Clinical evidences

The purpose of this eornpuLer project is Lo examine several polynuclear aromatic hydrocarbons and to relate their electron density patterns to their carcinogenic activity. If nucleophilic binding to DN.A is a significant step in blocking the normal transcription process of DN.A, electron density in the hydrocarbon should be positively correlated to its carcinogenic potency. To begin with, we shall rely on clinical evidence that benzene, naphthalene, and phenanthrene... 

One study (83) indicated that in mildly hypertensive male patients treated with an antihypertensive dmg, those below the age of 50 or having no clinical evidence of cardiovascular disease had no significant improvement from cardiovascular diseases within 3.3 years those over the age of 50 or having pre-existing cardiovascular disease benefited significantly. 

In a study with 3427 male and female patients having DBP of 95—109 mm Hg (12—15 Pa), and no clinical evidence of cardiovascular diseases, half of the patients were placebo-treated and half were SC antihypertensive dmg-treated, ie, step 1, chlorothiazide step 2, methyldopa, propranolol [525-66-6], or pindolol [13523-86-9], and step 3, hydralazine, or clonidine [4205-90-7] (86). Overall, when the DBP was reduced below 100 mm Hg (13 Pa), there were more deaths in the dmg-treated group than in the placebo group. The data suggest reduction of blood pressure by antihypertensive dmg treatment that includes a diuretic is accompanied by increased cardiovascular risks. 

The Oslo Trial (87) enrolled 785 male patients <50 years of age with DBP <110 mm Hg (15 Pa) and free of clinical evidence of cardiovascular disease. If the initial DBP was <100 mm Hg (13 Pa), there were no differences in mortaUty or cardiovascular events in the placebo- or dmg-treated groups. If the initial DBP was >100 mm Hg, then the incidence of cardiovascular disease was greater in the dmg-treated than in the placebo-treated group. 

Prostate Cancer. Evidence that phytoestrogens can influence the incidence of male-speciflc diseases is restricted to prostate cancer, and is largely of an observational nature. In the UK, prostate cancer is the most common hormone-related cancer in men. However, like breast cancer in women, it is comparatively rare as a clinically evident disease in men living in Asian countries. 

IFN- 3 reduces the induction by inflammatory cytokines of adhesion molecules and of MHC class I and II complex on endothelial cells, a process preceding attachment and transendothelial migration of T-cells. These anti-inflammatory effects of IFN- 3 exemplify antagonistic actions of type I and type IIIFN. There is, indeed, much clinical evidence for the involvement of IFN-y in inflammatory processes - through activation of iNOS and subsequent secretion of NO - leading to the establishment of autoimmune diseases as for instance in rheumatoid arthritis. 

Nickenig G, Ostergren J, Struijker-Boudier H (2006) Clinical evidence for the cardiovascular benefits of angiotensin receptor blockers. JRAAS 7 (Suppl 1) S1-S7... 

MANAGING HONE MARROW SUPPRESSION. Bone marrow suppression is a potentially dangerous adverse reaction resulting in decreased production of blood cells. Bone marrow suppression is manifested by abnormal laboratory test results and clinical evidence of leukopenia, thrombocytopenia, or anemia For example, there is a decrease in the white blood cells or leukocytes (leukopenia), a decrease in the thrombocytes (thrombocytopenia), and a decrease in the red blood cells, resulting in anemia Fhtients with leukopenia have a decreased resistance to infection, and the nurse must monitor them closely for any signs of infection. 

In 1992, the FDA issued a moratorium on silicone-gel-filled implants, and restricted their use to reconstmction and clinical smdies. In 2000, they approved saline-filled implants. In 2003, the General and Plastic Surgery Devices (GPSD) Advisory Panel recommended reapproval of gel-filled implants, but the FDA decided to wait for more clinical evidence of safety. In late 2005, the Panel recommended conditional approval of Mentor s and Inamed s gel implants. In October 2006, Health Canada approved the use of sUicone-gel-filled implants, with a warning that no medical device is 100% safe. ... 

Anaphylaxis is the most dramatic and potentially catastrophic manifestation of allergic disorders. It can affect virtually any organ including the cardiovascular system. Cardiovascular collapse and hypotensive shock in anaphylaxis have been attributed to peripheral vasodilation, enhanced vascular permeability and plasma leakage, rather than any direct effect on the myocardium. However, there is increasing experimental and clinical evidence that the human heart is a site and target of anaphylaxis. 

There are four types of economic evaluation cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis and cost-benefit analysis. The analytic framework chosen will depend upon the economic questions posed and the clinical evidence of effectiveness for the interventions (Gold et al, 1996 Dmmmondetal, 1997). 

A systematic search of published literature identified 13 studies concerned with the value for money of acetylcholinesterase inhibitors. The majority were cost analyses of the potential savings in providing health and social care which may accrue from the introduction of these drugs. However, the available clinical evidence is not sufficient to support the assumption that acetylcholinesterase inhibitors are equivalent to other interventions in terms of clinical effect or side effects (Birks and Melzer, 1999 NICE, 2001). Furthermore, research to assess potential cost savings implicitly assumes that... 

Epidermal nerve fiber analysis by immunocytochemical techniques using the panaxonal marker protein gene product 9.5 (PGP 9.5) allows the study of epidermal innervation by small fiber C and A5 nerve fibers (McCarthy et al. 1995 Holland et al. 1997). Studies of skin biopsies of HIV infected patients with DSP or ATN showed reduction in the number of epidermal fibers in distal areas of the lower extremities with an inverse correlation between neuropathic pain intensity and epidermal nerve fiber density (Polydefkis et al. 2002) (Fig. 4.3). There were also fewer epidermal fibers in HIV seropositive patients without clinical evidence of neuropathy, suggesting that HIV infection may be associated with the loss of cutaneous innervation even before the onset of sensory symptomatology (McCarthy et al. 1995). 

Stroke is the leading cause of major long-term disability in adults and the third leading cause of death in the United States. On average, a new stroke occurs every 45 seconds. Thrombolytic therapy with intravenous recombinant tissue-plasminogen activator (IV rt-PA) is the most effective treatment for acute ischemic stroke. In this chapter, we review the rationale for thrombolysis in acute ischemic stroke, clinical evidence supporting the use of thrombolytics, and the application of thrombolysis in practice. 

Finally, there is little or no clinical evidence that morphine causes psychological dependence or drug-seeking behaviour, tolerance or problematic respiratory depression in patients. These events simply do not occur when opioids are used to control pain. The reason is likely to be that the actions of morphine and the context of its use in a person in pain are neurobiologically quite different from the effects of opioids in street use. These actions of opioids are described in more detail in Chapter 23. 

Phytochemicals have little nutritional value and do not get absorbed in the body, but they seem to turn on certain switches in the biochemical mechanisms, which signal the beneficial pathways to maintain health, and to turn off the switches which proceed to adverse biochemical pathways. Rice bran products have demonstrated significant benefits as nutritional therapies in diabetes, hyperlipidemia, cancer, fatty liver, hypercalcuria and heart disease. There is experimental and clinical evidence for the beneficial health effects of the following bioactives of rice bran ... 

Ahnfelt-Ronne, 1., Nielsen, O.H., Christensen, A., Langholz, E., Binder, V. and Riis, P. (1990). Clinical evidence supporting the radical scavenger mechanism of 5-aminosalicylic acid. Gastroenterology 98, 1162-1169. 

Urine concentrations of PCP determined by enzyme immunoassay did not correlate with the state of intoxication at the time the urine sample was taken. The test was negative in 15 percent of 1,000 patients with clinical evidence of PCP toxicity, many of whom admitted taking PCP (McCarron et al. 1981a). Several of these negative urines were analyzed for PCP analogues none were found. 

Albuterol is the preferred bronchodilator for treatment of acute exacerbations because of its rapid onset of action. Ipratropium can be added to allow for lower doses of albuterol, thus reducing dose-dependent adverse effects such as tachycardia and tremor. Delivery can be through metered-dose inhaler (MDI) and spacer or nebulizer. The nebulizer route is preferred in patients with severe dyspnea and/or cough that would limit delivery of medication through an MDI with spacer. If response is inadequate, theophylline can be considered however, clinical evidence supporting its use is lacking. 

The primary objective in treating patients with acute leukemia is to achieve a complete and continuous remission (CCR). Remission is defined as the absence of all clinical evidence of... 

Prediabetes An asymptomatic but abnormal state that precedes the development of clinically evident diabetes. 

Recently, the notion that the chronicity of inflammation may not actually drive the fibrogenic process has been widely appreciated (Tables 1, 2, and 3). Some propose that it is indeed the alteration of the mesenchymal cell phenotypes that disrupts the balance between collagen synthesis and degradation in the wound-healing process, highlighted by clinical evidence that shows unsuccessful treatment of fibrosis with anti-inflammatory or immunosuppressive drugs (18,19). One scenario is that mesenchymal cells (myofibroblasts and fibroblasts) are phenotypically altered and thus do not undergo apoptosis after resolution. 

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