Research Chair, Canadian Institutes of Health Research/Medtronic
University of Ottawa Heart Institute
Ottawa, Ontario, Canada
Oral ganciclovir no longer is available in the United States womens health weight loss pills buy serophene 100 mg cheap, but oral valganciclovir is available both in tablet and in powder for oral solution formulations women's health big book of abs 4-week exercise plan purchase serophene 25mg on-line. Valganciclovir administered orally to young infants at 16 mg/kg/dose menopause rash itching buy 100mg serophene, twice daily menopause 60 years old cheap serophene 100mg visa, provides the same systemic ganciclovir exposure as does intravenous ganciclovir at 6 mg/kg/dose menstruation occurs when buy generic serophene 25mg. Antiviral therapy is not recommended routinely in neonates and young infants because of possible toxicities breast cancer 7000 scratch off purchase serophene 25mg free shipping, including neutropenia in a signifcant proportion of recipients menstrual extraction kit order generic serophene on-line. If such patients are treated with parenteral ganciclovir women's health urinary problems discount 25mg serophene mastercard, a reasonable approach is to treat for 2 weeks and then reassess responsiveness to therapy. If clinical data suggest beneft of treatment, an additional 1 to 2 weeks of parenteral ganciclovir can be considered if symptoms and signs have not been resolved. If such circumstances cannot be avoided, administration of antiviral therapy or monitoring for viremia and administering preemptive antiviral therapy is benefcial for decreasing this risk. Approximately 5% of patients develop severe dengue, which is more common with second or other subsequent infections. Less common clinical syndromes include myocarditis, pancreatitis, hepatitis, and neuroinvasive disease. Dengue is a dynamic disease beginning with a nonspecifc, acute febrile illness lasting 2 to 7 days (febrile phase), progressing to severe disease during fever defervescence (critical phase), and ending in a convalescent phase. Fever may be biphasic and usually is accompanied by muscle, joint, and/or bone pain, headache, retro-orbital pain, facial erythema, injected oropharynx, macular or maculopapular rash, leukopenia, and petechiae or other minor bleeding manifestations. Warning signs of progression to severe dengue occur in the late febrile phase and include persistent vomiting, abdominal pain, mucosal bleeding, diffculty breathing, early signs of shock, and a rapid decline in platelet count with an increase in hematocrit (hemoconcentration). Patients with nonsevere disease begin to improve during the critical phase, and people with clinically signifcant plasma leakage attributable to increased vascular permeability develop severe disease with pleural effusions and/or ascites, hypovolemic shock, and hemorrhage. In the United States, dengue is endemic in Puerto Rico, the Virgin Islands, and American Samoa. However, although 16 states have A aegypti and 35 states have A albopictus mosquitoes, local dengue transmission is uncommon because of infrequent contact between people and infected mosquitoes. Dengue occurs in both children and adults and affects both sexes with no differences in infection rates or disease severity. In humans, the incubation period is 3 to 14 days before symptom onset (intrinsic incubation). Infected people, both symptomatic and asymptomatic, can transmit to mosquitoes 1 to 2 days before symptoms develop and throughout the approximately 7-day viremic period. During the febrile phase, patients should stay well hydrated and avoid use of aspirin (acetylsalicylic acid), aspirin-containing drugs, and other nonsteroidal anti-infammatory drugs (eg, ibuprofen) to minimize the potential for bleeding. Additional supportive care is required if the patient becomes dehydrated or develops warning signs for severe disease at the time of fever defervescence. Early recognition of shock and intensive supportive therapy can reduce risk of death from approximately 10% to less than 1% in severe dengue. During the critical phase, maintenance of fuid volume and hemodynamic status is central to management of severe cases. Patients should be monitored for early signs of shock, occult bleeding, and resolution of plasma leak to avoid prolonged shock, end organ damage, and fuid overload. Patients with refractory shock may require intravenous colloids and/or blood or blood products after an initial trial of intravenous crystalloids. Reabsorption of extravascular fuid occurs during the convalescent phase with stabilization of hemodynamic status and diuresis. A number of candidates are in clinical trials to evaluate immunogenicity, safety, and effcacy. No chemoprophylaxis or antiviral medication is available to treat patients with dengue. Travelers should select accommodations that are air conditioned and/or have screened windows and doors. Aedes mosquitoes bite during the daytime, so bed nets are indicated for children sleeping during the day. Travelers should wear clothing that fully covers arms and legs, especially during early morning and late afternoon. Dengue, acquired locally in the United States and during travel, became a nationally notifable disease in 2010. Membranous pharyngitis associated with a bloody nasal discharge should suggest diphtheria. Local infections are associated with a low-grade fever and gradual onset of manifestations over 1 to 2 days. Less commonly, diphtheria presents as cutaneous, vaginal, conjunctival, or otic infection. Cutaneous diphtheria is more common in tropical areas and among the urban homeless. Extensive neck swelling with cervical lymphadenitis (bull neck) is a sign of severe disease. Palatal palsy, characterized by nasal speech, frequently occurs in pharyngeal diphtheria. In industrialized countries, toxigenic strains of Corynebacterium ulcerans are emerging as an important cause of a diphtheria-like illness. C diphtheriae is an irregularly staining, gram-positive, nonspore-forming, nonmotile, pleomorphic bacillus with 4 biotypes (mitis, intermedius, gravis, and belfanti). Toxigenic strains express an exotoxin that consists of an enzymatically active A domain and a binding B domain, which promotes the entry of A into the cell. Nontoxigenic strains of C diphtheriae can cause sore throat and, rarely, other invasive infections, including endocarditis. Organisms are spread by respiratory tract droplets and by contact with discharges from skin lesions. In untreated people, organisms can be present in discharges from the nose and throat and from eye and skin lesions for 2 to 6 weeks after infection. Patients treated with an appropriate antimicrobial agent usually are communicable for less than 4 days. People who travel to areas where diphtheria is endemic or people who come into contact with infected travelers from such areas are at increased risk of being infected with the organism; rarely, fomites and raw milk or milk products can serve as vehicles of transmission. Severe disease occurs more often in people who are unimmunized or inadequately immunized. The incidence of respiratory diphtheria is greatest during autumn and winter, but summer epidemics can occur in warm climates in which skin infections are prevalent. During the 1990s, epidemic diphtheria occurred throughout the newly independent states of the former Soviet Union, with case-fatality rates ranging from 3% to 23%. Diphtheria remains endemic in these countries as well as in countries in Africa, Latin America, Asia, the Middle East, and parts of Europe, where childhood immunization coverage with diphtheria toxoid-containing vaccines is suboptimal ( No case of respiratory tract diphtheria has been reported in the United States since 2003. Cases of cutaneous diphtheria likely still occur in the United States, but they are not reportable. Material should be obtained from beneath the membrane, or a portion of the membrane itself should be submitted for culture. Because special medium is required for isolation (cystine-tellurite blood agar or modifed Tinsdale agar), laboratory personnel should be notifed that C diphtheriae is suspected. Specimens collected for culture can be placed in any transport medium (eg, Amies, Stuart media) or in a sterile container and transported at 4fiC or in silica gel packs to a reference laboratory for culture. Because the condition of patients with diphtheria may deteriorate rapidly, a single dose of equine antitoxin should be administered on the basis of clinical diagnosis, even before culture results are available. To neutralize toxin from the organism as rapidly as possible, the preferred route of administration is intravenous. Before intravenous administration of antitoxin, tests for sensitivity to horse serum should be performed, initially with a scratch test of a 1:1000 dilution of antitoxin in saline solution followed by an intradermal test if the scratch test result is negative (see Sensitivity Tests for Reactions to Animal Sera, p 64). If the patient is sensitive to equine antitoxin, desensitization is necessary (see Desensitization to Animal Sera, p 64). The dose of antitoxin depends on the site and size of the diphtheria membrane, duration of illness, and degree of toxic effects; presence of soft, diffuse cervical lymphadenitis suggests moderate to severe toxin absorption. Antitoxin probably is of no value for cutaneous disease, but some experts recommend 20 000 to 40 000 U of antitoxin, because toxic sequelae have been reported. Erythromycin administered orally or parenterally for 14 days, penicillin G administered intramuscularly or intravenously for 14 days, or penicillin G procaine administered intramuscularly for 14 days constitute acceptable therapy. Antimicrobial therapy is required to stop toxin production, to eradicate C diphtheriae, and to prevent transmission but is not a substitute for antitoxin, which is the primary therapy. Elimination of the organism should be documented 24 hours after completion of treatment by 2 consecutive negative cultures from specimens taken 24 hours apart. Active immunization against diphtheria should be undertaken during convalescence from diphtheria; disease does not necessarily confer immunity. Thorough cleansing of the lesion with soap and water and administration of an appropriate antimicrobial agent for 10 days are recommended. If not immunized, carriers should receive active immunization promptly, and measures should be taken to ensure completion of the immunization schedule. Carriers should be given oral erythromycin or penicillin G for 10 to 14 days or a single intramuscular dose of penicillin G benzathine (600 000 U for children weighing less than 30 kg and 1. Two follow-up cultures should be obtained after completing antimicrobial treatment to ensure detection of relapse, which occurs in as many as 20% of patients treated with erythromycin. Erythromycin-resistant strains have been identifed, but their epidemiologic signifcance has not been determined. Fluoroquinolones (see Fluoroquinolones, p 800), rifampin, clarithromycin, and azithromycin have good in vitro activity and may be better tolerated than erythromycin, but they have not been evaluated in clinical infection or in carriers. Contact precautions are recommended for patients with cutaneous diphtheria until 2 cultures of skin lesions taken at least 24 hours apart and 24 hours after cessation of antimicrobial therapy are negative. Whenever respiratory diphtheria is suspected or proven, local public health offcials should be notifed promptly. Management of exposed people is based on individual circumstances, including immunization status and likelihood of adherence to follow-up and prophylaxis. Contact tracing should begin in the household and usually can be limited to household members and other people with a history of direct, habitual close contact (including kissing or sexual contacts), health care personnel exposed to nasopharyngeal secretions, people sharing utensils or kitchen facilities, and people caring for infected children. Follow-up cultures of pharyngeal specimens should be performed after completion of therapy for contacts proven to be carriers after completion of therapy (see Carriers, p 309). If cultures are positive, an additional 10-day course of erythromycin should be given, and follow-up cultures of pharyngeal specimens should be performed. Use of equine diphtheria antitoxin in unimmunized close contacts is not recommended, because there is no evidence that antitoxin provides additional beneft for contacts who have received antimicrobial prophylaxis. Universal immunization with a diphtheria toxoid-containing vaccine is the only effective control measure. The schedules for immunization against diphtheria are presented in the childhood and adolescent 1. The value of diphtheria toxoid immunization is proven by the rarity of disease in countries in which high rates of immunization with diphtheria toxoid-containing vaccines have been achieved. The decreased frequency of endogenous exposure to the organism in countries with high childhood coverage rates implies decreased boosting of immunity. Therefore, ensuring continuing immunity requires regular booster injections of diphtheria toxoid (as Tdap or as Td vaccine) every 10 years after completion of the initial immunization series. Other recommendations for diphtheria immunization, including recommendations for older children (7 through 18 years of age) and adults, can be found in the recommended childhood and adolescent 1. Common systemic manifestations present in more than 50% of patients include fever, headache, chills, malaise, myalgia, and nausea. More variable symptoms include arthralgia, vomiting, diarrhea, cough, and confusion, usually present in 20% to 50% of patients. For E chaffeensis, rash is reported in approximately 60% of children, although it is reported less commonly in adults; rash is present in fewer than 10% of people with anaplasmosis. When present, rash is variable in appearance (usually involving the trunk and sparing the hands and feet) and location and typically develops approximately 1 week after onset of illness. More severe manifestations of these diseases include acute respiratory distress syndrome, encephalopathy, meningitis, disseminated intravascular coagulation, spontaneous hemorrhage, and renal failure. Signifcant laboratory fndings in these diseases may include leukopenia, lymphopenia, thrombocytopenia, and elevated serum hepatic transaminase concentrations. Cerebrospinal fuid abnormalities (ie, pleocytosis with a predominance of lymphocytes and increased total protein concentration) are common. Symptoms typically last 1 to 2 weeks, and recovery generally occurs without sequelae; however, reports suggest the occurrence of neurologic complications in some children after severe disease. Secondary or opportunistic infections may occur in severe illness, resulting in a delay in recognition of ehrlichiosis and administration of appropriate antimicrobial treatment. Fulminant disease has been reported in people who initially received trimethoprimsulfamethoxazole before a correct diagnosis was confrmed. Ehrlichiosis results from infection with E chaffeensis, E ewingii, or E muris-like agent, and anaplasmosis is caused by A phagocytophilum. Most cases of E chaffeensis infection occur in people from the southeastern and south central United States, but a number of cases have been described from other areas. Cases attributable to the new E muris-like agent have been reported only from Minnesota and Wisconsin but possibly occur with the same distribution as Lyme disease. Ehrlichiosis caused by E chaffeensis and E ewingii are associated with the bite of the lone star tick (Amblyomma americanum). However, the distribution of A americanum is expanding, and the geographic range of reported ehrlichiosis may be expected to expand in the future as well. Most cases of human anaplasmosis have been reported in the north central and northeastern United States, particularly Wisconsin, Minnesota, Connecticut, and New York, but cases in many other states, including California, have been identifed. In most of the United States, A phagocytophilum is transmitted by the black-legged or deer tick (Ixodes scapularis), which also is the vector for Borrelia burgdorferi (the agent of Lyme disease) and probably for the E muris-like agent. In the western United States, the western black-legged tick (Ixodes pacifcus) is the main vector for A phagocytophilum. Various mammalian wildlife reservoirs for the agents of human ehrlichiosis have been identifed, including white-tailed deer, white-footed mice, and Neotoma wood rats. However, recent seroprevalence data indicate that exposure to Ehrlichia is common in children. Most human infections occur between April and September, and the peak occurrence is from May through July. Coinfections of anaplasmosis with other tickborne diseases, including babesiosis and Lyme disease, have been described. Specifc antigens are available for serologic testing of E chaffeensis and A phagocytophilum infections, although cross-reactivity between species can make it diffcult to interpret the causative agent in areas where geographic distributions overlap. Similarly, because IgM and IgG rise concurrently and IgM-only assays may be more prone to false-positive reactions, concurrent examination of both classes of antibodies is recommended when assessing acutely infected patients. E ewingii and probably the E muris-like agent share some antigens with E chaffeensis, so most cases of E ewingii ehrlichiosis can be diagnosed serologically using E chaffeensis antigens. Testing should be limited to patients with clinical presentations consistent with the illness. Examination of peripheral blood smears to detect morulae in peripheral blood monocytes or granulocytes is insensitive. Ehrlichiosis and anaplasmosis can be severe or fatal in untreated patients or patients with predisposing conditions, and initiation of therapy early in the course of disease helps minimize complications of illness. Failure to respond to doxycycline within the frst 3 days suggests infection with an agent other than Ehrlichia or Anaplasma species. Treatment should continue for at least 3 days after defervescence; the standard course of treatment is 7 to 14 days. Unequivocal evidence of clinical improvement generally is evident by 1 week, although some symptoms (eg, headache, weakness, malaise) can persist for weeks after adequate therapy. As with other rickettsial diseases, when a presumptive diagnosis of ehrlichiosis is made, doxycycline should be started immediately and should not be delayed pending laboratory confrmation of infection. Human-to-human transmission of ehrlichiosis or anaplasmosis, except in rare cases associated with transfusion of blood products, has not been documented. A risk of blood transfusion infection should be considered in areas with endemic infection. Prophylactic administration of doxycycline after a tick bite is not indicated because of the low risk of infection. The most common manifestation is nonspecifc febrile illness, which in young infants may lead to evaluation for bacterial sepsis. Other manifestations can include the following: (1) respiratory: coryza, pharyngitis, herpangina, stomatitis, bronchiolitis, pneumonia, and pleurodynia; (2) skin: hand-foot-and-mouth disease, onychomadesis (periodic shedding of nails), and nonspecifc exanthems; (3) neurologic: aseptic meningitis, encephalitis, and motor paralysis; (4) gastrointestinal/genitourinary: vomiting, diarrhea, abdominal pain, hepatitis, pancreatitis, and orchitis; (5) eye: acute hemorrhagic conjunctivitis and uveitis; (6) heart: myopericarditis; and (7) muscle: myositis. Neonates, especially those who acquire infection in the absence of serotype-specifc maternal antibody, are at risk of severe disease, including sepsis, meningoencephalitis, myocarditis, hepatitis, coagulopathy, and pneumonitis. Infection with enterovirus 71 is associated with hand-foot-andmouth disease, herpangina, and in a small proportion of cases, severe neurologic disease, including brainstem encephalomyelitis and paralytic disease, and secondary pulmonary edema/hemorrhage and cardiopulmonary collapse. Patients with humoral and combined immune defciencies can have persistent central nervous system infections, a dermatomyositis-like syndrome, and/or disseminated infection. Severe, multisystem disease is reported in hematopoietic stem cell transplant patients and children with malignancies. As a group, human parechoviruses (formerly echoviruses 22 and 23, and others) appear to cause similar clinical diseases as enteroviruses, including febrile illnesses, exanthems, sepsis-like syndromes, and respiratory tract, gastrointestinal tract, and central nervous system infections. Neonates and young infants have presented with more severe clinical disease and long-term sequelae than have older children. The nonpolio enteroviruses include more than 100 distinct serotypes formerly subclassifed as group A coxsackieviruses, group B coxsackieviruses, echoviruses, and newer numbered enteroviruses.
Trace: To follow the history of a process womens health quarterly exit christina diet secret articles discount serophene online amex, product menopause memory loss buy serophene 50mg, or service by review of documents menstruation krampfe purchase cheap serophene on-line. Traceability: the ability to track any product through all stages of collection breast cancer socks serophene 100mg with mastercard, processing women's health clinic coon rapids serophene 50mg visa, and distribution so that tasks can be traced one step backwards and one step forward at any point in the supply chain pregnancy 9 weeks ultrasound order generic serophene on-line. Transport: the physical act of transferring a cellular therapy product within or between facilities women's health clinic maroochydore discount serophene 100mg overnight delivery. During transportation the product does not leave the control of trained personnel at the transporting or receiving facility breast cancer 82 years old serophene 25mg low cost. Unique identifier: A numeric or alphanumeric sequence used to designate a given cellular therapy product with reasonable confidence that it will not be used for another purpose. Unplanned deviation: the action of departing from an established course or accepted standard without intent. Urgent medical need: A situation in which no comparable cellular therapy product is available and the recipient is likely to suffer death or serious morbidity without the cellular therapy product. Validation: Confirmation by examination and provision of objective evidence that particular requirements can consistently be fulfilled. A process is validated by establishing, by objective evidence, that the process consistently produces a cellular therapy product meeting its predetermined specifications. Verification: the confirmation of the accuracy of something or that specified requirements have been fulfilled. Concordance does not require identical levels of resolution for the two sets of typing but requires the two assignments be consistent with one another. Viability: Living cells as defined by dye exclusion, flow cytometry, or progenitor cell culture. Explanation: this standard is the definition of a Clinical Program, an entity that can be inspected and independently accredited. Different clinical sites that make up a single program must be within a defined location(s) that allows for integrated and regular interaction among all members of the medical team. Only those programs that truly function as a single integrated program may apply as one Clinical Program. It is possible to have more than one Clinical Program in a defined location or within a single metropolitan area. Each could be accredited separately if each alone meets the criteria detailed in the Standards. There will not be a limit on the total number of programs eligible for accreditation within one area. Evidence: the questions on the inspection application and checklist are designed to elicit the information necessary to determine if a single Clinical Program exists. Different clinical sites ideally should be no more than one hour travelling distance in each direction, and they should exist within a single metropolitan area. Advancement in technology and travel may allow for more geographically dispersed sites, but such programs would be expected to provide unequivocal evidence of integration. An organizational chart depicting the relationship between program sites will facilitate documentation of integration and site locale. No matter the distance between sites, the Clinical Program Director(s) should have a documented physical presence at all sites and be actively involved in daily operations to meet the intent of the standard. If the sites are more than one hour in traveling distance, data should show that there is no adverse impact on recipient care or donor safety. If there is a delay during the transfer of a patient or the transfer of a cellular therapy product, a plan needs to be put in place to ensure recipient care and donor safety are met. For example, if there is an accident during a patient transfer to another facility, what steps will the program take to continue providing adequate patient care, how will the patient be stabilized, and is there an alternate location to take the patientfi Explanation: Clinicians accredited together as a Clinical Program must work together in readily demonstrable ways on a frequent basis, and have a single director or co-directors (the Program Director(s)), responsible for these clinical activities. Several clinical sites, particularly with different directors or outside a defined network, joining together for the purpose of meeting criteria to qualify as a Clinical Program, do not fulfill the intent of the Standards. By itself, the presence of one or more of the characteristics in this standard does not necessarily define a single program nor meet the intent of the Standards. In the event of Co-Directors, it is required that the responsibilities for each Director are clearly defined, and that one will be named as the corresponding director for the accreditation activities and interaction with the accrediting organization. Evidence: It is incumbent on the applicant to demonstrate with evidence that there is sufficient integration. The inspector will expect to find the following if a single Clinical Program exists: fi Common or equivalent staff training programs, especially for nurses. Regular interaction means meetings and conferences that are regularly scheduled, multidisciplinary, involve all clinical sites, and are documented in meeting minutes, including documented attendees. Regular interaction should involve physicians, nurses, coordinators, social workers, education consultants, processing staff, collection staff, and others. This should include regularly scheduled conferences for topics such as morbidity and mortality, quality assessment and improvement, protocol development, journal clubs, patient assessment and evaluation, patient outcomes, tumor boards, continuing education presentations, interesting case presentations, etc. Such topics could also be reported in joint manuscripts or abstracts for national meetings. The inspector should check attendance to confirm that all sites are represented, and that attendance is documented. If a large hospital has both adult and pediatric units that are staffed by either specialist adult or pediatric nurses, this is considered to be two sites. In contrast, a large adult unit that transplants patients in two clinical care areas, but where nursing staff and physician coverage are integrated, would be considered one site. Explanation: It is not the intent of this standard to require clinical, collection, and processing facilities to be housed in one location. As long as each component of the process independently meets the Standards as stated for the activities and functions it performs, the intent of this standard is met. Such interaction provides helpful experience and improvements, but regulatory approval does not guarantee compliance with the Standards. Clinical Programs, and their collection and processing facilities that perform tasks related to the cellular therapy product may only briefly or simply handle the product, but they at least must meet the Standards while doing so. Evidence: If the site uses an external collection or processing facility, documentation of interactions and written agreements between the Clinical Program and that collection or processing facility must be available to the inspector. Collection and processing facilities that are external to the Clinical Program must undergo the inspection and accreditation process to demonstrate compliance with the Standards. The applicant Clinical Program should maintain documentation that the collection and processing facilities meet the Standards. A Clinical Program and the Collection Facility could be a joint facility, with the cells processed and stored by contract at another facility. In all cases, it is expected that these products represent the minority of products utilized by an accredited Clinical Program. When a cellular therapy product is manufactured by a third-party, the Clinical Program may be responsible for securing collection of the source material or preparing the product for administration. If these responsibilities are designated to the Clinical Program in written agreements, the following examples would require compliance with Part C or Part D of the Standards as applicable: fi Evaluation of the autologous or allogeneic donor for suitability. Explanation: the Standards apply to novel cellular therapy products that are manufactured by a third-party and routed through an accredited blood bank, accredited tissue bank, or a hospital pharmacy rather than a Processing Facility. Communication with manufacturers is critical to the safety, efficacy, and quality of the cellular therapy product, and the Clinical Program is responsible for handling products according to the Standards. Chain of custody documentation should include dates, times, and responsible parties for distribution and receipt; storage; and release for administration. The distribution conditions should be defined by the Clinical Program with documentation that those conditions were met. The program (or receiving blood bank, tissue bank, or pharmacy) should have a designated space with suitable equipment for receiving and storing cellular therapy products. Before administration to a recipient, the product must be compared against the written physician order and patient identity. Evidence: Coordination among the program, the manufacturer, the blood bank, the tissue bank, or the pharmacy must be readily apparent to the inspector via written responsibilities and ongoing quality management documentation. Compliance with the Standards does not guarantee compliance with all applicable laws and regulations. It is the responsibility of the individual Clinical Program to determine which laws and regulations are applicable. In some cases, regulations of governmental authorities outside of the jurisdiction of the program may apply; for example, when a program receives cellular therapy products either to or from outside of its immediate jurisdiction. Evidence: Current certificates, permits, or licenses will demonstrate which areas of a facility have been authorized by other organizations and governmental authorities. While observing facilities and processes, inspectors will note if there are apparent practices that are not in compliance with applicable laws and regulations. Evidence of compliance with the Standards will require preinspection information identifying prevailing governmental authorities. A cellular therapy product that is extensively manipulated, obtained from an unrelated donor, combined with a drug or device, or used for non-homologous use (does not perform the same function in the recipient as in the donor) is regulated as a drug, device, and biologic product under section 351 of the Public Health Service Act and other applicable regulations in title 21 of the Code of Federal Regulations. Explanation: National or state laws and regulations may require registration or certification with the government or may require accreditation from professional organizations for the activities performed within the program. A copy may not be immediately available at the clinical site; however, the Program Director(s) should know who in the institution is responsible for the registration, and where a copy may be obtained. The designated transplant team shall have been in place and performing cellular therapy for at least twelve (12) months and preceding initial accreditation. Explanation: A Clinical Program must have sufficient experience as a team in caring for transplant patients. A designated transplant team does not necessarily mean that each of the individuals has no other responsibilities or duties. It is likely that some individuals may perform basic research, clinical research, other non-transplant clinical care, or administrative work during the time they are not actively attending to transplant patients. However, each transplant team member must each meet the training and experience requirements in B3. Similarly, a program adding novel cellular therapies to its services may begin pursuing accreditation prior to 12 months of adding such services, so long as the team is in place and is undergoing training and gaining experience sufficient to comply with this standard at the time of accreditation. An attending physician may also serve as the Clinical Program Director, if appropriately credentialed. However, Clinical Program s m ust have an attending physician in addition to the director. The number of physicians overall should be proportionate to the volume of care provided. If there is a larger volume of patients, then there should be a higher number of physicians. If an experienced team relocates and develops a new Clinical Program, that new program must have been in place at least 12 months, and the team must have performed a minimum number of transplants (per Appendix I) at the new location prior to accreditation of the new program. In case of a vacancy in a key position, a qualified individual must be named to fill that position. The person so named must meet the minimal qualifications for the position, even if only filling it on an interim basis. It is also the responsibility of the Program Director(s) to report accurately the information required on interim and annual report forms sent to all accredited facilities mid-cycle. Changes in a Program Director do not necessarily require reinspection, especially if the majority of faculty and staff and the scope of transplant activities remain unchanged. Variability may be based on a number of factors, including the number and type (autologous or allogeneic) of transplants performed, the patient case mix, the cell source, epidemiological factors influencing the prevalence of opportunistic infections, and economic considerations. Evidence: the inspector will tour the inpatient unit during the on-site inspection. The type of air handling should be documentable from a facilities management office. Difficile and community respiratory virus infections; and procedures for monitoring airborne infections will provide evidence of compliance. Signs posted around the clinical unit and the behavior of the staff consistent with expectations for the type of infection control described in the policies and procedures demonstrate compliance with this standard. If there are renovation or construction projects underway, the appropriate environmental controls must be present. The risk of spread of communicable disease agents must be minimized in any setting where patients could reasonably be expected (including dialysis or intensive care units). Care should be taken that the ventilation from other isolation rooms (where infected patients may reside) does not pass through the rooms used for recipients. Evidence of compliance with this standard will require preinspection documentation of infection control policies, specifications of air handling, and floor plans. When an accredited Clinical Program is to be relocated, qualification and validation must be performed to confirm the new space meets the Standards. Most relocations will be assessed during regularly scheduled inspections or interim audits; however, if there are any concerns with the information submitted by the facility, a relocation inspection may be necessary. Single patient rooms should be located on a patient care unit where infection control policies can be implemented. Signs posted to inform the public about visitation restrictions could also include information about incubation periods and risks of live vaccines. In ambulatory settings, patients may be accommodated in a hostel, hotel, or home-based setting for periods of the transplant with frequent day case review and potential rapid inpatient admission. Clinical Programs should share criteria with these facilities regarding practices to prevent the spread of communicable infections. Explanation: these standards apply to the space where outpatients can be evaluated and treated. Given the interchange between inpatient and outpatient units, close organizational relationships should exist, particularly with respect to infection control. The Clinical Program must define appropriate measures of control to minimize the risk of airborne microbial contamination. The organizational relationship should also provide 24-hour coverage should recipients become ill in the outpatient area or at home. Evidence: the inspector will tour the outpatient areas during the on-site inspection. Example(s): It is acceptable to use a portion of an inpatient unit for outpatient visits. An ambulatory unit that provides space for outpatient visits, cellular therapy product administration, and transfusions may also comply with these standards. Explanation: An attending physician must be available at all times to manage cellular therapy recipients. The attending physician does not necessarily need to be the only health care provider on call nor be the first to see any patient requiring attention. Inspectors may choose to test attending physician availability by activating the on-call schedule during the period of the on-site inspection. Example(s): Numerous post-transplant complications may require prompt attention, such as central venous lineassociated bacterial sepsis. If needed because of distance to the in-patient facility or for other reasons, a protocol should exist for outpatient facilities to contact emergency medical services if needed for prompt care. Explanation: Clinical Programs must have written guidelines for the transfer of patients to an intensive care unit or equivalent coverage. The purpose of this standard is to facilitate clear communication between the program and any other departments and health care professionals, and the prompt transfer and ongoing monitoring of appropriate patients. It is not the intent to dictate which patients require transfer, to set criteria for patient transfer, nor to define the amount of intensive care that can or should be provided on a transplant unit. There should be quality parameters regarding the transfer, such as how quickly the patient is transferred. This requires the ability to provide multisystem support including assisted respiration. The outpatient plan for providing inpatient care if needed should be discussed with the patient regardless of the type of outpatient setting. The outpatient plan should address specific needs of transplant recipients, such as the need for isolation protocols for immunocompromised patients, transfer to transplant-designated units related to clinical indications, and transplant-specific discharge plans. This is acceptable if transfer is timely and there is a written agreement defining responsibilities of each party. This standard applies to hematologists, oncologists, hospitalists, general internists, physicians in other specialties, physician assistants, advanced nurse practitioners, or other advanced practice providers. There must be criteria for distinguishing when evaluation and treatment by an attending physician is required. There are patient care issues unique to cellular therapy that must be addressed by a physician with specific training for these events. Providers providing coverage must have a clear understanding of when the attending physician must be notified and how to reach that physician. Evidence: There must be guidelines that describe outpatient and afterhours care, including when and under what conditions the attending physician must be contacted by general medicine physicians. Explanation: Cellular therapy patients often require a highly specialized set of medications that may require special authorization or may not be routinely available. In addition to having medications available, there must always be a pharmacist available on-site or on-call. Example(s): Institutional limitations on select medications, such as expensive drugs, may need consideration. Tocilizumab is commonly needed to treat cytokine release syndrome, but is not routinely available in 24-hour pharmacies. Clinical Programs may need to consult with their pharmacies to develop a plan for accessing this drug on a 24-hour basis and ultimately dispensing it within 30 minutes of a request. Evidence: the Clinical Program must provide documentation that services such as dialysis are readily available to recipients.
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Relatively few people can still make new claims for contributionThere are three different types of Helpline freephone 08088 010 444 73 Work and finances (cont. These needs example, only those in receipt of must have been present for at the severe disability premium least six months. This allowance is for individuals aged 16 or older caring for Personal Independence someone for at least 35 hours a Payment week. The carer must not be in this benefit is for individuals full-time education or studying aged between 16 and State for 21 hours a week or more, and Pension age who require help their income must be less than at home with preparing food, fi128 a week after tax, national bathing and dressing because insurances and expenses. Personal already be in receipt of one of Independence Payment replaces these benefits: the old Disability Living Allowance. It is available for those on a low income or out You can find out more details of work. Disability Premium Allowance Universal Credit is being rolled out Disability Premium Allowance is across the country and replaces a payment which can be added six benefits: onto Universal Credit (or the 1. Your doctor or get benefits at the highest rate, clinical nurse specialist can fill avoid any extra assessments and this out. Special rules For full and up-to-date details of usually apply for up to three years. Helpline freephone 08088 010 444 77 Complementary therapies Complementary therapies are privately, but the types of non-mainstream treatments complementary therapies which are used together with included in this section will guide conventional anticancer you in what to seek. Aromatherapy, register will have a certain level of massage, reflexology, reiki and qualifications and insurance. A professional massage therapist will have completed a broad Patients use complementary training with qualifications therapies with their conventional in anatomy and physiology in anticancer treatments to promote addition to extensive massage general health and help with side techniques. The therapies described below include massage-based therapies, M Technique relaxation techniques and holistic the M technique is a very light techniques, which consider touch manual therapy which the whole person (physically, utilises a formula such that each psychologically, socially, and treatment is given in the same spiritually). The M technique is Regular Massage extremely relaxing and invaluable to anyone with low energy or high Therapeutic massage is a stress levels, or where deeper combination of different massage is inappropriate. The massage/touch techniques results are more similar to a manipulating the soft tissue meditative state. Each Treatment can be the full body or treatment will vary according to just specific areas. Oil or sometimes powder is used to ensure a smooth and Bowen Technique comfortable treatment. It uses subtle and health of the body, mind and precise mobilisations called spirit. These is most often delivered as a procedures follow prescribed massage but it can also be used sequences to affect the specific in creams, bath preparations, body systems. For example, Reiki lavender is known to relieve stress and anxiety and have a calming Originating from Japan, Reiki effect. It is based on the Aromatherapists combine the principle that a life force energy essential oils according to their flows through all of us, and if it properties to create a synergistic is unbalanced, we are more likely blend which will benefit the to get sick or feel stressed. These properties can is a holistic treatment which is assist with psychological, directed at the body, mind and emotional and physical issues. They can also help mitigate the side effects of treatments which Reiki is carried out by the might include nausea, poor sleep practitioners who are attuned and pain. Essential oils should to the Reiki energy and act as a always be diluted in oil or lotions, mirror to help students adjust except in the case of lavender their energy. Using their hands, and tea tree which are suitable to Reiki practitioners channel the apply directly onto the skin. You will dilution of an essential oil in a be given positive suggestions vegetable oil, often known as the to assist in a change in mental carrier oil. Unlike Hypnotherapy is a form of other therapies that work over a therapy that uses the power of prolonged period, hypnotherapy suggestion to create powerful will help you to move on as and positive changes in the mind. Acupuncture is a form of During your first hypnotherapy traditional Chinese medial session, the hypnotherapist will practice. Many people find take you through a progressive acupuncture very relaxing and relaxation, relaxing first the body useful for health problems such and then the mind. You will be as fatigue, sleep problems, worry, guided into a deeply relaxed state, nausea and pain. Doctors very relaxed state of awareness, and health professionals in the Helpline freephone 08088 010 444 81 Complementary therapies (cont. It has been adaptation of traditional Chinese linked to improvement of anxiety, medical acupuncture practised pain, nausea, sleep and digestive by non-medically qualified problems. It involves the insertion suffering with secondary of fine needles and acts mainly by lymphoedema. Reflexology is a form of holistic massage which involves Meditation applying intermittent pressure Meditation is a technique which to specific points on the feet and you can use to train your attention hands which are thought to be and awareness in order to help connected to certain organs and achieve a more emotionally body systems. It involves use specific thumb, finger, and observing your present moment hand massage techniques with experience without judgement. This the present, being aware of treatment of feet or hands is thoughts, physical sensations deeply relaxing. This will help With regular practice, this move improve your mental, emotional towards acceptance helps reduce and physical wellbeing. This can lead us to will talk about different mindful reduce physical and emotional approaches in more detail. Exercise-based There are a number of therapies meditation techniques, including Tai Chi mindfulness or focusing on a particular object in the present Tai chi is often described as moment, like awareness of meditation in motion. It uses sensations in the body or the a sequence of gentle flowing movement of breath. This is also movements that combine part of a number of exercisebreathing, movement and based disciplines such as tai chi awareness exercises with or yoga. Practiced regularly, tai chi can help reduce symptoms Mindfulness meditation involves or side effects, increase flexibility paying attention and awareness and balance, reduce stress and to the experience of the present anxiety, and improve overall moment, your own thoughts and physical and emotional wellbeing. There are many done seated or standing and there different styles of yoga, some is no floor work involved making very vigorous, and others slow, it suitable for any age or ability. Yoga aims to bring at cancer centres, hospices or balance to the whole mind, body hospital clinics as well as in the and spirit through an awareness community. Classes usually last one hour Alternative therapies and require loose or comfortable stretch clothing and bare feet. As opposed to complementary therapies, alternative therapies Yoga Nidra are non-mainstream practices Yoga nidra is a form of guided used instead of conventional visualisation bringing attention cancer treatments. They are used instead of conventional cancer treatment rather than with them because they may interact with conventional anticancer treatment, or create harmful side effects, particularly those based on herbal medicines. Not complying with conventional cancer treatment is known to decrease the survival rate from cancer. Helpline freephone 08088 010 444 85 Mindfulness Mindfulness is the state of being more effective in your response to aware of the present moment the present. It can Mindfulness-based cognitive give you a positive outlook on life therapy is recommended by the and determine how you respond National Institute for Health to challenges. We can respond mindfulness better to our constant stream of Mindfulness can be incorporated thoughts and worries. If you are in the sensations and the world around present being aware, rather than you on a daily basis, particularly judging previous experiences, being aware of the sights, sounds you will be less reactive and often 86 You to moment, and remember that can have a regular time every there is no right or wrong way to day when you decide to be aware experience the present moment. Turn off your anything from a few minutes to phone, television or music and longer practices of up to an hour. Each down, chopping up the vegetables time that you find your mind or taking a shower. Importantly, More information about mindfulness is not about banning mindfulness and online practice these thoughts, but being aware courses can be found on the Mind that they are just thoughts. There are several eight-week Formal mindfulness practice training courses in mindfulness provided by trained teachers In addition to practicing available called Mindfulness mindfulness in everyday life, we Based Stress Reduction, can practice mindfulness in more Mindfulness-based Cognitive formal sessions by setting time Therapy and Mindfulness aside and bringing awareness to Self-compassion. Teachers our breathing, our movement or and courses can be found on even the soles of our feet (such as These come in various the object of our mindfulness forms including the mindful body practice, it is important to notice scan, mindful walking, mindful what is happening from moment movement, and mindful sitting Helpline freephone 08088 010 444 87 Mindfulness (cont. There are also podcasts available that can help you and have been especially designed for people affected by blood cancers at. A short mindful breathing exercise video can be seen on YouTube from Every Mind Matters. Amino Acids Bone Marrow Organic molecules which are the soft blood-forming tissue the building blocks for making that fills the cavities of bones proteins. Bone Marrow Biopsy Blood Cells A bone marrow biopsy involves the cells present in the blood the collection of a sample of which include red blood cells, bone marrow from the hip bone, white blood cells and platelets. These three types of blood cell A bone marrow surgical make up 45% of the blood volume, instrument with a cylindrical with the remaining 55% being blade, called trephine, is used to plasma, the liquid component of remove a 1 or 2 cm core of bone blood. Chemotherapy Haematology Drugs that work in different ways the branch of medicine which to stop the growth of cancer cells, studies the cause, prognosis, either by killing the cells or by treatment, and prevention of stopping them from dividing. Clinical Commissioning Group Haemoglobin Clinically-led statutory A protein contained within the red National Health Service bodies blood cells and responsible for responsible for the planning and transporting oxygen to the tissues commissioning of health care of the body. These cells instructions used in the growth, are not fully developed and are development and functioning of called blasts or leukaemia cells. Depending on the type of blood Eosinophil cell involved, there are different types of leukaemia with varying A type of white blood cell which characteristics, such as being has a protective immunity role acute (develops quickly) or against parasites and allergens. T-cells Mucositis destroy the organisms that have Painful inflammation and been labelled by the B-cells, as ulceration of the mucous well as internal cells that have membranes lining the digestive become cancerous. Examples of any part of the body, but usually mucous membranes include lips, develops in the arms or legs. Mucous membranes system is blocked or does not are rich in mucous glands that work properly. A type of white blood cell that Myeloid submerges and digests cellular Relates to bone marrow. Parainfluenza Virus Neuropathy Viruses which cause upper and lower respiratory illnesses in Damage or dysfunction of one infants, young children, older or more nerves that can result adults, and people with weakened in numbness, tingling, muscle immune systems. Neutropenic Diet Physiology the diet recommended A branch of biology that studies for patients who have low the normal functions of living neutrophil counts and may be organisms. Plasma Cell Neutrophils A type of white blood cell that White blood cells involved in produces antibodies and is fighting inflammation and derived from a B-cell lymphocyte. Oedema Platelets Excess fluid in an area of the body One of the types of blood cells which usually causes swelling of which help to stop bleeding. Portacath Palliative Care An implanted venous Also known as supportive care, access device for frequent/ this is a type of care that focusses administration of chemotherapy. However, what makes the time of diagnosis or other these stem cells reproduce timepoint in the disease. The transplant of stem cells Radiation derived from part of the same the release of energy in the form individual or a donor. Cancer treatment that uses high White Blood Cells doses of radiation to kill cancer cells and shrink tumours. White blood cells are one of the types of cells found in the blood Red Blood Cells and bone marrow, along with red Small blood cells that contain blood cells and platelets. White haemoglobin and carry oxygen blood cells create an immune and other substances to all response against both infectious tissues of the body. Sepsis Other white blood cells include An infection in the blood that can the lymphocytes (recognise cause septic shock. Macmillan provides free practical, medical and financial support for Leukaemia Care people facing cancer. Helpline: 08088 010 444 (free from landlines and all major mobile networks) Office Line: 01905 755977 Since that time, new data have become available, these have been incorporated in the Monograph, and taken into consideration in the present evaluation. Exposure Data From a biological and toxicological perspective, there are three major groups of arsenic compounds: 1. The list is not exhaustrioxide, sodium arsenite and arsenic trichloride tive, nor does it comprise necessarily the most are the most common trivalent compounds, commercially important arsenic-containing and arsenic pentoxide, arsenic acid and arsesubstances; rather, it indicates the range of nates. Common organic arsenic compounds include arsanilic acid, methylarsonic acid, dimethyl1. Arsenite, As, and arseV tural chemicals, and applications in the mining, nate, As, are the predominant oxidation states metallurgical, glass-making, and semiconductor under, respectively, reducing and oxygenated industries. Na monosodium salt Potassium arsenated 7784-41-0 Arsenic acid [H AsO ], monopotassium salt H AsO. Mining, smelting of non-ferrous Arsenic and arsenic compounds are used for metals and burning of fossil fuels are the major a variety of other industrial purposes. Elemental anthropogenic sources of arsenic contamination arsenic is used in the manufacture of alloys, of air, water, and soil (primarily in the form of particularly with lead. Gallium arsenide and arsine are containing pesticides has lef large tracts of agriwidely used in the semiconductor and electronics cultural land contaminated. Arsine sulfde form in complex minerals containing is used as a doping agent to manufacture crystals silver, lead, copper, nickel, antimony, cobalt, and for computer chips and fbre optics. Arsenic is present in more than 200 mineral Arsenic and arsenic compounds are used in species, the most common of which is arsenopythe manufacture of pigments, sheep-dips, leather rite. They are also mately 5 mg/kg, although higher concentrations used in catalysts, pyrotechnics, antifouling agents are associated with sulfde deposits. Sedimentary in paints, pharmaceutical substances, dyes and iron and manganese ores as well as phosphatesoaps, ceramics, alloys (automotive solder and rock deposits occasionally contain levels of radiators), and electrophotography. Arsenic is emitted to the atmosphere from Since the voluntary ban on chromated copper both natural and anthropogenic sources. Tese emissions arise from the mining and smelting of base metals, fuel combustion. The primary regions where high Mean total arsenic concentrations in air range concentrations of arsenic have been measured in 3 from 0. Arsenic, from both natural and anthropoLevels of arsenic in afected areas may range genic sources, is mainly transported in the envifrom tens to hundreds or even thousands of ronment by water. The form and concentration micrograms per litre, whereas in unafected of arsenic depends on several factors, including areas, levels are typically only a few micrograms whether the water is oxygenated (for example, per litre. Trace amounts of methylated ciated with the conversion of inorganic arsenic arsenic species are typically found in drinkingto methylated arsenic acids), the type of water water, and higher levels are found in biological source (for example, open ocean seawater versus systems.
Stimulation of pituitary hormone secretion by neurotransmitter amino acids in humans menstrual emotions order serophene discount. Elderly women accommodate to a low-protein diet with losses of body cell mass women's health clinic east london order serophene 25 mg amex, muscle function breast cancer zip hoodies discount serophene 100mg free shipping, and immune response women's health issues 2012 generic serophene 100 mg without prescription. Methionine overcomes neural tube defects in rat embryos cultured on sera from lamininimmunized monkeys menstruation 24 buy serophene 50mg with mastercard. Human serum teratogenicity studied by rat embryo culture: Epilepsy menstruation in africa buy serophene with paypal, anticonvulsant drugs breast cancer statistics 25mg serophene with visa, and nutrition pregnancy hemorrhoids buy serophene 100 mg lowest price. Influence of progressive tumor growth on glutamine metabolism in skeletal muscle and kidney. Comparative nitrogen balance study between young and aged adults using three levels of protein intake from a combination wheat-soy-milk mixture. Protein turnover in the human fetus studied at term using stable isotope tracer amino acids. Determination of anserine, carnosine, and other histidine compounds in muscle extractives. Direct measurement by continuous intravenous tracer infusions of L-[ring-2H ] 5 phenylalanine and L-[1-13C] tyrosine in the postabsorptive state. Methionine and neural tube closure in cultured rat embryos: Morphological and biochemical analyses. Effects of dietary and intraperitoneal excess of L-lysine and L-leucine on rat pregnancy and offspring. Oral methionine loading as a cause of acute serum folate deficiency: Its relevance to parental nutrition. Plant-animal subsistence ratios and macronutrient energy estimations in worldwide huntergatherer diets. Oral load of tyrosine or L-dopa and plasma levels of free and sulfoconjugated catecholamines in healthy men. Purification and characterization of branched chain alpha-ketoacid dehydrogenase from bovine liver mitochondria. Threonine dehydrogenase is a minor degradative pathway of threonine catabolism in human adults. The amino acid composition of human milk corrected for amino acid digestibility. The rate of adaptation of urea cycle enzymes, aminotransferases and glutamic dehydrogenase to changes in dietary protein intake. Evidence for the possible formation of a toxic tyrosine metabolite by the liver microsomal drug metabolizing system. In vivo amino acid metabolism of gut and liver during short and prolonged starvation. Effects of potassium + magnesium aspartate on muscle metabolism and force development during short intensive static exercise. The effect of feeding different protein-free diets on the recovery and amino acid composition of endogenous protein collected from the distal ileum and feces in pigs. Protein-bound D-amino acids, and to a lesser extent lysinoalanine, decrease true ileal protein digestibility in minipigs as determined with 15N-labeling. Milk and nutrient intake of breast-fed infants from 1 to 6 months: Relation to growth and fatness. Total sulfur amino acid requirement in young men determined by indicator amino acid oxidation with L-[1-13C] phenylalanine. Twin pregnancy: the impact of the Higgins Nutrition Intervention Program on maternal and neonatal outcomes. Ability of the Higgins Nutrition Intervention Program to improve adolescent pregnancy outcome. The effect of varying protein quality and energy intake on the nitrogen metabolism of parenterally fed very low birthweight (<1600 g) infants. The dietary administration of monosodium glutamate or glutamic acid to C-57 black mice for 2 years. Amino acid excesses for young pigs: Effects of excess methionine, tryptophan, threonine or leucine. Effect of excess levels of methionine, tryptophan, arginine, lysine or threonine on growth and dietary choice in the pig. Protein needs of Chilean pre-school children fed milk and soy protein isolate diets. Protein-Energy Requirement Studies in Developing Countries: Results of International Research. The amino acid methionine reduces the valproic acid-induced spina bifida rate in the mouse. Effects of ingested steak and infused leucine on forelimb metabolism in man and the fate of the carbon skeletons and amino groups of branched-chain amino acids. The 24-h pattern and rate of leucine oxidation, with particular reference to tracer estimates of leucine requirements in healthy adults. Validation of the tracer-balance concept with reference to leucine: 24-h intravenous tracer studies with L-[1-13C]leucine and [15N-15N]urea. Moderate exercise at energy balance does not affect 24-h leucine oxidation or nitrogen retention in healthy men. Changes in total body composition during normal and diabetic pregnancy: Relation to oxygen consumption. Leucine uptake by splanchnic and leg tissues in man: Relative independence of insulin levels. Effects of supplemental methionine on antiserum-induced dysmorphology in rat embryos cultured in vitro. Correlations between brain tryptophan and plasma neutral amino acid levels following food consumption in rats. Short-term neuroendocrine effects of a large oral dose of monosodium glutamate in fasting male subjects. Rat embryo development on human sera is related to numbers of previous spontaneous abortions and nutritional factors. Correlation of aspartate dose, plasma dicarboxylic amino acid concentration, and neuronal necrosis in infant mice. Aspartate-induced neuronal necrosis in infant mice: Protective effect of carbohydrate and insulin. The 24-h whole body leucine and urea kinetics at normal and high protein intakes with exercise in healthy adults. Effect of chronic dietary treatment with L-tryptophan on spontaneous salt appetite of rats. Role of insulin and branched-chain amino acids in regulating protein metabolism during fasting. Impact of supplemental lysine or tryptophan on pregnancy course and outcome in rats. Adaptation of protein metabolism in relation to limits to high dietary protein intake. Human protein requirements: the effect of variations in energy intake within the maintenance range. Mutagenic activity of glycine upon nitrosation in the presence of chloride and human gastric juice: A possible role in gastric carcinogenesis. Protein-energy requirements of prepubertal school-age boys determined by using the nitrogen-balance response to a mixed-protein diet. Protein-energy requirements of boys 12-14 y old determined by using the nitrogen-balance response to a mixed-protein diet. Gaudichon C, Mahe S, Benamouzig R, Luengo C, Fouillet H, Dare S, Van Oycke M, Ferriere F, Rautureau J, Tome D. Net postprandial utilization of [15N]-labeled milk protein nitrogen is influenced by diet composition in humans. Multicenter, double blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. Oral L-histidine fails to reduce taste and smell acuity but induces anorexia and urinary zinc excretion. Effect of oral alanine on blood beta-hydroxybutyrate and plasma glucose, insulin, free fatty acids, and growth hormone in normal and diabetic subjects. Human protein requirements: Assessment of the adequacy of the current Recommended Dietary Allowance for dietary protein in elderly men and women. Mutagenicity spectra in Salmonella typhimurium strains of glutathione, L-cysteine and active oxygen species. Effects of central administration of alanine on body temperature of the rabbit: Comparisons with the effects of serine, glycine and taurine. Substituting ornithine for arginine in total parenteral nutrition eliminates enhanced tumor growth. Influence of leucine on arterial concentrations and regional exchange of amino acids in healthy subjects. Serum amino acid patterns and toxicity symptoms following the absorption of irrigant containing glycine in transurethral prostatic surgery. Hara S, Shibuya T, Nakakawaji K, Kyu M, Nakamura Y, Hoshikawa H, Takeuchi T, Iwao T, Ino H. Observations of pharmacological actions and toxicity of sodium glutamate, with comparisons between natural and synthetic products. Clinical trials of vitamin B6 and proline supplementation for gyrate atrophy of the choroid and retina. Rate and amount of weight gain during adolescent pregnancy: Associations with maternal weight-for-height and birth weight. Cerebellar dysfunction, mental changes, anorexia, and taste and smell dysfunction. L-Tryptophan-associated eosinophilic fasciitis prior to the 1989 eosinophilia-myalgia syndrome outbreak. The effect of a histidineexcess diet on cholesterol synthesis and degradation in rats. Dimethylglycine and chemically related amines tested for mutagenicity under potential nitrosation conditions. L-Glutamine supplementation in home total parenteral nutrition patients: Stability, safety, and effects on intestinal absorption. Sweat losses by and nitrogen balance of preadolescent girls consuming three levels of dietary protein. Protein requirements of normal infants at the age of 1 year: Maintenance nitrogen requirement and obligatory nitrogen losses. Blood and tissue branched-chain amino and -keto acid concentrations: Effect of diet, starvation, and disease. Long-term toxicity/carcinogenicity study of L-histidine monohydrochloride in F344 rats. Studies on protein requirements of young men fed egg protein and rice protein with excess and maintenance energy intakes. ProteinEnergy Requirement Studies in Developing Countries: Results of International Research. Protein requirements of Filipino children 20 to 29 months old consuming local diets. Hormonal and dietary regulation of lysosomal cysteine proteinases in liver under gluconeogenesis conditions. Effects of dietary protein content and glucagon administration on tyrosine metabolism and tyrosine toxicity in the rat. A study of growth hormone release in man after oral administration of amino acids. An evaluation of the nutritional value of a soy protein concentrate in young adult men using the shortterm N-balance method. Behavioural studies in rats treated with monosodium L-glutamate during the early stages of life. Indices of protein metabolism in term infants fed either human milk or formulas with reduced protein concentration and various whey/casein ratios. Nutrient intakes and eating behavior scores of vegetarian and nonvegetarian women. The impact of alanyl-glutamine on clinical safety, nitrogen balance, intestinal permeability, and clinical outcome in postoperative patients: A randomized, double-blind, controlled study in 120 patients. Quantitative analysis of amino acid oxidation and related gluconeogenesis in humans. Relation between transamination of branched-chain amino acid and urea synthesis: Evidence from human pregnancy. A morphological study of the acute toxicity of L-cysteine on the retina of young rats. Susceptibility of the cysteine-rich N-terminal and C-terminal ends of rat intestinal mucin Muc 2 to proteolytic cleavage. Determination of amino acid requirements of young pigs using an indicator amino acid. Glutamine-enriched diets support muscle glutamine metabolism without stimulating tumor growth. The proportionality of glutaminase content to growth rate and morphology of rat neoplasms. Evidence that histidine is an essential amino acid in normal and chronically uremic men. The effects of sweat nitrogen losses in evaluating protein utilization by preadolescent children. Oral and intravenous tracer protocols of the indicator amino acid oxidation method provide the same estimate of the lysine requirement in healthy men. Transport of amino acids by the human placenta: Predicted effects thereon of maternal hyperphenylalaninaemia. Lysine requirements of healthy adult Indian subjects, measured by an indicator amino acid balance technique. Lysine requirements of healthy adult Indian subjects receiving long-term feeding, measured with a 24-h indicator amino acid oxidation and balance technique. Threonine requirements of healthy Indian adults, measured by a 24-h indicator amino acid oxidation and balance technique. The effects of glutamine-supplemented parenteral nutrition in premature infants. The effects of neonatally-administered monosodium glutamate on the reproductive system of adult hamsters. Further observations on the effects of neonatally administered monosodium glutamate on the reproductive axis of hamsters. Tryptophan requirement in young adult women as determined by indicator amino acid oxidation with L-[13C]-phenylalanine. Effect of an oral tryptophan/carbohydrate load on tryptophan, large neutral amino acid, and serotonin and 5-hydroxyindoleacetic acid levels in monkey brain. Preliminary investigation of high-dose oral glycine on serum levels and negative symptoms in schizophrenia: An open-label trial. Is increased dietary protein necessary or beneficial for individuals with a physically active lifestylefi Protein requirements and muscle mass/strength changes during intensive training in novice bodybuilders. Serum glutamic acid levels and the occurrence of nausea and vomiting after the intravenous administration of amino acid mixtures. The effects of aspartame on human mood, performance, and plasma amino acid levels. Total exchangeable sodium and potassium in non-pregnant women and in normal and pre-eclamptic pregnancy. Long-term oral branched-chain amino acid treatment in chronic hepatic encephalopathy. Nutritional value of [15N]-soy protein isolate assessed from ileal digestibility and postprandial protein utilization in humans. The risk of pronounced hyperkalaemia after arginine infusion in the diabetic subject. The effects of excess amino acids on maintenance of pregnancy and fetal growth in rats. Studies on reproductive endocrine function in rats treated with monosodium L-glutamate early in life. The effects of oral administration of salts of aspartic acid on the metabolic response to prolonged exhausting exercise in man. Defective uptake of basic amino acids and L-cystine by intestinal mucosa of patients with cystinuria. Prolonged meat diets with a study of the metabolism of nitrogen, calcium and phosphorus. Contribution of rat liver and gastrointestinal tract to whole-body protein synthesis in the rat. Salvage of exogenous urea nitrogen enhances nitrogen balance in normal men consuming marginally inadequate protein diets. Plasma tyrosine in normal humans: Effects of oral tyrosine and protein-containing meals. Glutamate as a neurotransmitter in the brain: Review of physiology and pathology. Dietary protein requirements and body protein metabolism in endurance-trained men. Availability of intestinal microbial lysine for whole body lysine homeostasis in human subjects.
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