Lia Fernald PhD, MBA

• Professor, Community Health Sciences

https://publichealth.berkeley.edu/people/lia-fernald/

Sequential analysis of adolescents with chronic ache and their dad and mom throughout an train task revealed that when dad and mom made statements that discouraged youngster coping nuevo xl3 antiviral order cheap minipress on line, the kid was less likely to hiv infection causes immunodeficiency because it buy cheap minipress 2 mg line stay on task hiv infection rates by population minipress 2mg free shipping, which was considerably associated with functional incapacity and faculty absences (Reid et al antiviral treatment best 2 mg minipress. Similarly Impact of child ache on the family Paediatric persistent pain considerably impacts on the family anti viral cleanse and regimen reviews generic minipress 2mg with mastercard. Parents of youngsters with persistent ache report high levels of parental position stress hiv infection rate in libya generic minipress 2.5mg fast delivery, anxiousness and depressive symptoms, and social influence (Palermo and Eccleston, 2009). Rates of tension, despair, and somatoform problems are larger amongst moms of children with continual pain as compared to mothers of healthy youngsters (Campo et al. Mothers with greater psychological distress had been more likely to seek physician consultation with child report of stomach ache (Levy et al. Parental protectiveness mediated the connection between parent pain catastrophizing and adolescent school functioning and attendance (Logan et al. Furthermore, baby pain catastrophizing moderated the relationship between father or mother symptom-related talk during a painful task and child symptom complaints; while the relationship between non-symptom discuss and baby symptom complaints was moderated by child perceived pain-related menace (Williams et al. Future analysis should continue integrating findings from experimental and clinic-based research, and incorporate extra advanced multivariate analyses to permit stronger claims in regards to the causal relationships between parental beliefs, functioning and behaviours, and child ache outcomes. Child autonomy, particularly, has predicted greater useful impairment among adolescents with chronic ache after controlling for pubertal status, pain intensity, and depressive signs (Palermo et al. Greater parent� adolescent conflict, poorer household functioning, and fewer age-appropriate autonomy predicted greater depressive signs for adolescents with persistent complications (Lewandowski and Palermo, 2009). Greater parent�adolescent relationship distress was related to increased adolescent distress and lower ache depth, but to not adolescent functional incapacity (Logan et al. Parents reported nearer relationships with their adolescent than wholesome norms (Logan et al. This intensive parenting function is more akin to parenting a youthful child (Jordan et al. Influence of family functioning A current systematic review revealed vital variations in household functioning between households of kids with continual ache and healthy controls (Lewandowski et al. Families of children with persistent pain generally reported poorer family functioning as exemplified via less household cohesion, less organization, larger battle, and higher psychological misery. Poorer family functioning was also associated with elevated baby incapacity; nonetheless the relationship between family functioning and baby ache was less constant, probably as a outcome of variations in how household functioning was measured throughout reviewed research (Lewandowski et al. Altogether, these research help the crucial role of family factors in paediatric chronic ache and should be included as an necessary goal for intervention. Role of household in interventions for paediatric persistent ache Research helps the effectiveness of parental involvement in remedy of persistent ache. Of 25 randomized managed trials included in a recent meta-analytic evaluate, seven described involvement of oldsters in psychological therapies for paediatric continual ache (Palermo 2009); however, the affect of parent/family involvement on trial outcomes was not explored. Findings assist the influence of mother or father behaviours, psychological functioning, and beliefs about ache. Several studies have innovatively built-in medical and experimental methods of inquiry, representing a promising development within the area bringing both scientific rigour and external validity to analysis findings. Consideration of a developmental framework is usually omitted from present theories of pain and the family. Investigations of the household in paediatric chronic ache are increasing in scope, exploring the influence of individual, dyadic and familial degree components. In contrast, research analyzing the family in paediatric acute ache are narrowing in scope, in search of a more detailed understanding of parent�child interactions. Pain and the family stays a really lively and progressive area of inquiry, offering continued insight into the broader context inside which children experience pain. Children attending this programme also confirmed improvements in bodily perform and disability, anxiety, ache catastrophizing, somatic consciousness, and faculty attendance (Eccleston et al. Future research should explore the pathways by way of which household involvement exerts positive change on child ache outcomes. The function of parental involvement in additional up to date approaches to paediatric pain administration, corresponding to in acceptance-based remedies, is needed (Wicksell, 2007, 2008). The child-adult medical process interaction scalerevised: an assessment of validity. Differences between excessive and low coping youngsters and between father or mother and employees behaviors during painful medical procedures. Caregiver accuracy in detecting deception in facial expressions of pain in kids. View from the inside, part 2: what the children with arthritis mentioned, and the experiences of siblings, mothers, fathers and grandparents. A child-focused intervention for dealing with procedural pain: are father or mother and nurse coaches essential Adolescent chronic ache: patterns and predictors of emotional distress in adolescents with continual ache and their parents. Associations between mother or father and youngster pain and functioning in a pediatric chronic pain pattern: a mixed strategies approach. Parent-child pain relationships from a psychosocial perspective: a review of the literature. Aggregation of ache complaints and pain-related disability and handicap in a community pattern of households. Wiesenfeld-Hallin (eds) Proceedings of the eighth World Congress on Pain: Progress in pain analysis and administration, pp. Being a parent of the adolescent with complex chronic ache: an interpretative phenomenological analysis. Family components, emotional functioning, and useful impairment in juvenile fibromyalgia syndrome. Mothers, fathers, and friends as socialization brokers of sex-typed play behaviors in young kids. Relationship between the decision to take a baby to the clinic for stomach pain and maternal psychological misery. Parent-teen interactions as predictors of depressive signs in adolescents with headache. Systematic evaluation of family functioning in households of youngsters and adolescents with chronic ache. Relationships between family and father or mother traits and functional abilities in kids with recurrent ache syndromes: an investigation of moderating results on the pathway from ache to disability. Adolescent� parent relationships within the context of adolescent chronic pain circumstances. Psychological, behavioral, and household traits of pediatric sufferers with persistent ache: a 1-year retrospective research and cluster analysis. Epidemiology and administration of painful procedures in kids in Canadian hospitals. Systematic evaluation of the psychometric properties, interpretability and feasibility of self-report pain intensity measures to be used in scientific trials in kids and adolescents. Reducing the ache of childhood vaccination: an evidence-based scientific practice guideline. Reducing the pain of childhood vaccination: an evidencebased medical follow guideline (summary). The affect of adult behaviors on baby coping during venipuncture: a sequential evaluation. Social modulation of facial ache show in high-catastrophizing children: an observational study in schoolchildren and their parents. Parental responses to ache in excessive catastrophizing youngsters: the moderating effect of kid attachment. Parent consideration versus distraction: influence on symptom complaints by kids with and with out persistent functional abdominal ache. Values-based exposure and acceptance within the therapy of pediatric chronic pain: from symptom reduction to valued dwelling. Hayes (eds) Acceptance and mindfulness remedies for kids and adolescents: a practitioners guide, pp. Cognitive behavioural remedy for pediatric chronic ache: the issue, analysis, and practice. Adolescent autonomy and household functioning are associated with headache-related incapacity. Early parental and baby predictors of recurrent abdominal ache at college age: results of a big population-based examine. Clinicians ought to understand the challenges skilled by children with chronic pain and will attend to the social and faculty consequences of pain when working with this inhabitants. Although little analysis has examined interventions to manage the effects of persistent ache on college and social functioning, researchers have recognized helpful methods that may mitigate the adverse penalties to social and school functioning related to persistent ache. The targets of this chapter are: (1) to evaluation the literature on social and school functioning for children and adolescents with persistent ache; (2) discuss methods to ameliorate difficulties; and (3) highlight instructions for future research. This cycle of ache expression, interpretation, and subsequent pain expression may be as influential in the social interactions of kids and adolescents with chronic ache as particular person pain elements such as ache depth. Introduction Peer relationships and shut friendships are a elementary a half of child growth and become more and more essential as kids method adolescence. Peer relationships provide a milieu by way of which adolescents develop self-identity and values within the absence of grownup monitoring (Rubin et al. Indeed, positive peer relationships and shut friendships are associated with lower ranges of despair and loneliness (Nangle et al. Close friendships can buffer the negative results of peer victimization (Hodges et al. School functioning is crucial for constructive growth, as it has been linked to each educational and social success. Peer acceptance and shut friendships have an impact on social functioning no matter context, whereas instructor acceptance plays a important function at school functioning for children and adolescents Although usually growing children and adolescents usually expertise challenges in both college and social functioning, difficulties could be compounded for youngsters and adolescents with continual pain. Despite the significance of the relations between and among friends, friends, and school functioning for optimistic development, little is thought concerning the impact of recurrent and persistent ache on these areas of functioning. Background Peers and friends Research examining the relationship between peers, friends, and pain expertise is in its infancy. Peer acceptance (also defined as popularity) is a measure of general peer relationships primarily based on unilateral liking and ends in a sense of belonging and inclusion (Buhrmester and Furman, 1986). Close friendships are primarily based on mutual liking and supply one with intimacy and reliable alliance (Bagwell et al. Sullivan (1953) means that the necessity for peer acceptance is stronger for younger kids, whereas the necessity for close friendships surpasses the need for general peer acceptance in adolescence. Adolescents with persistent ache might have a heightened sensitivity to negative social conditions, as these conditions might have the potential to negatively impact their pain experience. These situations might then be interpreted with heightened sensitivity sooner or later, because of the potential of experiencing negative consequences. In different studies, adolescents with persistent ache described their pals as unable to understand their pain situation, alluding to the notion that their associates have been unsupportive (Carter et al. There are occasions when adolescents with continual pain are capable of socially have interaction very comparable to their healthy friends and different instances when pain interferes significantly with physical and social functioning. Interestingly, adolescents with persistent ache described some of their friends as having changed, versus altering themselves. This finding points to a possible dichotomy between adolescents with chronic pain and their associates. Healthy friends may understand the adolescent with continual ache as the one who has changed. Not solely does pain intrude with leisure and sport activities, but it could also contribute to disrupted sleep and irritability. One participant in a examine by S�llfors and colleagues (2002) described classmates being shocked as she turned extra irritable when she was in pain. Thus, fatigue and irritability (a form of pain expression) may clarify why some wholesome associates only want to work together with the adolescent with continual ache when pain expression is minimal. Friends of youngsters and adolescents with chronic pain proceed to have friendship wants, no matter whether the child or adolescent with chronic ache is able or prepared to interact in varied social actions. Healthy friends could also be extra understanding when the ache first begins however over time might have to discover different pals to fill their own friendship wants. Support from pals has a self-reported constructive impact on social functioning (Carter et al. Friends have been described as offering distraction, understanding, companionship (Carter et al. In the narrative vignette examine peer acceptance whereas for adolescents it might be linked extra to close friendships (Erdley et al. Pain first begins to intrude with social functioning by interrupting common physical actions, leisure activities, and faculty attendance (Logan et al. Missing bodily and leisure actions along with lacking school presents challenges for establishing and sustaining friendships, as these venues present many of the opportunities for youngsters and adolescents to interact with friends. Typically developing youngsters and adolescents have a mean of three to four close friends (Berndt and Hoyle, 1985). Although spending time with friends is important to foster friendships, time spent together may not be adequate for good social functioning or the development of close friendships. For example, structured leisure actions have been linked to decrease ranges of aggressive behaviour (Mahoney and Stattin, 2000) and assist within the development of self-identity (Coatsworth et al. Chronic ponain was found to be a catalyst for adolescents to rethink their identification (Forgeron et al. Recent research lends credence to this argument, as adolescents with chronic ache report lower vanity scores, elevated loneliness, and depressed mood scores compared to wholesome friends. It is feasible that having a unfavorable self-image contributes to feeling unequal to others in a gaggle and to decreased participation in sport and leisure actions. Even when these adolescents spend time with pals, they may really feel totally different and unequal to their pals, which might disrupt the establishment of close friendships. Close pals nearly all of the analysis on shut friendships and pain has been performed with adolescent populations.

Syndromes

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Vasculitis is being reported with elevated frequency in children and adolescents however stays unusual diferencia entre antiviral y vacuna purchase minipress now. Although complications could uncommonly be the initial symptom hiv infection by age group buy line minipress, different systemic symptoms have often preceded the headache hiv infection definition proven 2.5mg minipress. Other neurological signs may include behavioural changes hiv infection rates chicago cheapest generic minipress uk, cognitive dysfunction anti virus warning best buy minipress, seizures hiv infection rate oral generic 2mg minipress, and focal deficits. Emboli and thrombosis may be idiopathic or secondary trauma, coagulation problems, autoimmune disorders, and congenital coronary heart illness. Conditions such as moyamoya illness, fibromuscular dysplasia, arterial dissection, tumour, trauma, sickle cell anaemia, haemophilia, and dehydration may also cause secondary vascular illness. The sufferers might current with headache, altered consciousness, lethargy, focal neurological symptoms and seizures. Consideration must be given to this diagnosis within the presence of a coagulopathy, systemic malignancy, and/or chemotherapy. Overall, the treatment plan needs to incorporate all three elements to be successful. Oftentimes this is a misdiagnosis of a major headache, however must be dominated out and handled when suspected. A thorough review of secondary complications could be discovered within the Headaches (3rd edition; Olesen et al. The remainder of this chapter will highlight a quantity of secondary headaches that can be seen in kids. Medical-systemic causes of headache Secondary complications can happen as a symptom of other medical issues or to major neurological issues. This can embrace infections, metabolic problems, renal problems, mitochondrial issues, elevated blood strain, and haematological issues. When a affected person has a identified medical situation both the situation itself or the therapy might induce complications. Neoplasms Intracranial tumours are the second most common kind of neoplasm in youngsters (Honig, 1982). Certain genetic syndromes corresponding to neurofibromatosis, tuberous sclerosis, von Hippel�Lindau disease, and ataxia telangiectasis pose a larger threat for the event of neoplasms. The worry of a mind tumour is probably certainly one of the major issues of fogeys bringing their kids to the doctor for evaluation of headache. However, the prevalence of main headaches far outweighs the frequency of tumour-related headaches. There is a clear association between brain tumours and headaches with the vast majority of mind tumour having headache as one of many presenting manifestations. The headache due to a mind tumour is the outcome of increased intracranial strain due to the mass effect of the tumour or a blockage of cerebral spinal fluid drainage. In addition, the effects of the mind tumour on the surrounding tissue also induce changes in the neurological examination or neurological signs (Lewis et al. Other symptoms of mind tumour include seizures, ataxia, weak point, visible abnormalities, lethargy, and personality change within the majority of such patients-the course will be progressive. The neurological examination will be irregular and the prognosis can be confirmed by neuroimaging. Due to the continued growth of the tumour, the headache pattern is usually continual, progressive, with will increase in frequency and severity over time. The presence of an elevated temperature and tachycardia alone incessantly give rise to a pounding headache which is often relieved when the temperature is lowered and the an infection is handled. It happens more generally in kids with cyanotic congenital heart illness, open head trauma, persistent ear infections, chronic pulmonary illness, post-neurosurgical procedures, and in the immunocompromised affected person. Initial evaluation should embrace a brain imaging process to rule out a mass lesion. Conclusion the majority of recurrent complications in kids and adolescents are primary headaches. The historical past and bodily examination ought to assist determine whether or not a headache is primary or secondary with acceptable laboratory tests and neuroimaging confirming the suspicion. Ultimately, the prognosis of the secondary headache will be the resolution of the headache once the secondary trigger has been effectively treated, while persistence of recurrent headaches with out the secondary cause helps confirm the analysis and management of main headaches. Substance-induced headache Prescribed medications, illicit medication, dietary compounds, and toxins may cause headaches (Silberstein et al. These substances might initiate a headache, exacerbate a pre-existing headache, or cause headache on its withdrawal. A via history of publicity to medicines and non-medications needs to be carried out and removal or alteration of those substances, if attainable, could also be needed before the headache responds. One frequent stimulant used in youngsters and adults is caffeine and caffeine addiction and its withdrawal can contribute to headache and exacerbate primary complications. It is often related to a gradual enhance in frequency of medicines that were profitable or partially successful in headache therapy. These drugs are sometimes taken at low doses or with repeated doses constructing to very frequent usage-up to every day. Muscle tenderness in pericranial and neck-shoulder region in youngsters with headache. Divalproex extended-release in adolescent migraine prophylaxis: results of a randomized, double-blind, placebo-controlled study. Divalproex sodium extended-release for the prophylaxis of migraine headache in adolescents: results of a stand-alone, long-term open-label security research. An epidemiologic study of headache among youngsters and adolescents of southern Brazil. A non-selective (amitriptyline), but not a selective (citalopram), serotonin reuptake inhibitor is efficient within the prophylactic therapy of continual tension-type headache. Prevalence and traits of allodynia in headache sufferers: a population study. Medium-dose riboflavin as a prophylactic agent in kids with migraine: a preliminary placebo-controlled, randomised, doubleblind, cross-over trial. Prevalence of sleep problems in childhood and adolescence with headache: a case-control examine. Relationships between headache and sleep in a non-clinical population of youngsters and adolescents. The growth of cutaneous allodynia during a migraine assault: scientific proof for the sequential recruitment of spinal and supraspinal nociceptive neurons in migraine. Analgesic triptan action in an animal model of intracranial pain: a race towards the event of central sensitization. Defeating migraine pain with triptans: a race against the event of cutaneous allodynia. Effects of sensitization of trigeminovascular neurons to triptan remedy throughout migraine. Biofeedback-assisted relaxation coaching for young adolescents with tension-type headache: a controlled research. Feasibility evaluation of telephone-administered behavioral remedy for adolescent migraine. Decreased habituation of the R2 component of the blink reflex in migraine patients. Placebo efficacy in childhood and adolescence migraine: an evaluation of double-blind and placebo-controlled research. Plasma calcitonin gene-related peptide in diagnosing and predicting paediatric migraine. Electromyographic biofeedback-assisted leisure training in juvenile episodic tension-type headache: medical end result at threeyear follow-up. Pharmacological behavioural remedy for children and adolescents with tension-type headache: preliminary data. Biopsychosocial correlates of headache: what predicts pediatric headache occurrence Agreement of fogeys and youngsters on traits of pediatric headache, other pains, somatic signs, and depressive symptoms in an epidemiologic examine. Topiramate in the prophylaxis of pediatric migraine: a double-blind placebo-controlled trial. Relaxation therapy of adolescent headache victims: outcomes from a school-based replication sequence. Prevalence of headache in Swedish schoolchildren, with a give consideration to tension-type headache. A comparative study of cyproheptadine, amitriptyline, and propranolol in the remedy of adolescent migraine. Practice Parameter: pharmacological therapy of migraine headache in youngsters and adolescents: Report of the American Academy of Neurology Quality Standards Subcommittee and the Practice Committee of the Child Neurology Society. Randomized, double-blind, placebo-controlled research to consider the efficacy and safety of topiramate for migraine prevention in pediatric topics 12 to 17 years of age. Efficacy and tolerability of almotriptan in adolescents: a randomized, double-blind, placebo-controlled trial. Sumatriptan for the vary of complications in migraine sufferers: outcomes of the Spectrum Study. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis-part 2. Standardized dosing of amitriptyline is highly efficient in a pediatric headache middle population. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. The prevalence of headache and its affiliation with socioeconomic standing among schoolchildren Instanbul, Turkey. Acute remedy of pediatric headache within the emergency division and inpatient settings. Inpatient therapy of standing migraine with dihydroergotamine in children and adolescents. Tolerability and effectiveness of prochlorperazine for intractable migraine in children. Sensitization of trigeminal nociception specific for migraine however not pain of sinusitis. Acute migraine headache: possible sensitization of neurons within the spinal trigeminal nucleus Measuring the impact of headache in youngsters: a important evaluate of the literature. Clinical options, classification and prognosis of migraine and tension-type headache in children and adolescents: a long-term follow-up study. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis-part I. Comparison of selfhypnosis and propranolol in the remedy of juvenile traditional migraine. Emotional issues and prevalence of medicine overuse in pediatric continual daily headache. Headaches in obese kids and adolescents referred to a tertiary-care heart in Israel. Biobehavioral treatment, disability, and psychological results of pediatric headache. Quality of life in childhood migraines: medical impact and comparability to different persistent diseases. Emergency division management of acute migraine in children in Canada: a follow variation research. Analysis of the International Classification of Headache Disorders for analysis of migraine and tension-type headache in youngsters. A randomized, double-blinded, placebo-controlled, crossover, add-on examine of CoEnzyme Q10 in the prevention of pediatric and adolescent migraine. Epidemiology of migraine among college students from randomly chosen secondary colleges in Lodz. Serial headache drawings by kids with migraine: correlation with scientific headache status. Variable clinical expression of mutations in the P/Qtype calcium channel gene in familial hemiplegic migraine. Prevalence and clinical findings of migraine and tension-type headache in adolescents. Correlation between abnormal brain excitability and emotional symptomatology in paediatric migraine. Multiple views on the psychological functioning of kids with and with out migraine. Topiramate for migraine prevention in children: a randomized, double-blind, placebo-controlled trial. The irregular restoration cycle of somatosensory evoked potential components in kids with migraine could be reversed by topiramate. Oral magnesium oxide prophylaxis of frequent migrainous headache in kids: a randomized, double-blind, placebocontrolled trial. Whilst the epidemiology of medical illness varies throughout the world, the general principles of pain management are applicable to most medical sicknesses in kids and are effective. Using a two-step strategy for analgesic prescription: simple analgesics for mild ache (step 1), opioids for reasonable to extreme pain (step 2). It can be beneficial that children with persisting pain have medicines obtainable for breakthrough pain. Introduction Pain is usually skilled by kids within the context of medical sickness. This could also be as a outcome of acute or short-lived ache associated to procedures for diagnostic, treatment, or surgical interventions. Persisting pain in childhood illness implies the duration of pain is lasting beyond what can be anticipated from an acute harm. The reader is referred to other sections of this e-book for the problems and administration of persisting ache because of other circumstances and for non-pharmacological strategies for ache management.

Studies in adults with dysmenorrhea have demonstrated central nervous system modifications much like antiviral antibiotic buy minipress without prescription these seen in different chronic pain conditions stories about hiv infection purchase discount minipress. Such modifications include altered central processing of noxious stimuli (Vincent et al anti bullying viral video buy discount minipress 2.5mg line. Dysmenorrhea is subsequently a cyclic ache that seems to develop features of a continual neuropathic pain situation over time hiv infection from dentist purchase 2.5 mg minipress fast delivery. Endometriosis Endometriosis is a chronic inflammatory and painful condition outlined as the presence of uterine glands and stroma outside the uterus hiv symptoms directly after infection cheap 2 mg minipress. Endometriosis lesions could be discovered anywhere within the stomach and pelvic cavity describe the hiv infection cycle buy online minipress. Most lesions are seen on the ovaries, pelvic partitions and cul-de-sac, but can be found on bowel, bladder, ureters, liver, lung, and scar tissue. In adult girls, the commonest cause of chronic pelvic ache is endometriosis (Fauconnier and Chapron, 2005), estimated to affect 4% to 17% of post-menarchal females (Ranney, 1980). Population research of endometriosis in adolescents are likely to underestimate its prevalence because of underreporting of signs and failure to diagnose. Women experiencing these symptoms have a excessive threat of having endometriosis, particularly if they experience multiple of these symptoms (Ballard et al. Questioning adolescents about their menstrual history can determine markers associated with endometriosis (Chapron et al. In a consecutive collection of 355 ladies undergoing laparoscopy for suspected endometriosis, 90% of the ladies with histologically confirmed endometriosis had gastrointestinal symptoms (bloating constipation, diarrhoea, nausea, vomiting). While bloating was probably the most frequent gastrointestinal symptom, reported by 83% of women, 71% additionally had other gastrointestinal signs (Maroun et al. Gastrointestinal signs are reported almost as frequently as gynaecological symptoms in ladies with endometriosis (Maroun et al. Under direct vision, endometriosis lesions in adolescents typically appear as red and clear lesions and the extra basic black or brown lesions are extra generally seen in adult women (Laufer et al. The clear lesions could be difficult to visualize with out the use of specialised surgical methods. Other research have proven that 25% to 38% of adolescents with persistent pelvic pain who seek medical care and bear laparoscopy have endometriosis (Kontoravdis et al. The improve in prevalence from 70% to 97% may be because of the improvement of optics of laparoscopes with digital imaging. Although commonly understood to be a illness of grownup girls, endometriosis can happen in adolescents and in pre-menarchal women as early as eight years of age (Marsh and Laufer, 2005). As endometriosis is an oestrogen-dependent illness, endometriosis ought to be thought-about within the differential prognosis of all females with abdominal or pelvic pain once the benchmark of thelarche has been met (Economy and Laufer, 1999; Lubianca et al. More usually, women are diagnosed throughout their childbearing years when they search medical therapy for infertility. However, data from the Endometriosis Association point out that two-thirds of grownup girls with endometriosis reported onset of pelvic signs during adolescence, with 38% reporting symptom onset before age 15 years (Ballweg, 2004). Adolescent endometriosis can be a challenging diagnosis as signs and symptoms are often non-specific for gynaecological pathology and might differ from those reported by adults (Table 30. Adult ladies with endometriosis report gynaecological signs of abdominopelvic ache, severe dysmenorrhea, menorrhagia, irregular menses, subfertility or infertility, and acute adnexal pain because of Table 30. A high index of suspicion and data of the differences in presentation between adult women and adolescents is key to identifying and treating endometriosis. One long-term follow-up research shows that with early analysis and therapy, disease development may be retarded (Doyle et al. Several theories have attempted to clarify potential aetiologies, including developmental anomalies, retrograde menstruation, failure of endometrial cell apoptosis, immune and inflammatory illness, and genetics (Bulun, 2009). Other research suggests endometriosis, like migraine headache, is a neurovascular illness (Zhang et al. Visceral hyperalgesia is a common discovering in sufferers with endometriosis (Issa et al. The position of chronic irritation in the development of visceral hyperalgesia and neuropathic pain was the subject of a current evaluate of endometriosis pain mechanisms (Evans et al. The authors identified research showing invasion of nociceptors into peritoneal endometriosis lesions and elevated variety of nerve terminals in endometriotic tissue, in addition to activation of nociceptors by inflammatory mediators, sprouting of recent nociceptors, and activation of silent nociceptors present in regular endometrium and peritoneum (Anaf et al. Increased signalling from visceral nociceptors to the spinal cord leads to sensitization of dorsal horn cells, convergence of visceral and somatic afferent pathways, and alterations in neural modulation of inhibitory and excitatory pain pathways all through the central nervous system because of neuroplasticity (Bajaj et al. Over time, ache spreads to different viscera (viscero-visceral hyperalgesia) and to the abdominal wall and back (viscera-somatic hyperalgesia) with somatic signs of cutaneous hypersensitivity to touch, i. Surgical destruction of endometriosis and menstrual suppressive remedy can retard illness development (Doyle et al. Yet, these interventions are variably effective and many adolescents continue to report pain despite anti-endometriosis therapy. Managing chronic pelvic ache because of endometriosis is a multidisciplinary endeavour and communication among clinicians throughout disciplines, including pain drugs, gynaecology, and psychology, is important for good pain remedy outcomes. Acute exacerbations in endometriosis pain may be surgical or non-surgical and an effort should be made to establish the cause for an acute improve in pain. Non-surgical causes of acute ache flares include a missed or delayed oral contraceptive tablet, change in absorption of oral contraceptives because of medicines, or changeover in hormonal therapy. Suspected ovarian torsion, tubal, or ovarian cysts, and adhesions require surgical evaluation. Pelvic floor dysfunction Pelvic ground dysfunction is being recognized more incessantly as a cause of persistent pelvic ache in youngsters and adolescents. In adults, pelvic ground dysfunction is associated rising age and parity, and structural or mechanical changes within the pelvis (Baessler et al. Injury to the sacrum, coccyx, pubis, and hip joints is usually a explanation for misalignment, rigidity, and irritation of the attached ligaments, muscle tissue, and nerves in the pelvis. In children, pelvic floor pressure myalgia is associated with voiding or elimination dysfunction, and spasm of the pelvic flooring muscles. The typical presentation in children is evening time awakening with extreme decrease stomach or perineal pain. Urodynamic studies usually establish high urethral pressures with out structural obstruction of the outflow tract (Hoebeke et al. Conditions related to pelvic floor dysfunction have been proven to respond properly to biofeedback-assisted pelvic floor leisure remedy (Li et al. Leg-length discrepancy and pathology of the backbone or hip can be referred to the groin and pelvis. A sensory examination of the again and stomach to decide the presence of allodynia or hyperalgesia can provide proof of central sensitization and neuropathic pain. Pain of visceral origin and related viscero-somatic convergence may current as a nondermatomal area of hyperalgesia or allodynia over the stomach or again. A dermatomal distribution of pain over the stomach is suggestive of an intercostal or subcostal neuralgia, and should indicate pathology at any level along the nerve because it exits the spinal canal. Palpation of the world could reveal proximal and distal radiation alongside the course of the nerve, often known as Valleix phenomenon. Neuroimaging of the backbone is indicated if more proximal nerve involvement is suspected. The belly wall is innervated by the anterior rami of the decrease six thoracic nerves (T7�T12) and the primary lumbar nerve (L1�L2). Thoraco-abdominal nerves exit the spinal canal and terminate in posterior, lateral and anterior branches, offering sensory innervation to the belly wall and overlying skin. Similarly, L1 to L2 subcostal nerve involvement (ilioinguinal/iliohypogastric nerves) could current as vulvar or groin pain in women or scrotal pain in boys. Terminal branches of these somatic nerves course via the lateral abdominal wall within a plane between the interior oblique and transversus abdominis muscles. The thoracic branches are anchored at varied points through fibrous attachments inside the wall which can tether or trap the nerve alongside its course because it passes to the superficial layers. The anterior cutaneous department of an intercostal nerve is most susceptible to entrapment as a result of it makes a virtually 90-degree flip to enter a fibrous tunnel because it passes to the superficial tissues on the lateral border of the rectus abdominis muscle. A history of straining, coughing, or vomiting may be elicited as elevated intra-abdominal strain, intense muscle contraction, or blunt trauma to the stomach wall can lead to nerve entrapment. With the affected person within the supine place, the examiner palpates along the lateral border of the rectus sheath and asks the patient to try a sit up. If ache is from the viscera, tensing the muscular tissues guards against extra painful deeper palpation. A rectus sheath block may relieve an stomach cutaneous nerve entrapment; belly wall trigger points could have an analogous presentation and could be identified with careful palpation. Potassium instilled into the bladder is a neuroirritant and causes a rise in pain signs. Assessment A careful historical past can help direct the workup and evaluation of patients with chronic pelvic pain. Quality and location of ache may help determine whether or not ache symptoms originate from viscera, are musculoskeletal, or from an entrapped nerve. Pain descriptors corresponding to burning, aching, stabbing, spreading, or throbbing are frequent in patients with visceral hyperalgesia or neuralgia; inability to tolerate any tight fitting clothes and hypersensitivity of the belly wall or back to light contact or gentle pressure can indicate viscerosomatic convergence with referred pain to the abdomen or back. In addition to asking about location, onset, and frequency of pain signs, questioning for temporal affiliation with injury or trauma similar to an occult pelvic fracture, or suspected slipped capital femoral epiphysis, hip, or again damage can identify treatable orthopaedic circumstances. Obtaining a menstrual historical past and understanding norms for menstrual frequency, quantity of bleeding, and severity of ache is essential so as to decide whether additional gynaecological investigation is needed when evaluating a patient referred for chronic abdominopelvic ache. Cycles outside of the vary of 20 to 45 days are statistically uncommon, even in younger girls, and deserve analysis for potential treatable causes. A treatment history might reveal that the affected person is on an oral contraceptive pill. It is necessary to decide whether or not the pill was started for menstrual irregularities or pain, and observe whether or not symptoms have improved since starting hormonal remedy. A household history of gynaecological problems similar to endometriosis, severe dysmenorrhea, or infertility can guide referral to an adolescent gynaecologist. A patient with a positive family historical past of endometriosis in a first-degree relative has a 6. During the interview or examination, time should be set aside to communicate confidentially with the affected person about sexual activity, historical past of bodily or sexual assault, and sexually transmitted infections as information on these delicate topics may be withheld in the presence of parents or guardians. In a systematic evaluate of threat factors in ladies with and with out persistent pelvic pain, Lathe et al identified a robust affiliation between all forms of continual pelvic pain and pelvic pathology, history of childhood abuse, and psychological morbidity in adults (Latthe et al. Development of central sensitization and continual neuropathic pain could explain why pain continues regardless of therapy with standard anti-endometriosis therapies. Neuropathic ache analgesics embrace tricyclic antidepressants and anticonvulsants. Complicating the treatment of chronic pelvic pain is the observation that many adolescents with endometriosis and chronic pain have symptoms of hysteria and/or depression. Psychological support to develop pain coping strategies and to treat associated symptoms of despair or anxiety is a half of a multidisciplinary approach to pain management. When treatment is initiated, the selective serotonin re-uptake inhibitor class of antidepressants is regularly prescribed for melancholy and/or anxiousness. When medicine for anxiety or despair is a consideration, therapeutic dosing of amitriptyline as a neuropathic analgesic within the remedy of endometriosis pain can be limited as a result of concern for increased risk of serotonin syndrome. Patients benefit from bodily remedy as a part of a multidisciplinary method to therapy of continual pelvic pain. Prolonged periods of bed relaxation and compensatory postures can lead to myofascial ache and deconditioning, including to the general degree of pain-related incapacity. When the patient has turn out to be homebound and no longer participates in athletic or after college activities the rationale for practical restoration is evident. Aquatherapy, light stretching, core and pelvic flooring strengthening, and building endurance in a therapeutic setting could be the primary steps toward re-engaging the affected person in on a regular basis activities. Referred pain from the viscera, and viscero-somatic convergence of neural sensory pathways at the level of the spinal cord can lead to allodynia and hyperalgesia of the abdominal wall. The units may be worn throughout the day, with the patient controlling the level of current for maximal consolation. The use of acupuncture in managing painful durations is promising though information is restricted. Findings ought to be interpreted with caution as a result of the small variety of research and examine individuals. Conclusions Chronic pelvic ache is often described as belly pain in younger sufferers. Dysmenorrhea is extra frequent in adolescents than adults and may be associated with changes within the central nervous system and other chronic pain circumstances because of neuroplasticity. Central sensitization of visceral ache pathways can affect bowel and bladder function, and be associated with pelvic flooring pain and dysfunction, which may be improved with physical therapy. The prognosis of endometriosis is often delayed till maturity although symptoms begin during adolescence. Adolescents with endometriosis can report both cyclic or acyclic pain and current with a preponderance of gastrointestinal symptoms. Obtaining a full menstrual historical past is an important facet of the analysis of feminine adolescents with persistent abdominopelvic pain. Laparoscopic port websites located in the umbilicus, midline below the umbilicus, and left decrease quadrant were nicely healed. The belly tenderness was diffuse, but greatest over the left lower quadrant and periumbilical space. Light contact or superficial palpation triggered ache and she was unable to tolerate deep palpation. She has been completely investigated for stomach pain by a number of specialists from gastroenterology and general surgery over the previous yr. Last year she underwent laparoscopic cholecystectomy for presumed gallbladder dysfunction, and on the similar time had her appendix eliminated pre-emptively. The procedure was uneventful however she continued to report extreme ache postoperatively.

It represents an extended window of time during which the illness develops and corresponds to an opportunity for chemoprevention natural antiviral herbs 2.5 mg minipress with visa. When the illness turns into measurable however remains asymptomatic hiv infection rate nyc purchase 2 mg minipress overnight delivery, we enter the context of early diagnosis hiv infection rate in uae proven minipress 2 mg. These windows of time correspond to the different contexts during which different biomarker targets could be developed antiviral state generic 2.5 mg minipress fast delivery. The blood proteome Blood is a complex and dynamic medium whose elements can replicate various physiological or pathological states throughout the physique antiviral classification buy minipress 2.5mg fast delivery, including the presence of some cancers symptoms of recent hiv infection purchase 2 mg minipress with amex. Tumor associated proteins can be generated by tumor cells immediately or as host response to carcinogenesis by surrounding cells of microenvironment together with fibroblasts and immune cells. This info can thus provide a extra complete understanding of the illness when integrated into comprehensive genomic and transcriptomic analysis. These features can probably allow for early analysis of most cancers, monitoring of disease status, development of focused therapies, evaluation of response to therapy and survival. Several current research have investigated the extent to which proteomic applied sciences can unravel the complexity of the plasma proteome, and the Human Proteome Organization revealed a comprehensive collaborative examine that characterized the human serum and plasma proteomes [14]. Proteomic discovery platforms Several analytical approaches have been adopted to establish novel proteins and perceive their structure, operate and interplay with proteins and different molecules. There have been makes an attempt to bring this information to the clinic by means of new diagnostic and predictive biomarkers as properly as the identification of therapeutic targets. It is a simple and high-throughput approach that analyzes with modest sensitivity but larger specificity proteins expressed in advanced biological mixtures, such as serum, urine and tissues. The time it takes for every ion to hit the detector creates a signal, which indicates m/z ratio in the X axis and ion intensity within the Y axis. Proteomic approaches for discovery and validation of blood biomarkers Considerable progress has been made in the past decade in figuring out tumor characteristics via advances of molecular biology applied sciences. Much of this progress was pushed by growing information of tumor related aberrations that have an effect on nucleic acids both at genomic, transcriptional, and posttranscriptional ranges. Proteins are the useful finish product of genes that in the end management vital organic processes by way of their expression level, posttranslational modifications, and performance. Contamination by polysaccharides and nucleic acids No High High low 100�300 peaks Detection of plentiful proteins. No identification Yes High High High 500�4000 proteins High false discovery fee Quantitative, labeled reference peptides. Label free strategies Yes Low High High 1�100 proteins Cost of labeled peptides for absolute quantitation Not quantitative Yes High High High 50�500 proteins Antibody specificity and availability. It makes use of chromatographic chip arrays to selectively bind subsets of proteins from complicated samples. The surfaces can be washed to remove nonspecifically certain proteins and substances that can intervene with the ionization course of. The rapid proteomic profiling of blood, tissue, or urine with minimal pattern preparation, utilizing the height pattern as a diagnostic device, has generated nice enthusiasm, however has yet to be minimally Table 5. In the ion source of the instrument, irradiation of these with a quick laser pulse initiates the desorption-ionization events. Ions are therefore separated in time based on their mass as they journey the length of the time-of-flight. Average intensity of spectrum analysis between matched instances (red, plain line) and controls (blue dotted line) are offered. From the proteomic spectra of serum samples obtained from the training set, utilizing Biomarker Pattern software, they generated a classification tree with three totally different protein plenty that successfully identified lung cancer patients from controls with 94% accuracy, 91% sensitivity and 97% specificity. When utilized to the validation take a look at, the classification tree allowed 89% sensitivity, 91% specificity and 90% positive predictive value. The main preanalytical challenges are associated to variability in collection and preparation methods, leading to the introduction of analytical bias and lack of reproducibility. Analytically, it has been confirmed difficult to detect low-abundance/high molecular weight proteins and to develop a strong signal analytic algorithm for single patient classification. This classifier was highly predictive of response to erlotinib and 18 of 19 responders were recognized as proteomics "good". Patients on erlotinib who were proteomics "good" lived considerably longer than sufferers who have been proteomics "poor" (median survivals of 10. For patients assigned to three of the completely different terminal nodes, the likelihood of having most cancers was 92% within the coaching set and 90% within the validation set. When used alone, none of these 4 markers had adequate diagnostic power, however when mixed, they appeared to have value in suggesting lung cancer diagnosis and may be helpful for clinical management at totally different ranges. Recently, an automated know-how has been developed for the simultaneous measurement of serum peptides. This approach is straightforward, scalable and should provide higher reproducibility, multidimensionality and excessive throughput [29], but have to be validated in larger populations and from a quantity of institutions. Depletion procedures are restricted by difficulties in standardization and of reproducibility. This fractionation has a quantity of limitations as it requires large sample amounts, is costlier and timeconsuming, and increases the danger of variability within and between samples. This totally automated platform follows a "bottom-up" strategy (as against "top down" method where intact proteins are ionized and fragmented to peptide fragments). Based on our understanding of the fragments produced in the collision cell and their precise molecular weight, the peptide sequence could be deduced. Through comparisons of predicted sequences with the same nominal mass in databases, peptides are identified and proteins from which they came are deduced. To overcome some these challenges, different complexity discount strategies have been carried out. This cycle is repeated until the entire peptides have eluted from the chromatography column. These patterns are then in comparison with the experimental fragmentation spectrum to generate correlation scores. Positive identification of a protein is predicated on the observation of two or extra peptides issued from its sequence. In the final strategy, specific chemical probes are used to tag and facilitate isolation of a goal peptide. After digestion of proteins with trypsin within the shotgun approach, analyses are complicated by the large number of redundant peptides from each protein. By concentrating on peptides containing distinctive or uncommon amino acids or posttranslational modifications such as phosphorylation or glycosylation [47], we are ready to cut back the complexity of the biological samples and analyze subproteomes. Although fairly interesting these subproteomic methods are early in improvement and require methodological standardization. The affiliation of two mass filters leads to a very particular and sensitive identification. Bio-analytical validation of serum protein biomarkers Following the discovery of latest biomarkers, the next critical steps are to validate and evaluate their performance in clinically relevant affected person populations [56]. Multiple levels of validation need to take place before confirming the medical utility of the biomarkers [57, 58]. This includes confirmation of detected changes in protein degree by different methods, correlation with biological outcomes of lung cancer such as early detection, chemosensitivity, or survival. These phases of clinical validation will evaluate the biomarkers efficiency in related medical context and how they might impression medical administration of threat or disease [59] (see "Clinical validation of serum biomarkers" part below). Biochemical strategies for protein markers validation have been dominated by immuno-based assays. Although immune-based detection assays have been essentially the most trusted and reliable method for biomarker validation, they depend on the tight and specific binding of the antibodies against the targeted molecule but are restricted by the standard of antibodies, high labor depth and comparatively low-throughput [60]. In this methodology, anti-peptide antibodies immobilized on nano affinity columns are used to enrich particular peptides along with spiked stable-isotope-labeled inner standards of the same sequence. Upon elution from the anti-peptide antibody supports, electrospray mass spectrometry is used to quantify the peptides (natural and labeled). No blood-based biomarker for lung most cancers has yet been validated using these strategies, although ongoing technical enhancements of protein separation and detection may permit for applications of these approaches as validation platforms within the close to future. Using this technique, antibodies directed against Cterminal hydrolase L3 ubiquitin were identified within the sera of sufferers with colon cancer and, extra lately, within the blood of sufferers with lung adenocarcinoma [71]. The validation of these novel lung most cancers autoantibodies mandated the event of sturdy detection assays that are delicate, reproducible, and high-throughput. These efforts yielded an assay with high reproducibility, precision, and linearity that was able to identify practically 40% of major lung cancers through a peripheral blood test. These assays will also want further scientific validation in massive cohorts of high-risk patients, each retrospectively and prospectively before shifting to the scientific follow. These embrace overexpression, mutations, misfolding, truncation, and degradation [63]. Therefore, monitoring these autoantibodies in serum from people at high threat for lung cancer represents an attractive choice for developing a screening test. Using these approaches, several teams reported the identification of large numbers of immunogenic peptides that are potential targets for autoantibodies. However, many of the identified antigens had been found to elicit antibodies in a comparatively small proportion of patients, yielding a test of high specificity but very low sensitivity. One other frequent challenge to these phage show strategies is the inability to detect posttranslational modifications. Recently this obstacle was overcome by the development of a Clinical validation of serum biomarkers Appropriate examine design is crucial for the successful validation of a promising biomarker for clinical use. Specifically, random sampling of instances and controls recognized from inside a well-defined cohort population allows both circumstances and controls to be sampled from the identical supply inhabitants, thus offering validity to the casecontrol design. Matching methods could also be considered, corresponding to utilizing incidence density sampling to pattern controls at the identical time every case happens so that circumstances and controls are matched on time. While there are advantages to matching the Serum Proteomic Biomarkers potential pitfalls of matching should be fastidiously thought of previous to implementation [74, 75]. Assessment of the generalizability of biomarkers in different clinical settings and populations is necessary for a clinically useful biomarker. In biomarker discovery, the potential cohort from which the circumstances and controls are sampled should be consultant of the focused medical population to which the biomarker might be applied. Thus the cohort research population ought to comprise individuals with conditions found within the goal inhabitants, corresponding to inflammatory disease, granulomas, or benign tumors in order that false positives can be minimized and individuals developing lung most cancers may be differentiated from these not growing the disease [76]. Biospecimens essential for biomarker improvement ought to be collected on the initiation of the potential cohort research, prior to ascertainment of lung most cancers status [74], and probably over a quantity of time factors if the biomarker adjustments with age and with progression to disease [76]. Importantly, the finish result must be clearly outlined [77] and the biomarker assay development ought to be blinded to case-control standing to avoid information bias [74]. To validate the usefulness of a biomarker for early detection of lung cancer, diagnostic validation of the biomarker ought to be conducted in numerous, potentially confounding, populations apart from the one during which the biomarker was developed to take a look at specificity for lung most cancers [78]. Finally, this ought to be adopted by early diagnostic validation using a screening trial with lung most cancers mortality as the endpoint [79]. These clinically essential indices describe the chance 103 of growing or having disease given a positive check and the chance of not having the illness given a negative check. Merely focusing on the screening to a high-risk inhabitants based mostly on demographic elements can alter the screening test efficiency characteristics [81]. Thus for a biomarker to be clinically valid and generalizable, the biomarker validation course of have to be applied to a quantity of populations having completely different demographic traits for figuring out the scientific validity and utility of a biomarker, and every inhabitants may have completely different necessities for biomarker clinical utility. Current challenges in lung most cancers biomarker improvement and implementation One of the primary goals of molecular medicine in lung cancer is to determine biomarkers that discriminate between high and low threat people and between benign and malignant lung tumors. Ultimately these biomarkers can potentially be translated to noninvasive, easy, and reliable diagnostic tests for early detection of the disease. The underlying assumption behind these efforts is that tumor-specific or overexpressed proteins could be detected merely and precisely in advanced scientific samples such as surrogate tissues and biofluids. A record of a quantity of current diagnostic serum protein biomarker studies is summarized in Table 5. First, the proposed marker, or panel of markers must be quantitatively measurable and its efficiency examined in a minimum of one sample set of clinically relevant specimens. Second, the report should adhered to the rigorous clinical validation guidelines discussed above ("Clinical validation of serum biomarkers" section). The validation units reported in the tables correspond to an attempt to test the biomarker (or signature) in a real unbiased inhabitants, also described as 104 Lung Cancer novel proteins that may have a role within the development of lung cancer. High volume of information from multiple high-throughput biochemical analyses of clinical materials from "Omics" sources has been accumulating at an exponential fee in the previous few years, producing giant variety of biomarker candidates. Lung cancer is recognized as a posh and heterogeneous disease, not solely on the biochemical level (genes, proteins, metabolites), but additionally on the tissue, organism, and population degree. There is a need for incorporating findings from a quantity of discovery platforms into a mathematical framework that may enhance our stage of understanding of the illness course of. Clinical benefit could embrace further reductions in mortality and thus present significant cost-savings to the healthcare system. The significance of serum biomarkers also arises from its potential impact on our understanding of pathogenesis and progression of complex illness such as lung cancer, and will offer new opportunities within the early detection, prognosis, and therapeutic administration of the disease. In this text we attempted to provide an up-to-date overview of the latest progress in serum proteomics technologies and their wide selection of functions in lung most cancers, with a main emphasis on early detection. The fast improvement of proteomic technologies has led to the assembly of huge protein and peptide inventories and to a greater understanding of how they interact, of the position of specific posttranslational modifications, and to addressing some of their biological features. Although proteomic profiling of lung cancer sera and related biological specimens have yet to show scientific utility, it has the potential to spotlight variations between lung cancer and nonmalignant lesions, and between totally different ranges of risks as well as stages and histology subtypes. Molecular profiling could help with figuring out high-risk populations, offering a clinical validation [83], to consider the performance of the test in an independent cohort. This disappointingly gradual tempo of lung most cancers biomarkers discovery and validation is attributed to a bunch of technological and methodological components. The hole between promise and product can partially be defined by the truth that current discovery methods are neither dependable nor environment friendly. One cause is that the present analytical applied sciences nonetheless endure from the restricted power to detect low-abundant most cancers markers against a high background of high-abundance molecular species such as proteins in very advanced matrices corresponding to plasma or serum. These low-abundance markers in biofluids similar to serum could be the most promising cancer biomarkers.

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References

• Barbour A, Schmidt S, Rout WR, et al. Soft tissue penetration of cefuroxime determined by clinical microdialysis in morbidly obese patients undergoing abdominal surgery. Int J Antimicrob Agents. 2009;34(3):231-235.
• Rocha-Singh K, Jaff MR, Rosenfield K, ASPIRE-2 Trial Investigators: Evaluation of the safety and effectiveness of renal artery stenting after unsuccessful balloon angioplasty: the ASPIRE-2 study, J Am Coll Cardiol 46:776n783, 2005.
• Brauer A, Quintel M: Forced-air warming: technology, physical background and practical aspects. Curr Opin Anaesthesiol 22:769-774, 2009.
• Grayburn PA, Handshoe R, Smith MD, et al: Quantitative assessment of the hemodynamic consequences of aortic regurgitation by means of continuous wave Doppler recordings, J Am Coll Cardiol 8:1341-1347, 1986.
• Baquis GD, Pessin MS, Scott RM: Limb shaking-a carotid TIA, Stroke 16:444-448, 1985.
• Dalakas MC, Sivakumar K. The immunopathologic and inflammatory differences between dermatomyositis, polymyositis and sporadic inclusion body myositis. Curr Opin Neurol 1996;9(3):235-9.