睿学教育Wisdome Education

Joseph Y. Allen, MD, FAAP

• Assistant Professor of Pediatrics
• Baylor College of Medicine
• Texas Children? Hospital
• Houston, Texas

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Everyone assumed that all cats reproduced in a similar fashion hiv infection dendritic cells discount mebendazole 100 mg with visa, that is anti viral oil buy mebendazole with american express, males produced sperm throughout the year antiviral remedies herpes discount mebendazole 100 mg overnight delivery, but females were seasonal breeders and induced ovulators (the ova released in response to copulation). As recently as 1980, there were no clues about hormonal control of reproductive events in wild cats. Most scientists believed that it would be virtually impossible to study hormonal patterns in, for example, tigers. Zoos were realizing the need to become conservation catalysts rather than wildlife exploiters. It suddenly was anathema to take from nature, but rather to focus on developing self-sustaining wildlife populations that, in turn, were ambassadors for the wild that served to educate the public. If no more animals were to be removed from nature, then managers soon realized the need to develop state-of-the-art approaches for maintaining healthy populations of these complex species in artifcial environments. The concept of Species Survival Plans emerged, essentially the formation of zoo consortia that shared animals for breeding to maximize genetic heterozygosity. While some species (lions and tigers) seemed to breed at whim, others defed reproduction. Additionally, managers soon learned the insidious effects of poor husbandry, especially the adverse impacts of inbreeding. Besides behavioral challenges, other factors were emerging as important regulators of reproductive success. Early studies revealed inherently low amounts of genetic diversity in some wild felid species unrelated to zoo breeding but originating from population bottlenecks in nature. Th e cheeTah, o n e o F several Felid s p ec i e s /s u b s p ec i e s w i T h l o w geneTic variaTion T h a T r o u T i n e ly ejaculaTes h i g h p r o p o r T i o n s o F p l e i omo r p h i c (m a l F o r m e d ) s p e r m a T o z o a (p h oTo g r a p h b). Thus, there was a broad menu of factors to study and signifcant motivation from two directions, one being simply intellectual curiosity and the other being Fi g u r e 3. In retrospect, our laboratorys contribution to the study of wild felids was grounded in extensive prerequisite studies of the reproductive biology of the domestic laboratory cat. Begun in 1975, our early investigations of gonadal and gamete function, hormonal profles, behavior and assisted breeding provided us the fundamental information (and confdence) to expand studies to many wild felid species. Efforts were bolstered through partnerships with zoos and wildlife reserves throughout the world. We encountered a common interest wherever we went, agreement that these magnifcent species deserved immediate research attention. The details of the important fndings in wild felid reproductive biology are beyond the scope of this chapter. However, areas of signifcant discovery by us and other laboratories included: tH e I m P o R t a n c e o f s P e c I e s -sPecIfIcIt y cats evolved unique reproductive traits that no doubt maximize reproductive ftness within their normal wild niche. For instance, spontaneous (non-copulatory induced) ovulation is not uncommon in certain wild species (i. The female ocelot and margay show distinctive ovarian cycles throughout the year, contrasted to the tightly regulated Pallas cat that generally cycles for only two months annually. In giving exogenous gonadotropins to artifcially stimulate ovarian activity and ovulation, there is no relationship between species body mass and hormone dosage required. For example, the ocelot is rather tolerant to these exogenous hormone treatments (i. Defects range from simple bending of the midpiece or fagellum to extensive derangements of the mitochondrial sheath and acrosome. Etiology is not well understood, although malformed sperm are prevalent in species or populations that have diminished genetic diversity. These males have normal pituitary function, but often low circulating testosterone. Sperm (including normal appearing cells) from these teratospermic species are compromised in ability to undergo the acrosome reaction, bind, penetrate and decondense in the cytoplasm of the oocyte. In short, abnormal and even normal appearing sperm from teratospermic males do not participate in fertilization. While the cellular defect is now clearly understood, there is a need to better understand the etiology of teratospermia, a condition that interestingly is common in the human. The study of male reproductive potential has benefted from the ability to safely anesthetize and collect sperm by electroejaculation.

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Patients/clients are reluctant to social (abusing families hiv infection from kissing mebendazole 100 mg buy without a prescription, homeless persons hiv infection rate in peru purchase 100 mg mebendazole overnight delivery, immigrants seek care without insurance and providers/facilities are and refugees) hiv infection rate mexico order generic mebendazole on line. Many of these vulnerable groups have reluctant to provide care since services may not be crosscutting health needs such as battered pregnant reimbursed. Insurance reform is a health policy issue women, pregnant, homeless, substance-abusing women. A single-parent Hispanic woman with Reimbursement Levels three children and no insurance, living in a rural area, likely experiences the following barriers: Reimbursement levels for health services have been a major disincentive for providers and health Fewer providers in rural areas care facilities. While government programs and private Providers may not take uninsured insurance companies have attempted to implement cost Providers may not understand language and containment and reasonable reimbursement, significant culture gaps exist and exacerbate the barriers that populations Transportation and childcare may not be available at risk may experience. Testing Access to health service, in particular, a regular the equity of access involves measuring utilization of source of medical care, is contingent upon services services as well as outcomes and determining barriers being available where and when needed by the service to care. Barriers based on availability, for example, America (1993), the Institute of Medicine proposed five occur when services are located only in more urban indicators for assessing access: areas creating barriers for remote rural populations or during hours when those working are unable to come Promoting successful birth outcomes for services. Lack of access to the appropriate health Reducing the incidence of vaccine-preventable service and extended waiting times are also examples diseases of access limited by availability. The implications for these indicators provides useful clues to how Americans women are significant. In these selected examples, notable access to appropriate care has a significant impact. Women also need preventive services to main- There is a striking difference between Caucasians tain their health, Pap tests, family planning services for and African Americans receiving prenatal care example. Access to health care will be a major area of concern Elderly white women were more than twice as for women and will require policy actions to remediate likely as younger white women to never have this gap. Suggested Reading Those with dental insurance made an average of about one more visit to the dentist than those Aday, L. Unequal treatment: Confronting racial Insurance, as a key to accessing health services in and ethnic disparities in health. Group-level change involves change at 56 Acculturation the societal level, such as a change in economic or having been assimilated by Spain. A Basque identifies political regime to which the entire population must first as Basque, and may even refuse to identify as adapt. In Cyprus, a Greek Cypriot will not identify modernization, great economic and political changes with a Turk Cypriot, even if both have been born on take place that impact the society at large. Individual-level accultura- European-descent Americans, who may say I am tion can be a consequence of group-level acculturation, American rather than I am Irish American. It is possible that because they have been less welcome in the United individuals are suddenly confronted with the need to States than white European groups. Thus, it makes the group level it is possible that some changes happen more sense for them to identify as African American, very slowly. For instance, the evolution of attitudes Latino/Hispanic American, and Asian American rather toward vaccination or toward boiling water may require than as American. The resulting stress has been labeled accul- In the early years of acculturation research, it was turative stress. These pressures may come from the host believed that immigrants would lose their culture while society and involve the requirement of learning the lan- gaining the culture of the host society. The latter type of acculturative stress is com- while retaining their own cultural skills. Immigrants do not lose their native whose communities expect them to retain the behaviors language unless they migrate at an early age and are and traditions of their parents. Learning a new stress has been less studied and it has often been disre- language does not have to happen at the expense of garded in the literature. Many immigrants are bilingual; one Acculturative stress can result in poorer mental or does not have to forget ones own language in order to physical health outcomes. European countries exemplify bilingual had to leave children behind and cannot send for them or multilingual societies in which bilingualism is not until much later often experience depression due to sep- perceived as interfering with cognitive processes. Immigrants who have fled While language acquisition may be relatively fast, war situations often suffer from posttraumatic stress particularly if immigrants are exposed to education and disorder in addition to acculturative stress. In order to training in the new language, cultural identity may alleviate their pain, some immigrants may resort to alco- change more slowly. It requires interventions not only to help immi- multiple examples in which ethnic identity is more grants adapt to the new society but also to help the host powerful than national unity. The Basque people have culture to successfully integrate the contribution of new retained their own ethnic identity and language despite immigrants.

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She objected to Freuds concept of libido hiv infection from hospital 100 mg mebendazole otc, a death thalidomide antivirus windows xp best order mebendazole, prescribed as a sedative during pregnancy symptomatic hiv infection symptoms mebendazole 100 mg buy with amex. She further asserted that the source of Alice Hamilton (18691970) has become known as much of womens psychological distress was due to a the matriarch of industrial medicine. Her 1910 study of the poisoning New York Psychoanalytic Institute, and, together with of approximately 600 workers implicated seven different Erich Fromm, founded the American Journal of industrial processes as the cause. Harriet Hardy was largely responsible for the Reproductive Health identification of beryllium as the cause of an outbreak Bertha Van Hoosen (18631952), while on staff of of sarcoidosis of the lung among predominantly female Illinois Universitys Medical School, invented what has employees at a fluorescent light plant in Massachusetts. Van exposures were responsible for the outbreak, their find- Hoosen delivered over 2,000 babies using this tech- ings were suppressed as a result of industry pressure. Health and Spirituality Mary Baker Eddy (18211910) is best known as a Pediatrics founder of Christian Science. Although this represents Ethel Collins Dunham (18831969) set the standard a religious or spiritual orientation, its tenets are inti- of care for the treatment of premature infants. Eddys first turn of the 20th century, some cities were experiencing edition of Science and Health, which addressed the a 30% mortality rate among infants under the age of concept of mind healing, was published in 1875. White (18271915) cofounded the Seventh the association between prematurity and infant death. Day Adventist Church, together with her husband Her text, entitled Premature Infants: A Manual for James White, in 1863. During the early 1900s, the United States had one of the highest infant and maternal death rates in the Health Care Western world. In 1908, Baker was appointed to head During the early to mid-1900s, South Carolina was the Bureau of Child Hygiene within New Yorks known for its lack of attention to the health problems Department of Health; this was the first tax-supported plaguing its African American residents. As a public attention was paid to diseases that disproportionately health administrator, Baker worked ceaselessly to affected the African American populace, it was often decrease the rate of infant mortality. Ultimately, Bakers she began a clinic for expectant mothers, infants, and efforts led to a reduction in the rate of child mortality children. American businessmen and, eventually, state and local Evangeline Cory Booth (18651950) was the governments. In 1904, Immigrant Health Evangeline Booth assumed the leadership of the Salvation Army in the United States. Her social reform efforts included the founding of the settlement house, Hull House, to serve Chicagos poor immigrant population. Substance Use and Pediatrics Unlike many of her predecessors, Addams believed that poverty resulted from social dynamics rather than Clara Hale (19051992), a social worker, was the from personal defects. Hull House offered numerous founder of Hale House, the first official home for babies services including day care, vocational training, citi- who were born addicted to drugs. Hale began babysit- zenship and literacy classes, child and medical care, ting in her home during the 1930s and first became music and art classes, and leisure activities. She is credited with having of Hull House were instrumental in the passage of state raised 40 foster children. Hale first took care of a drug- child labor laws, compulsory education laws, and addicted baby in 1969. In 1975, Hale House became the the establishment of the first juvenile court in the Center for the Promotion of Human Potential, which United States. Her advocacy of labor unions and her stance as a pacifist during World War I led to her Women in the Health Professions loss of support and her identification on a traitor list of the Senate Judiciary Committee. However, in 1931, Florence Nightingale (18201910) is known as the Addams became the first woman to receive the Nobel founder of modern nursing. Nightingale supervised a Peace Prize and, to this day, remains the only social unit of field nurses in British army hospitals during the worker to have ever been awarded that honor. Crimean War, with an emphasis on hygiene and the 47 Women Advocates, Reformers, and Pioneers need for prompt attention. Few received any financial ing school for nurses, which became the model for remuneration for their efforts. Still others, such as Jane physician in the United States, lived during the same Addams and Lucy Parsons, were condemned for their period of time as Nightingale and considered work when it became politically undesirable. Blackwell was denied admission to Carol Gilligan has maintained that the process every medical school in New York and Philadelphia of moral development in women differs from that because of her sex. Her research findings indicate that, while York voted to admit Blackwell, believing that the com- men may emphasize fairness and rules in the resolution pletion of the application by a woman was a prank.

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Most neutralizing antibodies against inuenza bind to hemag- glutinin antiviral quotes mebendazole 100 mg discount, the viruss dominant surface molecule (Wilson and Cox 1990) hiv infection early warning signs generic mebendazole 100 mg buy on line. Three major subtypes of hemagglutinin have circulated in human pop- ulations since about 1890 hiv infection in the us mebendazole 100 mg line, labeled H1, H2, and H3. Although antibodies to a partic- ular variant do not always protect against infection by other variants of the same subtype, the antibodies to variants of a subtype do often cross-react to some extent. The strains labeled A/strain des- ignation (subtype) were used to test for antibodies to a particular subtype by measuring the degree to which blood samples carried antibodies that reacted signicantly against the test strain. These patterns of cross-reaction allow one to measure immunological proles of individuals with regard to previous exposure to each of the three subtypes. By measuring individuals of dierent ages, a picture emerges of the past history of exposure and immunity to the dierent subtypes. The 1957 pandemic was caused by an H2 subtype and the 196869 pandemic was caused by an H3 subtype. Original data from Housworth and Spoon (1971), with permission from Oxford University Press. Note that antibodies against H1 occur in 8090% of individuals who were less than twenty years old during the pandemic years, suggesting widespread dis- tribution of the disease. The drop in the seropositive level for individu- als born before 1900 may be explained by the typically lower percentage of adults than children infected by inuenza epidemics (Nguyen-Van- Tam 1998). The largedropinseroprevalence after 1922 suggests that H1 declined in frequency after the pandemic. Perhaps because of widespread immunity to H1, variants of this subtype had diculty spreading between hosts. Cohorts born in the years before the pandemic had very high seroprevalence, suggesting widespread infection. Seropreva- lence declined sharply in those born just after the pandemic, implying that H3 had nearly disappeared from circulation. Older people often suer higher mor- tality from inuenza than do younger people (Nguyen-Van-Tam 1998), so the pattern in 1957 appears to be typical. The contained mortality among older individuals in 196869 may have been caused partly by immunological memory to the H3 pandemic of 1890 and consequent protection against this subtype. The age structure of immunity proles has probably inuenced the waxing and waning of the various inuenza A subtypes over the past 110 years. Inuenza causes uniquely widespread and rapid epidemics; thus the details of age-related immune proles and antigenic variation likely dier in other pathogens. Malaria is perhaps the only other disease for which existing data suggest interesting hypotheses. In areas withendemicPlasmodium falciparum infection, hosts often pass through three stages of immunity (Gupta and Day 1994; Barra- gan et al. Maternal antibodies pro- vide signicant protection for newborns up to six months of age. After maternal antibodies fade, high infection rates with severe disease fre- quently occur until the age of two to three years. Acquired immunity develops gradually over the following years, with signicant reduction in the severity of symptoms. Individuals who depart and live in malaria-free areas for many months become signicantly more susceptible upon return (Neva 1977; Cohenand Lambert 1982). The slow buildup of immunity partly depends on the high antigenic variation of Plasmodium falciparum (Marsh and Howard 1986; Forsyth et al. An individual appar- ently requires exposure to several of the locally common variants before acquiring a suciently broad immunological prole to protect against disease (Barragan et al. Newborns, memory decay, and migration provide the main sources of new susceptible hosts. Ospring of mice and hu- mans obtain IgA antibodies in milk andIgGantibodies through the pla- centa(Janeway et al. The newborn inherits circulating IgG titers in the blood that match the mothers antibody levels. The infant receives the particular antibody specicities generated by the mothers history of ex- posure to particular antigens. Infection of a baby early in life may be cleared by maternal antibody, thereby failing to stimulate an immune response and generate long-lasting memory (Albrecht et al. Other vertebrates also transmit maternal antibodies to newborns (Zin- kernagel et al.

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In special cases late asthma qualifies for recognition if there are attacks up to 16 hours after the exposure in the workplace antiviral innate immunity order 100 mg mebendazole. However hiv infection from dried blood purchase mebendazole online pills, in such cases it has to be documented that similar attacks do not occur at the same hour of the day during weekends or holidays (i symptoms of hiv infection early stages mebendazole 100 mg buy low price. On the other hand, there is no requirement for the exposure to have a certain duration or severity. This is because asthma is in some cases triggered after a short while and in connection with even limited exposures. Examples of pre-existing and competitive diseases/factors Like most other diseases, asthma can develop or become aggravated as a consequence of other diseases or factors not connected with work. Therefore the National Board of Industrial Injuries will make a concrete assessment of whether any disclosed competitive factors are of a nature and scope that may give grounds for turning down the disease entirely or whether, if the claim is recognised, there are grounds for making a deduction in the compensation. Examples of possible competitive factors which may affect the onset or the course of the disease: Tobacco smoking Private allergy (for instance to house-dust mites or pollen) Genetic disposition to allergy Medicine consumption Tobacco smoking cannot be deemed to be the primary cause of asthma. But there may be consistence in the symptomatic picture for asthma and diseases that are primarily caused by tobacco smoking. Therefore, in some cases smoking may have the effect that a reduction is made in the compensation payment. Managing claims without applying the list Only asthma is covered by group E, item 8 of the list. Furthermore, as stated in the list of occupational diseases, there must have been exposures meeting the recognition requirements. Asthma not covered by the list will in special cases qualify for recognition after submission of the claim to the Occupational Diseases Committee. Examples of cases that may qualify for recognition not based on the list: Asthma caused by working for a long time with low-molecular irritants (factory worker who operated a wall paper printing machine producing using acrylic foam) Asthma bronchiale caused by several years of cleaning of smoke ovens, using alkaline foam detergents and chlorinated substances etc. Shortly after she started work she would catch a cold very often and had sinusitis and problems when staying indoors. In the course of her employment she developed a persistent cough and tended to have breathing problems and eventually a specialist of pulmonary diseases diagnosed her with asthma. A building report described rather substantial deficiencies in the indoor air quality in her workplace, in the form of humidity damage, and according to the report there was visible mould formation. The day-care worker developed asthma after working in humidity damaged rooms with visible mould attack. There is a good time and causal relationship between the development of asthma and exposure to harmful plants (mould fungus) in the workplace. After 10 years he became responsible for the production and the machines, the administrative work being performed in an office in affiliation with the packing department. In the course of the last year he developed increasing respiratory passage problems with coughing, periodic attacks of wheezing, and breathing problems. In connection with being transferred to a different department he experienced a considerable improvement in his symptoms. He was diagnosed with asthma and tests showed that he was allergic to certain types of fish. The allergies were relevant in relation to the exposures to fish vapour in the workplace, and peak flow measurements showed aggravation when we was there. The fishing industry worker developed asthma as a consequence of work on premises where there was fish vapour. He was furthermore diagnosed with allergy towards certain types of fish which were also part of the production in the workplace. There is a good causal relationship between the development of asthma and the exposures in the workplace to vapour from animals/animal products. Towards the end of the period he developed symptoms of asthma in the form of red and irrigated eyes as well as breathing problems which developed when he was in the workplace. The symptoms disappeared after a long presence from work and completely disappeared after cessation of work.

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Thus hiv infection immediate symptoms cheap 100 mg mebendazole amex, they might be effective at preventing the establishment of infection even after virus challenge hiv infection rates utah trusted mebendazole 100 mg. It was 62% effective when given 5 hours after challenge and 33% effective when given 6 hours or more after challenge hiv infection through food purchase mebendazole 100 mg visa. On the other hand, providing com- plement did not change 694/98-Ds activity in providing postexposure prophylaxis (114). Sequence analysis of the V3 region of this virus demonstrated amino acid changes in the epitope recognized by 694/98-D and in one amino acid nearby. Thus, mutation leading to escape from neutralization is a risk of therapy with one monoclonal antibody and supports the need for studying com- binations of antibodies. However, statistically nonsignificant trends toward delayed time to opportunistic infection and time to death were noted. No effects on weight, Karnofsky per- formance score, or serum 2-microglobulin levels were seen (127). These patients received either 250 or 500 mL of the hyperimmune plasma or albumin once a month for 1 year. No effects on the occurrence of opportunistic infections or serum 2-microglobulin were seen (129). Presumably, these were women with more advanced disease and greater risks of transmitting infection to their newborns. The antibody administered neutralized the primary virus isolate of 9 of the 11 recipient patients. In sum, although a number of these human studies suggested a clinical benefit from the administration of various passive immunization products, no clear antiviral effect has been demonstrated to date. These include 212 Jacobson clinical isolates, which are more resistant than laboratory-adapted strains to neutral- ization by antibodies. Exogenous administration of protective quantities of more potent tar- geted antibodies seems to be technically feasible and practical in the clinical setting. It was felt that these concentrations could be safely reached in the sera of patients after administration of monoclonal antibody preparations (137). Treatment of infection, as opposed to prevention of infection, is likely to require even higher doses and/or potency. No clear therapeutic antiviral benefit has been seen with the antibody preparations studied to date, but monoclonal antibodies with potent neutralizing activity against clinical isolates have not yet gone into clinical trials. Monoclonal antibodies will need to be administered in combination to obtain syn- ergistic potency, reduce dosage requirements, counteract any infection enhancement activity of any antibodies in the combination, and prevent the emergence of mutant viral strains resistant to neutralization. The response is partially effective in controlling viral replication but not in eradicating infection in most circumstances. Passively administered antibodies might prove to be particularly useful in protection against the initial infection of dendritic cells, as well as monocytes and lymphocytes and might thus protect against the establishment of the infection. Mother-to-infant transmission of human immunodeficiency virus type 1: association with prematurity or low anti-gp120. Vertical transmission of human immunodeficiency virus is correlated with the absence of high-affinity/avidity maternal antibodies to the gp120 principal neutralizing domain. Characterization of human immunodefi- ciency virus type 1-specific cytotoxic T lymphocyte clones isolated during acute serocon- version: recognition of autologous virus sequences within a conserved immunodominant epitope. Successful protection of humans exposed to rabies infection: postexposure treatment with the new human diploid cell rabies vaccine and antirabies serum. Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children. Use of cytomegalovirus immune glob- ulin to prevent cytomegalovirus disease in renal transplant recipients. Efficacy of hepatitis B immune globulin for preven- tion of perinatal transmission of the hepatitis B virus carrier state: final report of a ran- domized double-blind, placebo-controlled trial. Modification of chicken pox in family contacts by administration of gamma globulin. Evaluation of Red Cross gamma globulin as a pro- phylactic agent for poliomyelitis.

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Autocrine and paracrine regulation of growth and inhibition of thyrocytes via growth factors and their receptors antiviral immunity discount 100 mg mebendazole. The factors may be also secreted by the surrounding stromal tissue hiv infection timeline of symptoms order generic mebendazole, thus giving rise to proliferation of endothelial cells and fibroblasts hiv aids infection rates for south africa 100 mg mebendazole free shipping. Major factors with stimulatory and inhibitory effect on growth of thyroid follicular cells. Significance of vascular endothelial growth factor and epidermal growth factor in development of papillary thyroid cancer. Introduction Early diagnosis and radical management of thyroid cancer do not always result in curing the patient. Epidemoilogy of papillary thyroid carcinoma Papillary thyroid carcinoma accounts for the majority of thyroid cancers and is commonly believed to be the least malignant type. In Europe and the United States, it presently constitutes approximately 75-80% of all diagnosed thyroid cancers [1]. The tumor is detected in young individuals (usually before they turn 40 years of age) and is 2-3 times more common in females. As a rule, it is a multifocal disease (in 60% of patients) involving one thyroid lobe, although in 50% of cases microscopic neoplastic lesions are present in the contralateral lobe. One should be also aware of the possible presence of a small, 2-10 mm focus of papillary thyroid carcinoma termed microcarcinoma, which is asymptomatic and detected by chance in the course of histopathology of the thyroid gland resected in a patient with goiter or in serial autopsies of the thyroid (such post-mortem examinations detected 35. Approximately 50% of patients demonstrate the presence of metastases in the lymph nodes. Oncogenesis The presently prevalent opinion states that genetic factors play an ever-increasing role in the development of neoplastic lesions. In view of the present knowledge, a prerequisite for neoplastic transformation to occur is a mutation involving two basic groups of genes - proto-oncogenes and suppressor genes, also called anti-oncogenes. Under the effect of various external and internal factors, they may be converted into oncogenes. Early neoplastic lesions usually involve a single cell line and appear as a consequence of a single or several serial mutations. Such mutations result in an increased capability of the cells to undergo mitotic divisions with a simultaneous decrease of their apoptotic capability as compared to the adjacent cells. Thus, a cell line develops that may give origin to for example hyperplasia of the thyroid tissue associated with neoplastic growth, since the borderline separating neoplastic transformation and hyperplastic proliferation is very thin [4,5]. In view of the high metabolism of cells undergoing division, the growth of a non- vascularized tumor is low. The clinical presentation of this growth phase is most commonly carcinoma in situ. The subsequent phase of tumor growth depends on the formation of new blood vessels (neoangiogenesis). Neoangiogenesis is a process composed of numerous interactions occurring in the paracrine and endocrine path between neoplastic cells and cells forming the vascular endothelium, connective tissue interstitium and some morphotic blood elements, such as macrophages or mastocytes. In consequence of these interactions, the microenvironment in the area surrounding the tumor changes, thus providing the neoplastic lesion with an opportunity for further uncontrollable growth and progression. A prerequisite for the initiation of angiogenic phenomena is a disturbed balance between the systems of pro- and anti-angiogenic factors. In accordance with currently accepted theories, the initiation of angiogenesis occurs through hypoxia of neoplastic cells that are situated the most distally from the lumen of a blood vessel, as well as through a defect of the genetic apparatus, in consequence of which the so-called angiogenic phenotype emerges. The term denotes the condition characterized by a permanent, constitutional activation of genes that encode growth factors. As early as more than 20 years ago, investigators demonstrated that an increase in thyroid vascularization in patients with hyperthyroid goiter was regulated by cytokines secreted by thyreocytes. The regulation of this process is complex and the contributing factors include both neoplastic cells capable of producing such factors as cytokines and chemokines, as well as immunocompetent cells situated in the vicinity of tumor cells or infiltrating the tumor itself; the latter also produce cytokines, chemokines and growth factors. The interrelation of such factor production, especially in the case of chemokines, significantly intensifies angiogenesis. Chemokines, which contain the repeated sequence of glutamine-leucine- arginine, show an angiogenic activity [6-10]. Angiogenesis The basic process of the formation of new blood vessels originating from the previously existing structures is the branching off of capillary vessels and budding of new vascular limbs that takes place both in fetal life and in mature organisms. The process is short-lived (approximately 5 days on the average), subject to strict regulations, and its sudden termination results from the reduction of stimulatory factors and/or a decrease of inhibitor levels.

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A: Exposure to stressful events or situations (either short- or long-lasting) of an exceptionally threatening or catastrophic nature B: 1 symptoms of hiv infection in one week discount mebendazole online master card. Repeated reliving of the trauma in intrusive memories ("flashbacks") or nightmares hiv infection long term effects 100 mg mebendazole order fast delivery, or 2 antiviral therapy journal generic 100 mg mebendazole with mastercard. Severe discomfort at exposure to circumstances reminiscent of the trauma C: Avoidance of all activities reminiscent of the trauma D: 1. Partial or total loss of memory (amnesia) regarding the traumatic experiences or 2. Persistent symptoms of autonomic hyper arousal with hyper vigilance, including at least two of the following a. However, the English version also shows that it is possible to specifically disregard the requirement. Recognition will be based on an assessment of the diagnosis made by a specialist of psychiatry. It is the National Board of Industrial Injuries that assesses whether the diagnosis requirements are met, including the requirements for extraordinarily stressful mental exposures and the time correlation. Other diagnoses such as stress response (including acute or unspecified stress response), adjustment reaction and depression are not covered by item F. A number of the other conditions/diseases may, however, in case of extraordinary mental stresses, be recognised without the list after submission of the case to the Occupational Diseases Committee. Exposure requirements The disease is deemed to be caused mainly by external stresses and may perhaps have permanent mental consequences. In principle it is not possible to make this diagnosis unless there has been exposure to traumatic events or situations, short- or long-lasting, of an exceptionally threatening or catastrophic nature. Examples of relevant exposure may be severe threats causing a sense of mortal danger, for instance war action, being under fire, or dangerous driving in mined areas rescue work in catastrophe areas with severe stresses mortal danger when exposed to violence or threats of violence 1. Examples of pre-existing and competitive diseases/factors In some cases there may be pre-existing or competitive mental illness which is without any correlation with the particularly stressful exposures in the workplace, but relevant for the overall pathological picture. Similarly, other circumstances than circumstances related to work may be significant for a persons mental condition. Examples of pre-existing or competitive diseases may be depression, anxiety, psychoses, or similar disorders. Other symptoms or exposures not on the list will in special cases qualify for recognition after submission to the Occupational Diseases Committee. The following mental diseases may, after a concrete assessment, be deemed to have been caused by external stresses and may be recognised after submission of the claim to the Committee: Stress response (including acute stress response, other stress disorders and unspecified forms of stress response (F43)) Depression (including depressive single episode F32). Most depressions are passing, and usually it is not possible to distinguish these from the more persistent types of depression, other than by following the course of the disorder. Enduring psychoses are not, however, deemed generally to have external stress factors as dominant causes Enduring personality change after catastrophic experience F62 (when the disease is not covered by the diagnosis of posttraumatic stress disorder) Whether these mental diseases will be deemed to have been caused by a work-related exposure will depend on a concrete assessment including symptom onset, the course of the disease and the nature and extent of mental exposures. Mental illness with the diagnosis of adjustment reaction will not normally qualify for recognition as an occupational disease. This diagnosis covers very moderate, unspecified and passing mental complaints which are not usually regarded as actual occupational diseases within the meaning of the Act and may besides develop after even very moderate exposures. Examples of decisions based on the list Posting (military stationing and relief work) Example 1: Recognition after stationing to the peace-keeping forces An officer who was stationed more than once, to regions at war, in the peace-keeping forces saw how a local soldier was executed by being shot through the mouth. He was furthermore exposed to a number of violent incidents, both direct war action and assaults on civilians. As part of the service in the peace-keeping forces, the officer had been exposed to a number of stressful situations. The medical examinations established a mental disease in the form of posttraumatic stress disorder, and there was good correlation between the work-related exposures of an exceptionally threatening and stressful nature and the disease. Example 2: Recognition after relief work A driver drove relief supplies to regions at war. He saw how whole towns were wiped out and he had to drive in regions with direct war action. The convoy was stopped every day by armed soldiers or civilians who threatened him with arms to get money etc. The driver developed posttraumatic stress syndrome after having been exposed to a number of violent incidents as a driver delivering relief supplies in regions with direct war action and threats in connection with robberies and similar incidents. There is furthermore good correlation between the work-related exposures and the disease. Example 3: Recognition after work for relief organisation in Kosovo A male employee in a Danish relief organisation worked for nearly 6 months as a warehouse manager in a major city in a region at war, where he was exposed to violence and murder threats.

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Guardianship Suggested Reading proceedings hiv infection rates msm purchase generic mebendazole canada, which are referred to as conservatorship proceedings in some states antiviral uk release mebendazole 100 mg buy mastercard, are a matter of state law hiv infection rate in botswana purchase mebendazole 100 mg without a prescription. Philadelphia: Lippincott, Williams Clear and convincing evidence is required to support a & Wilkins. Electrolyte 1 Understanding the terminology used in your state is very important; for example, some states have both guardianship and conservative Cannabis see Marijuana proceedings, which are distinct and applicable in different situations. In 2001, women were approxi- new insight into diseases of the brain and causes of mately 58% of the population age 60 and older and 70% dementia, such as Alzheimers disease, which reduce an of the population age 85 and older. Since women have individuals ability to retain and process information greater longevity than men, they are more likely to face accurately. For exam- financial matters and health care while they have the ple, in many states, the test of competence or capac- capacity to do so. Although it is difficult to contemplate being those facing the family or caregiver of an individual incapacitated and unable to control ones personal and who developed impairments as an adult or in later life. Similarly, adults whose and sources of support of middle-aged and older adults with cognitive or reasoning abilities are diminished may intellectual disability. Risk factors Suggested Resources increase with age and may worsen after menopause. High-dose oral contraceptives of prior is available about optimal preventive, diagnostic, and years increased the incidence of heart attack, deep therapeutic modalities. The main mechanism sent with atypical symptoms of chest pain, which may appeared to be stimulating clot (thrombus) formation in appear noncardiac and because electrocardiographic the heart or brain arteries and leg veins. Therefore, oral contraceptives are existent cardiac disease should undergo cardiac contraindicated in female smokers older than 35 years. Most women with valvular or congenital heart disease will require antibiotic prophylaxis prior to delivery. Women constitute twice the risk of myocardial infarction than those who 75% of the population with rheumatic mitral valve dis- took estrogen. Risks included a two- to fourfold increased blood volume and tachycardia (rapid heart increased incidence of venous thromboembolism (vein beat) associated with pregnancy and labor will aggra- blood clot) and more than 50% increase in the need for vate the blood stasis (pooling or sluggish movement of gallbladder surgery. In these situations, some women may be mone-treated women and an unfavorable global risk candidates for balloon mitral valvuloplasty (a procedure score. The presence of high levels of tolerate well the cardiac changes related to pregnancy. This is more likely However, women are affected twice as often as men to occur in women who have history of renal disease, with immune, noninfectious endocarditis. Also, they are more likely the criteria for replacing the valve is enlargement of to have valvular heart disease or abnormalities in heart the heart chamber. They likely benefit as much as men (narrowing) develop less ventricular hypertrophy from implantable defibrillators, a device that corrects (thickening of the heart ventricle muscle) than men and heart rhythm abnormalities, but overall fewer women more often have preserved left ventricular function than have been studied in the clinical trials involving these men. This results in operation at a more form ventricular tachycardia, a special form of ventricu- advanced stage and thus worse outcome. Less dangerous but more frequent are the Endocarditis is an infectious or inflammatory supraventricular tachycardias (rapid heart rate initiated disease of the heart valves that can lead to damage of in the upper heart chambers). Women have more fre- the heart valves causing either thickening of the heart quent supraventricular tachycardia than men (2:1 ratio) valves (stenosis) or backflow/incompetence of the and their symptoms may be triggered by pregnancy or valves (regurgitation). Bacterial infections of the the particular phase (luteal phase) of the menstrual heart valves occur more often in men than in women cycle. Such factors include appetite suppres- high as in men and therefore they should receive long- sants, cocaine, and autoimmune connective tissue term anticoagulation. Women comprise up to 75% of their higher risk of bleeding from the anticoagulation patients who have either taken appetite suppressive therapy; therefore, they need more careful follow-up drugs or have systemic lupus. The amphetamine aminorex led to an epidemic of pulmonary hypertension in late 1960s. Women make up to 60% of total derma, and phospholipids syndrome are also associated deaths from stroke. Therefore, early treatment of The oral vasodilators of choice are long-acting formula- hypertension, diabetes, and dyslipidemia (abnormal fats tions of calcium channel blockers (such as nifedipine or in the blood)the major risk factors for strokecan diltiazem). However, only about one third of patients have great impact on prevention of stroke at older age respond to this treatment. Any abnormal elevation in the arterial or venous pulmonary Connective tissue disorders are a cluster of autoim- pressures can lead to pulmonary hypertension (elevated mune diseases in which antibodies are generated pressure in the lung circulation).

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In the early 1990s hiv infection in south africa mebendazole 100 mg without a prescription, national legislation hiv infection exposure mebendazole 100 mg order on-line, uni- versal access to health care hiv infection symptoms stories 100 mg mebendazole order visa, was introduced by President Clinton and the Congress as a way to provide Culture health security for all Americans. Health care providers and facilities that do not The effort, although unsuccessful, has kept the problem understand the cultural expectations and norms of the of health care access on the public agenda. Initially, ficulty in achieving compliance with necessary medical the premise was access to physicians and hospitals. More recently, health care access has included a variety of providers, services, and facilities. In addition, access Attitudes, Beliefs describes the actual use of health services and factors that facilitate or impede health care. The relationship between the provider of services Aday (2001) and Anderson (see Anderson et al. Barriers occur when patients/clients per- refers to health care system characteristics that influence ceive attitudes and beliefs about the nature of their the use of services. Realized access is the actual use of health as negative and not consistent with their own health services. This results in delays and lack vices determined by demographic characteristics and of compliance that undermines successful treatment out- need. Efficient access minimizes the cost of health care ser- Human Behaviors vices and maximizes health status or satisfaction. Thus, each type of access to care is influenced by a number Individual characteristics may serve as barriers to of characteristics and events. Patients with physical or emotional disabili- the influences on access to health care, numerous ties may find it difficult to find services to meet their studies have examined the barriers to care in specific needs. These efforts is experiencing out-of-pocket expenses as a barrier to may not be sustained since they are not a reimbursable obtaining services. Women frequently encounter this barrier when they are dependent on others for transportation. These are often individuals and groups who are Insurance Coverage vulnerable and need multiple services. Aday (2001) notes that the principal health needs of vulnerable Insurance coverage, tied to employment, is the populations are physical (high-risk mothers and infants, admission ticket to health services. Awareness of the multifactor- ial pathogenesis of acne has facilitated the rational Suggested Reading application of combination therapies with different Balls Organista, P. Milder cases of acne are gener- relationship between acculturation and ethnic minority mental ally treated with topical products including benzoyl per- health. The side Acculturation: Advances in theory, measurement, and applied research (pp. The most commonly prescribed systemic cross-cultural psychology: Social behavior and applications (2nd antibiotics are in the tetracycline class including ed. The marginal man: A study in personality of the systemic drugs are associated with various side and culture conflict. The abbre- counseling before starting the medication and careful viated multidimensional acculturation scale: Empirical validation monitoring during the treatment course. Adult female acne is significantly influenced by the effect of androgens on the pilosebaceous unit. It specifically involves the pilosebaceous unit, tion is particularly challenging to treat because it tends consisting of the hair follicle and sebaceous gland. The not to respond to the traditional therapies employed in cause is multifactorial and the four major causal compo- teenage patients. It primarily affects teenagers but is not confined to for this indication, alter the hormonal milieu of the this age group. The most important aspect of acne treatment is Noninflammatory lesions include open and closed patient compliance with medications. Contrary to pop- comedones, also known as whiteheads and blackheads, ular belief, particular foods are not implicated in the respectively.

Grok, 37 years: Treatment of refractory disseminated nontuberculous mycobacterial infection with interferon : a pre- liminary report. Uptake and transport of copoly- mer biodegradable microspheres by rabbit Peyers patch M cells. The Pathogenesis frequencies of organ involvement at presentation are described in Table 22. The culling of variation depends on the intensity of nat- ural selection acting on the particular regulatory step.

Altus, 24 years: Presenilin 1 gene silencing by S-adenosylmethionine: a treatment for Alzheimer disease? Smears for malaria should consist of Wheatly-Gomoris Trichrome solution both thick and thin flms. If the brain becomes damaged, it may become unable to send messages to the muscles and could leave a person unable to walk, talk, or to use his or her hands. It is rec- dwellings that provide habitats favoring the 122 ommended that paid blood donors be banned survival and reproduction of kissing bugs.

Grompel, 63 years: By contrast, inuenza A infects humans, several other mammalian species including pigs and horses, and many avian species. This sheet would be helpful to give people so they can take it with them when they see their doctor. These proteins include enzymes & structural components responsible for all the developmental & metabolic processes of an organism. Humoral, mucosal, and cellular immunity in response to a human immunodeficiency virus type 1 immunogen expressed by a Venezue- lan equine encephalitis virus vaccine vector.

Fedor, 25 years: The names and addresses of con- In cohort studies the ratio of incidence in trols were obtained from the patient list held by exposed to incidence in unexposed is calcu- the health authority. The second section notesthatantigenic variants can also be classied by phylogeny. A clinical cardiac disease was recorded in an adult free-ranging male from Switzerland that died of a circulatory failure attributed to a cardiomyopathy (Ryser-Degiorgis et al. Summary: Katherine worked hard to recover from the bone cancer that gave her painful lesions, too numerous to count three years ago.

Wenzel, 34 years: Gold nanoparticles can be the presence of citric acid as a nonexpensive covered with a gadolinium complex of cysteine and nontoxic reducing agent and stabilizer diethylenetriaminepentaacetic acid because sul- (Behdadfar et al. The elec- ping agent used during synthesis can leave tric field intensity and the scattering and functional groups available for subsequent func- absorption cross-sections are all strongly tionalization (e. Protein carbonyls can be formed via several mech- anisms including site-specifc metal-catalyzed oxidation of lysine, arginine, proline, and threonine residues; glycation 4. Impact of nanotechnol- Review on current trends and advancement in drugs ogy on drug delivery.

Zakosh, 41 years: At the examination patients in many cases need to lie still in an enclosed small cylinder (torpedo) for at least the 20 to 30 minutes that the scan takes. But she had not eliminated isopropyl alcohol so she was at great risk for getting cancer or getting it back if she had it earlier. Get involved in activities that require the use of your hands, such as beading, sewing, or a fx-up project around the house. However, repeat lumbar puncture is essential in patients without clinical improvement in 48 hours.

Mazin, 26 years: It is the end-stage vation by Minot and Murphy (1926) that feeding with of autoimmune gastritis characterized by the loss of gastric cooked liver cured the anemia. Silver- produce antimicrobial effects: interacting with based antiseptics that may have membrane or cell wall (Yamanaka et al. Lipid deposition occurs at the margins of the hemorraghe, and microaneurisms (small vascular dilatations) and edema may appear. An additional consideration to bear in mind is that only those prime habitat patches located in the south of the national park have the potential to be expanded as a source area, provided that adequate habitat management is undertaken to recover rabbits.

Bengerd, 42 years: Abuse potential is limited with daily in the morning and last up to longer-acting agents. Effect of supplementation with selenium on postpartum de pression: a randomized doubleblind placebo-controlled trial. Principles of disease and control of disease in primary and multiplier prevention in integrated broiler operations In: broiler breeder operations. Leopards for release would therefore be sourced from the managed conservation breeding programmes in the worlds zoos, and pre-release breeding and management protocols are being designed to mitigate all the above factors as far as possible (see below).

Ugolf, 47 years: Lung tumors have a propensity for bleeding, but his lung cancer was in the past, or so we thought. If the area is pressed and leaves a dent for 5 seconds or more, edema is likely to be present. Experiments were performed to determine if Wnt3a secretion changes in the microenviron ment of the aortic valve endothelial cells with and without lipids. Among them, tions to support clinical documentation in microphages mainly contribute to the genera- 2014 (Weblink2).

Giacomo, 50 years: Lesions are commonest on the upper trunk and may coalesce or occur in a linear pattern (Hsu et al. Immunological memory creates strong selective pressure on the viruses to change anti- genic properties, escape immune memory responses within hosts, and initiate newoutbreaks (Wilson and Cox 1990; Cox and Bender 1995). It should be strictly monitored whether patients fill out a questionnaire at the time of hospitalization under the same conditions. This was deemed to be the most 1 carcinogenic of all chemicals when it was discovered; /10 1 of a mg ( /10 of a flyspeck) placed under the skin of a mouse, would induce tumors many months later and would kill the mouse.

Ur-Gosh, 39 years: For example, untreated Chlamydia and gonorrhea can lead to pelvic inflammatory disease, ectopic pregnancy, and infertility. The use of the hemoglobin A1c (A1C) for the diagnosis of diabetes is not recommended at this time. Peripheral neuropathy occurs with stavudine, didanosine, and zalcitabine, and can be painful and debilitating. The fetal brain curs in the course of pregnancy, the less pronounced the reacts diferently to infectious agents than the neonatal changes usually are.

Elber, 36 years: And the calcium level had risen to normal, showing that toxins were now out of the parathyroid. Serum ratio of triiodothyr- onine to thyroxine, and thyroxine-binding globulin and are treated with beta-blockers until the free T4 concentra- calcitonin concentrations in Graves disease and destruction- tion returns to normal. It has been proposed that a centrally mediated effect of calorie restriction activates endogenous steroid production leading to immunosuppression (18). Thus, "mixed acidophil-basophil adenocarcinoma," should be coded in the same manner as "mixed acidophil-basophil carcinoma," which appears in the list under "Carcinoma.

Finley, 31 years: Vaccinated persons with varicella may not have fever and may only have a few lesions that may resemble bug bites. Sec- tion usually involves only 10-15 adult female ondary infections of lesions, particularly as a 40-43 result of scratching, are common; and post- mites. Beta-Carotene supplementation at pharmacologic levels may modestly increase lung cancer incidence in cigarette smokers, and this effect may be associated with heavier smoking and higher alco hol intake. Helicobacter pylori-induced histone modication, associated gene expression in gastric epithelial cells, and its implication in patho- genesis.

Grubuz, 55 years: The spread of an epidemic genotype carries along in strong association the alleles of that genotype atdierent loci. Collectively, these factors contribute to Myc-mediated epigenetic control over stem cell renewal and maintenance of pluripotency. In the late stage of the disease there is perma- usually appear around 36 months afer the initial mea- nent hemiparesis. Furthermore, knowledge on disease susceptibility and carrier role of lynx is necessary to propose adequate health management measures, e.

Rathgar, 56 years: Relationships during the coitus-induced luteal and ovarian-stimulatory effects of equine and human phase and the estrous period without mating. Among them, Graves dis- ease is the most important to be ruled out becuase it is the There are no definitive criteria for the diagnosis of orbital first cause of thickened extraocular muscle involvement (13). Treatment is directed at rheumatic chorea (Sydenham chorea) symptomatic management of the movements of Chorea-acanthocytosis (neuroacanthocytosis) chorea and athetosis, if necessary. Foundation Topics in Womens Health History of Womens Health in the United States water, and sanitation; education; decent housing; secure History of Womens Health in work; useful role in society; and political will and public support.

Karmok, 29 years: Daily intake of Goldenseal can reduce Sinus Infection symptoms after a point of time. This may cause syndrome is the recognition of the possibility that compression of the medulla, with altered they might occur. The ideal number of animals for such reference values must be around 120, but a more realistic number of 60 may be suffcient if a Gaussian distribution is present. Thyroid surgery in the 19th century carried a mortality of around 40% even in the most skilled surgical hands, mainly due to haemorrhage and infection.

Marik, 51 years: Viral meningitis is self-limiting and requires only supportive care with intravenous fluids and pain management. If you have cancer and yet have a creatinine level that is very low, you can guess that you are unable to make enough creatine or are wast- ing it in the urine. The Committee found that the right-side bursitis and beginning calcification of the shoulder had not been caused, mainly or solely, by the work. If the centre of the caseating granuloma is solid, it is iso- or hypointense to normal brain tissue on T1-weighted and T2-weighted images, and might enhance het- may be recognized by the lack of meningo-vascular en- erogeneously.

Steve, 53 years: From April 11June 5, both communities, and the public without needed turkey and egg laying hens were infected. Ivar Sandstrm, a Swedish medical student, in 1879 was the first to describe the parathyroid glands. This mechanism has been dem- onstrated for antigens that were presented in large numbers, thus during infection or fol- lowing injection of superantigens (Moskophidis et al. Patients receiving chemotherapy may depofoam), preferably via an Ommaya require more frequent follow-up.

Pyran, 38 years: Some skin and connective tissue diseases, such as those discussed in this section of genes and disease, are due strictly to genetic inheritance, while others do not have specific gene abnormalities as their sole cause. Samuel Gross wrote in 1848: "Can the thyroid gland when in the state of enlargement be removed? The catastrophic antiphospholipid syndrome in the antiphospholipid syndrome: A randomized, double- Ashersons syndrome. An accelerated pulse during sleep or cognitive difficulties are also considered to suggest the diagnosis of hyperthyroidism in such cases (Hall et al.

Vigo, 35 years: Avoid placing a Usually use surface stim ulation, less often Motor neuron diseases (e. The causes of environmental stereotypies have been, and continue to be, the subject of many investigations, and a detailed revision of the neurophysiological mechanisms responsible for such behaviours is beyond the objectives of this article. These substrates establish the condensed and decondensed states of the chromatin [1]. Isolation of a Miller-Dieker lissencephaly gene containing G protein beta-subunit-like repeats.

References

• Chandra H, Reddy PJ, Srivastava S. Protein microarrays and novel detection platforms. Expert Rev Proteomics 2011;8:61-79.
• Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA. 2001;286(21):2703-2710.
• Orpen N, Goodman R, Bowker C, Lakhoo K. Intralobar sequestration with congenital cystic adenomatous malformation and rhabdomyomatous dysplasia. Pediatr Surg Internat 2003;19:610-11.
• Erdur B, Ersoy G, Yilmaz O, et al: A comparison of the prophylactic uses of topical mupirocin and nitrofurazone in murine crush contaminated wounds. Am J Emerg Med 26:137, 2008.