Thursday, April 21, 2016

Most Common Diseases of 50plus: Pulmonary vascular disease(Respiratory disease): Pulmonary embolism- Treatment In Herbal and TCM medicine perspective

Kyle J. Norton(Scholar and Master of Nutrients, all right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                           Respiratory Disease

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and muscles breathing, etc,.

         Pulmonary vascular disease:  Pulmonary embolism


Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.

Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States

                               The Treatment

B. In Herbal medicine perspective
In the study to investigate the effect of aqueous extract of several herbs on human platelet aggregation in vitro of of 28 herbs/nutriceuticals investigated, camomile, nettle alfalfa, garlic and onion exhibited most significant anti-platelet activity (>or=45% inhibition), indicated that queous extracts of alfalfa, fresh nettle, and camomile inhibited ADP induced-platelet aggregation by 73, 65 and 60%, respectively, compared with control (P < 0.05). Camomile and alfalfa inhibited collagen-induced platelet aggregation by 84 and 65%, respectively, but nettle could not inhibit collagen-induced aggregation. In contrast, nettle was the most potent inhibitor (66%) of whole blood aggregation induced by collagen, followed by alfalfa (52%), and camomile (30%) compared with control (P < 0.05). None of these three herbs however could inhibit arachidonic acid or thrombin induced platelet aggregation. Camomile and alfalfa strongly inhibited thromboxane B2 synthesis induced by ADP or collagen, but nettle had no effect. Alfalfa and nettle increased cGMP levels in platelets by 50 and 35%, respectively, compared with the control (1.85 +/- 0.23 nM) (P < 0.005). All these data indicate that camomile, nettle and alfalfa have potent anti-platelet properties, and their inhibitory actions are mediated via different mechanisms(53).
C. In traditional Chinese perspective
According to the China Academy of Traditional Chinese Medicine, in the study of Herbs of activating blood circulation to remove blood stasis, drugs of anti-hyperviscosemia, anti-coagulants, anti-platelet drugs, anti-thrombotics, vasodilators, endothelial cell protectors and anti-arthrosclerosis should be considered as hemorheologicals due to the actions in keeping blood fluidity and in maintaining normal vascular functions. Hemorheologicals are importance for and aging and life-threatening diseases. Blood stasis syndrome is a common pathological syndrome in the elderly. In traditional Chinese medicine, the treatment for the syndrome is by herbs which activates blood circulation to remove blood stasis. The herbs have the efficacy of improving hemorheological events. Therefore, the herbs are the source for developing hemorheologicals. Ligustrazine isolated from Chuangxiong is an example. It showed significant inhibition on shear induced platelet aggregation and on platelet intracellular calcium demonstrated by laser confocal microscope(54).

All Forms of Arthritis are Curable


Ovarian Cysts And PCOS Elimination


Sources
(53) http://www.ncbi.nlm.nih.gov/pubmed/16287614
(54) http://www.ncbi.nlm.nih.gov/pubmed/11321431

Wednesday, April 20, 2016

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The Diagnosis

Kyle J. Norton (Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia



                                                      Rheumatoid Arthritis

Rheumatoid Arthritis is defined a chronic disorder as a result of inflammation, affecting mostly the flexible (synovial) joints and tissues and organs in the body. The disease affects more women than men and generally occurs after the ages of 40, causing diminished quality of life of many elders(1). According to CDC, Musculoskeletal disorders (MSDs) affects over 52 millions of adults in the US alone, including 294,000 children under age 18 with some form of arthritis or rheumatic conditions(2). Rheumatoid Arthritis can induced bone loss through elevating bone resorption without increasing bone formation(4). A cross-sectional population-based study of 1042 patients with rheumatoid arthritis showed that RA patients had an increased risk of death from various causes(4a).

                          The Diagnosis

If you are experience certain subtle symptoms, such as achy joints or a morning stiffness, etc,....you may be at the early stage onset of rheumatoid arthritis. If your doctor suspect that have develop RA because of some RA symptoms such as such as warmth, swelling and pain in the joints, after physical exam, certain blood tests may be necessary, including
1. Erythrocyte sedimentation rate
ESR is a a common hematology test to calculate the rate of red blood cells sediment in a period of one hour. According to Dr. Wolfe F said " ESR is sensitive to immunoglobulins and rheumatoid factor (RF),... but a a poorer measure of inflammation"(64a) and may be effected by other factors. Other clinical findings, the individual's health history, and results from laboratory tests are necessary, such as C-reactive protein(64a) to rule out a suspected diagnosis for the confirmation of the result. Dr Sokka T and Dr. Pincus T. normal ESR and CRPC-reactive protein, are seen in a substantial proportion of patients with RA.(65a)

2. C-reactive protein
A group of "acute phase reactants" protein produced by liver and found in patient with rheumatoid arthritis.,tends to elevate in case of inflammation. According to the Copenhagen University Hospital, oral nonsteroidal antiinflammatory drugs (NSAIDs) does not effects the levels of protein but may be constituted to the influence of NSAIDs on cardiovascular complications in patient with RA(66).



3. Test for Anemia
According to statistic, the prevalence of mild anemia characterized by low serum iron concentration ranged between 33% and 60% are found in patient with rheumatoid arthritis(67), such as aplastic anemia and iron deficiency anemia. In fact, patient with combination of RA and amenia are mostly experience severe forms of joint disease and improvement of anemia is found to contribute to over all quality of life (QOL) and response to RA therapy(67).

4. Anti-cyclic citrullinate d peptide (anti-CCP antibodies)
Cyclic citrullinated peptides (CCP) in most cases is ordered in conjunction with the test of rheumatoid factor in patient with RA. The positive find of anti-citrullinated peptide/protein antibodies may contribute to the presence of the early event in the disease(68). Dr van Venrooij WJ and the research team at the Radboud University said"...., the presence of these antibodies was highly predictive of and specific for RA, and illustrating the importance of ACPA"(69).
5. Rheumatoid factor
Rheumatoid factor test is a blood test to measure the antibody in patient with rheumatoid arthritis.
The study of 71 patients with rheumatoid arthritis and 25 control subjects. AIF-1 is found to associated with the pathogenesis of RA involved in the immunological process underlying RA(70).
Others such as elevation of interleukin-7 receptor (IL-7Ralpha)(71), interleukin-18(72),.... also involve in the presence of RA.
6. X ray
X ray may be important to determine the changes of bone mineral density. Patient with RA are found to have an lower BMD of that can lead to increased risk of major fracture and hip fracture(73). The family notebook suggested the relative change of Rheumatoid Arthritis found in X ray according to Dr. Kirwan J and Dr. Byron M, Watt I. include soft tissue swelling, joint space narrowing and erosive damage(74).
Arthritis Is CurableYou Can Eliminate OsteoarthritisBy addressing the Underlying Causes through Clinical Trials and Studies
Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How ToPermanently Eliminate All Types of Ovarian Cysts Within 2 Months
Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer recommended by Kyle J. Norton
Back to Kyle J. Norton Home page http://kylejnorton.blogspot.ca
References
(1) 8 Areas of Age-Related Change(NIH)
(2) Arthritis-Related Statistics(CDC)
(3) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(4) Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity ,Bone Mineral Density and Radiological Grading by Mehaney DA, Eissa M, Anwar S, El-Din SF(PubMed)
(4a) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study by Sihvonen S1, Korpela M, Laippala P, Mustonen J, Pasternack A(PubMed)
(64) Risk of rheumatoid arthritis following vaccination with tetanus, influenza and hepatitis B vaccines among persons 15-59 years of age by Ray P1, Black S, Shinefield H, Dillon A, Carpenter D, Lewis E, Ross P, Chen RT, Klein NP, Baxter R; Vaccine Safety Datalink Team.(PubMed)
(65) Can immunisation trigger rheumatoid arthritis? by D P Symmons and K Chakravarty(PubMed)
(64a) Comparative usefulness of C-reactive protein and erythrocyte sedimentation rate in patients with rheumatoid arthritis by Wolfe F1.(PubMed)
(65a) Erythrocyte sedimentation rate, C-reactive protein, or rheumatoid factor are normal at presentation in 35%-45% of patients with rheumatoid arthritis seen between 1980 and 2004: analyses from Finland and the United States by Sokka T1, Pincus T.(PubMed)
(66) Effect of nonsteroidal antiinflammatory drugs on the C-reactive protein level in rheumatoid arthritis: a meta-analysis of randomized controlled trials by Tarp S1, Bartels EM, Bliddal H, Furst DE, Boers M, Danneskiold-Samsøe B, Rasmussen M, Christensen R.(PubMed)
(67) Prevalence and outcomes of anemia in rheumatoid arthritis: a systematic review of the literature by Wilson A1, Yu HT, Goodnough LT, Nissenson AR.(PubMed)
(68) Anti-CCP antibodies: the past, the present and the future by van Venrooij WJ1, van Beers JJ, Pruijn GJ.(PubMed)
(69) Anti-citrullinated protein antibodies (ACPA) in early rheumatoid arthritis by Suwannalai P1, Trouw LA, Toes RE, Huizinga TW(PubMed)
(70) Expression of allograft inflammatory factor-1 in peripheral blood monocytes and synovial membranes in patients with rheumatoid arthritis by Pawlik A1, Kotrych D2, Paczkowska E3, Roginska D3, Dziedziejko V4, Safranow K4, Machalinski B5.(PubMed)
(71) Elevated expression of interleukin-7 receptor in inflamed joints mediates interleukin-7-induced immune activation in rheumatoid arthritis by Hartgring SA1, van Roon JA, Wenting-van Wijk M, Jacobs KM, Jahangier ZN, Willis CR, Bijlsma JW, Lafeber FP.(PubMed)
(72) Interferon-gamma-inducing activity of interleukin-18 in the joint with rheumatoid arthritis by Yamamura M1, Kawashima M, Taniai M, Yamauchi H, Tanimoto T, Kurimoto M, Morita Y, Ohmoto Y, Makino H.(PubMed)
(73) [Risk factors for bone mineral density changes in patients with rheumatoid arthritis and fracture risk assessment].[Article in Chinese] by Wang Y1, Hao YJ1, Deng XR1, Li GT1, Geng Y1, Zhao J1, Zhou W1, Zhang ZL1.(PubMed)
(74) The relationship between soft tissue swelling, joint space narrowing and erosive damage in hand X-rays of patients with rheumatoid arthritis by Kirwan J1, Byron M, Watt I.(PubMed)

The Smoothie of Orange, Yogurt, Honey and Ginger in Prevention and Treatment of Vaginal yeast infection

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

The Incredible and Effective smoothie for Prevention and treatment of vaginal yeast infection
Yield: 2 servings (about 8 ounces each)
1   cup orange
1/4 cup yogurt
1/4 cup honey
1 cup ginger herbal tea

1. Place all ingredients in a blender and puree about 1 minute
2. Blend on high speed about 1 minute or until the mixture is thick and the ice is well crushed.
3. Serve immediately
Candida albicans are members of a large group of micro organism whose cells contain complex structures enclosed within the membranes, including yeast, fungi, and mold that live among the gut flora in the human mouth and gastrointestinal tract. In fact, under normal circumstances, Candida albicans that do not cause harmful effects, but overgrowth results in candidiasis(1)

The finding of a natural source for reduced risk and treatment of vaginal yeast infection to replace the conventional medicine has been running into many obstacles, many ingredients showed initially with promising result in animal studies have not produced same potentials in either large sample size and mutli centers human trials.

Yogurt, make from whole milk may consist a powerful ingredient for prevention and treatment of Vaginal yeast infection as its promote the suppression of C. albicans growth through Lactobacillus colonization the in the reproductive tract(2).
The study of the Central Emek Hospital, Afula, Israel, insisted, "daily ingestion of 150 mL of yogurt, enriched with live L acidophilus, was associated with an increased prevalence of colonization of the rectum and vagina by the bacteria, and this ingestion of yogurt may have reduced episodes of BV."(3).
Vitamin C found abundantly in orange, a water soluble vitamin, as free radical scavengers and regenerated oxidized vitamin E for immune support may be a potential ingredient for treatment of vaginal yeast infection(4).
Feminella Vagi C, a commercial product of Vitamin C (Ascorbic Acid) exhibited anti bacterial vaginosis (BV) and/or mycotic infection activity when used conjunction with Nifuratel, Nistatin)(5) leading to higher percentage of clinically recovery (86.7% vs 84.6%), better microbiological cleaning (86.7% vs 82.1%) and longer effect of treatment.

Ginger (Zingiber officinale) or ginger root is the genus Zingiber, belongings to the family Zingiberaceae, native to Tamil, used in traditional and Chinese medicine to treat morning sickness, gastroparesis, constipation,...etc. According to the Teikyo University Institute of Medical Mycology, ginger essential oils, and particularly those from seed and air-dried rhizomes, had potent inhibitory activity, particular the 6]-shogaol constituent(6).
Dr. Giriraju A and Dr. Yunus GY. said, " 10% ethanolic ginger extract showed: (a) Maximum zone of inhibition of 8 mm, 14 mm, and 11 mm against S. mutans, C. albicans, and E. faecalis respectively. (b) MIC of 1.25%, 2.5%, and 2.5% against S. mutans, C. albicans, and E. faecalis respectively"(7).
Interestingly, the Institute of Veterinary Sciences University Ibn-KhadounTiaret, study suggested that use of ginger starch may allow honey benefit in constituted an alternative way against the resistance to antifungal agents(8).

The effectiveness of Orange, Yogurt, Honey and Ginger may serve as cornerstones of pharmaceutical target for further studies in production of a potential medication for for Reduced Risk and treatment of  vaginal yeast infection with little or no adverse effects.

Women who are at increased risk of  vaginal yeast infection may drink at least one serving daily and women with  vaginal yeast infection may drink as much as they can, depending to the digestive toleration.
Life style and dietary patter change are recommended.


All Forms of Arthritis are Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies


Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months


Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer

References
(1) The Reader Guide To Cure Candidiasis: Testing Candidiasis by Kyle J. Norton
(2) Utility of the oestrogen-dependent vaginal candidosis murine model in evaluating the efficacy of various therapies against vaginal Candida albicans infection by Hamad M1, Muta'eb E, Abu-Shaqra Q, Fraij A, Abu-Elteen K, Yasin SR.(PubMed)
(3) Ingestion of yogurt containing Lactobacillus acidophilus compared with pasteurized yogurt as prophylaxis for recurrent candidal vaginitis and bacterial vaginosis by Shalev E1, Battino S, Weiner E, Colodner R, Keness Y.(PubMed)
(4) Vulvovaginitis: screening for and management of trichomoniasis, vulvovaginal candidiasis, and bacterial vaginosis by van Schalkwyk J1, Yudin MH2; Infectious Disease Committee, Yudin MH2, Allen V3, Bouchard C4, Boucher M5, Boucoiran I1, Caddy S6, Castillo E6, Kennedy VL2, Money DM1, Murphy K2, Ogilvie G1, Paquet C7, van Schalkwy JK1; Society of Obstetricians and Gynaecologists of Canada.(PubMed)
(5) [Multipurpose treatment of vaginal infections].[Article in Bulgarian] by Nikolov A, Masseva A, Shopova E, Georgiev S.(PubMed)
(6) Anti-Candida and radical scavenging activities of essential oils and oleoresins of Zingiber officinale Roscoe and essential oils of other plants belonging to the family Zingiberaceae by Takahashi M1, Inouye S, Abe S.(PubMed)
(7) Assessment of antimicrobial potential of 10% ginger extract against Streptococcus mutans, Candida albicans, and Enterococcus faecalis: an in vitro study by Giriraju A1, Yunus GY.(PubMed)
(9) Additive potential of ginger starch on antifungal potency of honey against Candida albicans by Moussa A1, Noureddine D, Hammoudi SM, Saad A, Bourabeh A, Houari H(PubMed)

Most Common Diseases of 50plus: Pulmonary vascular disease(Respiratory disease): Pulmonary ebolism- Treatment In conventional medicine perspective

Kyle J. Norton(Scholar and Master of Nutrients, all right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                           Respiratory Disease

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and muscles breathing, etc,.

         Pulmonary vascular disease:  Pulmonary ebolism


Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
                                                   
Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States

                               The Treatment

A. In conventional medicine perspective
A. Medication
1. Anticoagulants, including
Heparin,Warfarin (Coumadin) and rivaroxaban (Xarelto). In the study of 256 patients with acute pulmonary embolism and pulmonary hypertension or right ventricular dysfunction but without arterial hypotension or shock. The patients were randomly assigned in double-blind fashion to receive heparin plus 100 mg of alteplase or heparin plus placebo over a period of two hours. found that when given in conjunction with heparin, alteplase can improve the clinical course of stable patients who have acute submassive pulmonary embolism and can prevent clinical deterioration requiring the escalation of treatment during the hospital stay(48).
2. Clot dis solvers
Patients with acute pulmonary embolism are at risk for early death or chronic morbidity. Appropriate therapy can dramatically reduce the incidence of both. Appropriate therapy can dramatically reduce the incidence of both. Oxygen and heparin therapy should be started as soon as the diagnosis is suspected. The condition of a hypotensive patient with right ventricular overload from acute pulmonary embolism usually is made worse by a fluid challenge; hypotension may be relieved by preload reduction or even by gentle diuresis. Norepinephrine (Levophed), isoproterenol hydrochloride (Isuprel), and epinephrine are the pressor agents of choice. Immediate thrombolysis is the standard of care for any patient with significant hypoxemia or hypotension due to proven pulmonary embolism. Beyond this, the potential benefit of using thrombolytic agents should be considered routinely for every patient with proven pulmonary embolism(49).
B. Surgical treatments
1. Clot removal
The aim is to remove the existed large blood clot with a thin flexible tube (catheter) through your blood vessels. According to the study by Harvard Medical School, pulmonary suction thrombectomy can be a successful interventional tool in the treatment of pulmonary thromboembolism. Removal of clot burden typically results in prompt recovery of hemodynamic stability and improved oxygenation. However, in rare cases, clot removal does not sufficiently improve the clinical situation. Herein, two patients with massive pulmonary thromboembolism are presented whose condition improved only after they received nitric oxide as an adjunct to pulmonary suction thrombectomy(50).
2. Vein filter
The aim of placing a filter in the main vein called the inferior vena cava that leads from your legs to the right side of your heart is to filter catches and stops blood clots moving through the blood stream toward your lungs. In the study to investigate clinical experience with the Recovery filter as a retrievable inferior vena cava (IVC) filter, in one hundred seven Recovery filters were placed in 106 patients with an initial clinical indication for temporary caval filtration, found that although all the filters were placed with the intention of being removed, a large percentage of filters were not retrieved. The Recovery filter was safe and effective in preventing PE when used as a retrievable IVC filter(51).
3. Surgery
In case of acute pulmonary embolism, emergency surgery may be the only option to remove as much as clot as possible, specially there is a large clot in your main (central) pulmonary artery, if patients are in shock and thrombolytic medication isn’t working quickly enough. In the study to investigate the effectiveness of a comprehensive therapeutic algorithm including extracorporeal life support (ECLS) in high-risk acute pulmonary embolism (aPE) treated with pulmonary embolectomy, indicated that among the 25 patients, 24 had a PAOI≥0.5 and 23 had a RV-to-LV diameter ratio≥1.0. Four patients had right heart thrombi. Sixteen patients developed preoperative instability requiring inotropic and/or mechanical support. Eight in the 16 had a preoperative cardiac arrest (CA) and six of these were bridged to surgery on ECLS. Three in the 6 patients weaned ECLS after surgery and survived to discharge. The overall in-hospital mortality was 20% (n=5). A preoperative CA (Odds ratio [OR]: 16, 95% confidence interval [CI]: 1.4-185.4, p=0.027, c-index: 0.80) and a postoperative requirement of ECLS (OR: 36, 95% CI: 2.1-501.3, p=0.008, c-index: 0.85) was the pre- and postoperative predictor of in-hospital mortality. No late deaths or re-admission for recurrence were found during a median follow-up of 19 months(52).

All Forms of Arthritis are Curable


Ovarian Cysts And PCOS Elimination


Sources
(48) http://www.ncbi.nlm.nih.gov/pubmed/12374874
(49) http://www.ncbi.nlm.nih.gov/pubmed/7816717
(50) http://www.ncbi.nlm.nih.gov/pubmed/15525752
(51) http://www.ncbi.nlm.nih.gov/pubmed/16151059
(52) http://www.ncbi.nlm.nih.gov/pubmed/23583612

Most Common Disease of50plus: The Clinical trials and Studies of Musculo-Skeletal disorders(MSDs) - Rheumatoid Arthritis: The Risk factors

Kyle J. Norton (Scholar)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

Musculoskeletal disorders (MSDs) are medical condition mostly caused by work related occupations and working environment, affecting patients’ muscles, joints, tendons, ligaments and nerves and developing over time. A community sample of 73 females and 32 males aged 85 and over underwent a standardised examination at home. Musculoskeletal pain was reported by 57% of those interviewed. A major restriction of joint movement range was frequent in the shoulder but uncommon in other joints(1).

Types of Musculo-Skeletal disorders in elder(2)

1. Osteoarthritis
2. Gout
3. Rheumatoid Arthritis
4. Polymalagia Arthritis
5. Cervical myleopathy and spinal canal stenosis
6. Osteoporosis
7. Low back pain
8. Fibromyalgia



                                                      Rheumatoid Arthritis

Rheumatoid Arthritis is defined a chronic disorder as a result of inflammation, affecting mostly the flexible (synovial) joints and tissues and organs in the body. The disease affects more women than men and generally occurs after the ages of 40, causing diminished quality of life of many elders(1). According to CDC, Musculoskeletal disorders (MSDs) affects over 52 millions of adults in the US alone, including 294,000 children under age 18 with some form of arthritis or rheumatic conditions(2). Rheumatoid Arthritis can induced bone loss through elevating bone resorption without increasing bone formation(4). A cross-sectional population-based study of 1042 patients with rheumatoid arthritis showed that RA patients had an increased risk of death from various causes(4a).

                            The Risk factors

1. Age
The prevalence of Rheumatoid arthritis is proportional with the progression of age. The University of Twente study suggests age is independently associated with the levels of both acute phase reactants in early RA.(48).
In a study of 950 RA patients, the median age at the time of onset of RA according to age of the young-onset RA (YORA) and late-onset RA (LORA) is 58(49).
According to the joint study lead by the Leiden University Medical Center, Zone, expression of gene IL7R gene expression associates with longevity and healthy ageing are also found to involved risk of immune-related disease, such as RA and reduced health(50).

2. Gender and body mass index
If you are women and overweight, you are at increased risk to develop Rheumatoid Arthritis(51)(52)(54), probably due to the association between body composition BMI and inflammatory activity of in rheumatoid arthritis(55). The Korea study suggests, Middle- and old-aged women accounted for the majority of the Korean RA population, of which interfere with daily activity and employment rate(53).

3. Race
Genome-wide association studies and meta-analysis indicate that several genes/loci are consistently associated with rheumatoid arthritis (RA) in European and Asian populations(40). In treatment of RA, Dr. Constantinescu F and the research team at the Virginia Commonwealth University said " (there is) racial disparities in treatment preferences for rheumatoid arthritis(56). The University of Nebraska, Omaha suggests 52 percent of African American subjects were found to be risk averse compared with 12% of the white subjects. Race remained strongly associated with risk aversion in RA(57).

4. Smoking
Smoking is considered as one of the environment risk factor in involvement of Rheumatoid arthritis (RA) development and severity(58). The Danish study insisted that smoking exhibits other risk factors including IgM-rheumatoid factor, anti-CCP and shared epitopes in contribution to the early onset of rheumatoid arthritis(59). In fact, the medical literature was reviewed from 1985 to 2001 with the assistance of a MEDLINE showed that cigarette smoking has been increasingly shown in epidemiologic and case-control studies to be an important risk factor for both the incidence and severity of RA, especially in seropositive men. The poor habit also induce mutations or alterations in p53, a suppressor gene found in patients with RA(60).


5. Family history
Rheumatoid arthritis (RA) is associated to greater risk in the first degree relatives in familial clustering, mothers confer susceptibility to RA on their offspring more often than fathers(61). According to the data on patients with RA were ascertained through the nationwide Swedish Patient Register of 88,639, the clinical Swedish Rheumatology Quality Register of 11,519, risk of RA are same in both sex but Familial factors is found to be overlap between seropositive RA and seronegative RA(62).


6. Vaccines
Certain vaccines may cause Rheumatoid Arthritis(65). But there is no statistically significant association between exposure to vaccine and onset of RA, according to the Kaiser Permanente Vaccine Study Center(64).

7. Other risk factors
Dr. Oliver JE and Dr. Silman AJ. in the study risk factors are that lead to the development of rheumatoid arthritis (RA). suggest diets high in caffeine, low in antioxidants, high in red meat, changes in the female hormonal environment such as in pregnancy, breastfeeding and the use of the oral contraceptive (OC) pill, cigarette smoking and passive inhalation of smoke may also contribute to an increased risk of RA(63).


Arthritis Is Curable
You Can Eliminate Osteoarthritis
By addressing the Underlying Causes through Clinical Trials and Studies

Ovarian Cysts And PCOS Elimination
Holistic System In Existence That Will Show You How To
Permanently Eliminate All Types of Ovarian Cysts Within 2 Months

Super foods Library, Eat Yourself Healthy With The Best of the Best Nature Has to Offer recommended by Kyle J. Norton

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References

(1) 8 Areas of Age-Related Change(NIH)
(2) Arthritis-Related Statistics(CDC)
(3) Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis by Keenan MA1, Peabody TD, Gronley JK, Perry J.(PubMed)
(4) Serum Sclerostin Level Among Egyptian Rheumatoid Arthritis Patients: Relation to Disease Activity ,Bone Mineral Density and Radiological Grading by Mehaney DA, Eissa M, Anwar S, El-Din SF(PubMed)
(4a) Death rates and causes of death in patients with rheumatoid arthritis: a population-based study by Sihvonen S1, Korpela M, Laippala P, Mustonen J, Pasternack A(PubMed)
(48) How age and sex affect the erythrocyte sedimentation rate and C-reactive protein in early rheumatoid arthritis by Siemons L1, Ten Klooster PM, Vonkeman HE, van Riel PL, Glas CA, van de Laar MA.(PubMed)
(49) Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study by Innala L, Berglin E, Möller B, Ljung L, Smedby T, Södergren A, Magnusson S, Rantapää-Dahlqvist S, Wållberg-Jonsson S.(PubMed)
(50) IL7R gene expression network associates with human healthy ageing by Passtoors WM1, van den Akker EB2, Deelen J3, Maier AB4, van der Breggen R1, Jansen R5, Trompet S6, van Heemst D7, Derhovanessian E8, Pawelec G8, van Ommen GJ9, Slagboom PE3, Beekman M3.(PubMed)
(51) Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study by Jawaheer D, Olsen J, Lahiff M, Forsberg S, Lähteenmäki J, da Silveira IG, Rocha FA, Magalhães Laurindo IM, Henrique da Mota LM, Drosos AA, Murphy E,Sheehy C, Quirke E, Cutolo M, Rexhepi S, Dadoniene J, Verstappen SM, Sokka T; QUEST-RA.(PubMed)
(52) Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUEST-RA study by Sokka T, Toloza S, Cutolo M, Kautiainen H, Makinen H, Gogus F, Skakic V, Badsha H, Peets T, Baranauskaite A, Géher P, Ujfalussy I, Skopouli FN, Mavrommati M, Alten R, Pohl C, Sibilia J, Stancati A, Salaffi F, Romanowski W, Zarowny-Wierzbinska D, Henrohn D, Bresnihan B, Minnock P, Knudsen LS, Jacobs JW,Calvo-Alen J, Lazovskis J, Pinheiro Gda R, Karateev D, Andersone D, Rexhepi S, Yazici Y, Pincus T; QUEST-RA Group.(PubMed)
(53) Socioeconomic and employment status of patients with rheumatoid arthritis in Korea by Kwon JM1, Rhee J, Ku H, Lee EK.(PubMed)
(54) Body mass index and the risk of rheumatoid arthritis: a systematic review and dose-response meta-analysis by Qin B1, Yang M2,3, Fu H4, Ma N5, Wei T6, Tang Q7, Hu Z8, Liang Y9, Yang Z10, Zhong R11.(PubMed)
(55) Association between body composition and inflammatory activity in rheumatoid arthritis. A systematic review.[Article in English, Spanish]by Alvarez-Nemegyei J1, Buenfil-Relloy FA2, Pacheco-Pantoja EL3.(PubMed)
(56) Racial disparities in treatment preferences for rheumatoid arthritis by Constantinescu F1, Goucher S, Weinstein A, Fraenkel L.(PubMed)
(57) The association of race and ethnicity with disease expression in male US veterans with rheumatoid arthritis by Mikuls TR1, Kazi S, Cipher D, Hooker R, Kerr GS, Richards JS, Cannon GW.(PubMed)
(58) Smoking and rheumatoid arthritis by Chang K1, Yang SM2, Kim SH3, Han KH4, Park SJ5, Shin JI2.(PubMed)
(59) [Smoking--a risk factor for rheumatoid arthritis development].[Article in Danish] by Christensen AF1, Lindegaard HM, Junker P.(PubMed)
(60) Cigarette smoking and rheumatoid arthritis by Albano SA1, Santana-Sahagun E, Weisman MH.(PubMed)
(61) Family history as a risk factor for rheumatoid arthritis: a case-control study by Koumantaki Y1, Giziaki E, Linos A, Kontomerkos A, Kaklamanis P, Vaiopoulos G, Mandas J, Kaklamani E.(PubMed)
(62) Familial risks and heritability of rheumatoid arthritis: role of rheumatoid factor/anti-citrullinated protein antibody status, number and type of affected relatives, sex, and age by Frisell T1, Holmqvist M, Källberg H, Klareskog L, Alfredsson L, Askling J.(PubMed)
(63) Risk factors for the development of rheumatoid arthritis by Oliver JE1, Silman AJ.(PubMed)

The Smoothie of Carrot, Brazil Nut and Green Tea for Prevention and Treatment of Vulvar Cancer

Kyle J. Norton(Scholar, Master of Nutrients), all right reserved.
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

The smoothie for prevention and treatment of  Vulvar Cancer
Yield: 2 servings (about 8 ounces each)
1 cup Brazil nut
1/2 cup carrot
1 cup green tea drink (Make from 4 grams of green tea and a cup of hot water lipped for 5 minutes, and let cool to room temperature)

1. Place all ingredients in a blender and puree about 1 minute
2. Blend on high speed about 1 minute or until the mixture is thick and the ice is well crushed.
3. Serve immediately

The finding of a natural source for treatment of  Vulvar Cancer has been running into many obstacles, many ingredients showed initially with promising result in animal studies have not produced same potentials in large sample size and mutli centers human trials.

Vulva cancer is a cancer arises from the abnormal cells growth of the epidermis of the vulvar tissue. The invasive cancer tends to affects women in later life and accounts for approximate 4 % of all female reproductive organs cancers.
Recent studies back by well known institutions proposed, Green Tea(1) may be the next generation of natural ingredients for prevention and treatment of Vulvar Cancer.
Green tea has been a precious drink in traditional Chinese culture and used exceptional in socialization for more than 4000 thousand years. Due to its commercial values and health effects, green tea now has been cultivated all over the world in suitable climate. According to Associates in Women's Health Care, women who adopt healthy lifestyles and practice preventive healthy behaviors can reduce the risks of some cancers and other diseases, such as drinking tea(1) and intake of tomatoes regularly(1) and  Pap smear in screening(1)(2).
Dr. Han J said,"green tea extract inhibited 12-O-tetradecanoylphorbol-3-acetate-induced epidermal ornithine decarboxylase activity and counteracted 12-O-tetradecanoylphorbol-3-acetate-induced ear edema in mice. It is interesting that green tea extract inhibited the transformation of Balb/c 3T3 cells induced by methylcholanthrene and 12-O-tetradenanoylphorbol-3-acetate" of that related to the develop and progression of vulvar leukoplakia(3).

Major carotenoids, particular alpha carotene in common fruits and vegetables such as tomatoes and carrot might have a protective and preventive effect in reduced risk of Vulvar Cancer(4). According to the study of a total of in 88 women with gynecologic cancer (9vulvar, 15 cervical, 36 endometrial and 28 ovarian carcinomas) and 31 healthy control by Tampere University Central Hospital, serum of vitamin A is lower in women with vulvar Cancer(5).
13-cis-retinoic acid, a synthetic version with similar effect as vitamin A showed a significant effect in chronic epithelial vulvar dystrophies from long term and local retinoid treatment(6). The chemical also induced complete disappearance of dystrophy of the vulva in 33 out of 53 patients(7).

Selenium found abundantly in Brazil nut may also exhibited anti cancer effect(3). Patients with vulvar cancer are associated to reduced serum of selenium and antioxidative mechanisms(8).
Dr, Sundström H and colleagues,said," (selenium ) may be defective and that treatment with selenium and vitamin E results in changes of biochemical factors related to lipid peroxidation (in in uterine, ovarian or vulvar cancer)"(8).

Taking altogether, the combination of Carrot, Brazil Nut and Green Tea may process the activities in reduced risk and treatment of patient with Vulvar Cancer
Women who are at increased risk of Vulvar Cancer due to family history, genetic mutation, .... should drink 1 serving daily and people with Vulvar Cancer should drink as much as they can, depending to digestive toleration.
Life style and diet pattern changed are recommended

References
(1) Tomatoes, Pap smears, and tea? Adopting behaviors that may prevent reproductive cancers and improve health by Furniss K1.(PubMed)
(2) Screening for gynecologic cancer. Vulvar, vaginal, endometrial, and ovarian neoplasms by Hall KL1, Dewar MA, Perchalski J.(PubMed)
(3) Highlights of the cancer chemoprevention studies in China by Han J1.(PubMed)
(4) Diet and the risk of vulvar cancer by Sturgeon SR1, Ziegler RG, Brinton LA, Nasca PC, Mallin K, Gridley G.(PubMed)
(5) Serum vitamins A and E and carotene in patients with gynecologic cancer by Heinonen PK1, Kuoppala T, Koskinen T, Punnonen R.(PubMed)
(6) Leukoplakia of the vulva locally treated by 13-cis-retinoic acid by Markowska J, Janik P, Wiese E, Ostrowski J.(PubMed)
(7) Dystrophy of the vulva locally treated with 13-cis retinoic acid by Markowska J1, Wiese E.(PubMed)

Most Common Diseases of 50plus: Pulmonary vascular disease(Respiratory disease): Pulmonary embolism- Misdiagnosis and Diagnosis

Kyle J. Norton(Scholar and Master of Nutrients, all right reserved)
Health article writer and researcher; Over 10.000 articles and research papers have been written and published on line, including world wide health, ezine articles, article base, healthblogs, selfgrowth, best before it's news, the karate GB daily, etc.,.
Named TOP 50 MEDICAL ESSAYS FOR ARTISTS & AUTHORS TO READ by Disilgold.com Named 50 of the best health Tweeters Canada - Huffington Post
Nominated for shorty award over last 4 years
Some articles have been used as references in medical research, such as international journal Pharma and Bio science, ISSN 0975-6299.

                           Respiratory Disease

Respiratory Disease is defined as medical conditions, affecting the breathing organ and tissues including Inflammatory lung disease, Obstructive lung diseases, Restrictive lung diseases, Respiratory tract infections, trachea, bronchi, bronchioles, alveoli, the nerves and muscles breathing, etc,.

         Pulmonary vascular disease:  Pulmonary embolism


Pulmonary vascular disease is defined as a condition of blood flow to the lung’s artery is blocked suddenly due to a blood clot somewhere in the body, including pulmonary embolism, chronic thromboembolic disease, pulmonary arterial hypertension, pulmonary veno-occlusive disease, pulmonary arteriovenous malformations, pulmonary edema, etc.
                                                   
Pulmonary embolism (PE) is defined as a condition of blockage of blood flow due to a blood clot of either in main artery of the lung or somewhere else in the body. In most cases, it is in the deep veins of the legs or pelvic. The disease is a common and affect as many as 500,000 persons annually in the United States

                   Misdiagnosis and Diagnosis

D.1. Misdiagnosis
1. Congenital absence of the pericardium
There is a report of a case of a 23 year-old-male, who presented to the hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, according to St Francis Medical Center(29).
2. Pulmonary Artery Leiomyosarcoma
There is a report of a 64-year-old woman presented with progressive weakness, fatigue, malaise, and dyspnea, and a marked elevation of pulmonary artery pressure was admitted. She was initially diagnosed with chronic pulmonary thromboembolism and chest computed tomography (CT) scan revealed that lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. MRI demonstrated a polypoid lesion at trunk with extension to left main pulmonary artery and its first branch(30).
3. Soft tissue sarcomas of the lower limb
Deep venous thrombosis (DVT) or pulmonary embolism (PE) is a rare, but not exceptional presentation of soft tissue sarcomas (STSs). According to the study by the University Hospital Agostino Gemelli, Catholic University of the Sacred Heart School of Medicine, STSs of the lower extremities can rarely present with DVT or PE. This possibility should be considered in the differential diagnosis of painful leg swelling, especially in patients with recurrent or refractory venous thrombosis. When a STS is suspected, MRI should be obtained followed by excisional biopsy of the eventual mass. A delay in diagnosis and treatment of STSs often results in very poor prognosis.Level of evidence(31).
4. Acute anterior myocardial infarction
Pulmonary embolism remains the major malingerer of acute chest disease. There is a report of a case of bilateral pulmonary embolism in a patient of 50 years. The electrocardiogram showed ST elevation in anteroseptal and lateral leads. The diagnosis of acute myocardial infarction was selected and a fibrinolysis achieved. Getting out under beta-blocker therapy, antiplatelet, statin and angiotensin-converting enzyme inhibitors after 10 days hospitalization, the patient was readmitted one month later for a massive pulmonary embolism(32).
5. Acute abdomen
Pulmonary embolisms (PEs) are easily missed both in children and adults because of the varied presentations and subtle clinical findings. There is a report of a series of 2 cases of PE presenting as acute abdomen. Case 1 is a 14-year-old adolescent boy who presented to a pediatric emergency department with abdominal pain, whereas case 2 is a 22-year-old man who presented to the adult emergency department of the same institution with abdominal pain. There was a delay in diagnosis in both cases due to lack of recognition of the unusual presentation. Awareness of the unusual presentations of PE and the risk factors in both adults and children can assist the clinician toward an accurate diagnosis and timely therapeutic intervention(33).
6. Pulmonary artery sarcoma
In a Case analysis and literature review by Chinese Academy of Medical Science and Peking Union Medical College, pulmonary artery Sarcoma can be easily misdiagnosed as pulmonary thromboembolism(34).
D.2. Diagnosis
1. Chest X-ray
In the study to investigate if preliminary chest radiograph (CXR) findings can define the optimum role of lung scintigraphy in subjects investigated for pulmonary embolism (PE), showed that In subjects investigated for PE, an abnormal CXR increases the prevalence of non-diagnostic scintigrams. A normal pre-test CXR is more often associated with a definitive (normal or high probability) scintigram result. The chest radiograph may be useful in deciding the optimum sequence of investigations(35).
2. Ventilation-perfusion (V/Q) scan(Lung scan) and Spiral CT scan
Ventilation-perfusion (V/Q) imaging has been used as the screening test for pulmonary embolism (PE) for many years with diagnostic algorithms developed as a result of the Prospective Investigation of Pulmonary Embolism Diagnosis study. With the increasing availability of spiral (helical) computed tomography (CT) and many studies showing a high degree of accuracy for PE, there is much support for the replacement of V/Q by spiral CT. This article reviews the literature concerning V/Q scanning, spiral (helical) CT, and the future potential for magnetic resonance in the diagnosis of PE(36).
3. Pulmonary angiogram
Traditionally, pulmonary angiography has been the gold standard, but over the years computed tomography pulmonary angiography (CTPA) has replaced it and is now the first line imaging test(37).
4. D-dimer blood test
In the study to validate the use of the Wells clinical decision rule combined with a point of care D-dimer test to safely exclude pulmonary embolism of 598 adults with suspected pulmonary embolism in primary care, found that pulmonary embolism was present in 73 patients (prevalence 12.2%). On the basis of a threshold Wells score of ≤ 4 and a negative qualitative D-dimer test result, 272 of 598 patients were classified as low risk (efficiency 45.5%). Four cases of pulmonary embolism were observed in these 272 patients (false negative rate 1.5%, 95% confidence interval 0.4% to 3.7%). The sensitivity and specificity of this combined diagnostic approach was 94.5% (86.6% to 98.5%) and 51.0% (46.7% to 55.4%)respectively(38).
5. Thorax ultrasound (TUS)
In the multicenter study to determine the accuracy of thorax ultrasound (TUS) in the diagnosis of PE (TUSPE) with data from January 2002 through September 2003 of 352 patients with suspected PE, showed that TUS is a noninvasive method to diagnose peripheral PE. In the absence of CTPA, TUS is a suitable tool to demonstrate a PE at the bedside and in the emergency setting(39).
6. Magnetic resonance imaging (MRI)
In the study to assess the individual and combined usefulness of MRI techniques in cases of acute pulmonary embolism and to compare the usefulness of these techniques with that of 16-MDC, showed that MR perfusion imaging had a sensitivity of 93% for subsegmental pulmonary embolism(40).

All Forms of Arthritis are Curable


Ovarian Cysts And PCOS Elimination


Sources
(29) http://www.ncbi.nlm.nih.gov/pubmed/23580923
(30) http://www.ncbi.nlm.nih.gov/pubmed/23607029
(31) http://www.ncbi.nlm.nih.gov/pubmed/23421389
(32) http://www.ncbi.nlm.nih.gov/pubmed/21272851
(33) http://www.ncbi.nlm.nih.gov/pubmed/19555633
(34) http://www.ncbi.nlm.nih.gov/pubmed/15634383
(35) http://www.ncbi.nlm.nih.gov/pubmed/11384139
(36) http://www.ncbi.nlm.nih.gov/pubmed/15199498
(37) http://www.ncbi.nlm.nih.gov/pubmed/23591793
(38) http://www.ncbi.nlm.nih.gov/pubmed/23036917
(39) http://www.ncbi.nlm.nih.gov/pubmed/16162754
(40) http://www.ncbi.nlm.nih.gov/pubmed/16794142