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Kumagai and Kouchi [34] investigated cozaar 25mg discount, in Lotus japonicus hairy roots cheap cozaar 25 mg with mastercard, an effcient system for loss-of- 278 S. This process has been investigated in Duboisia hybrid hairy roots to overexpress the hyoscyamine-6-hydroxylase (H- 6-H) encoding enzyme, which catalyzes two consecutive steps of the tropane alkaloid biosynthesis pathway [35]. This metabolic engineering strategy was successfully applied to circumvent prob- lems related to precursor availability or negative feedback regulatory loops. If no chemical or physical trap is known, the possibility of introducing a transgene encoding a protein capable of trapping the expected metabolite may be possible. In Solanum khasianum hairy roots, this strategy has been explored to divert the negative feedback regulatory loop performed by solasodine glycoside, an antineoplastic agent, on its own expression [42]. The binding of solasodine glycoside with its recombinant antibody, expressed from a foreign gene after its integration into the genome of the hairy roots, has been successfully developed. By eliminating the negative feedback, the production of solasodine glycoside was enhanced by two to threefold [43]. Chapter 14 Hairy Roots: a Powerful Tool for Plant Biotechnological Advances 279 14. Complex proteins, expressed in plant organs, must often be extracted from tissues and purifed by costly and labourious processes. This fusion protein was tested in mouse as an antigen, showing that proteins fused to ricin B, taken as a mucosal adjuvant in mamma- lian immune responses, can be effciently produced by hairy roots. Moreover, the production of this protein can be improved with a system based on culture confnement. In fact, ricin B is sensitive to the proteases present in the culture medium of hairy roots; nevertheless a two-phase extraction process can im- prove the stability of this protein by increasing its production and facilitating its harvest in the organic phase [46]. A nondestructive rhizosecretion system, coupled to a trapping process, can lead to high amounts of recombinant pro- teins and facilitate their downstream purifcation. These studies demonstrate that hairy roots are becoming a serious alternative to whole plants for the pro- duction of therapeutically functional animal proteins. Toxic organic molecules can accumulate in plant organs in an unchanged form (a process called phytoextraction) or converted enzymati- cally into a harmless form (a process called phytotransformation) [48]. Hairy roots represent a biological study model without interference with other part 280 S. In this way, hairy roots from hyperaccumulator plants able to uptake cadmium, nickel, or uranium have been investigated recently because of their greater penetration, increasing their ability to retrieve contaminants from deeper soils, and enzymatic degradation (Table 14. In addition to the phytoremediation strategies, knowledge of genetic engineering offers new possibilities by which the environment can be cleaned. Depending on the plant species and the organ culture, bioreactors adapted to liquid, air, or both conditions of cultures have recently been designed and optimized (Table 14. In addition, the airlift system designed for microorganisms or plant cells in a liquid medium, has been reported to work effciently for the growth of Arteme- sia annua hairy roots [58] and for producing betalaine from Beta vulgaris hairy roots [57]. The scale up favored both productivity and tissue growth by using Chapter 14 Hairy Roots: a Powerful Tool for Plant Biotechnological Advances 281 Table 14. The diffculty with organ cultures of hairy roots is in achieving good homogenization of the roots in the bioreactor. This problem could be avoided if hairy roots are cultured in an airlift mesh draught reactor, as described by Caspeta et al. Attaching hairy roots to a mesh support allows reduction of the volume of culture and allows the concentration of the secreted metabolite. This system was used in a mist culture system for Hyoscyamus muticus [62], Tagetes patula [60] and Campthoteca hairy roots. The multiplication of reactors, instead of raising the culture volume, enhances the capacity of metabolite production by hairy roots and, if a problem appears, the production of only one reactor is lost. When the expected metabolite is stable and does not require confned conditions of culture, a cheaper hydroponic cul- ture can be designed. Such a hydroponic system was used to produce a recom- binant protein rhizosecreted by adventitious roots and hairy roots [44]. Scaling up such cultures for industry can be achieved by optimizing culture medium parameters and overexpression of metabolic genes. The discovery of new genes that participate in the metabolic pathways from hairy root studies increases the tremendous potential of such cultures. It is also predicted that this model of pharmaceutical production is relatively safe and stands as a viable alternative to the whole-plant molecular farming sys- tem. This prediction is strengthened by the observation that emerging private companies have converted this technology to allow production at a commercial scale. This is a serious indication that in the near future, hairy roots will become powerful tools for biotechnologists with which to reach the precious under- ground resources of the plant kingdom. Inoguchi M, Ogawa S, Furukawa S, Kondo H (2003) Biosci Biotechnol Biochem 67:863 6. Guillon S, Trémouillaux-Guiller J, Kumar Pati K, Rideau M, Gantet P (2006) Trends Biotechnol 24:403 15. Guillon S, Tremouillaux-Guiller J, Kumar Pati P, Rideau M, Gantet P (2006) Curr Opin Plant Biol 9:341 16. Staniszewska I, Krolicka A, Malinski E, Lojkowska E, Szafranek J (2003) Enzyme Microb Technol 33:565 18.

Over 80 generic 25mg cozaar,000 soldiers perished in the Civil War buy discount cozaar 25mg online, not from bullets, but from dehydration related to diarrheal disease. Diarrhea is a common ailment and may go away on its own simply by restricting your patient to clear fluids and avoiding solid food for a period of time. However, there are some symptoms that may present in association with diarrhea that can be a sign of something more serious. Those symptoms are: Fever equal to or greater than 101 degrees Fahrenheit Blood or mucus in the stool Black or grey-white stool Severe vomiting Major abdominal distension and pain Moderate to severe dehydration Diarrhea lasting more than 3 days All of the above may be signs of serious infection, intestinal bleeding, liver dysfunction, or even surgical conditions such as appendicitis. As well, all of the above will increase the likelihood that the person affected won’t be able to regulate their fluid balance. Epidemics caused by organisms that cause diarrhea have been a part of the human experience since before recorded history. Cholera is one particularly dangerous disease that was epidemic in the past and may be once again in the uncertain future. Although there is a vaccination, it is not very effective; therefore, I cannot recommend it. Typhoid fever is another very dangerous illness caused by contaminated food or drink. It is characterized by bloody diarrhea and pain and, like cholera, has been the cause of deadly outbreaks over the centuries. In typhoid cases, fever rises daily and, after a week or more, you may see a splotchy rash and spontaneous nosebleeds. The end result (and most common cause of death) of untreated diarrheal illness is dehydration. Children become dehydrated more easily than adults: 4 million children die every year in underdeveloped countries from dehydration due to diarrhea and other causes. The thirst mechanism is activated when you have lost just 1% of your total body water content. You are still functioning normally but if you fail to replace the fluids, you will begin to feel ill. As the percentage of water lost increases, however, you begin to see additional symptoms and increased risks. Dehydration is often classified as mild, moderate, and severe: Mild dehydration: 2% of water content lost (5% of body weight). Pulse rate and respiration rate may begin to increase Moderate dehydration: 4% of water content lost (10% of body weight). In addition to the above symptoms, the patient experiences nausea and vomiting (even if they didn’t before), dizziness, fatigue and mood swings. In addition to the above symptoms, the patient experiences loss of coordination and becomes incoherent and delirious. In severe dehydration, you will notice changes in the skin elasticity, also known as “turgor”. To determine skin turgor, pick up the skin on the lower arm or torso between two fingers so that it is “tented” up. Skin with decreased turgor remains elevated or returns slowly to normal in a severely dehydrated individual. Once a person is severely dehydrated, continued water loss begins to cause the patient to be unable to regulate their own body temperature. Once they reach approximately 20% water loss, the patient may slip into a coma and die. Clear fluids are easier for the body to absorb; examples include: water, clear broth, gelatin, Gatorade, Pedialyte, etc. Oral rehydration packets are commercially available, but you can produce your own homemade rehydration fluid very easily: To a liter of water, add: 6-8 teaspoons of sugar (sucrose) 1 teaspoon of salt (sodium chloride) ½ teaspoon of salt substitute (potassium chloride) A pinch of baking soda (sodium bicarbonate) As the patient shows an ability to tolerate these fluids, advancement of the diet to juices, puddings and thin cereals like grits or farina (cream of wheat) is undertaken. This diet consists of: Bananas Rice Applesauce Plain Toast (or crackers) The advantage of this strategy is that these food items are very bland, easily tolerated, and slow down intestinal motility (the rapidity of movement of food/fluids through your system). In a collapse situation, you will probably not have many bananas, but hopefully you have stored rice and/or applesauce, and have the ability to bake bread. Of course, there are medicines that can help and you should stockpile these in quantity. They don’t cure infections, but they will slow down the number of bowel movements and conserve water. Doctors will usually have no qualms about writing this prescription, especially if you are traveling out of the country. Herbal remedies that are thought to “dry up” the mucous membranes in the intestine include: Blackberry leaf Raspberry leaf Peppermint Make a tea with the leaves and drink a cup every 2-3 hours.

If you draw a line vertically down the length of their body discount cozaar 25 mg with amex, each side is essentially the same order cozaar 50 mg online. This means that, if you are uncertain whether a limb is injured or deformed, you can compare it to the other side. Certainly, there’s a lot more to a physical exam than what you’ve just read, but practicing exams on others will give you experience. Once you get the hang of it, your efforts will prepare you for making a diagnosis if we find ourselves without access to modern medical care. Most of these exams will be unhurried and routine, but, occasionally, you will have to make some quick decisions. A victim’s chance of survival decreases significantly if not treated within 1 hour of the injury. The responsibilities of a medic in times of trouble will usually be one-to-one; that is, the healthcare provider will be dealing with one ill or injured individual at a time. If you have dedicated yourself to medical preparedness, you will have accumulated significant stores of supplies and some knowledge. Therefore, your encounter with any one person should be, with any luck, within your expertise and resources. There may be a day, however, when you find yourself confronted with a scenario in which multiple people are injured. A mass casualty incident is any event in which your medical resources are inadequate for the number and severity of injuries incurred. They might be: Doomsday scenario events, such as nuclear weapon detonations Terrorist acts, such as occurred on 9/11 or in Oklahoma City Consequences of a storm, such as a tornado or hurricane Consequences of civil unrest Mass transit mishap (train derailment, plane crash, etc. Triage comes from the French word “to sort” (“Trier”) and is the process by which medical personnel (like you, survival medic) can rapidly assess and prioritize a number of injured individuals, thereby doing the most good for the most people. Let’s assume that you are in a marketplace somewhere in the Middle East or perhaps in your survival village near the border with another (hostile) group. As the first to respond to the scene, medic, you are Incident Commander until someone with more medical expertise arrives on the scene. Your initial actions may determine the outcome of the emergency response in this situation. Safety Assessment: In the Middle East, an insidious strategy on the part of terrorists is the use of primary and secondary bombs. The main bomb causes the most casualties, and the second bomb is timed to go off or is triggered just as the medical/security personnel arrive. Many medical professionals wince when I talk about not approaching the injured in a hostile setting. Because your primary goal as medic is your own self-preservation; keeping the medical personnel alive is likely to save more lives down the road. Therefore, you do your family and community a disservice by becoming the next casualty. In the immediate aftermath of the Oklahoma City bombing, various medical personnel rushed in to aid the many victims. One of them was a heroic 37 year old Licensed Practical Nurse who, as she entered the area, was struck by a falling piece of concrete. Do not rush in there until it is certain that you and your helpers are safe entering the area. Are there areas open enough for vehicles to come through to help transport victims? Sending for Help: If modern medical care is available, call 911 and say (for example): “I am calling to report a mass casualty incident involving a multi-vehicle auto accident at the intersection of Hollywood and Vine (location). I’m sure you could do even better than I did above, but you want to inform the emergency medical services without much delay. If you are the current Incident Commander, get your walkie-talkie or handie-talkie and notify base camp of the situation and what you’ll need in terms of personnel and supplies. The most experienced medical person who arrives then becomes the new Incident Commander. Set-Up: Determine likely areas for various triage levels (see below) to be further evaluated and treated. Also, determine the appropriate entry and exit points for victims that need immediate transport to medical facilities, if they exist. If you are blessed with lots of help at the scene, determine triage, treatment, and transport team leaders. The first round of triage, known as “primary triage”, should be fast (30 seconds per patient if possible) and does not involve extensive treatment of injuries. Evaluation in primary triage consists mostly of quick evaluation of respirations (or the lack thereof), perfusion (adequacy of circulation), and mental status. Other than controlling massive bleeding and clearing airways, very little treatment is performed in primary triage.

Ballantyne cozaar 50 mg amex, Marrs and Syversen was published by John Wiley & Sons on 23rd October 2009 cheap cozaar 25 mg on-line. Peroxynitrite leads to a partial breakdown of the blood‐brain barrier, leading to increased chemical access to the brain. Once the cycle is initiated, it becomes the cause of the chronic illness, with the initiating chemical, viral or traumatic stressor often long gone. The Endocrinologist 2002:12:513‐522), indicating that the post‐ exertional increase in symptoms may be explained by the hypocortisol responses. As Pall says: “Clearly one cannot claim to be doing science whilst simultaneously ignoring most of the relevant scientific literature. Wherever data exists clearly contradicting their views, they simply pretend it does not exist”. Pall challenged Stanley, Salmon and Peters to show that each of these eight abnormalities was consistent with their interpretation of a “rigorous scientific framework”. As Pall notes in his book “Explaining ‘Unexplained Illnesses’”: “One of the great puzzles about the psychogenic literature regarding these multisystem illnesses is how do so many bad papers get published? How do so many papers dominated by emotion laden phrases, by transparent falsehoods, by logical flaws, by overstated claims and by unsupported or poorly supported opinion get published in what appear to be respectable, peer‐reviewed journals? These papers consistently ignore massive amounts of contrary data and opinion and cannot, therefore, lay claim to objective assessment of the literature. The Wessely School persistently fail to assess the scientific evidence and continue to base their beliefs on ignorance rather than current knowledge, an ideology that, according to Pall, is intellectually bankrupt. They have made it difficult to obtain research funding on the physiological basis of these multisystem illnesses. What is not legitimate is to use their economic and political influence to stifle the scientific and health needs. They should be using their influence with the media, with political organizations and with scientists to push for research leading to the development of specific biomarkers of these illnesses such that any illegitimate claims can be falsified. Their failure to do this is sufficient evidence to infer that these powerful and very canny organizations have a different goal entirely: it is to deny legitimate claims and therefore deny any culpability on their part. To the extent that psychogenic advocates act to encourage such behaviour, they have a lot to answer for. To the extent that they make it difficult to develop truly effective therapies for these illnesses, they have still more”. At worst, it is a nightmare of increasing disability with both physical and neurocognitive components. It is hard to imagine or understand the shattered world experienced by patients in this book. The patients of ‘Lost Voices’ and their carers are heroes in the best sense of the term”. Fourteen years earlier, in his Eliot Slater Memorial Lecture in May 1994 referred to above, Simon Wessely said: “Organic diseases lose their credibility as their psychological causes are recognised”. Despite Wessely’s confident assertion, it has not been possible to find an example of an organic disorder losing its organic status when its psychological cause was recognised. Wessely did not mention that psychiatrists have a long track record of medical misattribution: the literature is replete with examples of diseases with (then) “unexplained” symptoms that psychiatrists claimed – with absolute certainty – as psychosomatic. These diseases include diabetes mellitus; epilepsy; multiple sclerosis, Graves’ disease; pernicious anaemia; myasthenia gravis; Parkinson’s Disease; gastric ulcer; migraine; Dupuytren’s contracture; gout; glaucoma; asthma; angina; ulcerative colitis and hay fever (Case Histories in Psychosomatic Medicine. As noted by George Davey‐Smith, Professor of Clinical Epidemiology at Bristol, a further example is that in 1948 – long before H‐Pylori was discovered in 1989‐‐ doctors in Mount Sinai Hospital advocated antibiotics for peptic ulcers, a treatment they knew was successful. A patent for an antibiotic formulation was issued in 1961, but the “stress model” served to block people from building on this and moving towards an answer that would have led to a treatment that could have dramatically improved the quality of life for millions of people. Various psychological interventions for peptic ulcer were advocated and large numbers of people were subjected to them. The usual claims for dramatic success were made, but properly conducted randomised controlled trials demonstrated no benefit. The conclusion of one well‐conducted trial was that “our study demonstrates a need for humility about the degree to which psychological interventions can effect powerful biological processes”. Davey‐Smith is the one dissenting voice in Biopsychosocial Medicine: his contribution (“The biopsychosocial approach: a note of caution”) carries the torch for intellectual integrity. Davey‐Smith showed that bias can generate spurious findings and that when interventional studies to examine the efficacy of a psychosocial approach have been used, the results have been disappointing. To quote from Davey Smith’s contribution: “Over the past 50 years many psychosocial factors have been proposed and accepted as important aetiological agents for particular diseases and then they have quietly been dropped from consideration and discussion”. Davey‐Smith went on to quote Susan Sontag’s well‐known dictum: “Theories that diseases are caused by mental state and can be cured by willpower are always an index of how much is not understood about the physical basis of the disease” (Illness as a metaphor. In his book “The Greatest Benefit to Mankind” (Harper Collins, London, 1997) the late Roy Porter noted that it was the biomedical model (not the psychosocial model) that has provided advances in the understanding ‐‐ and thus in the treatment and prevention ‐‐ of disease processes.