Entocort

Jeffrey T. Wieczorkiewicz, PharmD, BCPS

• Assistant Professor, Department of Pharmacy Practice, Chicago College of Pharmacy, Midwestern University, Downers Grove
• Clinical Pharmacy Specialist—Acute Care Internal Medicine, Edward Hines Jr. VA Hospital, Hines, Illinois

Proceedings of the National 64 Biochemistry Academy of Sciences of the United States of America allergy treatment herbal buy entocort 200mcg mastercard, Vol allergy testing baltimore 100mcg entocort fast delivery. Design allergy shots and diabetes purchase entocort master card, synthesis allergy juice recipe entocort 200mcg, and evaluation of indole compounds as novel inhibitors targeting Gp41 allergy treatment questions order entocort 200 mcg line. It is essential for several important activities allergy rhinitis treatment buy generic entocort 200mcg online, such as muscle contraction and transmembrane signaling (Luna & Hitt, 1992; Salmon, 1989). Actin consists of actin filaments and a variety of associated proteins (Schmidt & Hall, 1998). Many proteins associated with the actin cytoskeleton control actin assembly and disassembly. These proteins regulate actin assembly at multiple levels, including the organization of actin monomers into actin polymers (Schmidt & Hall, 1998). One key actin-regulatory protein is profilin, which associates with polymerization of actin. Profilin plays an important role in the regulation of actin polymerization in a number of motility functions (Haarer & Brown, 1990). The ability of profilin to bind to many ligands suggests that profilin is involved in signal transduction and may link transmembrane signaling to the control of the microfilament system (Korenbaum et al. Early biochemical studies indicated that profilin interacts with actin in a 1:1 ratio and participates in the addition of monomers at the free barbed end of the filament then disassociates at the barbed end (Pantaloni & Carlier, 1993). Latest work has suggested several more functions of profilin aside from its monomer-sequestering ability. Profilin promotes the exchange of adenine nucleotide bound to actin monomer and also effectively lowers the critical concentration of monomer actin for polymerization of actin (Borisy & Svitkina, 2000; Theriot & Mitchison, 1993). It also promotes nucleotide exchange on an actin monomer by lowering the affinity of the actin monomer for its bound nucleotide by 1000 fold (Goldschmidt-Clermont et al. It became progressively clear that profilins are vital constituents of the cytoskeleton. Additionally, the role of profilins in several cytoskeleton-based processes of clinical relevance has been proven. For example, high levels of profilin expression have been reported in human gastric cancer (Tanaka et al. On the contrary, profilin-I has been described as a tumor suppressor in some other types of cancer such as breast cancer (Das et al. Another clinical problem in which profilins may be involved is the lateral spreading of some infectious diseases (Pistor et al. In this regard, profilins have been reported as major allergens implicated in pollen and food allergies in approximately 20% of type I allergy patients (Ebner et al. Therefore, the aim of this chapter is to shed light on the significance of profilin-I via understanding the molecular and cellular aspects of this molecule, and its role in the vascular diseases. Normally, the isoforms are expressed by diverse genes; nevertheless, differentially spliced isoforms are known to be present as well. In humans, profilin-I is expressed in every cell, while other isoforms are expressed in specific tissues. Yet, the expression timing was different during the rat testis post-natal development and in the rat spermatogenetic cycle. As evident by immunostaining expression patterns for the profilin isoforms was different. At the early stages of embryogenesis, profilin-I confines to the cytoplasm and to the cellular contacts, while at the later stages of embryogenesis it confines to the nerve ring. Based on the small sizes of profilin (15 kDa) and the profilactin complex (57 kDa) one might expect that they can easily diffuse to the nucleus. Nonetheless, profilin ordinarily is excluded from the nucleus and can be found only in the cytoplasm. Either the most part of profilin is bound in the cytoplasm and only a small portion can diffuse freely or there is a particular export mechanism that can actively take the profilin out of the nucleus (Witke, 2004). Exportin 6 identifies the actin-bound profilin only, as a cargo and moves it out of the nucleus. The reasons for the existence of this profilactin-specific exportin still unclear, but this finding proposes that the nuclear levels of profilin and actin should be strictly regulated (Witke, 2004). For example, it has been reported that profilin-I is linked with subnuclear structures such as ribonuclear particles and Cajal bodies, and anti-profilin antibodies interfere with splicing in vitro. Only a role for profilin and actin in splicing, chromatin remodeling or transcriptional regulation can be speculated. A more detailed understanding of the dynamics and properties of nuclear profilin and actin is required. It is possible that in the nucleus these proteins are considered necessary momentarily during the cell cycle or, particularly, in cells experiencing transcriptional activity changes (Witke, 2004). Numerous studies on profilins from different origins demonstrate that they have highly similar tertiary structures (Fedorov et al. On one side, this core is flanked by N and C-terminal helices, with both termini next to each other, and on the opposed side by an extra helix attached to either additional helix or a small strand (Schluter et al. It has been reported that there are three groups of ligands characterize profilins: (1) G-actin and actin-related proteins (Machesky et al. Recently, there are more than 50 described profilin-binding Profilin, and Vascular Diseases 69 ligands from diverse origins. However, this represents only a part of the real number of profilin-binding partners. While a small number of these interactions demonstrated a physiological relevance, the recognition of profilin-interacting proteins could explain the unpredicted roles of profilin in mammalian cells. The profilin-ligands binding might help in linking different pathways to cytoskeletal dynamics via a mechanism that still unknown. Non-conserved residues are shown in blue; conserved residues are shown in brown, adapted from Witke, (2004) with permission. Among this large number of profilin ligands we will focus on the binding of profilin to some of those ligands believed to be of relevant role in vascular problems such as actin and ligands in Rho/Rac pathway. Proteins that are known to interact with profilin are grouped according to their cellular location or the complexes in which they are found. Some of the profilin ligands are shared among different complexes (indicated by the intersecting fields), which suggests a crosstalk among signaling platforms, with profilin as the common denominator. Direct interactions between profilin and the ligands are indicated by unbroken lines, whereas potentially direct interactions are indicated by broken lines. Additionally, capping the plus end of the filaments inhibits the addition of the profilin-actin complexes and consequently limits the activity of profilin to a simple sequestering effect (Pantaloni & Carlier, 1993; Perelroizen et al. Thus, the presence of other G-actin binding and/or capping proteins could regulate the profilin effect on cellular actin (Schluter et al. In vitro, three major functions have been identified for profilins in the regulation of actin polymerization. Previously, it has been considered that the profilins effect on nucleotide exchange on actin directly regulates their ability to promote filament assembly at the plus end. These data demonstrate that the major effect of profilins on actin polymerization cannot be linked with their capacity to work as nucleotide exchange factors. Generally, the data obtained from cells with different profilin levels are in harmony with the notion that in lower eukaryotes the central role of profilin is to sequester G-actin, whereas in higher eukaryotes this is mainly done via other G-actin binding proteins such as thymosin 4 (Safer et al. Based on this notion, lower eukaryotes deficient in profilins should exhibit an increase in F actin, however in higher eukaryotes this would not be the principal outcome. Conversely, several studies reported about filament-stabilizing or regulating functions of profilin in higher eukaryotes. For example, the overall F-actin content and stability were elevated whereas; a considerable amount of F-actin was shifted from stress fibers to the cortical actin network in Chinese hamster ovary cells overexpressing profilin (Finkel et al. Likewise, actin filaments were stabilized against cytochalasin D and latrunculin in baby hamster kidney cells overexpressing birch profilin (Rothkegel et al. In addition, a shift in F-actin from stress fibers to thick peripheral actin filament bundles with a corresponding increase in cellular adhesion to fibronectin has been reported in cultured human endothelial cells overexpressing profilin (Moldovan et al. Although these findings indicated a differential role of profilins between lower and higher eukaryotes, a few studies showed contradictory data to these reports (Cao et al. Consequently, a final conclusion on the validity of the assumption regarding differential functions of profilins in higher and lower eukaryotes needs to be confirmed with further experimentations (Schluter et al. RhoA binding to the N terminus releases the autoinhibition and activates actin nucleation (Alberts, 2002). Profilin binding occurs through the proline-rich formin homology domain that present in the core of that diaphanous molecule (Watanabe et al. One interesting possibility is that diaphanous can move actin after it has been sequestered by profilin and activate actin polymerization (Li & Higgs, 2003). However, this is limited by the argument that the studies of profilin-diaphanous binding used truncated versions of diaphanous, rather than the full-length protein. In vivo, it has been suggested that large complex of diaphanous oligomers is present as well (Li & Higgs, 2003), which via diaphanous monomers can interact with profilin and/or profilactin molecules. Nevertheless, the structure and regulation of this enormous signaling platform for actin nucleation need to be understood (Witke, 2004). Initially, profilin binds with high affinity (micromolar range) to G-actin in a 1:1 stoichiometric complex (Schluter et al. Nevertheless, this hypothesis was neglected due to (1) the absence of this sequence in mammalian profilins, (2) the ability of Saccharomyces profilin to interact with actin even after deletion of this motif (Haarer et al. Studies on bovine profilin-I and actin showed that the actin binding sites on profilin are localized in the helix 3, the proximal part of helix 4, and in the strands 4, 5 and 6 (Schutt et al. These residues bind to subdomains 1 and 3 on the actin molecule; however, they do not exhibit a conserved sequence motif (Thorn et al. In the bovine complex, Phe375 appears to be a key residue that interacts with Ile73, His119, Gly121 and Asn124 on the profilin side (Schutt et al. Similarly, other studies on Acanthamoeba reported that actin-related proteins such as Arp2 interact with profilin using the same binding site (Kelleher et al. Topographical relation of the main ligand binding domains as seen on the X-ray structure of bovine profilin (Schutt et al. On the other hand, studies on Acanthamoeba described a positively charged area opposing both termini, placed in the G-actin binding site as the binding motif of the second key ligand of profilin, PtdIns 4, 5-P2 (Fedorov et al. This was supported by mutation studies on Saccharomyces profilin and human profilin-I. Point mutations in this region diminished the binding affinity of profilin to PtdIns 4, 5-P2 (Haarer et al. In line with the observation that the binding sites of G-actin and PtdIns 4, 5-P2 on profilin overlap ure 5), it has been reported that these ligands compete with each other for binding to profilin (Lassing & Lindberg, 1985; 1988; Machesky et al. In addition, other reports showed that binding of PtdIns 4, 5-P2 results in a conformational change in profilin and disrupts the profilin-actin complex (Raghunathan et al. Also, it has been revealed that profilin can bind a variety of phosphatidylinositol and the binding affinity of human profilin-I to phosphatidylinositol 3, 4-bisphosphate (PtdIns 3, 4-P2), and phosphatidylinositol 3, 4, 5-trisphosphate (PtdIns 3, 4, 5-P3) is higher than its affinity to PtdIns 4, 5-P2 (Lu et al. Phosphorylation and activation of this lipase as a result of transmembrane signaling (Goldschmidt-Clermont et al. For effective profilin binding, it has been proposed that 6 continuous prolines would be sufficient (Metzler et al. These proline stretches may be interrupted by single glycine residues (Domke et al. Initially, the structural requirements for the profilin-ligand binding are not completely understood. In spite of binding of profilin to an extremely diverse group of ligands either directly or as part of a larger complex, the binding sites on both profilin and ligands appear to be well conserved. The only exception, so far, to this model is gephyrin, which appears to bind to a special profilin domain (Giesemann et al. All profilin ligands are characterized by the presence of stretched or nearly stretched proline-rich domains that are required for profilin binding. A lot of profilin ligands contain in their proline-rich domains proline repeats of no more than three or four successive prolines. The second important factor in regulating the binding of profilins to their ligands is the binding specificity of ligands to the different profilins. Eventually, identifying the structural features of different profilin complexes will be helpful to understand the basis of specificity. Finally, the profilin ligands binding should be a dynamic process and the mechanisms of ligand release under physiological conditions have to be determined. For example, actin can be released from profilactin complex via PtdIns(4, 5)P2, and an analogous mechanism might be used for ligand binding regulation. In these signaling platforms profilins appear to be a common denominator (Witke, 2004). Figure 6 is a schematic representation demonstrating various interactions between profilin, the microfilament system and different signaling pathways.

It presupposes that users adjust their use patterns to differences in nicotine levels and that nor malizing the amount of nicotine will remove the differences in formu lation intended to exploit this compensatory behaviour allergy forecast netherlands purchase line entocort. Compensatory behaviour is somewhat less of a concern with smokeless tobacco allergy testing columbia mo buy generic entocort 100mcg on line, as the principal form of compensation is use of increased amounts allergy symptoms burning nose order entocort 200mcg visa, as opposed to cigarettes allergy treatment doctor purchase 100mcg entocort overnight delivery, with which the intake of nicotine is increased largely by altering puffing behaviour allergy shots one time order entocort with american express. One concern is that manufacturers might simply add nicotine to the product to meet the standards allergy watch generic entocort 200mcg overnight delivery. An unresolved question with respect to this approach is whether the normalization should be to total nicotine or to nicotine in the free (unprotonated) form. While the free form of nicotine is the form of greatest concern for blood nicotine levels, it is possible to alter the free nicotine levels independently of the total nicotine levels, in ways that might result in dramatic changes in free nicotine levels when the product is mixed with saliva. Manufac turers might be able to increase the amount of nicotine in a product but reduce the pH, thus reducing the fraction in the free form. This approach would be appropriate only if the regulation also included a standard for nicotine. It is being evaluated by the United States National Cancer Institute for use in normalizing measurements of smokeless to bacco toxicants. Few data are available, however, on use of this approach, and it would be premature to recommend it. TobReg considered each of the above approaches and, after weighing their strengths and limitations, recommended that the amount of toxicant be nor malized per gram of dry weight of smokeless tobacco. This metric is intended to be a product performance standard rather than a measure of human expo sure to toxicants. It is in accordance with currently established laboratory practice and may be modified as that practice is improved. That literature includes measurements made over several decades and with various methods in different laboratories, and is for products currently being marketed as well as older products. Some of the differences in reported levels may be due to use of different methods by 32 different laboratories. In order to identify the concentrations that could be achieved with existing techniques in a range of current products, TobReg concentrated on recent studies in two well-respected laboratories (12, 17) (Table 3). Equally important, the results show that the concentrations in other traditional smokeless tobacco products on the market substantially exceed this value. When considering a recommended concentration of benzo[a]pyrene, TobReg investigated whether there was justification for any benzo[a]pyrene in smokeless tobacco, as it is a product of combustion, and combustion does not occur in smokeless tobacco use. The sources of benzo[a]pyrene in smokeless tobacco are curing of tobacco with wood smoke (exposure to benzo[a]pyrene as a combustion product of wood) and, to some extent, high ambient general air pollution (3). Examination of tables 2 and 3 shows that low concentrations of benzo[a]pyrene are present (often below the threshold for detection) in most of the newer smokeless tobacco products and in some traditional products. The tables show higher levels in other manufactured products, indicating that there is an opportunity to reduce the benzo[a]pyrene levels through regulation. While sophisticated methods can detect extremely low levels of this toxicant, most can detect concentrations > 4. TobReg therefore recommends a regu latory level of < 5 ng/g dry weight of tobacco for benzo[a]pyrene. As lower detection limits for benzo[a]pyrene become technically feasible, TobReg recommends that this recommendation be revised. The regulatory limit recommended for benzo[a]pyrene is a maximal concen tration of: benzo[a]pyrene: 5 ng/g dry weight of tobacco. This recommendation is not intended to address questions of reduction in risk or harm that may occur when shifting from one tobacco product to another, or the question of whether use of smokeless tobacco should be recommended as a harm reduction strategy to current cigarette smokers. The mandated limits on carcinogen concentrations recommended in this re port constitute a first step towards regulation of smokeless tobacco products by setting performance standards. The immediate next steps would include methods to address the carcinogen levels present in products produced by cottage industries, which might initially have to focus more on education and technology transfer than on regulatory levels. Mandating levels and disallowing brands with higher levels from the market does not imply that the remaining brands are safe or less hazardous than the brands that are removed. It also does not represent government recognition of the safety of the products that remain on the market. The proposed strategy for limiting carcinogens is based on sound precautionary approaches, similar to those used for other consumer products. As an essential part of this pro posal, regulators must assume responsibility to ensure that consumers are not told directly or indirectly or led to believe that smokeless tobacco products that meet the carcinogen limits established pursuant to this proposal are less 34 hazardous than similar products, have been approved by the government or meet government-established health or safety standards. In particular, rank ing of brands by the metric proposed in this report could be interpreted by users as reliable differences in the probable exposure or harm that will result from using different smokeless tobacco brands. The proposed strategy must be applied in ways that will prevent the new standards from being used as marketing tools to misinform consumers. Un substantiated claims for health or exposure on the basis of the proposed testing should be prohibited, as a companion condition essential to responsible im plementation of this regulatory strategy. Measurements of carcinogen levels by brand and all the costs associated with testing and reporting are expected to be the responsibility of tobacco product manufacturers. The results should be reported to the regulatory authority, and a sample of the results should be verified by an independent laboratory. Al ternatively, some regulators may wish to conduct the testing themselves, with funding from taxation or licensing of tobacco products. Given the existing scientific limitations, regulatory authorities have an obli gation to ensure that the public is not misled by the results of the recom mended testing and regulatory strategy. TobReg recommends that any regulatory approach specifically prohibit use of the results of the proposed testing in marketing or other communications with the consuming public, including product labelling. TobReg also recommends that manufacturers be prohibited from making statements that a brand has met government regula tory standards or from publicizing the relative ranking of brands by testing level. Regulators should pursue whatever corrective action is necessary to prevent consumers from being misled. Bethesda, Maryland, National Cancer Institute, 1992 (Smoking and Tobacco Control Monograph No. New and traditional smokeless tobacco: comparison of toxicant and carcinogen levels. Unusually high levels of carcinogenic tobacco-specific nitrosamines in Sudan snuff (toombak). Surveillance of moist snuff: total nicotine, moisture, pH, un ionized nicotine, and tobacco-specific nitrosamines. Statement of principles guiding the evaluation of new or modified tobacco products. Overall recommendations this report addresses two types of products that currently concern scientists because of their potential for harming public health and the inadequacy of regulations governing their promotion, sale and use. They are marketed under a variety of brand names and descriptions around the world but fall into a regulatory gap in most countries. Smokeless tobacco products are also used in many countries, and scientifically documented differences have been found in their content and formulations that may explain the observed differences in adverse health outcomes. Substantial variation in carcinogen levels has been found in smokeless tobacco products marketed in different regions and among prod ucts marketed within a region. It is desirable and feasible to lower these levels through better manufacturing and sales practices. Clinical trials, behavioural and psychological studies and post-marketing studies at individual and population levels are needed to answer these questions. Claims imputing health benefits, reduced harm or use in smoking cessation should be prohibited until they are scientifically proven. Member States should ensure that the manufacturers of these products comply with all existing regulatory re quirements to preclude unsubstantiated claims that may derail public health efforts in tobacco control. Regulators should inform consumers that, like cigarettes, smokeless tobacco products that meet 40 safety standards may be no less hazardous, and they should prohibit product ranking or publicizing test results that are likely to influence user behaviour in ways that will cause harm. As they do for other consumer products, regulators should lower the concentrations of carcino gens present in smokeless tobacco by limiting the concentrations that can be present in products that are marketed. As lower detection limits become tech nically feasible, more aggressive targets for mandated lowering can be set by regulatory authorities. The effects of nicotine, denicotinized tobacco, and nicotine-containing Save items tobacco on cigarette craving, withdrawal, and self-administration in male Add to FavoritesAdd to Favorites and female smokers. During four randomized blinded sessions, participants self affective smoking withdrawal[Clin Ther. They could then self-administer their preferred brand of [Psychopharmacology (Berl). Save items Tracking the rise in popularity of electronic nicotine delivery systems (electronic cigarettes) using search query surveillance. Searches for each week were scaled to the highest weekly search proportion (100), with lower [Tob Control. This method may be Prediction of dengue incidence generalized to other behavioral, biological, informational, or psychological outcomes manifested on using search query surveillance. Electronic cigarettes as a harm reduction strategy for tobacco control: a Save items step forward or a repeat of past mistakes Related citations in Abstract PubMed the issue of harm reduction has long been controversial in the public health practice of tobacco European Union policy on control. Health advocates have been reluctant to endorse a harm reduction approach out of fear that smokeless tobacco: a statement[Tob Control. Recently, companies independent of the tobacco industry introduced promise and perils. We review the existing evidence on the safety and efficacy of electronic cigarettes. We then revisit the tobacco Lessons from the history of harm reduction debate, with a focus on these novel products. By Review Tobacco, nicotine and dramatically expanding the potential for harm reduction strategies to achieve substantial health harm reduction. LinkOut more resources Cited by 2 PubMed Central articles Successful smoking cessation with electronic cigarettes in[J Med Case Rep. Farsalinos1 and Giorgio Romagna2 1onassis Cardiac Surgery Center, Kallithea, Greece. Electronic cigarettes are battery-operated devices that deliver nicotine to the lungs by evaporation of a liquid. Chronic idiopathic neutrophilia is a condition characterized by elevated white blood cell and neutrophil counts without any underlying disease; smoking has been implicated as a potential cause. Case Presentation: A male Caucasian patient, born in 1977, presented in September 2005 with asymptomatic elevation of white blood cell and neutrophil count, and mildly-elevated C-reactive protein levels. He was a smoker since 1996 and was treated with 20 mg/day of simvastatin since 2003 due to hyperlipidemia. Clinical examination, and laboratory and imaging investigations ruled out any infec tious, haematological, rheumatological, or endocrine conditions. He had 2 unsuccessful attempts to quit smoking; one was unassisted and the second was performed with the use of both varenicline and nicotine replacement therapy (patches). In February 2012, he started using electronic cigarettes and he managed to quit smoking within 10 days. After 6 months, laboratory examination showed normalized leukocyte count and C-reactive protein levels, confrmed immediately by a second laboratory and by repeated tests after 1 and 2 months. Conclusion: Smoking cessation with the use of electronic cigarette led to reversal of chronic idiopathic neutrophilia. The daily use of electronic cigarette may help preserve the benefcial effects of smoking cessation. Unrestricted non-commercial use is permitted provided the original work is properly cited. Clinical Medicine Insights: Case Reports 2013:6 15 Farsalinos and Romagna Introduction which was treated with simvastatin at 20 mg/day since Cigarette smoking is a major cause of disease, affect 2003. The test was smoking cessation, long term quit-rates are relatively repeated twice in a different laboratory with similar low. He was completely asymptomatic, had no his and products have been developed, with the main goal tory of recent infections or trauma and reported no to reduce the amount of harmful substances adminis fever. Clinical examination was Electronic cigarettes have been introduced to the market in recent years as an alternative to smoking. Routine laboratory exam They are hand-held electronic nicotine-delivery inations did not reveal any renal or liver dysfunc devices consisting of a battery, a cartridge contain tion. Thyroid hormones were within normal range, ing liquid, and an electrical resistance that is heated as were serum cortisol levels. C-reactive protein was the do not contain tobacco and there is no combus elevated at 14 mg/L (normal range, 5 mg/L). Chest x-ray, echocardiogram dence on their effcacy in reversing smoking-related and upper abdominal ultrasound were normal. Once again he was and leukocyte count is a predictor of future cardio asymptomatic and with no signs of infection or any vascular events. He was also a smoker since 1996 (9 pack-years at the time of advised to stop smoking. White blood cell, neutrophil and lymphocyte count over the course of 7 years follow-up of the patient. The time of initiation of electronic cigarette, leading to smoking cessation, is also indicated by an arrow. It should be mentioned cessful attempts to quit smoking, one without any that use of electronic cigarettes was a personal choice medical treatment in 2006 and one with varenicline of the patient; no advice or recommendation to use it plus nicotine patches in 2010.

Echter allergy treatment vancouver entocort 200mcg line, in de discussie worden studies legden wij aan alle Nederlandse ziekenhuizen een enquete voor allergy treatment with honey order 100mcg entocort otc. In deze enquete aangehaald die potentieel gevaarlijke bijwerkingen en complicaties van deze werden onder andere vragen gesteld over hoe de foetale conditie werd technieken beschrijven allergy treatment 197 discount 200mcg entocort fast delivery. Daarom adviseren wij deze technieken niet routinematig in gemonitord allergy testing cost buy generic entocort pills, hoe foetale nood werd gediagnosticeerd allergy shots while traveling buy entocort australia, welke acties werden de klinische praktijk the gebruiken allergy medicine bag order entocort without prescription, maar eerst zowel de positieve als negatieve ondernomen bij verdenking op foetale nood en volgens welke richtlijnen werd effecten goed the onderzoeken. In geval 213 Chapter 10 van foetale nood wordt in een derde van de ziekenhuizen amnio-infusie toegediend werd duidelijk dat de duur en diepte van variabele deceleraties afnamen, zoals en in 58% wordt maternale hyperoxygenatie toegepast. Een ander voordeel van dit model is dat het effect van klinische interventies waardoor de resultaten uit nieuwere studies nog niet zullen zijn meegenomen in de kan worden bestudeerd, zonder patienten aan de interventies bloot the stellen. Echter, het simulatiemodel is een vereenvoudiging van de werkelijkheid, en potentiele neveneffecten van maternale hyperoxygenatie konden hiermee niet Uit het door ons opgestelde overzicht van de beschikbare literatuur over het effect worden onderzocht. Derhalve kunnen simulaties klinische studies niet volledig van de verschillende intra-uteriene resuscitatietechnieken, bleek dat met name de vervangen. Dit omvat toenemen van circa 100 tot 475 mmHg, als gevolg van het inademen van 100% alle interventies die normaliter in Maxima Medisch Centrum kunnen worden gestart zuurstof. Maternale hyperoxygenatie is geen onderdeel frequentie, duur en intensiteit the simuleren. In de interventiegroep werd gestart met 100% zuurstof via een onderzoeksgroep had al aangetoond dat het model geschikt was om veranderingen mond-neus masker. Indien dit binnen 10 minuten geen acceptabele verbetering van in de foetale hartslag ten gevolge van contracties the onderzoeken. Secundaire uitkomstmaten bevatten verschillende ontstaan van variabele deceleraties van verschillende frequentie, diepte en duur. Ook 214 Samenvatting van foetale nood wordt in een derde van de ziekenhuizen amnio-infusie toegediend werd duidelijk dat de duur en diepte van variabele deceleraties afnamen, zoals en in 58% wordt maternale hyperoxygenatie toegepast. Om die reden hebben wij tevens een klinisch gerandomiseerd onderzoek opgezet de toepassing van deze technieken, en ook in de Nederlandse klinische praktijk om in vivo het effect van maternale hyperoxygenatie, en eventuele neveneffecten the worden deze interventies zeer wisselend gebruikt. Wanneer er een verdenking bestond op foetale nood tijdens de We zijn gestart met het onderzoeken van het effect van maternale hyperoxygenatie uitdrijving, werd middels loting worden bepaald volgens welke van de twee studie in een mathematisch model, geschikt om de foetomaternale oxygenatie en armen de patiente behandeld zou worden. De maternale oxygenatie zal binnen enkele minuten In de eerste studie-arm, de controlegroep, werd normale zorg gestart. Ook 215 Chapter 10 We onderzochten of bovengenoemde uitkomstmaten veranderden voor en na het de deelneemster meldde geen bijwerkingen van de zuurstoftoevoer of het starten van het studieprotocol, en we maakten een vergelijking tussen de gelaatsmasker. Er namen 117 patienten deel aan dit onderzoek, om een power van 90% the behalen met een van 0, 05. Er is geen significant verschil in neonatale uitkomst of wijze van de amplitude van variabele deceleraties gevonden. Omdat eerdere onderzoeken Tenslotte hebben wij onderzocht of maternaal Hb ten tijde van de bevalling beschreven dat maternale hyperoxygenatie mogelijk schadelijk was voor de foetus voorspellend is voor het optreden van foetale nood tijdens de vaginale baring, en en/of moeder, hebben wij in deze studie onderzocht of er verschil is in neonatale de wijze van bevallen. Studies in schapen wezen uit dat bloedarmoede bij de uitkomst en de modus partus (de manier van bevallen), en of de moeder moeder leidt tot verminderde zuurstoftoevoer naar het kind. Ook werd specifiek gekeken naar de groepen waarin een suboptimaal, effect van maternaal Hb op de kans op foetale nood, modus partus, Apgar-score, dan wel abnormaal hartslagpatroon gezien werd. Het zijn veelal kleine, niet gerandomiseerde studies, waargenomen in de interventiegroep dan in de controlegroep (16, 7 versus 5, 7%). Over het effect op Apgar-score en 216 Samenvatting We onderzochten of bovengenoemde uitkomstmaten veranderden voor en na het de deelneemster meldde geen bijwerkingen van de zuurstoftoevoer of het starten van het studieprotocol, en we maakten een vergelijking tussen de gelaatsmasker. Bij het analyseren van de risico op foetale nood en het beloop van de baring kunnen beinvloeden. Ook werd specifiek gekeken naar de groepen waarin een suboptimaal, effect van maternaal Hb op de kans op foetale nood, modus partus, Apgar-score, 10 dan wel abnormaal hartslagpatroon gezien werd. We vonden 810 artikelen in naar de groep neonaten met een laag geboortegewicht (<p10). Deze artikelen werden gescreend op titel en samenvatting, waarna 13 artikelen overbleven die voldeden Verbetering van het foetale hartslagpatroon werd bijna drie keer zo vaak aan de inclusiecriteria. Er werd een grotere, retrospectieve studie Ook verslechterde het hartslagpatroon significant vaker in de controlegroep, ten geincludeerd waaraan ruim 75. Er waren drie (5, 0%) neonaten met Apgar-score <7 na vijf In deze artikelen werd de kans op foetale nood, verschillende neonatale minuten in de controlegroep, vergeleken met een (1, 8%) in de interventiegroep (p = uitkomstmaten en modus partus vergeleken tussen anemische en niet-anemische 0, 62). Bloedgasanalyse in navelstrengbloed en de wijze van bevallen waren niet moeders (wel of geen bloedarmoede). Er was ook geen verschil in de hoeveelheid vrije keken naar navelstreng pH of naar het optreden van foetale nood tijdens de zuurstofradicalen in beide groepen. Bij een derde van de bevallingen werd het toedienen van zuurstof gestopt voordat het kind werd Er lijkt een toegenomen kans op een niet-geplande keizersnede in geval van geboren, voornamelijk als gevolg van discomfort ervaren door de moeder. Over het effect op Apgar-score en 217 op foetale nood en een ongunstige neonatale uitkomst niet gerelateerd aan het Hb van de moeder. Wel lijkt er een hoger risico the bestaan op een niet-spontane Chapter 10 bevalling in geval van anemie. Een algemene discussie van de onderwerpen die in de proefschrift aan gekomen wordt gevoerd in hoofdstuk 9, waarna aanbevelingen voor verder anemische versus niet-anemische moeder, al zal dit deels the verklaren zijn door hetanemische versus niet-anemische moeder, al zal dit deels the verklaren zijn door het bod zijn gekomen wordt gevoerd in hoofdstuk 10, waarna aanbevelingen voor onderzoek worden gedaan. Er zijn grote verschillen tussen de aanbevelingen van de internationale richtlijnen tussen de modus partus, de reden voor een niet-spontane baring, neonataletussen de modus partus, de reden voor een niet-spontane baring, neonatale richtlijnen over welke interventies toe the passen bij de verdenking op foetale over interventies bij foetale nood. Deze uitkomsten staan beschreven inDeze uitkomsten staan beschreven in hoofdstuk 8hoofdstuk 8. In ons onderzoek hebben wij Hb als continue waarde voor verbetering van de placentaire en foetale oxygenatie, en leidt tot een foetaal hartslagpatroon. Maternaal Hb ten tijde van de baring lijkt niet van invloed the zijn op de kans het ontstaan van foetale nood. Het is onduidelijk of het meer risico geeft op lage vacuumextractie wegens foetale nood. Het Hb ten tijde van de baring bleek gerelateerd aan de leeftijd van de moeder, relatief lager Hb. Het Hb ten tijde van de baring bleek gerelateerd aan de leeftijd etniciteit, het aantal eerdere bevallingen, geslacht en geboortegewicht van devan de moeder, etniciteit, het aantal eerdere bevallingen, geslacht en neonaat. Concluderend bleek het risico op foetale nood en een ongunstige neonataleConcluderend bleek het risico op foetale nood en een ongunstige neonatale uitkomst niet gerelateerd aan het Hb van de moeder. Wel lijkt er een hoger risico the bestaan op een niet-spontane bevalling in geval van anemie. Er Hoofdstuk 9 bevat deze Nederlandse en een Engelse samenvatting van dit Een algemene discussie van de onderwerpen die in de proefschrift aan bod zijn werd geen duidelijk verschil gevonden in het risico op perinatale sterfte bijwerd geen duidelijk verschil gevonden in het risico op perinatale sterfte bij proefschrift. Hoofdstuk 10 bevat deze Nederlandse en een Engelse relatief weinig voorkomen van perinatale sterfte. De belangrijkste conclusies uit dit proefschrift zijn: De belangrijkste conclusies uit dit proefschrift zijn: Wij hebben een retrospectieve analyse uitgevoerd op data van ruim 9. Er is weinig goed onderzoek gedaan naar het effect van intra-uteriene bevallen vrouwen uit ons eigen ziekenhuis (Maxima Medisch Centrum, Veldhoven). Het beleid rondom diagnostiek en behandeling van foetale nood verschilt in bepaald die invloed hebben op het Hb van de moeder ten tijde van de bevalling. Het beleid rondom diagnostiek en behandeling van foetale nood verschilt in Nederland per kliniek. De uitkomsten van het nabootsen van het effect van maternale in een simulatiemodel suggereren dat deze interventie leidt tot verbetering van Alle vrouwen die zijn bevallen in Maxima Medisch Centrum tussen 2009 en 2016Alle vrouwen die zijn bevallen in Maxima Medisch Centrum tussen 2009 en 2016 hyperoxygenatie in een simulatiemodel suggereren dat deze interventie zorgt de placentaire en foetale oxygenatie, en leidt tot een verbetering van het werden geincludeerd. Maternaal Hb ten tijde van de baring lijkt niet van invloed the zijn op de kans op en de kans op een vacuumextractie om welke reden dan ook, en op eenen de kans op een vacuumextractie om welke reden dan ook, en op een 6. Wel lijkt het risico op een niet een keizersnede wegens een niet-vorderende baring. Wel lijkt er een hoger risico teuitkomst niet gerelateerd aan het Hb van de moeder. Am Jfetal blood, amniotic fluid, and cerebrospinal fluid of the mother and the baby. Oxygen tension in maternal and fetal blood, amniotic fluid, and cerebrospinal fluid of the mother and the baby. Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome a retrospective cohort study. Management of intrapartum fetal distress in the Netherlands: a clinical practice survey. Interventions for intrauterine resuscitation in suspected fetal distress during term labor: a systematic review. Intrapartum maternal hemoglobin level, does it affect fetal and neonatal outcome and mode of delivery A to the limit: a simulation model used to evaluate a clinical intervention during labor. Practice variation in the management of intrapartum fetal distress in the Netherlands and the Western world. Acta Obstet 19th Annual meeting of the Society in Europe for Simulation Applied to Medicine Gynecol Scand. Comparison of complication rates between umbilical and peripherally inserted central venous catheters in newborns. Does arterial shear explain the umbilicalis lijn meer complicaties in vergelijking met andere centraal veneuze lijnen magnitude of flow-mediated dilation The impact of baseline diameter on flow-mediated dilation differs in young and older humans. Maternal hemoglobin level and its relation to fetal distress, mode of delivery, and short-term neonatal outcome: a retrospective cohort study. Sensitivity analysis for validation of a model to simulate fetal heart rate during labor. Graag wil ik iedereen bedanken die mij geholpen heeft bij het schrijven van dit proefschrift. Ik ben heel trots en dankbaar dat ik samen met je mag werken en nog veel van jouw adviezen kan leren. Alle gynaecologen met wie ik de afgelopen jaren met heel veel plezier heb mogen samenwerken: veel dank voor jullie actieve interesse en jullie voorbeeldfunctie. Lieve arts-assistenten, mijn maatjes, heel veel dank voor jullie gezelligheid, collegialiteit en vriendschap! Het was even zoeken naar een mooi project dat paste bij mijn klinische werk, maar het is gelukt! Ik ben je heel dankbaar voor je vertrouwen, positiviteit en zelfs ik ben jaloers op jouw onuitputtelijke voorraad energie! Jij bent de perfecte brug tussen de (voor mij soms onbegrijpelijke) technische en medische kant van het onderzoek, en iemand op wie ik altijd kon rekenen. Daarnaast leverde jij vaak een kritische noot vanuit medisch oogpunt, wat de stukken telkens weer beter maakte! Met name de opleiders bedankt voor de ruimte die ik kreeg voor het uitvoeren van mijn onderzoek. Nu deze bevalling achter de rug is kunnen we ons Dank aan de leden van de promotiecommissie voor het kritisch beoordelen van dit voorbereiden op de volgende, waarna we nog een mooie dochter rijker zijn. Lieve familie en vrienden, heel erg bedankt voor jullie interesse in mijn onderzoek, maar vooral voor gezelligheid en nodige ontspanning tussendoor! Lieve Eva, mijn vriendinnetje, drie jaar geleden mocht ik tijdens jouw promotie aan je zijde staan, nu mag jij eindelijk deze plaats naast mij innemen. Lieve Eva, mijn zusje, vriendin en nu ook paranimf, met jou is het altijd een feestje! Ik ben heel trots op jou en bewonder je enorm door je creativiteit, eigenzinnigheid en doorzettingsvermogen. Bedankt voor jullie interesse in ons, en dat jullie altijd voor ons en ons kleine meisje klaar staan. Jullie hebben me zoveel kansen gegeven in mijn leven, wat heeft gemaakt dat ik me kon ontwikkelen tot wie ik ben. Het hardlopen rond de Eiffeltoren, speurtocht in Italie, escape room in heel erg trots op! Je werkt hard om je doelen the bereiken, terwijl je mij opdraagt om Guids tuinhuisje en de zwembad/pannenkoekenparty in Orlando geven blijk van een op zijn tijd wat rustiger aan the doen en meer aan mezelf the denken. Mijn paranimfen, Eva en Eva, hoe toepasselijk voor een proefschrift rondom nieuw leven! Wat heerlijk dat je met Dennis eindelijk een eigen plek heb gevonden in Tilburg, als ook jullie derde telg ter wereld is gekomen is het weer tijd om wijntjes the drinken in de tuin! Ik waardeer je enorm om je nuchterheid, gastvrijheid, uitgebreide bierkennis, en dat je zo goed op mijn zusje past! Het schooljaar 2001 2002 studeerde zij aan het Liceo Classico Siotto Pintor in Cagliari (Sardinie, Italie). Na het afronden van de middelbare school startte zij de opleiding Geneeskunde aan de Radboud Universiteit in Nijmegen. In december 2010 begon zij als arts-assistent Obstetrie en Gynaecologie in Maxima Medisch Centrum, waar zij kort hierna startte met het onderzoek naar foetale oxygenatie binnen de onderzoeksgroep Fundamentele Perinatologie onder leiding van Prof. In 2014-2015 doorliep zij het academische deel van de opleiding in het Maastricht Universitair Medisch Centrum (Prof. Na het voltooien van het 4e opleidingsjaar in Maxima Medisch Centrum startte zij in juni 2017 in het Catharina Ziekenhuis met de differentiatie Urogynaecologie, en in november 2018 met de differentiatie Minimaal Invasieve Chirurgie in Maxima Medisch Centrum. Lauren woont samen met Gert-Jan Lauret en hun dochter Mare in Eindhoven, in maart 2019 verwachten zij hun tweede kindje. Dazu zahlen insbesondere Adipositas, Diabetes mellitus Typ 2, Dyslipoproteinamie, Hypertonie, Herz und Gefakrankheiten und Krebskrankheiten. Die relative Bedeutung dieser Krankheiten hat in den letzten Jahrzehnten kontinuierlich zugenommen, dementsprechend ist ihr Anteil an den Ausgaben im Gesundheitssystem standig gewachsen.

Buy entocort online from canada. Guardians of the Galaxy Vol 2 : Audience Reactions | May 5 2017.

Syndromes

• Avoid going out in dry, cold weather without putting on lip balm or lipstick
• Meprobamate (Equanil)
• If the medication was prescribed for the patient
• 1 tbsp mayo-type salad dressing
• Transfusion of blood from a donor with a blood type that does not match
• Depression

Drawing test: Any of a variety of psychological tests in which the subject is asked to draw certain familiar objects allergy pills 200 mcg entocort overnight delivery, such as people trees allergy symptoms of pollen purchase entocort 100 mcg without a prescription, and houses allergy medicine ok to take while breastfeeding purchase entocort 100 mcg amex. Alti tudes and feelings are often revealed in the way the subject depicts those objects jackfruit allergy treatment buy entocort with a mastercard. Dream: Mental activity during sleep in which thoughts allergy medicine for 8 year old order entocort us, emotions allergy symptoms of gluten intolerance buy generic entocort pills, and images are experienced as though real. The dream was regarded by Freud as providing an outlet for the discharge in disguised form of unconscious and often acceptable impulses and wishes. Dream analysis: Finding hidden meanings in disguised symbolic form by interpreting the content of dreams. Dreams analysis is a particular tool of the psychoanalytic schools of thought proposed by Freud and Jung. Dream work: A term used by Freud to mean the complex process by which unconscious wishes and fantasies are disguised in dreams, appearing in symbolic form. Dreamy state: An altered state of consciousness, likened to a dream situation, that develops suddenly and from which the patient usually recovers within a few minutes. It is accompanied by visual, auditory and olfactory hallucinations and is most commonly associated with temporal lesions. It refers to a basic urge that produces a state of psychic tension that motivates the person into action to alleviate the tension. Drive-reduction theory: the theory that motivation occurs, and behaviour is energized mainly or entirely as a result of the need to alleviate or reduce drives. It is a rather negative theory in that it assumes that all drives produce tension or arousal and that the organism is always motivated to minimize drive states. The failure to encompass enjoyment and activities which deliberately increase arousal (like exploration and sky diving) was one reason for the decline of the theory. Drug abuse: the self-administration of a medicinal or pleasurable substance in a quantity or manner that impairs health or social functioning. The term has prorative overtones so it is advisable to restricts its use to indicate the malevolence of an individual, or of his or her behaviour. Drug abuse may be secondary Dictionary of Psychology & Allied Sciences 125 to a psychiatric disorder. The term, and the concept on which it is based, have been contested in the light of evidence that dependent and nondepen dent abuse of drugs cannot be reliably distin guished. Drug dependence: A state, psychic and sometimes also physical, resulting from taking a drug, characterized by behavioural and other responses that always include a compulsion to take a drug on a conti nuous or periodic basis in order to experience its psychic effects, and sometimes to avoid the discomfort of the absence. Drug Tolerance: Repeated use of some substance or drug, often narcotics, so that larger and larger doses are required to produce the same physiologic and /or psychologic effect obtained previously by a smaller dose. Drug withdrawal syndrome: State associated with the discontinuation of the taking of a drug, ranging from severe, as specified for alcohol (delirium tremens), to less severe states characterized by one or more symptoms such as convulsions, tremor, anxiety, restlessness, gastrointestinal and muscular complaints, and mild disorientation and memory disturbance. Drunkenness, pathological: Acute psychotic episode induced by relatively small amounts of alcohol. These are regarded as individual idiosyncratic reaction to alcohol, not due to excessive consump tion, and without conspicuous neurological signs of intoxication. Dualism: the view that the mind is a separate entity that exists apart from the body and other aspects of material reality. Dual-memory theory: A model of memory first proposed by William James, in 1890, and later developed by (among other) Miller and Atkinson and Shiffrin. Dual memory theory postulates two independent memory systems, a limited-capacity, immediate or short-term memory, and a large-capacity, long-term memory. Dual-Sex Therapy: A specific form of psychotherapy developed by William Masters and Virginia Johnson, in which treatment is focused on a particular sexual disorder. The crux of the program is the round-table session, in which both a male therapist and a female therapist are present with the patient couple. Special exercise are prescribed for the couple, the overall goal being to diminish fears of sexual performance and to facilitate communication in sexual and non-sexual areas. Dictionary of Psychology & Allied Sciences 127 E Eating disorder: A disorder characterized by a marked disturbance in eating behaviour. The behaviour is considered by some authors to be an attempt by the patient to maintain a continuity of thought processes. Echul: A culture specific syndrome described in native Americans in Southern California consisting sexual anxiety and convulsions related to severe stress, such as death and spouse. Ecology: the study of environment, with an underlying assumption that environment characteristics are responsible for the ways organisms function. Ecological validity: the extent to which controlled experimental results can be generalized beyond the confines of the particular experimental context of a variety of contexts in the real world. Encounters: One who obtains gratifications through listening to sexual accouters; eavesdropper; the audible counterpart of voyeur. Ecouteurism: Sexual pleasure obtained from sounds or listening to sexual or toilet activities of others. In Britain practitioners are employed within the educational system to deal with psychological issues concerning children in school, and to assess and monitor the progress of children with special needs. They are usually based in Schools Psychological Services or Child Guidance Clinics. In some areas the work is largely taken up with assessing children who are having difficulties in school and making recommendations about which kind of educational setting they need. Other areas have been able to develop much more varied work ranging from therapy with individual children and their families, through curriculum development and teacher training, to consulting with the school on more effective management structures. Effort after meaning:A term used by Bartlett to describe the ways in which individuals attempt to organize Dictionary of Psychology & Allied Sciences 129 their memories, and to make sense of them; if necessary, altering the content of the specific information in order to do so. Ego: One of the three components of the psychic apparatus in the Freudian structural framework. Although the ego has some conscious compo nents, many of its operations are automatic. It occupies a position between the primal instincts and the demands of the outer world; therefore, it mediates between the person and external reality. In so doing, it performs the important functions of perceiving the needs of the self, both physical and psychological, and the qualities and attitudes of the environment. It evaluates, coordinates, and integrates those perceptions so that internal demands can be adjusted to external requirements. It is also responsible for certain defensive functions to protect the person against the demands of the id and the superego. It has a host of functions, but adaptation to reality is perhaps the most important one psychiatric usage of the term should not be confused with common usage which connotes self love. Ego analysis: Intensive psychoanalytic study and analysis of the ways in which the ego resolves for attempts to deal with intrapsychic conflicts, especially in relation to the development of mental mechanisms and the maturation of capacity for rational thought and action. Modern psycho analysis gives more emphasis to considerations of the defensive operations of the ego than did earlier techniques, which emphasized instinctual forces to a greater degree. Ego boundaries: A concept introduced by Federn that refers to the ability of the intact ego to differentiate 130 Dictionary of Psychology & Allied Sciences the real boundaries prevent repressed unconscious material from overwhelming the ego. Egocentricity or egocentrism: A central concept in Piagetian theory, egocentricity refers to the idea that children take their own perspective as central, and tend to assume that other people have the same understandings, motives and needs as the child. When used of adults the term does have implications of selfishness though perhaps in should just imply a delayed cognitive develop ment. According to Piaget, this is a significant part of the child; acquisition of speech; it forms a valuable tool of thought, which the child practices as it performs mental operations on the external world. Ego-coping skill: adaptive method or capacity developed by a person to deal with or overcome a psychological or social problem. Ego-dystonic homosexuality: A psychosexual disorder in which a person has unwanted and distressful homosexual arousal and wishes to acquire or increase heterosexual arousal. Ego ideal: the part of the personality that comprises the aims and goals for the self; usually refers to the conscious or unconscious emulation of signi ficant figures with whom one has identified. The ego ideal emphasizes what one should be or do in contrast to what one should not be or not do. It is not always clear whether this refers to the energy available for ego functions or self-love. Egopathy: Hostile behaviour due to psychopathically exaggerated sense of self-importance. Ego psychology: the study and elucidation of those slowly changing functions known as psychic struc tures which usually shape, channel, and organize mental activity into meaningful and tolerable 132 Dictionary of Psychology & Allied Sciences patterns of experience. The usual structures referred to in this sense are memory, speech, locomotion, cognition, drive, restraint, discharge, and the capacity to make judgements and decisions. Ego strength: Ability to retain reality and manage the forces of the bid and supergo. Egotism: A constant tendency overvalue oneself and therefore to undervalue other people. The differ ence from egoism in that egotists tend not to be interested exploit them. Egotistical attitudes tend to be clearly displayed whereas egoism may need to be concealed to be effective. Einstellung: A term coined by the Gestalt school of psychology of refer to the kinds of mental sets which can influence problem-solving by inducing a rigidity of thought which precludes the perceptions of alternative strategies or solutions. Eidetic image: Unusually vivid and apparently exact mental image, may be a memory, fantasy, or dream. Egotization: the process by which a mental process or function becomes part of the self, structure or deaggressified and desexualized. An emissary of the Zurich school, he gained fame as the first person to be analyzed by Freud in a few sessions in 1907. Later, he became the first chief of the Berlin Psychoanalytic clinic, a founder of the Berlin Psychoanalytic Institute, and founder of the Palestine Psychoanalytic Society. Dictionary of Psychology & Allied Sciences 133 Ejaculatory incompetence (impotence): Inability to reach orgasm and ejaculate during sexual inter course despite adequacy of erection. Elaborated code: A term used by Bernstein to refer to the form of language commonly used by middle class families, characterized by an extensive use of nouns, explanations, and synonyms. This is due mainly to the theory having been associated with the verbal deprivation of class difference in language use, which argue that restricted language use implies restricted cognitive possibilities. Elaboration: An unconscious process or expansion and embellishment of detail, especially with reference to a symbol or representation in a dream. Elation: An effective state of joyous gaiety which, when intensified and out of keeping with life circum stances, is a dominant symptom of mania and hypomania. Elective mutism: A childhood mental disorder in which a child who is able and willing to speak to select persons persistently refuses to speak in other social or school situations. Elopement: In psychiatry, escape; absenting oneself from a mental hospital without permission. Elusion: Term used by Laing (1961) to describe the process by which a person may avoid confron tation with himself and others by impersonating himself i.

References

• Fisher AR, Jones P, Barlow P, et al: The influence of mannitol on renal function during and after openheart surgery, Perfusion 13:181-186, 1998.
• Dietrich CF, Ignee A, Braden B, et al. Improved differentiation of pancreatic tumors using contrast-enhanced endoscopic ultrasound. Clin Gastroenterol Hepatol. 2008;6:590-597, e1.
• Giri U, Patel K, Martin MG. Second primary malignancies and cardiovascular mortality in Hodgkin disease survivors: a Surveillance, Epidemiology, and End Results Registry Database study. Blood 2017;130(Suppl 1):1513.
• Madersbacher H, Murz G: Efficacy, tolerability and safety profile of propiverine in the treatment of the overactive bladder (non-neurogenic and neurogenic), World J Urol 19:324, 2001.
• Libby P, Aikawa M, Jain MK: Vascular endothelium and atherosclerosis, Handb Exp Pharmacol (176 Pt 2):285-306, 2006.