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E. Hjalte, M.A., Ph.D.

Medical Instructor, University of California, San Diego School of Medicine

The patient may feel weak and hungry on the first two days, but afterwards the condition will be stabilised by itself. Recent research has discovered in this vegetable a valuable content called tartroric acid which inhibits the conversion of sugar and other carbohydrates into fat. A helping of cabbage salad would be the simplest way to stay slim, a painless way of dieting. A hundred grams of cabbage yields only 27 kilo calories of energy while the same quantity of wheat bread will yield about 240 calories. Cabbage is found to possess the maximum biological value with minimum calorific value. Moreover, it gives a lasting feeling of fullness in the stomach and is easily digestible. Along with dietetic treatment, the patient should adopt all other natural methods of reducing weight. It helps to use up calories stored in body fat and relieves tension, besides toning up the muscles of the body. Walking is the best exercise to begin with and may be followed by running, swimming, rowing and other outdoor sports. Not only do they break up or re-distribute fatty deposits and help slimming, but they also strengthen the flabby areas. Sarvangasana, halasana, bhujangasana, shalabhasana, dhanurasana, chakrasana, naukasana, ardh-matsyendrasana, paschimottanasana, vajrasana, yogamudra and trikonasana are recommended. These asanas work on the glands, improve circulation, strengthen many weak areas and induce deep breathing which helps to melt off excess fat gradually. Yogic kriyas like kunjal and jalneti and pranayamas such as kapalbhati and bhastrika are also helpful in normalising body weight. The patient should also adopt measures which bring on excessive perspiration such as sauna baths, steam bath and heavy massage. Above all, obese persons should make every effort to avoid negative motions such as anxiety, fear, hostility and insecurity and develop a positive outlook on life. An ulcer may form in any part of the digestive tract which is exposed to acid gastric juice, but is usually found in the stomach and the duodenum. The ulcer located in the stomach is known as gastric ulcer and that located in the duodenum is called a deudenal ulcer. Symptoms the most common symptoms of peptic ulcer are sharp and severe pain and discomfort in the upper central abdomen. Duodenal ulcer pan usually occurs between meals when the stomach is empty and is relieved by food, especially milk. It is often described as hunger pain and gets the sufferer out of bed between 2 and 4 a. As the disease progresses there is distension of the stomach due to excessive flatulence, besides mental tension, insomnia and a gradual weakening of the body. Causes Peptic ulcers result from hyperacidity which is a condition caused by an increase in hydrochloric acid in the stomach. This strong acid, secreted by the cells lining the stomach, affects much of the breakdown of food. It can be potentially dangerous and, under certain circumstances, it may eat its way through the lining of the stomach or duodenum producing, first, irritation of the stomach wall and eventually an ulcer. Dietetic indiscretion, like overeating, taking of heavy meals or highly spiced foods, coffee, alcohol and smoking are the main factors contributing to this condition. The ingestion of certain drugs, particularly aspirin, food poisoning, infections like influenza and septicaemia and gout may also cause ulcers. Emotional stress or nervous tension also plays a major role in the formation of ulcers. The diet should be so arranged as to provide adequate nutrition to afford rest to the disturbed organs, to maintain continuous neutralisation of the gastric acid, to inhibit production of acid and to reduce mechanical and chemical irritation.

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As Kerrigan29 points out, many of these studies contradict one another, are performed by only one researcher on a number of different experimental models, and often use an inadequate cohort that precludes statistical validation of the results. Anticoagulants Dextran, originally designed as a volume expander, has been a tool of the microvascular surgeon for many years. Rothkopf et al246 cite a review of the effects of dextran, which include decrease in platelet adhesiveness and procoagulant activity; increased bleeding time; inhibition of platelet aggregation; and decrease in blood viscosity. Working on a venous model, Zhang and Wieslander248 observed increased microcirculatory patency when using dextran 70. The microperfusion was further enhanced when lowmolecular-weight heparin was added. Later Salemark, Knudsen, and Dougan249 noted increased patency of microcirculation with dextran 40, but only on a short term basis. Disa et al250 conducted a prospective randomized analysis of the morbidity associated with dextran and aspirin prophylaxis in head and neck microsurgery patients. The incidence of system complications for patients receiving low molecular weight dextran for 120 hours was 51%; for 48 hours, it was 29%; and for aspirin, 7%. Dextran is associated with significant systemic morbidity including anaphylaxis, pulmonary edema, cardiac complications, adult respiratory distress syndrome, and renal failure. Heparin is more effective at preventing venous thrombosis than arterial thrombosis. Sawada, Hatayama, and Sone253 report improved flap survival when heparin was continuously and topically administered to specific regions of their flaps. They attributed the beneficial effect to platelet disaggregation and maintenance of vascular patency by heparin, not to vasodilatation and increased vascular flow. These findings correspond with those of the Cox group,254 who noted a dose-related increase in flap patency with heparin. The effect was first noted at heparin concentrations of 100 U/mL, a dose the researchers find to be ideal from a morbidity standpoint. Kroll et al256 retrospectively reviewed 517 free flaps and noted a lower incidence of flap loss when heparin was administered (either as bolus or in low dose), but this difference was not statistically significant. Hudson et al257 reported the experimental and clinical use of a catheter placed proximal to the venous anastomosis for the direct infusion of heparin to prevent veous thrombosis. The local partial thromboplastin time was elevated but the systemic value ramined normal, therefore reducing the systemic complications of heparin. Thrombolytic agents act by the stimulation of plasminogen which is the precursor of plasmin which acts to cleave fibrin within a thrombus. Thrombolytics have been effective in animal models for the salvage of flaps after microvascular thrombosis. In flap salvage it is injected into the arterial side of the flap and drained through the venous side, usually avoiding systemic effects. Serletti et al260 reported 5 cases of venous thrombosis that were salvaged by revision of the venous anastomosis followed by intraoperative infusion of 250,000 units of urokinase. Leeches have been used in medicine since ancient times for the treatment of various ailments. In addition, leeches secrete hyaluronidase, which facilitates spread of the anticoagulant within the tissues, and a vasodilator, which contributes to prolonged bleeding (up to 48 hrs). Nevertheless, according to Rodgers et al,264 "no controlled study has proven the efficacy of leeching. The primary contraindication to leeches is arterial insufficiency, in which case the leeches will simply not attach themselves to the flap. The most significant risks are bacterial infection from the gram-negative rod Aeromonas hydrophila (which is the leech enteric organism resposible for red cell digestion), anaphylaxis, persistent bleeding, and excessive scarring. Current recommendations for treatment with medicinal leeches include prophylaxis with an aminoglycoside and a third-generation cephalosporin and caution when treating immunocompromised patients. Topical nitroglycerin is a potent vasodilator with a greater effect on the venous circulation than on arterial vessels. Rohrich and colleagues272 reported improved survival of axial flaps in pigs and rats treated with nitroglycerin ointment, as did Price and Pearl, 273 who applied nitroglycerin transdermally. Nichter,274 on the other hand, found no increase in survival of random pattern flaps in rats treated with nitroglycerin paste. In a later clinical study, Ichioka et al276 demonstrated an increase in microcirculatory blood flow in flaps after intravenous administration and a decrease in vasospasm after topical application of amrinone to the pedicle.

Post-translational processing of the glycoproteins of lymphocytic choriomeningitis virus. The signal peptide of the Junнn arenavirus envelope glycoprotein is myristoylated and forms an essential subunit of the mature G1-G2 complex. Arenavirus entry occurs through a cholesterol-dependent, non-caveolar, clathrin-mediated endocytic mechanism. Transferrin receptor 1 is a cellular receptor for New World haemorrhagic fever arenaviruses. Identification of -dystroglycan as a receptor for lymphocytic choriomeningitis virus and Lassa fever virus. Genome-wide scans provide evidence for positive selection of genes implicated in Lassa fever. Genome-wide detection and characterization of positive selection in human populations. Genome-wide identification of susceptibility alleles for viral infections through a population genetics approach. Biochemical and immunological evidence that the 11 kDa zincbinding protein of lymphocytic choriomeningitis virus is a structural component of the virus. Molecular biology of the prototype arenavirus, lymphocytic choriomeningitis virus. Lassa virus Z protein is a matrix protein and sufficient for the release of virus-like particles [corrected]. Differential inhibition of type I interferon induction by arenavirus nucleoproteins. Inhibition of the type I interferon response by the nucleoprotein of the prototypic arenavirus lymphocytic choriomeningitis virus. Physiological and immunologic disturbances associated with shock in a primate model of Lassa fever. Experimental infection of guinea pigs with Venezuelan hemorrhagic fever virus (Guanarito): a model of human disease. Ultrastructural and immunohistochemical study of the human kidney in Argentine haemorrhagic fever. Experimental Argentine hemorrhagic fever in rhesus macaques: viral strain-dependent clinical response. Experimental Argentine hemorrhagic fever in rhesus macaques: virus-specific variations in pathology. Replication of dengue and Junin viruses in cultured rabbit and human endothelial cells. Alteration of blood coagulation and complement system in neotropical primates infected with Junin virus. Studies of the coagulation system and blood pressure during experimental Bolivian hemorrhagic fever in rhesus monkeys. Studies of blood coagulation and pathology in experimental infection of guinea pigs with Junin virus. Junin virus infection of guinea pigs: immunohistochemical and ultrastructural studies of hemopoietic tissue. Normal platelet aggregation and release are inhibited by plasma from patients with Argentine hemorrhagic fever. Further studies on the plasma inhibitor of platelet activation in Argentine hemorrhagic fever. Early and strong immune responses are associated with control of viral replication and recovery in Lassa virus-infected cynomolgus monkeys. Low levels of interleukin-8 and interferon-inducible protein-10 in serum are associated with fatal infections in acute Lassa fever. Cutting edge: impairment of dendritic cells and adaptive immunity by Ebola and Lassa viruses. Lassa virus infection of human dendritic cells and macrophages is productive but fails to activate cells. Junнn virus infection of guinea pigs: electron microscopic studies of peripheral blood and bone marrow.

This risk factor includes both active and inactive inflammatory bowel diseases such as ulcerative colitis or regional ileitis. Swollen legs (current) Swollen legs include pitting edema of any level, loss of definition of the bony prominences, obscured surface foot veins, or indentation of the leg when a stocking is removed. Heart attack this refers to an acute myocardial infarction during the past 30 days. Congestive Heart Failure this risk factor includes patients who have had an episode within the last month. An ejection fraction alone should not be used when determining if a patient qualifies for this risk factor. Pneumonia) A "serious infection" is defined as a patient who requires hospitalization and intravenous antibiotics for treatment. Treatments that are less severe and are managed on an outpatient basis with oral antibiotics are not included. Serious infections would include diverticulitis, bacterial infection of the bladder and lungs, and septicemia. This would include, but not limited to , any patient with sarcoidosis, pulmonary fibrosis, pulmonary hypertension, and bronchiectasis. Patients who present with more than one diagnosis meeting the criteria for lung disease will receive a point for each diagnosis. Asthma is not considered a "lung disease" for the purpose of the risk assessment score. Additionally, patients with restrictive pulmonary disease related to obesity would not be included in these criteria. Bed rest (Restricted Mobility) [1 or 2 points depending on duration] We define restricted mobility (bedrest) as any individual who is unable to ambulate continuously more than 30 feet. We realize that there are other definitions regarding ambulation but we feel the above data are the most robust. We would answer that the bedrest in hospitalized patients is associated with their underlying disease process. For example, a person who has congestive failure, severe pain, infection, stroke, etc. A normal person goes to bed to get necessary rest, not because of a specific illness. Patients moving short distances to the bathroom or sitting in a chair are not ambulatory according to this definition. Although we use the term medical patients at bedrest, these scores apply to all patients. Patients who are using a cane or walker for stability are not considered as having restricted mobility if they are using their calf muscles for ambulation. Non-Removable Plaster Cast Or Mold (Worn For > 72 Hours) That Prevents Leg Movement Within the Last Month (2 points) the intent of this criterion is to capture any limitation in leg mobility which would interfere with calf muscle pumping action such as a leg brace or cast. The use of an assistive device for stability, such as a walker, would not meet the criteria if the patient is using their calf muscles. Confined to bed for 72 hours or more (unable to ambulate continuously 30 feet) "Confined to bed" is confusing terminology and should be referred to as impaired mobility. This would also apply to any patient who is unable to ambulate using both leg muscles. For example, a patient who requires crutches and is non-weight bearing would be considered as restricted mobility even though they can ambulate 30 feet. Patients who are using a cane or walker for stability are not included in this group if they are using their calf muscles for ambulation. Patients moving a short distance to the bathroom or sitting in a chair are not ambulatory according to this definition. Central Venous Lines Tube in blood vessel in the neck or chest that delivers blood or medicine directly to the heart within the last month.