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Blood cells, 43.6% would accept some autologous blood products P .009, 95% confidence interval of the difference 0.27 0.52 ; . No significant differences in responses were noted for any of the above-mentioned variables Table 2 ; . The sample size n 61 ; is small. The maximum margin of error corresponding to this sample size is 12.6% at 95% confidence intervals. This basically means that, 95% of the time, the same results would be obtained within 12.6%. DISCUSSION The refusal of Jehovah's Witnesses to accept blood or blood products stems from their interpretation of the previously mentioned Old Testament passages from the Christian Bible. Their tradition teaches that receiving blood products may lead to excommunication and eternal damnation, and an individual who offers to transfuse blood is considered by many members of the sect to be acting under the devil's influence.6 It is with this background that a pregnant Jehovah's Witness initially approaches a health care proxy. Obstetric hemorrhage is not infrequent. Approximately 2% of women who present to a labor and delivery floor will require a blood transfusion, 4 and as previously stated, this can lead to a 44-fold increased risk of maternal mortality if the patient refuses all transfusion therapy.5 For many young female Jehovah's Witnesses, filling out the health care proxy is the first time they have been directly confronted with the necessity to make a personal commitment to their religious beliefs. The New York State Health Care Proxy is specific to Jehovah's Witnesses. It begins by stating that, as a member of that sect, the person signing the form refuses all homologous or stored autologous blood. The form then lists several blood fractions and gives the Jehovah's Witness the option to accept all, some, or none of those products. These include albumin, erythropoietin, synthesized clotting factors, and Rh immune globulin RhoGAM, Ortho-Clinical Diagnostics, Inc, Raritan, NJ ; . With respect to nonstored autologous blood, the patient has the option of accepting hemodilution, intraoperative or postoperative salvage of her own blood, or none of the above. Normovolemic hemodilution, a technique performed by an anesthesiologist, involves removing a quantity of the patient's whole blood in the immediate preoperative period, and replacing it with crystalloid or colloid solutions.7 When this technique is used, the blood lost during the operative case is low in red cells, and because the oxygen dissociation curve is shifted to the right, the oxygen-carrying capacity is optimized. At the end of the case, the previously removed.
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Research and development expenses increased .5 million for 2004, as compared to 2003, primarily due to: a .4 million increase in spending on Renal research and development programs; a .6 million increase in spending on Therapeutics research and development programs; an .4 million increase in spending on Transplant research and development programs; and a .7 million increase in spending for Corporate research and development efforts related to our corporate science activities that we do not allocate to our reporting segments.
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Characteristics of Study Technologies Technologies may be used to prevent or cure disease; they may be used to improve our capacity to diagnose disease, or they may help extend survival, even if only briefly, for persons with life-threatening conditions. Technologies can be used for rehabilitating the ill, or simply to serve as a palliative to reduce the pain and suffering of a chronic or terminal illness Rosenthal, 1977 ; . Notably, more than half of our study technologies is intended to prevent disease through mass screening programs see Table 5 ; . Of our remaining technologies, one is diagnostic PET ; , two are palliative coronary artery stents and inhaled insulin ; and one focuses on extending survival monoclonal antibodies ; . Notably, none are curative. The selection of such a large number of screening technologies may be indicative of more global trends in technological change. As we have become more proficient at treating disease, through the development of antibiotics and other interventions, the focus overall may be on earlier, preventive intervention. Certainly, private and public insurers have broadened their coverage of preventive services, such as screening mammographies, Pap smears, and influenza vaccines in recent years. Technologies may also be classified according to their impact on resource consumption. Battista et al. 1991 ; identified three broad groups according to the intensity of resources each technology consumes: high, medium, and low. High technologies require not only a large investment in capital equipment, but major human, physical and administrative commitments, as well. PET for cancer is an example of a high technology. Medium technologies require substantial resources to develop, but far and norethindrone.
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Pletely suppressed, drug-resistant variants emerge through the accumulation of mutations in the HIV-1 RT or PR genes, leading to therapeutic failure Hirsch et al. 2000 ; . Genotypic testing for resistance is a relatively rapid and inexpensive method to identify PR and RT amino acid substitutions leading to drug resistance Baxter et al. 2000; Schinazi et al. 2000; Shafer 2002 ; . Genotyping is recommended for use in clinical practice Hirsch et al. 2000 ; . However, rules-based interpretation systems are retrospective in nature and must be frequently updated to accommodate new mutational patterns and new antiretrovirals. As a result, genotypic predictions for complex mutational patterns and for new antiretrovirals may be inaccurate Baxter et al. 2000 ; . Cell-based viral phenotyping assays Hertogs et.
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Present study, we intended to evaluate factors that influence presence of spermatogenesis in long-term recipients, which includes inevitably the injury of the testes before transplantation. Unfortunately, in the majority of the patients we have no data on the spermatogenesis status before transplantation; only 3 participating patients cryopreserved sperm immediately before transplantation, and so far no one recovered spermatogenesis. Data from patients treated with reduced-intensity conditioning suggest that the dose and the type of agent used for conditioning cannot alone explain the azoospermia. Therefore, even in patients given transplants with reduced-intensity conditioning, the age of the patient, the treatment before transplantation, the kinetics of spermatogenesis after allogeneic HSCT, and the presence or not of chronic GvHD have to be considered. The reason for the high rate of spermatogenesis usually observed in patients with aplastic anemia conditioned with cyclophosphamide alone5, 8 is likely to be related to the younger age at transplantation and the absence of chemotherapy before transplantation. Despite the fact that we collected the information concerning paternity before and after HSCT, this study was not designed to evaluate paternity as a consequence of presence of spermatogenesis. We do not have information concerning the intention of male recipients to become fathers after HSCT, nor did we perform paternity tests in case of a child's birth occurring after transplantation. Nevertheless, 3 of the 11 patients with sperm production reported fathering a child after HSCT. In the present series, only recipients with normal sperm cell counts fathered a child. Therefore, the question is whether incomplete sperm production with oligozoospermic or even cryptozoospermic seminal fluid is of clinical relevance for the recipient after transplantation. Fathering of a healthy child from a severely oligozoospermic patient after autologous HSCT using an assisted reproductive technique has been reported.17 But more importantly, reduced fertility due to low sperm count and poor sperm motility can be circumvented by assisted reproduction, in particular with intracytoplasmic sperm injection.18 At present, cryopreservation of spermatozoa is an established option for sustaining the viability of sperm over a long period of time, allowing the sperm to be used for insemination at a later date.19-21 Cryopreservation should be offered to all men at risk of infertility and should be done prior to treatment, and it must be emphasized and encouraged. According to our findings, young patients undergoing transplantation before adolescence and without cryopreserved sperm have a reasonable chance of spermatogenesis after HSCT. In conclusion, the results of our prospective cohort study suggest that long-term survivors after stem cell transplantation have a substantial likelihood of recovering some degree of testicular sperm production even when conditioned with TBI, provided they are younger than 25 years at HSCT and apparently when they remain free of chronic GvHD and norvir.
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Ischemic stroke.1 Furthermore, both overweight and obese patients have significant decreases in life expectancy. Another related risk factor that is growing in importance is the metabolic syndrome. The metabolic syndrome is defined as the presence of 3 or more of the following conditions in any one patient: waist circumference greater than 40 inches in men or greater than 35 inches in women, triglycerides greater than 150 mg dL, HDL or high-density lipoprotein levels less than 40 mg dL in men or less than 50 mg dL in women, blood pressure greater than 130 85 mm Hg, or fasting glucose higher than 110 mg dL. Currently, there are over 47 million Americans that are at an increased risk of developing CVD and death from CVD causes attributable to the metabolic syndrome.1 It is often decreased physical activity and poor nutritional habits that lead to obesity and the presence of the metabolic syndrome. Finally, cigarette smokers have a 2- to 3-fold increased risk of dying from coronary disease.1 Cigarette smoking is the single most preventable cause of premature death in the U.S. Smoking enhances thrombogenesis and platelet reactivity. Smoking 1 to 4 cigarettes per day can double or triple your risk for CHD. On average, smokers die almost 7 years earlier than nonsmokers. Patient Presentation Over 1.1 million Americans experience an AMI each year. Of those, almost one-third will have a STEMI.1, 5 One-third of patients who experience a STEMI will die within the first 24 hours of their heart attack, and those who survive have an increased risk of related illness that is 2 to times higher than that of the general population.5 In addition, less than 25% of patients having an AMI and novantrone.
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Laurent Pordi Ladakh is a district of the state Jammu & Kashmir in the Indian Himalayas. Known as 'Little Tibet', this Buddhist region is now developing and opening itself to the 'modern world'. The consequences for the local environment, both social and natur al, ar e many and form part of a complex system in which many parameters are interrelated. It is therefore necessary to investi gate dev elopment, economy, politics, environment, health systems, demography, climate, tour ism, religion, etc. , in order to obtain a global and accurate understanding of the unique relationship between Tibetan medicine locally named amchi medicine ; and the environment in this era of modernization. This appr oach will take into account the relation between the transformations of environment and way of life, and the change of mentality and behaviour. This article aims to present a panorama of the actual situation reminding us that the plants are not only biological objects but also social and cultural objects. The Tibetan medicine reflects a holistic wa y of thought in which sickness is treated as a physical, emotional and spiritual whole. The rGyud-bZhi, or 'Four Tantras', is the sacred book containing the body of medical knowledge CLARK 1995, YESHI 1997 ; . It describes, from a scient ific perspective, the theoretical relationship between humankind and the environment in which observed phenomena are understood according to the links which unite them and give them coherence. The fundamental concept of Tibetan medicine is based on the theory of five cosmo-physical elements: Sa earth ; , Chu water ; , Me fire ; , rLung air or wind ; and Nam-kha space ; , and three nes-pa or humors: rLung wind ; , mKris-pa bile ; and Badkan phlegm ; . These nes-pa are the functional physiological expressions of the five cosmo-physical elements and the natural humoral constitution produces certain physical, physiological and emotional characteristics MEYER 1988, YESHI 1986 ; . According to this theory, the rGyud-bZhi states that the composition of the body is the sa me as that of the universe and this similarity between the macrocosm and the microcosm explains the reciprocal influences that one element has on the others and the interdependence that connects the human beings to the environment. Considering this and novolog.
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We gratefully acknowledge the volunteer subjects who committed substantial time and effort to make this study successful. We also gratefully acknowledge Dr. Kevin Yarasheski and his laboratory for assistance with specimen analysis, and Dr. Yarasheski's helpful suggestions about the writing of the manuscript. Received April 28, 2004. Accepted July 8, 2004. Address all correspondence and requests for reprints to: Dr. Fred R. Sattler, Departments of Medicine and Biokinesiology and Physical Therapy, University of Southern California, 1540 East Alcazar Street, CHP155, Los Angeles, California 90033. E-mail: fsattler usc . This work was supported in part by NIH Grant GCRC MOI-RR-00043 and a grant-in-aid from Savient Pharmaceuticals, Inc. The body composition and metabolic components of the study were performed at the University of Southern California National Center for Research Resources-funded General Clinical Research Center.
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