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It would require a blastocyst that has the potential for cre- ating a human being to be sacrificed as a “tissue” donor for the patient cheap albendazole 400mg free shipping. Therefore purchase albendazole canada, such an approach would be unsat- isfactory because of both ethical reasons and technical obstacles trusted albendazole 400 mg. Based on these limitations, the major application of nuclear transplantation may be to identify the molecular mechanisms required for genetic reprogramming. Once the essential complex of factors is established, these may be provided in a purified form to repro- gram cells obviating the need to create blastocysts. Interconversion Between Cell Types for Cell Therapies A more modest reprogramming might be envisioned in which cells need only be interconverted between lineages. Interconversion of brain stem cells to hematopoi- etic lineages was reported recently in Science (Bjornson et al 1999). In addition, it has been reported that mesenchymal stem cells can differentiate into adipose (fat), chondrocytes (cartilage), and osteocytes (bone). Multipotent stem cells could be used as cellular therapies to replace cells lost in patients suffering from various mal- adies including diabetes or Parkinson is disease (see Chapter 9). Genetically Modified Livestock for Xenotransplantation However promising these methods may be, the most pressing limitation is the insuf- ficient supply of human organs and tissues for transplantation. Efforts to induce immunological toler- ance using gene therapy approaches have spawned increasing hopes for xenotrans- plantation. Alternatively, the antigenicity of the tissues may be reduced by targeted disruption of histocompatibility genes in donor animals. Nuclear transplantation provides the technical means to introduce the necessary genetic modifications to minimize rejection and produce genetically uniform donors. Providing Cells for Tissue Engineering Ideally, rejection of transplants could be eliminated by using cells from individual patients to regenerate their organs through tissue engineering. Great strides have been made in creating skin equivalents for treating chronic wounds. More com- plex tissues such as arteries and corneal tissues have also been successfully grown in vitro. The most stunning example was the growth of a functional bladder from precursor cells. Advances in biocompatible polymers will continue to extend the range of organs that can be grown in vitro. Presently, the amount that primary cell cultures can be expanded in vitro is limited by cellular senescence. Nuclear transplantation appears to reset the mechanisms regulating in vitro life spans. Tissue engineering approaches would also benefit from the ability to generate multipotent stem cell populations from individual patients to provide autologous transplants. The goal, here, is to prevent unethical research from being done in the first place. However, this directive may not be as feasible in practice as it appears in theory. Sometimes actual facts and consequences of research are not what was hypothetically predicted; and when such consequences are morally relevant, our moral judgments might be altered. This will likely be the case with regard to much of human embryonic stem cell research. For example, if it turns out to be the case that the few embryos used so far to generate several lines of stem cells are sufficient to satisfy research needs far into the future (because of the seemingly unlimited regenerative capacity of these cells), then it seems we have a minor ethical problem at best. On the other hand, if future research requires tens of thousands of embryos to be created and destroyed in order to meet highly spe- cialized future research needs, then we have a more serious ethical problem. The central moral conflict enunciated, to date, regarding this research is between its enormous therapeutic potential and the need to destroy human embryos (poten- tial human persons) to realize that therapeutic outcome. Alzheimer’s disease, Parkinson’s, diabetes, heart disease, to name just a few, are seen as being substan- tially ameliorable (if not curable) if stem cell research realizes its potential (Wright, 1999), as the Patients’ Coalition for Urgent Research hopes (a coalition of two dozen national organizations). Further, advocates of a “sanctity of life” ethic claim that even if such therapeutic gains were certain of real- ization, the means by which they were achieved would be evil, the destruction of embryos, which they regard as being persons with the same moral rights as you and I. The moral argument is that the destruction of the embryos will happen anyway, and this research permits some substantial therapeutic good to be realized. No one is being paid to create embryos for research purposes (though that is another ethics issue that ought to be addressed). Further, the argument goes, the moral status of embryos is at least controversial. A more impartial descrip- tion of their moral status would say they are “potential” persons whereas the individuals who must endure Alzheimer’s or heart disease are clearly actual persons with actual moral rights and compelling health needs. McGee and Caplan (1999) have pointed out that, strictly speaking, this research might not require the destruction of embryos. It may be medically possi- ble to harvest a very few stem cells from an embryo that is then implanted in the womb for normal development. Further, it is imaginable that this would become a standard reproductive option that would allow those stem cells to be saved for pos- sible future use by that person, thereby avoiding potential tissue rejection problems should future medical need require a transplant. It is not obvious that a defender of a sanctity of life ethic would be able to raise a strong moral objection to that procedure. What Richard Doerflinger (1999) of the National Conference of Catholic Bishops has suggested is that there is an alternate line of research that ought to be pursued that might achieve the same therapeutic goals without having to destroy embryos, namely research that would begin with adult stem cells. The practical problem, however, is that this line of research has not thus far been established as viable. In the meantime proponents of the current research argue that it would be unconscionable to delay for years achieving the therapeutic promise of what we have now, especially if a substantial majority of Americans reject the view that embryos have the moral status of persons from the moment of conception. However, it is important to note that there is no ethical obligation to achieve that good. No one’s moral rights would be vio- lated if those research dollars were redirected to some other worthy medical or social use. Second, there are other moral risks associated with this research that are rarely noted, namely risks to social justice.

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Macdonald N purchase 400mg albendazole overnight delivery, Squires B best 400 mg albendazole, Hawkins D buy 400 mg albendazole, Downie J, Aberman A, Armstrong P, Davidof F, Detsky A, Hall J, Hennen B, Rouleau J, Roy C, Scott J, Stewart D. Article titles containing a Greek letter, chemical formula, or another special character. Suzuki T, Hide I, Matsubara A, Hama C, Harada K, Miyano K, Andra M, Matsubayashi H, Sakai N, Kohsaka S, Inoue K, Nakata Y. Forthcoming article title containing Greek letters, superscripts, or subscripts 10. Forthcoming article that is a letter to the editor Article Type for Forthcoming Articles (optional) General Rules for Article Type • An article type alerts the user that the reference is to an abstract or a letter to the editor, not a full article • Place [abstract] or [letter] afer the article title • Follow the bracketed article type with a period Specific Rules for Article Type • Article titles ending in punctuation other than a period • Article titles not in English Box 25. Forthcoming article that is a letter to the editor Forthcoming ("in press") 697 Journal Title for Forthcoming Articles (required) General Rules for Journal Title • Enter a journal title in the original language • Abbreviate signifcant words in a journal title (see Abbreviation rules for journal titles below) and omit other words, such as articles, conjunctions, and prepositions • Capitalize all remaining title words, including abbreviations • End the journal title with a period unless an Edition statement or a Type of Medium is included (see below) Box 18. Injury Prevention: Journal of the International Society for Child and Adolescent Injury Prevention becomes Inj Prev. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics becomes Oral Surg Oral Med Oral Pathol Oral Radiol Endod • Some bibliographies and online databases show a place of publication afer a journal title, such as Clin Toxicol (Phila). Tis practice is used to show that two or more journal titles with the same name reside in a library collection or database; the name of the city where the journal is published distinguishes the various titles. Te city is usually shown in abbreviated format following the same rules as for words in journal titles, as Phila for Philadelphia in the example above. If you use a bibliography or database such as PubMed to help construct your reference and a place name is included, you may keep it if you wish. Abbreviate it according to the Abbreviation rules for journal titles and capitalize all remaining words, including abbreviations. Abbreviate it according to the Abbreviation rules for journal titles and capitalize all remaining words, including abbreviations. Do not abbreviate any of the words or omit any words; use the capitalization system of the particular language. If you do, abbreviate the title according to the Abbreviation rules for journal titles and indicate the language of the article afer the journal title. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Forthcoming article in a journal title with an edition Forthcoming ("in press") 701 13. Forthcoming article in an Internet journal Edition for Forthcoming Articles (required) General Rules for Edition • Indicate the edition/version being cited afer the title if a journal is published in more than one edition or version • Abbreviate each signifcant word (see Abbreviation rules for editions below) and omit other words, such as articles, conjunctions, and prepositions • Capitalize all remaining title words, including abbreviations • Place the edition statement in parentheses, such as (Br Ed) • End the edition statement with a period placed outside the parenthesis unless the Type of Medium is included (see below) Box 23. See Appendix A for a list of commonly abbreviated English words in journal titles. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Example: ĉ or ç becomes c ⚬ Separate the edition from the title proper by a space and place it in parentheses ⚬ Do not follow abbreviated words with a period, but end all journal title information with a period Example: Pharmakeutikon Deltion. Tis rule ignores some conventions used in non-English languages to simplify rules for English-language publications. Examples: ŏ becomes o ū becomes u ⚬ Separate the edition from the title proper by a space and place it in parentheses ⚬ End all the title information with a period Example: Fang She Hsueh Shi Jian. If you do, abbreviate them according to the Abbreviation rules for journal titles. Dutch uitgave Uitg editie Ed Finnish julkaisu Julk French edition Ed German Ausgabe Ausg Greek ekdosis Ekd Box 24 continues on next page... Language Word Abbreviation Italian edizione Ed Norwegian publikasjon Publ Portuguese edicao Ed Russian izdanieIzd Spanish edicion Ed Swedish upplaga n. Forthcoming article in an Internet journal Volume Number for Forthcoming Articles (optional) General Rules for Volume Number • Omit "volume", "vol. Specific Rules for Volume Number • Supplements, parts, special numbers to a volume • Non-English names for volume • No volume number present Box 28. A volume will sometimes be published with a further subdivision instead of an issue. See the following examples: Language Suppl Spec No Pt French supplement nombre speciale partie annexe part German Beiblatt spezielle Zahl Teil Beilage Box 28 continues on next page... Occasionally a journal will publish a series of issues without volumes or will publish a supplement, part, or special number to a date of publication rather than to a volume or issue. Forthcoming article with volume and issue predicted Issue Number for Forthcoming Articles (optional) General Rules for Issue Number • Omit "number", "no. An issue will sometimes be published with a further subdivision, usually called a supplement, part, or special number. Part = Pt Special Number = Spec No • Place them afer the issue number and inside the parentheses. Forthcoming article with volume and issue predicted Language for Forthcoming Articles (required) General Rules for Language • Give the language of publication if not English • Capitalize the language name • Follow the language name with a period Forthcoming ("in press") 711 Specific Rules for Language • Articles appearing in more than one language Box 35. Indicate all languages of publication afer the journal title and any volume or issue number Colombo C. Indicate the particular languages, separated by a comma, afer the journal title and any volume or issue number. Forthcoming article with a title not in English Notes for Forthcoming Articles (required) General Rules for Notes • Begin with the word Forthcoming • Enter the year of intended publication, if known • End with a period Specific Rules for Notes • Other types of material to include in notes • Options for date 712 Citing Medicine Box 36. Te notes element may be used to provide any information that the compiler of the reference feels is useful to the user. Supported by research grants from the Tureus Foundation and the National Heart, Lung, and Blood Institute. Structural shielding design and evaluation for megavoltage x-and gamma-ray radiotherapy facilities. Structural shielding design and evaluation for megavoltage x-and gamma-ray radiotherapy facilities.

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If the proventricular wall ap- flammation buy albendazole line, esophageal perforation or laceration trusted 400mg albendazole, pears thin and friable albendazole 400mg amex, the potential for postoperative proventricular dilatation, beak disorders, pharyngeal incisional leakage may warrant placement of a duo- disorders and any condition resulting in hypophagia denal feeding tube. This will allow enteral alimenta- or anorexia places a nutritional demand on the pa- tion of the patient while bypassing the gastric incision. Proper attention to the patient’s nitrogen balance The ventriculus is best approached through a can make the difference between success and failure proven-triculotomy incision. The opening into the ventriculus can be gently dilated to A technique for placement of a duodenostomy tube allow the introduction of instruments appropriate for has been described in domestic pigeons. Some surgeons sug- five catheterized birds had minor weight loss after 14 gest that a ventriculotomy (transverse abdominal days of total nutritional support through the enteros- approach) is easier than a proventriculotomy (left tomy tube (4% to 10%). The lighter-colored, elliptical area removal, all the birds had regained their normal of the ventriculus, where the muscle is thin and the weight. The ascending duodenum is easily identified The incision is made transversely across the muscle by its close association with the pancreas (see Anat- fibers into the lumen. A “through-the-needle” catheter (in- placed close together to prevent leakage, because a dwelling jugular catheter) is used with the needle serosal seal cannot be created by using an inverting passing first through the left abdominal wall, then suture pattern. The catheter diameter should be less than one-third the diameter of the intestine. One or two sutures are midline celiotomy or to debride necrotic bowel secon- placed between the left body wall and the duodenum dary to constrictions caused by adhesions (see Color at the entry site of the catheter to secure the intestine 14). The midline celiotomy is closed ture on either side of the cloaca; however, when the routinely. If mattress sutures are used, they must The catheter is secured to the outside left abdominal allow for the passage of droppings. The needle is method involves the placement of two sutures trans- protected within its “snapguard,” and the snapguard versely across the vent. The excess is coiled and the from a few days to several weeks depending on the catheter is secured to the lateral and dorsal body wall clinical situation. The catheter is flushed with sa- dicated due to frequent postsurgical cloacal atony line to assure patency, and an injection cap is placed secondary to nerve damage. A percutaneous cloacopexy may be performed as a Once the caloric need is calculated (see Chapter 40), temporary or definitive treatment for cloacal pro- the amount of liquid diet required is calculated based lapse. A variety of liquid diets is commercially avail- tained within the cloaca to help identify its limits, able and their compositions have been described (see and two or three sutures are placed percutaneously Chapter 15). The su- equal volumes and injected four to six times daily at tures should be removed in two to four weeks. This a rate of approximately 1 ml/15 seconds to allow the procedure carries the risk of inadvertently entrap- intestine to accommodate the volume. In some cases, prolapse is due to atony of the vent The catheter should be maintained a minimum of sphincter. This condition may be treated by surgi- five days to allow a seal to form between the intestine cally narrowing the vent opening. Simple Once the catheter is no longer needed, the finger trap interrupted sutures are placed from one side of the suture is cut, the catheter removed and the defect left vent to the other in order to partially close the open- to heal by second intention. This will decrease the size of the vent opening permanently, preventing prolapse of the cloaca. Daily weight and biochemistry changes can be used to alter A rib cloacopexy is an effective treatment for severe the volume and content of the liquid diet. It may be necessary to Cloacal Prolapse use a moistened cotton-tipped applicator or the fin- ger of a gloved assistant to reduce the prolapse and Cloacopexy is indicated to correct problems with define its limits intraoperatively. This appears be most common in Old World psittacine birds, espe- to be crucial for a successful surgery. Chronic gram-negative enteritis may incision is elevated with the index finger, bringing be an initiating factor,2 underscoring the need for the ribs into view to facilitate suture placement. A cloacal cultures as part of the patient evaluation suture is placed around the last rib on each side of process. The attachments of the cloaca are damaged, the bird and passed through the full thickness of the allowing the entire structure to prolapse, which may ventral aspect of the craniolateral extent of the cause occlusion of the ureters and colon. The suture should be tied with enough lapses may respond to placement of a mattress su- tension to slightly invert the vent. Several other sutures are then placed be- tween the body wall and the wall of the cloaca. The A transverse abdominal cloacopexy may provide cloaca may be sutured to the caudal border of the more even distribution of tension than a ventral midline approach. A corresponding paramedian incision is made in the peritoneal surface of the body wall at a point that will maintain the cloaca in a position that will result in slight inversion of the vent. Three or four sutures are placed between each side of the two incisions such that the serosal surfaces are sutured and the subse- rosal surfaces of the two structures are apposed. Alternatively, a routine ventral midline incision may be made, the cloaca reduced and the associated fat excised. The cloaca is incised to the level of management including ovocentesis should be at- the submucosa, and the seromuscular layer is then tempted prior to considering surgical intervention. Prolapse of oviduct or uterine tissue occurs with some degree of frequency in egg-bound birds, espe- cially budgerigars and cockatiels. The tissue may have been expelled through the vaginal opening into the cloaca and potentially externalized through Surgery of the the vent. As the tissue protrudes through the cloaca, Reproductive Tract it undergoes axial torsion, making it difficult to iden- tify the lumen. Surgery on the female reproductive tract is most Ovocentesis often indicated in cases of egg binding, ectopic ovula- If medical management of egg binding fails, ovocen- tion, soft-shelled eggs, congenital atresia of the ovi- tesis and collapsing the egg may be successful. Under duct, damage to the uterus, salpingitis, neoplasia, general anesthesia, the opening of the vagina into abnormal egg production, biopsy and culture of the the cloaca is identified. Once the egg is visualized, a needle can ally, only the left side of the female reproductive tract be inserted into the egg to aspirate its contents. The right oviduct may become cystic in Following ovocentesis, the egg can be collapsed and older fowl,43 and this condition has been reported in the shell fragments removed (see Chapter 29). It is depending upon which portion of the reproductive prudent to reconstruct the egg to be certain that all tract is to be evaluated. Alternatively, a radiograph may be valuable to rule out the presence of another egg or remaining fragments. Egg Binding Egg binding occurs commonly in companion birds If the lumen is not identifiable, the prolapsed tissue and has been associated with a genetic predisposi- may be incised to deliver the egg. Once the egg is tion, improper nutrition, atony of the uterus, over- removed, the layers of uterine wall should be sutured sized eggs, inexperience of the hen, tumors of the with a fine (6-0 to 10-0) monofilament, absorbable reproductive tract and extraluminal compression of material on an atraumatic needle in a simple apposi- the reproductive tract by abdominal masses.

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Not surprisingly buy discount albendazole 400mg on-line, these same nutrients are also of great significance in cancer prevention order albendazole with a mastercard, as aging and cancer share many mechanisms buy discount albendazole 400mg line. Carotenes An important class of dietary antioxidants for longevity is the carotenes, the most widespread group of naturally occurring plant pigments. For many people (physicians included) the term carotene is synonymous with provitamin A, but only 30 to 50 of the more than 400 carotenoids that have been identified are believed to have vitamin A activity. Considerable evidence now demonstrates that carotenes do much more than just serve as a precursor to vitamin A. Although research has primarily focused on beta-carotene, other carotenes such as lycopene, lutein, and astaxanthin are more potent in their antioxidant activity and are deposited in tissues to a greater degree. It should also be kept in mind that while research tends to focus on beta-carotene intake, eating a diet rich in beta-carotene means that you are also getting many other carotenes. Concentration of Carotenoids and Maximum Life-span Potential The Influence of Carotene Content on Life Span Potential It appears that tissue carotenoid content is one of the most significant factors in determining life span in mammals, including humans. Consumption of foods rich in carotenes (green leafy vegetables, pumpkin, sweet potatoes, carrots, etc. High carotene intake may also offer significant benefit to the immune system—the thymus gland is largely composed of epithelial cells, and carotenes concentrated in those cells are able to significantly reduce the shrinkage the thymus gland undergoes during normal aging and stress. In addition, studies have shown that thymus-gland-mediated immune functions could be improved with carotene supplementation (see the chapter “Immune System Support”). Flavonoids Another group of plant pigments with remarkable protection against free radical damage is the flavonoids. However, these compounds serve other functions in plant metabolism besides contributing to the plants’ aesthetic quality. That is, they modify the body’s reaction to other compounds, such as allergens, viruses, and carcinogens, as evidenced by flavonoids’ anti-inflammatory, anti-allergenic, antiviral, and anticancer properties. Flavonoid molecules are also quite unusual in their antioxidant and free radical scavenging activity, in that they are active against a wide variety of oxidants and free radicals. The best way to ensure an adequate intake of flavonoids is to eat a varied diet rich in colorful fruits and vegetables. The richest dietary sources of flavonoids include citrus fruits, berries, onions, parsley, legumes, green tea, and red wine. While there is significant overlap among these flavonoid-rich extracts, Ginkgo biloba deserves some special mention. In herbal medicine, for centuries it was believed that plants were signed by the Creator with some visible or other clue that would indicate their therapeutic use. The sole surviving species of the family Ginkgoaceae, the ginkgo tree can be traced back more than 200 million years to the fossils of the Permian period and for this reason is often referred to as a “living fossil. The ginkgo tree was brought to America in 1784 to the garden of William Hamilton near Philadelphia. The ginkgo is now planted throughout much of the United States as an ornamental tree, as it will grow where other trees quickly die. Although the notion of a doctrine of signatures is fanciful, the bottom line is that Ginkgo biloba extract can be very useful in increasing the quality of life in the elderly. Many symptoms common in the elderly are a result of insufficient blood and oxygen supply. Ginkgo biloba extract has demonstrated beneficial effects in improving blood and oxygen supply to the brain and as a result may help improve a number of common symptoms of aging, including short-term memory loss, dizziness, headache, ringing in the ears, hearing loss, and depression. It is found in low levels in the skin of red grapes, red wine, cocoa powder, baking chocolate, dark chocolate, peanuts, and the skin of mulberries. Red wine is perhaps the most widely recognized source of resveratrol; however, red wine contains only 1 mg per glass. Most resveratrol supplements use Japanese knotweed (Polygonum cuspidatum) as the source. Resveratrol occurs naturally in two forms: cis-resveratrol and trans- resveratrol. Trans-resveratrol is much more bioactive and clinically beneficial than cis-resveratrol. Resveratrol has received a lot of attention as a longevity aid, but the scientific basis for this relies on test tube and animal studies—there are only a few published human studies at this time, and many questions remain to be answered. The effects of resveratrol in animal studies are very similar to the benefits noted with calorie restriction, but are obtained without actually reducing calorie intake. Its longevity-promoting effects have been demonstrated in yeast, fish, and mice but have not yet been properly assessed in humans. At this time we prefer to recommend less expensive and more substantiated measures, such as ensuring optimal vitamin D levels (discussed below). Vitamin D The list of the benefits of vitamin D supplementation is growing at a rapid pace. An analysis of studies of vitamin D supplementation showed that participants who took vitamin D supplements had a 7% lower risk of death compared with those who did not. It is now known that virtually every cell in our body has receptors for vitamin D. It has been shown to protect against certain cancers (particularly breast and prostate), autoimmune diseases such as multiple sclerosis and type 1 diabetes, and heart disease. In terms of the effect on aging, there was a five-year difference in telomere length in those with the highest levels of vitamin D compared with those with the lowest levels. Obesity, smoking, and lack of physical activity can shorten the telomere length, but the researchers found that increasing vitamin D levels overcame these effects. What this five-year difference means is that a 70-year-old woman with higher vitamin D levels would have a biological age of 65. For men over 50, again we recommend using blood or saliva measurements to determine the dosage. Typically, we have found the dosage required to achieve this goal is between 25 and 50 mg. Melatonin Melatonin (not to be confused with melanin, the compound responsible for producing skin pigment) is a hormone manufactured from serotonin and secreted by the pineal gland. The pineal gland, a small pea-sized gland at the base of the brain, has been a source of curiosity since antiquity. The ancient Greeks considered the pineal gland the seat of the soul, a concept that was extended by the philosopher Descartes. In the 17th and 18th centuries physicians associated “madness” with the pineal gland.