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Couples who know that the woman is a carrier of the haemophilia gene have a range of options to consider when thinking about the possibility of becoming parents. New medical technologies now offer a variety of screening and testing possibilities although these can lead to difficult choices, including the option of terminating the pregnancy. These are very personal and sensitive decisions. Some couples may be content to let nature take its course and to go ahead and try for a baby knowing that there is a chance it will be a boy with haemophilia. Others may wish to avoid having a child with haemophilia, and may therefore want to choose one of the latest screening tests and or assisted conception options. Screening for haemophilia will usually only take place where there is a history of severe haemophilia in the family. Assisted conception techniques are not yet widely available within the NHS, and some are only at a very experimental stage.
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Bethanechol more drug side effects Adolescent rape exists in a sociocultural context in which issues of male dominance, appropriate gender behaviors, female victimization, and power imbalances in relationships are highly visible. Prevention messages for adolescents need to be designed for males and females.33, 34, 54 56 Adolescents need to be able to identify high-risk situations and should be encouraged to seek medical care after a rape. Factors that may increase the likelihood of assault eg, late night use of drugs or alcohol ; and strategies to prevent rape should be discussed, and associated educational materials should be distributed.33, 34, 54 56 Screening of adolescents for sexual victimization should be part of a routine history. Adolescents should be asked direct questions regarding their past sexual experiences. These questions should include those that explore age of first sexual experience, unwanted voluntary or forced sexual acts, and a description of events. Exploration of gender roles and relationship parameters eg, exploitative, nonconsensual vs healthy ; are critical. The patient needs the opportunity to describe the experience in his or her own words.30 34, for instance, rxlist. Phagocytes and rheumatoid synovitis. Mastermind or workhorse in arthritis? Arthritis Rheum 1997, 40: 518 Erdmann VA, Szymanski M, Hochberg A, Groot N, Barciszewski J: Non-coding, mRNA-like RNAs database Y2K. Nucleic Acids Res 2000, 28: 197200 Erdmann VA, Barciszewska MZ, Hochberg A, de Groot N, Barciszewski J: Regulatory RNAs. Cell Mol Life Sci 2001, 58: 960 Ariel I, de Groot N, Hochberg A: Imprinted H19 gene expression in embryogenesis and human cancer: the oncofetal connection. J Med Genet 2000, 91: 46 Hurst LD, Smith NG: Molecular evolutionary evidence that H19 mRNA is functional. Trends Genet 1999, 15: 134 Juan V, Crain C, Wilson C: Evidence for evolutionarily conserved secondary structure in the H19 tumor suppressor RNA. Nucl Acids Res 2000, 28: 12211227 Goshen R, Rachmilewitz J, Schneider T, de Groot N, Ariel I, Palti Z, Hochberg AA: The expression of the H-19 and IGF-2 genes during human embryogenesis and placental development. Mol Reprod Dev 1993, 34: 374 Lustig O, Ariel I, Ilan J, Lev-Lehman E, de Groot N, Hochberg A: Expression of the imprinted gene H19 in the human fetus. Mol Reprod Dev 1994, 38: 239 Ariel I, Sughayer M, Fellig Y, Pizov G, Ayesh S, Podeh D, Libdeh BA, Levy C, Birman T, Tykocinski ML, de Groot N, Hochberg A: The imprinted H19 gene is a marker of early recurrence in human bladder carcinoma. Mol Pathol 2000, 53: 320 Ariel I, Ayesh S, Perlman EJ, Pizov G, Tanos V, Schneider T, Erdmann VA, Podeh D, Komitowski D, Quasem AS, de Groot N, Hochberg A: The product of the imprinted H19 gene is an oncofetal RNA. Mol Pathol 1997, 50: 34 Biran H, Ariel I, de Groot N, Shani A, Hochberg A: Human imprinted genes as oncodevelopmental markers. Tumour Biol 1994, 15: 123 Bertherat J, Logie A, Gicquel C, Mourrieras F, Luton JP, Le Bouc Y: Alterations of the 11p15 imprinted region and the IGFs system in a case of recurrent non-islet-cell tumour hypoglycaemia NICTH ; . Clin Endocrinol 2000, 53: 213220 Casola S, Pedone PV, Cavazzana AO, Basso G, Luksch R, d'Amore ES, Carli M, Bruni CB, Riccio A: Expression and parental imprinting of the H19 gene in human rhabdomyosarcoma. Oncogene 1997, 14: 15031510 Moulton T, Crenshaw T, Hao Y, Moosikasuwan J, Lin N, Dembitzer F, Hensle T, Weiss L, McMorrow L, Loew T, et al: Epigenetic lesions at the H19 locus in Wilms' tumour patients. Nat Genet 1994, 7: 440 Liu J, Kahri AI, Heikkila P, Ilvesmaki V, Voutilainen R: H19 and insulin-like growth factor-II gene expression in adrenal tumors and cultured adrenal cells. J Clin Endocrinol Metab 1995, 80: 492 Yballe CM, Vu TH, Hoffman AR: Imprinting and expression of insulinlike growth factor-II and H19 in normal breast tissue and breast tumor. J Clin Endocrinol Metab 1996, 81: 16071612 Adriaenssens E, Lottin S, Dugimont T, Fauquette W, Coll J, Dupouy JP, Boilly B, Curgy JJ: Steroid hormones modulate H19 gene expression in both mammary gland and uterus. Oncogene 1999, 18: 4460 Hao Y, Crenshaw T, Moulton T, Newcomb E, Tycko B: Tumoursuppressor activity of H19 RNA. Nature 1993, 365: 764 Ayesh S, Matouk I, Schneider T, Ohana P, Laster M, Al-Sharef W, De-Groot N, Hochberg A: Possible physiological role of H19 RNA. Mol Carcinog 2002, 35: 6374 Lottin S, Adriaenssens E, Dupressoir T, Berteaux N, Montpellier C, Coll J, Dugimont T, Curgy JJ: Overexpression of an ectopic H19 gene enhances the tumorigenic properties of breast cancer cells. Carcinogenesis 2002, 23: 18851895 Adriaenssens E, Lemoine J, El Yazidi-Belkoura I, Hondermarck H: Growth signaling in breast cancer cells: outcomes and promises of proteomics. Biochem Pharmacol 2002, 64: 797 Hayashida T, Eversole-Cire P, Jones PA, Sasaki H: Imprinted genes are up-regulated by growth arrest in embryonic fibroblasts. J Biochem 1997, 122: 901903 Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS, Healey LA, Kaplan SR, Liang MH, Luthra HS, Medsger Jr TA, Mitchell DM, Neustadt DH, Pinals RS, Schaller JG, Sharp JT, Wilder RL, Hunder GG: The American Rheumatism Association 1987 revised and isoptin. New Business A. Criteria for Re-review of Therapeutic Classes: The Committee agreed that previously reviewed therapeutic classes from those PDL phases subject to re-review may be opened for re-review if one or more of the following has occurred: a ; New drug in the therapeutic class. b ; New indication for an existing drug in the therapeutic class. c ; New FDA-approved study or three peer-reviewed studies for a drug in the therapeutic class. DHHS and First Health will examine the therapeutic classes from Phases 1, 2, and 3 to determine which classes meet the criteria and are therefore eligible for rereview at the next P&T Committee meeting. B. General Discussion: 1 ; PDL Process - Discussion was held regarding the general PDL process and the P&T Committee's role in the PDL recommendations. As mentioned earlier, it was noted that the final group of drug classes for PDL inclusion were reviewed at this meeting. It was mentioned that it would be time-consuming and redundant to have all therapeutic classes re-reviewed. Therefore, it is prudent to use the re-review criteria to determine which classes will be opened for re-review. It was decided that the re-review criteria would be used. 2 ; Expert clinicians - A member discussed the value of having expert clinicians provide input for certain drugs such as the procedure followed for glaucoma drugs. At the time of that review, ophthalmologists were asked to evaluate and provide recommendations to the P&T Committee. No decisions were made on this discussion item. 3 ; Correspondence - Another member discussed the amount of correspondence being received from physicians and industry in regard to the pros and cons for certain drugs being considered for the PDL. Other members agreed that much information was being provided. No decisions were made on this issue. 4 ; Long Term Care Facilities - A member expressed concern about drug utilization in long term care facilities. Another member suggested that perhaps there were methods for changing practices without being enforcers. Discussion was held regarding the possibility of creating a website for treatment guidelines. It was suggested that a website could include "best practice" drugs for long term care patients. No decisions were made. 5 ; Disclosure - Discussion was held regarding whether speakers prior to their presentations should provide full financial disclosure. No decisions were made on this issue. 6 ; ARB's Discussion was held regarding the need to re-review ARB's due to this class' impact upon stroke prevention. A member suggested use of a costaveraging approach in making PDL recommendations. Discussion was then held regarding the Committee's direction from DHHS that P&T members examine clinical issues only. It will be determined if ARB's meet criteria and should be re-reviewed.

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