utvardering av Medicinsk Metodik [Swedish Council on Technology Assessment in Health Care]; 1994. Book with unknown place, publisher, and date of publication Steriu D, Stefanoiu V. Acute reactions to trauma and psychotherapy: a multidisciplinary and international perspective. Sample Citation and Introduction to Citing Individual Volumes With a Separate Title but Without Separate Authors/ Editors Te general format for a reference to a volume of a book with a separate title but without separate authors/editors, including pagination: 186 Citing Medicine Examples of Citations to Individual Volumes With a Separate Title but Without Separate Authors/Editors Many medical texts are published in more than one volume because the number of pages is too large to be contained in one physical volume. If a book is published in multiple volumes, and if each volume has a separate title, the volumes may be cited individually: • Use the title page and the verso (back) of the title page of the individual volume as the source for authoritative information. Continue to Citation Rules with Examples for Individual Volumes With a Separate Title but Without Separate Authors/Editors. Continue to Examples of Citations to Individual Volumes With a Separate Title but Without Separate Authors/Editors. Citation Rules with Examples for One Volume of a Book Without Separate Authors/Editors Components/elements are listed in the order they should appear in a reference. An R afer the component name means that it is required in the citation; an O afer the name means it is optional. Book (R) | Volume and Number (R) | Title (R) | Location (Pagination) (O) Book (required) General Rules for Book • Cite the overall book according to Chapter 2A Entire Books, but omit the Pagination Books 187 Volume and Number of Volume (required) General Rules for Volume and Number of Volume • Place volume and number information afer the title of the book and any Content Type, Type of Medium, Edition statement, or Secondary Author • Enter "Vol. When other names are used: • Abbreviate them and end the abbreviated words with a period Section = Sect. Volumes of books without separate authors/editors following an edition statement 3. Volumes of books without separate authors/editors following an edition statement and secondary authors 4. Volumes of books without separate authors/editors with numbers labeled other than volume 6. Volumes of non-English books without separate authors/editors Title of Volume (required) General Rules for Title of Volume • Enter the title of the volume as it appears in the book • Capitalize only the frst word of a title, proper nouns, proper adjectives, acronyms, and initialisms • End title information with a period Specific Rules for Title of Volume • Non-English titles for volumes • Titles containing a Greek letter, chemical formula, or another special character Box 61. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Volumes of books without separate authors/editors following an edition statement 3. Volumes of books without separate authors/editors following an edition statement and secondary authors 192 Citing Medicine 4. Volumes of books without separate authors/editors with numbers labeled other than volume 6. Volumes of non-English books without separate authors/editors Location (Pagination) of Volume (optional) General Rules for Pagination of Volume • Place pagination afer the date of publication • Provide the total number of pages on which the text of the volume appears • Do not count pages for such items as introductory material, appendixes, and indexes unless they are included in the pagination of the text • Follow the number by a space and "p. Specific Rules for Pagination of Volume • Roman numerals for page numbers • Volumes continuously paginated Box 63. Many books published in multiple volumes with separate titles are paginated anew with each volume. Volumes of books without separate authors/editors continuously paginated Examples of Citations to Volumes of Books with a Separate Title for the Volume but Without Separate Authors/Editors 1. Pocket atlas of sectional anatomy: computer tomography and magnetic resonance imaging.

Massive air embolism from continuous electromechanical dissociation in a cardiac surgical patient malegra dxt 130mg. The effect of circuit “down time” on uraemic control during continuous veno-venous haemofiltration buy 130mg malegra dxt with amex. Fluid accumulation cheap malegra dxt express, survival and recovery of kidney function in critically ill patients with acute kidney injury order cheap malegra dxt on-line. Regional citrate versus systemic heparin anticoagulation for continuous renal replacement in critically ill patients. Guidelines on the use of therapeutic apheresis in clinical practice—evidence-based approach from the apheresis applications committee of the American Society for Apheresis. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic or mechanical, including uploading, downloading, printing, decompiling, recording or otherwise, except as permitted under Sections 107 or 108 of the 1976 United States Copyright Act, without the prior written permission of the Publisher. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional person should be sought. Branch Introduction 1 Genetic Manifestations of Molecular Medicine 2 Gene Therapy and Patterns of Gene Expression 7 Gene Therapy and Molecular Medicine 8 Gene Therapy: Current Basic Science Issues 15 Human Gene Therapy: Current Status and Basic Science Research Needs 17 Gene Therapies: Next Horizon 18 Key Concepts 20 Suggested Readings 22 Chapter 2 Nuclear Transplantation and New Frontiers in Genetic Molecular Medicine 25 D. Fleck Background 25 Introduction 25 Nuclear Transplantation: A Tool in Developmental Biology 26 Technical Developments in Nuclear Transplantation 29 Defining the Limits of Nuclear Reprogramming in Mammals 32 Toward an Understanding of the Mechanisms of Genetic Reprogramming 34 Application of Genetic Reprogramming 38 Human Embroyonic Stem Cell Research: An Ethics Note 39 Summary 41 Key Concepts 41 Suggested Readings 42 Chapter 3 Builing a Better Mouse: Genetically Altered Mice as Models for Gene Therapy 47 Eric Sandgren and William C. Schuster, and George Wu Background 153 Introduction 153 General Principles for Hepatic Gene Therapy 154 Clinical Applications of Liver-Directed Gene Therapy 161 Summary 178 Key Concepts 179 Suggested Readings 180 Chapter 8 Gene Therapy in Cardiovascular Disease 183 Victor J. Mann Introduction 183 Genetic Manipulation of Cardiovascular Tissue 184 Gene Therapy of Restenosis 187 Gene Therapy for Angiogenesis 189 Gene Therapy of Vascular Grafts 192 Gene Therapy for the Heart 195 Summary 198 Key Concepts 198 Suggested Readings 199 Chapter 9 Components of Cell and Gene Therapy for Neurological Disorders 203 Laurie C. Doering Introduction 203 Sorting Out the Complexity of the Nervous System 205 What Goes Wrong in Neurological Disorders? Fleck Background 319 Introduction 319 Molecular Medicine and Gene Therapy: Ethical Issues in the Clinical Context 320 Gene Therapy: Ethical Issues at the Policy Level 333 Key Concepts 343 Suggested Readings 345 Chapter 15 Epilogue: Personal Genetic Medicine—The Future Is Now 347 Thomas F. On an almost daily basis, there appears in the media a “breaking story” of a gene-based research finding. An implication of the story is that this research breakthrough will speedily trans- form, in the next few years, into a marvelous new therapy in molecular genetic medicine. An Introduction to Gene Therapy and Molecular Medicine provides a basis to interpret new clinical and basic research findings in the areas of cloning, gene transfer and targeting, the application of genetic medicine to clinical conditions, ethics, government regulation, genomics, and biotechnology and bioinformatics. The text provides the reader with fundamental and comprehensive basic as well as clinical research observations and findings relative to gene therapy and molecu- lar medicine. An Introduction to Gene Therapy and Molecular Medicine can be divided into three sections: basic science introductory Chapters 1 to 5; clinical application Chap- ters 6 to 12; and Chapters 13 to 15, and Appendix, addressing evolving issues related to gene therapy and molecular medicine. Each chapter, as well as the appendix, con- tains key concepts that the authors wish to leave the readers and a specific itemized listing of suggested readings in the field. The reading lists comprise state-of-the-art reviews, salient research articles, and articles useful for lay readership as well. It pre- sents in broad general terms the diseases targeted by gene therapy and the tools researchers use and the future needs of the field. It address what may be the “holy grail” of medicine, possible approaches for reversing the process of aging. Chapter 3 provides a fundamental need for basic research in addressing human disease and the generation and use of animal models of disease. Specifically useful for gene therapy and molecular medicine are transgenic mouse models of human pathogenesis. Chapter 4 provides what appears to be endless detail related to vectors and their use in gene transfer. Chapter 5 rounds out the section on basic research by providing useful approaches to target genes to produce a spe- cific desired expression of the gene. Chapter 6 presents the use of gene therapy approaches to hematology with a special discus- sion of application of gene therapy using hemopoietic stem cells. Chapter 7 presents gene therapy in liver diseases describing approaches for inherited metabolic dis- eases as well as acquired infectious diseases such as hepatitis C. Chapter 8 presents impressive, realistic approaches to use gene therapy for the therapy of “broken hearts” and cardiovascular diseases. Chapter 10 provides an overview of how gene therapy can be used in the treatment of cancer. Chapter 12 provides a “disease contrast” in that it addresses an incredi- bly debilitating disease, rheumatoid arthritis, and how gene therapy can be used in amelioration of joint destruction. The last section of the book provides individual presentations related to gene therapy and molecular medicine. Chapter 13 provides an update on the issue of federal regulation and oversight of gene therapy research. Chapter 14 provides an ethical essay on gene therapy and the use of molecular medicine with an insight into health care rationing. Chapter 15 is a brief description of where the practice of molecular medicine is today. Finally, the appendix is an important presentation of some commercial aspects in molecu- lar medicine and gene therapy. After all, if gene therapy is to reach the public in all walks of life a commercial venue is needed. Thus, An Introduction to Gene Therapy and Molecular Medicine is a compre- hensive manual that can be used as an aid through the rapidly moving field of gene therapy and its application in molecular medicine. Schematic representation of chronic ischemia induced by placement of Ameroid constrictor around the circumflex coronary artery in pigs. Sections were stained with hematoxylin/van Gieson (A and C) and a monoclonal antibody against rabbit macrophages (B and D). Note the rounded morphology, aggregation, clumping, and satellite colonies of growth. The science of gene therapy is derived from significant research advances in the fields of genetics, molecular biology, clinical medicine, and human genomics. Thus, gene therapy can be defined as the use of genetic manipulation for treatment of disease. Experimental gene therapy research breakthroughs observed in model systems are modified for clinical or bedside use, forming the emerging practice of molecular medicine. Molecular medicine encompasses the elucidation of the genetic basis of disease, diagnosis of the disease, the design of an appropriate approach to disease management or therapy, the application of approved therapeutic protocols, and monitoring of clinical outcomes. In the history of the practice of western medicine, initial concepts of disease were related to an imbalance in the persona or humus. As the practice of medicine advanced to and through the twentieth century, more information became available regarding the physiology of the body as well as its organ and tissue structure. Most recently, research investigations opened insight into the genetic basis of inheritance and the biological processes at the molecular level. These were mainly in the genetics and molecular biology of selective breeding practices for plants and animals. The bases for this application to human disease are the successful development of the medical and surgical techniques in human organ transplantation, the western tradition of pharmacotherapy, and the continuing elucidation of the human genome and its regulatory elements. On what seems to be an almost daily basis, startling new molecular genetic discoveries are publicized. Others lead to a profound understanding of the pathogenesis of human disease, such as the identification of the mutation in the genes responsible for liver diseases, such as, hemochromatosis or, in pediatrics, Alagille syndrome. The cloning studies show us the new frontiers of genetic medicine and challenge us to use them wisely. The dis- coveries of mutant genes leading to disease pathology lend the promise of rapid diagnosis and potentially early clinical intervention allowing for better medical man- agement. However, the discoveries of genes responsible for human pathology chal- lenge us in the use of genetic population screening. The evolving field of genetic epidemiology can provide precise data on the incidence and prevalence of a spe- cific inherited trait. The challenge here is to use this information ethically and in a medically beneficial manner (see Chapter 14).

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Phytochemical analysis showed that both aqueous extract and dried powder of Phyllanthus niruri L buy malegra dxt master card. Quantitative determination of mineral contents in whole plant of Phyllanthus niruri L buy cheap malegra dxt 130 mg. The patients were tested for oral glucose tolerance test for base line examination buy 130mg malegra dxt amex. On next day purchase malegra dxt 130 mg otc, after fasting blood sample was collected, the 3 dose was given and oral glucose tolerance test was done. A patient tolerated the drugs well and except for mild gastrointestinal upset, no serious side effects had been reported. A double blind control study on anti-inflammatory and antiplague activity of Ponna- yeik (Ixora coccinea Linn. May Aye Than; Moe Wint Oo; Tin Tun Hla; Mar Mar Nyein; Aye Than; Thein Tut; Tin Nu Swe; Mya Thet Lwin. In Myanmar, 80% of school children had gingivitis and 18% of them had periodontal destruction. Bacterial plague in oral cavity is regarded as the primary local etiological factor in inflammatory disease. Preventing and controlling of periodontal disease would prevent the microbial colonization of plague on the teeth and gingival. This study aimed to evaluate the efficacy of Ponna-yeik mouthwashes, which was easily available at low cost, was conducted at the Insitute of Dental Medicine, Yangon. The study was a double blind controlled, study design and chlorhexidine gluconate using as a positive standard drug. Twenty patients with typical chronic gingivitis were participated in this study and randomly divided into two groups, 10 patients for 0. The plague score, bleeding on probing supra-gingival plague formation, staining effect and severity of gingivitis has been examined prior to the clinical trial, during the study for weekly up to 4 weeks and after trial. Both chlorhexidine and Ponna-yeik mouthwashes showed significant effective in plague score, bleeding on probing and severity of gingivitis (p0. Staining effects were observed in patients using chlorhexidine but not in patients using Ponna- yeik mouthwashes. There was no significant difference between two groups on all score except staining score. It was concluded that Ponna-yeik mouthwashes revealed anti-inflammation and anti-plague activity without staining. The plant extracts were prepared using different concentrations of ethanol, aqueous solution and ethyl acetate in various rations. Kywe-kyaung-hmin-sae was extracted with 50% ethanol, 95% ethanol, ethyl acetate and aqueous solution and the extracts were used to screen enteric infections, testing of antiamoebic effect and antibacterial activity in vitro. In vivo screening was done for inhibitory effect of the pe-natha seeds extracts on adrenaline induced hyperglycaemia in animal models. The morphology and anatomy of these plants were investigated so as to ascertain their correct identification. In addition, quercetin was identified and isolated from Euphorbia hypericifolia L. The purpose of the present study was to evaluate scientifically smooth muscle relaxant effect of Aegle marmelos Linn. In this study, ethanolic and aqueous extraction of Okshit dried leaves, acute toxicity and pharmacological screening tests, phytochemical analysis of both ethanolic and aqueous extracts of Okshit and experiments for smooth muscle were carried out. In acute toxicity study in mice, it was observed that both extracts of Okshit were not toxic up to the maximal feasible dose of (16g/kg) body weight. General pharmacology screening test of both extracts of Okshit had shown no abnormal changes. In isolated rabbit jejunum, both extracts caused relaxation of intestinal smooth muscles and had dose-dependent antagonism with histamine or acetylcholine. Their relaxation effects on intestinal smooth muscle could not be blocked by either tolazoline or propranolol. In isolated rabbit aortic strip, both extracts did not show any contractile effect and they did not relax the contraction caused by adrenaline. In isolated rat uterus, ethanolic extract showed no relaxation effect on normal rat uterus preparation but had antagonism against contraction caused by acetylcholine and oxytoxin. It may be an antagonist of histamine or an anticholinergic activity, but it is more likely to be due to its direct action on tissues. A total of 24 apparently healthy young male Myanmar adults were selected as subjects. For the two groups the changes in serum lipid profile after consumption of 100g avocado with salt and 100g avocado with sugar per day for 6 weeks period was studied. The serum total cholesterol and triglyeride levels were decreased significantly with p<0. The consumption of avocado with salt and avocado with sugar has similar beneficial effect on serum lipid levels. Effect of Azadirachta indica Neem seed kernel extracts on Anopheles dirus mosquitoes. At a concentration of 2% no anopheles biting and the protection provided was 100% during 10-12 hrs periods. Moreover, under laboratory condition with 2 and 4%, the ovicidal effect was found to be 100% control. Theingi Thwin; Thet Thet Mar; Hnin Lwin Tun; Khin Than Yee; Mie Mie Nwe; Lwin Zar Maw; Tin Ko Ko Oo; Aye Myint Oo. The effect of administering dried Chinese quince fruits on high-cholesterol-fed rats was studied for a period of 90 days. A total of twenty male Wistar rat with 150-200gm body weight were included in the study. Thoroughly dried Chinese quince fruits were ordered from Lashio (Northern Shan State) and made into a fine powder. All rats were supplemented with a high cholesterol diet which was enriched with coconut oil (25% by weight) and egg yolk (66. Dried Chinese quince fruit powder was put into water in a ratio of 1:100 (w/v) and boiled for 10 hours to make a watery extract. One ml of watery extract (144mg dried Chinese quince/kg body weight) and an equal volume of distilled water were administered orally by intragastric intubation daily for ninety days to the test and control group (10 in each), respectively. When serum total cholesterol levels were compared between the test and control group on Day 30 (180. Effect of dried quince fruits (Cydonia cathayensis) supplementation on plasma lipid profile and peroxidation in hypercholesterolemic subjects. Theingi Thwin; Thet Thet Mar; Hnin Lwin Tun; Lwin Zar Maw; Tin Ko Ko Oo; Aye Myint Oo. The effect of dried quince fruit (Cydonia cathayensis) supplementation on plasma lipid profile and peroxidation was investigated for a period of ninety days in 12 hypercholesterolemic subjects (≥200mg% plasma total cholesterol levels). Throughly dried quince fruits were made into a fine powder and formed 250mg tablets. In comparison with the Simvastatin group, the mean plasma total cholesterol levels of the quince group were significantly higher than those of Simvastatin group on Day 45 and Day 90 (186. Plasma total cholesterol lowering effect of dried quince fruit supplementation was not as much as that of Simvastatin administration. The acute carbon tetrachloride induced liver damage was shown to be protected by Eclipta alba, an indigenous medicinal herb found in Burma. The parameters used for the assesment were (1) histology, (2) behavioural changes, (3) body weight changes, (4) mortality rate and (5) biochemical changes. Using rats as experimental animals reliable models of acute alcohol related liver disease was produced initially. After establishment of the model four experimental groups of rats were used in the present study. The test group of animals received daily oral intubation of 50% ethyl alcohol for 45 days: the protected group received E. All the rats were sacrificed at the end of the experimental period which lasted for 45 days. The protective effect of Eclipta alba on carbon tetrachloride induced acute liver damage was studied by using 63 female guniea pigs as experimental animals. Sixteen healthy volunteers were administered six gram daily dose of commonly used Burmese indigenous antipyretics Halleidda Sonna for 2 weeks. Antipyrine was selected for a locus for oxidative metabolism as it reflects the functional activity of cytochrome p-450 dependent mixed-function oxidase systems.

As long as evidence for some bundle components remains disputable 130mg malegra dxt with mastercard, how can the impact of the bundles as a whole be assessed and interpreted? Moreover purchase malegra dxt online from canada, institution of sepsis bundles with unproven components may lead physicians to provide inappropriate or even harmful care [19] purchase 130mg malegra dxt with visa. Second purchase 130mg malegra dxt mastercard, as new study results are published, when and how should the bundles be adapted? Third, there is con- siderable evidence that early diagnosis and initiation of appropriate therapy is crucial in patients with sepsis – e. Rather than encouraging completion of a bundle within 6 or 24 h, it may be better to en- courage completion of each component “as soon as possible” (and, of course, to record it). Our recent study suggested that outcomes could have been improved if the sepsis manage- ment bundle had been completed within 12 h rather than the recommended 24-h [9]. It has taught us important lessons about guideline devel- opment and highlighted the lack of good-quality evidence in intensive care medicine. The development of sepsis bundles has helped promote discussion of the optimal approach to sepsis management and has introduced some degree of uniformity to the process of treat- ing patients with severe sepsis. It has encouraged a more standardised approach to patient management at a global level. Where the management of patients with sepsis is already optimal and follows best practice, starting to use bundles of care is unlikely to make any difference to mortality rates and may even represent a step backwards by restricting the freedom of trained intensivists to use their skills and expertise to adapt management to the individual patient. Zambon M, Ceola M, Almeida-de-Castro R et al (2008) Implementation of the Surviving Sepsis Campaign guidelines for severe sepsis and septic shock: we could go faster. Crit Care Med 34:1025– 1032 18 What Have We Learned from the Surviving Sepsis Campaign? Girardis M, Rinaldi L, Donno L et al (2009) Effects on management and outcome of severe sepsis and septic shock patients admitted to the intensive care unit after implementation of a sepsis program: a pilot study. Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. Severe sepsis is de¿ned as sepsis plus sepsis-induced organ dysfunction or tissue hypoperfusion [2, 3]. The term source control was ¿rst used in the early twentieth century but regained attention over the past 10 years when a panel of ex- perts was asked to provide guidelines for treating severe sepsis and septic shock during the Surviving Sepsis Campaign project. A bundle is a simple principle of care resulting from evidence-based practice guidelines that, when implemented as a group, have a signi¿cant effect on outcomes beyond implementing the individual elements alone. Each hospital can elaborate a sepsis protocol, but it must meet the standards created by the bundle [6]. However, sepsis often requires time to manifest and may rapidly develop with fatal consequences. Any infection starts with the invasion of host tissues by microorganism, which creates human immune system res- ponse, which activates an inÀammatory process to challenge the invasion. Understanding this pathophysiological cascade permits clarifying the principles of source-control: drainage, debridement and de¿nitive measures to control the effects of injury and restore the previ- ous correct function [4]. To achieve this identi¿ca- tion, the clinician should always consider clinical and laboratory signs of sepsis. Further- more, an early identi¿cation (according to the guidelines in the ¿rst 6 h) improves out- comes, reducing both mortality rates and costs [4, 5, 9, 10]. Once an infection site has been identi¿ed, the clinician should consider which procedure is more effective and safest for the patient: supported source-control measures are draining an abscess or local focus of in- fection, debriding infected necrotic tissue, removing a potentially infected device or de¿ni- tively controlling a source of ongoing microbial contamination (Table 19. To avoid more invasive procedures, percutaneous and endoscopic treatment is preferred to surgery when possible [13]. Such infectious foci should be controlled as soon as possible following successful initial resuscitation and antibiotic treatment [12–14]. The only exception to these criteria is peripancreatic necrosis, as a randomised, controlled trial comparing early vs. Antibiotic treatment must be started rapidly, but any kind of microbiologi- cal identi¿cation must be performed prior to beginning antibiotic treatment [11]. Promptly removing intravascular access devices that are potentially the source of severe sepsis or septic shock, after establishing another vascular access, is an important source-control measure [12]. Drainage may occur spontaneously or can be obtained with surgi- cal intervention or percutaneously. When evaluating the drainage method, the physician should choose the one that permits full drainage of the septic collection with the least 19 Source Control 229 Table 19. Percutaneous drainage Absolute indications Extended indications Non loculated Àuid collections Multi loculated and multiple abscesses No communication between abscess and viscus Abscesses with ¿stula No fungal aetiology Pancreatic Àuid collections Abscesses secondary to appendicitis or acute diverticulitis Retroperitoneal abscesses Pelvic abscesses physical trauma to the patient. Laparoscopic drainage of abdominal abscesses showed no signi¿cant advantage over open surgery or percutane- ous technique [19]. A plastic drain is normally left in to support the communication cre- ated by any of these techniques. There are four main methods of debridement: autolytic, mechanical, enzymatic and surgical. Surgical debridement remains the standard of care and consists of removal of devitalised tissue by a physician using a scalpel, scissors or other sharp instrument [4, 11]. Autolytic and enzymatic debridements are enzymatic processes that liq- uefy nonviable tissues [24]. Physicians help autolysis with moist wound dressings (mainly hydrocolloids and hydrogels), whereas a direct enzymatic action is obtained with topical ointments, such as collagenase, promoting debridement. Mechanical debridement generally occurs when patients use dressings that adhere to wounds, which are usually wet-to-dry dressings [25]. With any of these methods, debridement is of paramount importance, as it permits the development of a clear demarcation between necrotic and adjacent vital tissue. Timing for debridement differs in many conditions characterised by different risks and different evolution. In necrotising fasciitis, the spread of tissue necrosis is quick, so it needs early and aggressive debridement to attain a good outcome [14]. In other types of infections, such as retroperitoneal infections, the high risk of complications suggests de- laying the debridement to guarantee a safer procedure [15]. Cozza Relatively “old” debridement techniques that are obtaining new importance are biological methods: for example, larval therapy for super¿cial leg infections [26]. On the other hand, negative-pressure wound therapy and platelet-rich gel have shown signi¿cant bene¿cial effects on the wound-healing process [27–29]. The choice of primary or secondary restoration is based on the pathological condition and the source-control strategy chosen. Regardless, a less invasive but nonde¿nitive source-control method is preferred; de¿nitive measures should be delayed and performed electively, as the initial source of infection has not yet been removed. Examples are sepsis secondary to gangrenous cholecystitis, with primary percutaneous cholecystostomy and delayed cholecystectomy; or diverticu- litis, when the intervention can be performed while the infection is walled off by the host immune system and antibiotic treatment and an abscess has formed. On the other hand, if percutaneous drainage or less invasive treatment are not feasible (for example, perforated diverticulitis with diffuse peritonitis), an open treatment must be undertaken, and de¿ni- tive measures can be performed directly (for example, restoring the perforated colon and, if possible, immediate anastomosis) [21, 22]. Relaparotomy is neces- sary when the cause of sepsis (abscesses, dehiscence) is documented. On the other hand, when a diagnosis of sepsis is given with a suspected but not documented source of infec- tion, many authors suggest an explorative relaparotomy to detect the source of sepsis. The main debates on abdominal surgery centre around the risks (because of frequent critical conditions) and the real utility of interventions usually taken early in accordance with source-control principles. These types of “second look” are usually performed every 24–72 h, irrespective of the patient’s clinical condition, to prevent 19 Source Control 231 Table 19. Historical procedures • Radical surgical debridement (Hudspeth, 1975) • Continuous postoperative peritoneal lavage (Stephen-Lowenthal, 1979) Relaparotomy • Directed relaparotomy • Non-directed (or blind or empiric or à la demande) relaparotomy • Scheduled (or planned or programmed) relaparotomy Open Abdomen (Laparostomy) • Open abdomen • Zipper, meshes • Marsupialisation development of further septic Àuid collections, thus precluding their systemic effects. When a patient needs continuous control of the abdominal status, open-abdomen tech- niques are indicated. Open management facilitates frequent reexploration and, by treat- ing the entire peritoneal cavity as one large infected collection, continuous exposure for maximal drainage. Gastrointestinal ¿stulas and abdominal-wall defects plague simple open management. These complications should be minimised by introducing temporary abdominal closure devices, such as arti¿- cial mesh-zipper techniques [32]. It is essential for increasing the survival rate, especially in the critically ill patient in the intensive care unit. Drainage, debridement and de¿nitive surgical management are the usual consecutive steps to be carried out, but in many circumstances, the procedure must be tailored to the individual patient.

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