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It has been found that 5-HT1B receptor antagonists administered intraperitoneally or microinjected into the NAc shell reduce the cocaine-induced locomotor hyperactivity, while agonists of those receptors produce opposite effects [Przegaliski et al., Behav Pharmacol, 2001; Przegaliski et al., J Physiol Pharmacol, 2002]. These results indicate that 5-HT1B receptors of the NAc shell play a permissive role in the cocaine-induced locomotor hyperactivity. At the same time, an increase in the cocaine hyperlocomotion induced by 5-HT1B agonists administered into the VTA seems to be an additive effect of either agent, since these agonists administered into this structure increase basal locomotor activity [Przegaliski et al., Eur Neuropsychopharmacol, 2004]. Regarding the development of sensitization of the locomotor hyperactivity response to cocaine, it was observed that that effect was modified by 5-HT1B receptor ligands microinjected into the VTA [Przegaliski et al., Eur Neuropsychopharmacol, 2004]. On the other hand, only peripheral and intraaccumbal into the NAc shell ; administration of 5-HT1B receptor agonists enhanced the expression of cocaine sensitization [Przegaliski et al., Eur Neuropsychopharmacol, 2002]. On the basis of the above results, it is concluded that 5-HT1B receptors of the VTA are involved in the development of cocaine sensitization, while the enhancement of the expression of cocaine sensitization by 5-HT1B receptor agonists administered into the NAc shell may be related to its enhancing effect on the cocaine-induced locomotor hyperactivity. The above conclusions are in line with the general concept that the VTA is involved, for example, premarin vaginal cream side effects.

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Background In Poland 10% population of teenagers aged 13-15 years are obese 1 ; . An inappropriate slimming therapy may lead to growth inhibition, the occurrence of psychoneurological disorders or losses of lean body mass. Thus it is necessary to monitor thoroughly and systematically the course of the therapy in a way making it possible to monitor changes in the components of body composition BC ; . Objective The aim of this study was to assess the effectiveness of weight reduction program and to develop recommendations for the therapeutic program conducted under sanatorium conditions, taking into consideration the composition of the diet and the share of macrocomponents in the negative energy balance. Design Investigations were conducted for 6 years during 12 sanatorium stay periods of 24 days each. The study included 174 obese adolescents aged 12 - 16 years. The nutritive value of 288 diets prepared at the sanatorium was established on the basis of daily menus. Total daily energy expenditure TDEE ; during therapy was assessed by 24-hour HR monitoring. The body composition fat mass - FM, fat free mass - FFM, body cell mass - BCM, total body water TBW ; were measured using bioelectrical impedance before and during therapy as well as six month later. Outcomes Weight reduction program consisted of low energy diet 5.47 MJ 24h, 18% protein, 26% fat ; and physical exercises. TDEE of individuals staying at the sanatorium considerably P 0.001 ; exceeded energy intake from the diet, which was manifested in changes of body weight and BC of adolescents during the therapy. Six months after therapy at the sanatorium no statistically significant changes were recorded in the mean FFM, BCM and TBW contents. Conclusions These results made it possible to establish optimum recommendations concerning low-energy diet and the degree of negative energy balance and their interrelations, determining the maximization of fat mass losses at the simultaneous minimization of lean body mass losses. 1. Grajeta H., Biernat J. Investigation of the causes of overweight and obesity in 13-15 year-old children. Bromatology and Toxicological Chemistry. 2005; 37: 41-44 and prilosec.
Steroid dehydrogenase 17 HSD ; . Two isozymes of 17 HSD, type 2 and 4 are localized in the colon mucosa, and may provide a barrier for ingested steroids 8 ; . Normal human colon tissue converts E2 to E1 high rate, and this activity is reduced in colon tumors 9 ; . Incubation of human colon tumor cells Caco-2 ; with E2 increased cell growth, whereas E1 inhibited proliferation 10 ; . Hence, E1 may be an antiproliferative agent in the colon 11 ; . The primary types of HRT Prejarin Prempak C ; contain -8-E1 sulfate, which may explain in part their protective effects on colon cancer. In this study, we investigated the response of azoxymethane-induced colon tumors in ovariectomized, female mice with intact wild type, WT ; or disrupted ER ER KO ; dietary soy protein, genistein, NovaSoy or E1. We hypothesized that phytoestrogens and E1 would protect WT mice from colon cancer, but the absence of ER would eliminate the protective effect. MATERIALS AND METHODS.

Abstraction forms, and a third reviewer G.W. ; verified the data. Abstraction included information on pertinent methodological aspects of the study design, characteristics of the participants, the specific estrogen and progestin preparations used, and the outcomes assessed. In particular, the mean percent change from baseline and sd values for bone density and the number of vertebral and nonvertebral fractures were abstracted. 5. Analysis. For the analysis of bone density, the weighted mean difference in bone density between HRT and control groups was calculated using the difference in the percent change from baseline in the treatment and placebo groups and their associated sd values. For the analysis of vertebral and nonvertebral fractures, the relative risk of fracture was calculated. Fleiss 11 ; has described the methods we used for pooling the results. For the pooled results, site-specific 95% CIs were calculated for bone density lumbar spine, forearm, femoral neck ; and fractures vertebral, nonvertebral ; . Data were initially pooled broadly across prevention and treatment trials, regardless of the estrogen dose, the type of preparation, or whether or not the estrogen was opposed. We conducted subgroup analysis for: 1 ; prevention vs. treatment; 2 ; opposed vs. unopposed estrogen; 3 ; estrogen dose low-dose estrogen was equivalent to 0.3 mg Premarin, medium dose to 0.625 mg, and high dose 0.9 mg and 4 ; type of estrogen preparation transdermal, oral estradiol, and oral CEE Prearin ; . When pooling results from the lumbar spine, we pooled dualphoton absorptiometry and DXA but not QCT. The precision error of QCT is not as good as DXA of the posterior anterior spine. QCT provides a measure of volumetric density, and higher rates of bone change have been reported with QCT. We tested for homogeneity using a 2 test procedure 11 ; and assessed publication bias using funnel plots and prinivil.

Advanced liver disease complications Advanced liver disease complications of both chronic HBV and HCV infection consist of liver failure decompensated cirrhosis ; , often in association with signs of portal hypertension such as refractory ascites and variceal bleeding, and HCC. In chronic hepatitis C, HCC only develops if there is underlying severe fibrosis or cirrhosis. In contrast, as HBV itself is oncogenic, HCC can develop in people with chronic hepatitis B without significant liver fibrosis. Symptoms and signs of liver failure are the same for chronic HBV and HCV, and are similar to symptoms and signs associated with other causes of decompensated cirrhosis. Consistent with the underlying lack of synthetic function hypoalbuminaemia and coagulopathy ; , early symptoms of liver failure may include ankle and mild abdominal swelling, and easy bruising. Increasing lethargy is generally also a feature. Clinical examination should reveal some peripheral stigmata of chronic liver disease, as well as some evidence of either peripheral oedema or ascites. Later signs may include jaundice, which indicates a poor prognosis in the presence of liver failure, loss of hair and gynaecomastia. Clinical evidence of portal hypertension may include abdominal venous distension, splenomegaly and ascites. Patients who have ascites may develop spontaneous bacterial peritonitis SBP ; . Patients with unexplained fever or encephalopathy should raise the suspicion of SBP and they should be referred for diagnostic paracentesis. In addition, the presence of peripheral neuropathy and cerebellar ataxia may suggest alcohol as a contributing cause of liver disease.4 A history of haematemesis in a person with other evidence of advanced liver disease suggests the presence of oesophageal varices related to underlying portal hypertension. Hepatic encephalopathy also may be present in advanced liver disease and may be subclinical in early stages. A history of reversal of diurnal sleep patterns, forgetfulness or inappropriate behaviour may signal the onset of early hepatic encephalopathy. Presence of either hepatic encephalopathy or oesophageal varices indicates a poor prognosis. Table 7.2 summarises the different signs and symptoms related to stages of liver disease in chronic hepatitis B and C. Extrahepatic manifestations Extrahepatic manifestations, although uncommon, represent clinically important aspects of hepatitis B and C. Specific treatment can be directed towards these conditions, some of which are listed in Table 7.3. Dermatological presentations include porphyria cutanea tarda PCT ; , lichen planus and vasculitic rashes associated with cryoglobulinaemia. These presentations should alert the clinician to the possibility of chronic viral hepatitis. In patients with PCT, which is typically associated with chronic hepatitis C, blistered lesions, which are exacerbated by exposure to the sun, occur on the dorsum of the hands and forearms, and ferritin levels are often mildly elevated. These patients respond very well to venesection. Rheumatological manifestations include arthropathy, Sjogren's syndrome and polyarteritis nodosa. A high serum globulin level, often associated with positive antinuclear antibody ANA ; and rheumatoid factor, may indicate the presence of cryoglobulinemia, which may be associated with systemic complications such as glomerulonephritis and vasculitis. Other haematological abnormalities include thrombocytopenia and leucopenia. Thrombocytopenia may be the result of hypersplenism or drug therapy, or it may be immune-mediated. Neurological complications may be related to cryoglobulinemia and present with mononeuritis of cranial or peripheral nerves. Thyroid disease may be subclinical. A variety of thyroid diseases have been described in association with chronic viral hepatitis. Patients who test positive for ANA are more. REQUIREMENTS FOR REGIONAL ADVANCED LIFE SUPPORT SERVICES MANAGEMENT OF INTER-HOSPITAL TRANSFERS REVISED JANUARY 13, 2005 This policy shall be followed for all pre-arranged ALS inter-facility transfers hospital-tohospital ; for which out-of-hospital intervention is necessary or highly likely such as an unstable cardiac patient or a patient with IV medications being administered. The attending physician must make arrangements, prior to patient transfer; with an on-duty regional EMS approved Medical Command Physician. The Medical Command Physician must be made aware of the patient's condition s ; , and be willing to provide medical command for the patient, if the need for command arises in transit. The sending hospital is responsible for the care rendered to the patient being transferred until the patient arrives at the destination facility. The sending hospital is responsible for providing the ALS crew transferring the patient with a complete past and present medical history, current treatment and medications being administered to the patient, and implicit WRITTEN orders from the attending physician regarding IV and medication rates for those IVs and or medications that the regional paramedic can administer. For those patients requiring treatment beyond the scope of practice for paramedics, the transferring ALS service or hospital may provide a Health Professional-R.N. with Medical Command Authorization and the approval of a regional EMS approved Medical Command Physician. In the event that a Medical Command Physician is not willing to assume medical command responsibility for the patient or the patient requires care beyond the scope of practice for a paramedic, the sending hospital will need to assign a qualified hospital staff member to accompany and manage the patient during the transfer or arrange an alternate method of transfer, such as by air ambulance. Under circumstances of denied medical command, a regional paramedic cannot participate in the advanced life support care of the patient and procardia. 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Statistics show that there is a significant increase in the usage of complementary and alternative medicine CAM ; among adolescents. Present data on CAM therapies indicate that they are effective in enhancing athletic capability, promoting mental health, and treating certain common pediatric conditions such as asthma and headaches. Boston researchers concluded that there was insufficient support for the effectiveness of cranberries in treating urinary tract infections UTIs ; and asthma, or improving athletic performance. However, the researchers agree that Ginkgo biloba and massage may be used to effectively treat asthma, UTIs, and headaches. The researchers suggest more complete research on CAM therapies for adolescents is needed and also advice that general practitioners to be more familiar with the CAM therapies their patients are currently practicing.
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