By W. Sulfock. Louisiana State University at Alexandria.
Rationale for Definitions Nondigestible carbohydrates are frequently isolated to concentrate a desirable attribute of the mixture from which it was extracted buy feldene 20 mg low cost. Distinguish- ing a category of Functional Fiber allows for the desirable characteristics of such components to be highlighted order feldene 20mg online. In the relatively near future, plant and animal synthetic enzymes may be produced as recombinant proteins, which in turn may be used in the manufacture of fiber-like materials. The definition will allow for the inclusion of these materials and will provide a viable avenue to synthesize specific oligosaccharides and polysaccharides that are part of plant and animal tissues. Thus, it is difficult to separate out the effect of fiber per se from the high fiber food. Attempts have been made to do this, particularly in epidemiological studies, by controlling for other substances in those foods, but these attempts were not always successful. The advantage, then, of adding isolated non- digestible carbohydrates as a fiber source to a food is that one may be able to draw conclusions about Functional Fiber itself with regard to its physi- ological role rather than that of the vehicle in which it is found. The proposed definitions do not preclude research directed towards the health benefits of Dietary Fiber in foods, but it is not necessary to demonstrate a physiological effect in order for a food fiber to be listed as Dietary Fiber. An important aspect of the recommended definitions is that a sub- stance is required to demonstrate a beneficial physiological effect to be classified as Functional Fiber. Research has shown that extraction or isola- tion of a polysaccharide, usually through chemical, enzymatic, or aqueous means, can either enhance its health benefit (usually because it is a more concentrated source) or diminish the beneficial effect. These recommen- dations should be helpful in evaluating diet and disease relationship studies as it will be possible to classify fiber-like components as Functional Fibers due to their documented health benefits. Although databases are not cur- rently constructed to delineate potential beneficial effects of specific fibers, there is no reason that this could not be accomplished in the future. Potential Functional Fibers for food labeling include isolated, nondigestible plant (e. How the Definitions Affect the Interpretation of This Report The reason that a definition of fiber is so important is that what is or is not considered to be dietary fiber in, for example, a major epidemiological study on fiber and heart disease or fiber and colon cancer, could deter- mine the results and interpretation of that study. However, that should not detract from the relevance of the recommendations, as the database used to mea- sure fiber for these studies will be noted. Such a database represents Dietary Fiber, since Functional Fibers that serve as food ingredients contribute a minor amount to the Total Fiber content of foods. Other epidemiological studies have assessed intake of specific high fiber foods, such as legumes, breakfast cereals, fruits, and vegetables (Hill, 1997; Thun et al. Intervention studies often use specific fiber supplements such as pectin, psyllium, and guar gum, which would, by the above definition, be considered Functional Fibers if their role in human health is documented. For the above reasons, the type of fiber (Dietary, Functional, or Total Fiber) used in the studies discussed later in this chapter is identified. Description of the Common Dietary and Functional Fibers Below is a description of the Dietary Fibers that are most abundant in foods and the Functional Fibers that are commonly added to foods or pro- vided as supplements. To be classified as a Functional Fiber for food labeling purposes, a certain level of information on the beneficial physiological effects in humans will be needed. For some of the known beneficial effects of Dietary and potential Functional Fibers, see “Physiological Effects of Iso- lated and Synthetic Fibers” and “Evidence Considered for Estimating the Requirement for Dietary Fiber and Functional Fiber. Cellulose, a polysaccharide consisting of linear β-(1,4)−linked glucopyranoside units, is the main structural component of plant cell walls. Powdered cellulose is a purified, mechani- cally disintegrated cellulose obtained as a pulp from wood or cotton and is added to food as an anticaking, thickening, and texturizing agent. Dietary cellulose can be classified as Dietary Fiber or Functional Fiber, depending on whether it is naturally occurring in food (Dietary Fiber) or added to foods (Functional Fiber). Chitin is an amino-polysaccharide containing β-(1,4) linkages as is present in cellulose. Chitin and chitosan are primarily consumed as a supplement and poten- tially can be classified as Functional Fibers if sufficient data on physiological benefits in humans are documented. These β-linked D-glucopyranose polymers are constituents of fungi, algae, and higher plants (e. Naturally occurring β-glucans can be classified as Dietary Fibers, whereas added or isolated β-glucans are potential Functional Fibers. Gums consist of a diverse group of polysaccharides usually iso- lated from seeds and have a viscous feature. Galactomannans are highly viscous and are therefore used as food ingredients for their thickening, gelling, and stabi- lizing properties. Hemicelluloses are a group of polysaccharides found in plant cell walls that surround cellulose. These polymers can be linear or branched and consist of glucose, arabinose, mannose, xylose, and galact- uronic acid. Most of the commercially available inulin and oligofructose is either synthesized from sucrose or extracted and purified from chicory roots. Inulin is a polydisperse β-(2,1)-linked fructan with a glucose molecule at the end of each fructose chain.
By deciphering the human genome re- searchers obtained profound new insights into the hered- itary basis of the human body buy feldene 20 mg lowest price. From the mass of genetic in- formation now available researchers can filter out potential target molecules for new Terms biopharmaceuticals generic 20mg feldene amex. T Since the late 1990s pro- Chimeric made up of components from two different species or individuals. The technique led to the produc- tion of the first humanised chimeric antibodies, in which variable seg- development. Because pro- ments obtained from mouse antibodies are combined with a constant teins can act either as target segment from a human antibody. Copegus (ribavirin) a Roche product used in combination with molecules or as drug mole- Pegasys for the treatment of hepatitis C. Therapeutic antibodies antibodies used as agents for the treat- and proteins have recently ment of diseases. It Therapeutic proteins proteins used as active substances in has been recognised that drugs. In addition, modifi- cations of therapeutic proteins strongly influence their effi- cacy and stability. T In recent years researchers have succeeded in shedding more light on the key functions of the immune system. These findings have led to various new diagnostic approaches and more refined methods for developing therapeutic antibodies. Research-orientated: development of therapeutic proteins Identification of The number of good molecular targets for new molecular therapeutic proteins is limited targets Assessment Pick the winners; assessment in cellular and animal of available models and new targets Design of therapeutic proteins, e. Most important Modern medical biotechnology uses a wide range drug group: therapeutic of methods to diagnose and treat diseases – from proteins the biotechnological production of simple natu- ral products to gene therapy. The most important group of biotechnological drugs by far, however, are the thera- peutic proteins. Most therapeutic proteins are chemical mes- sengers, enzymes or, especially in recent times, monoclonal an- tibodies. Now these molecules can be produced in genetical- ly modified cells that carry the hereditary information for pro- ducing the human protein. Main avenues of research 41 In addition, new findings from basic research now allow thera- peutic proteins to be coupled with non-protein components to improve their efficacy and duration of action. Since the substance is produced mainly in the kidneys, patients with renal damage are prone to develop anemia. Those affected – often dialysis patients – generally feel weak and tired, because their red blood cells no longer carry sufficient supplies of oxygen to the body. Since the early 1990s recombinant erythropoietin has replaced time-consuming, costly and risky blood transfusions, previous- ly the standard treatment for anemic patients. Because the hor- mone is a glycoprotein (see illustration), it cannot be produced in bacterial or yeast-cell cultures: the erythropoietin molecule has several carbohydrate side chains that slow its breakdown in the body but also modify its intrinsic bioactivity. These side chains can be attached to proteins only by the synthe- Erythropoietin: the molecule sising apparatus found in carbohydrate chain mammalian cells. For this reason, only mammalian cells can be used to produce complex therapeutic pro- teins. In renal clinical trials untreated anemic patients can ex- perience a correction of their anemia with one injection twice a month. Patients who are in maintenance can be managed with a single monthly injection whether they have reached end stage renal disease (chronic kidney disease stage 5) or not (typically chronic kidney disease stages 3 and 4). Less frequent adminis- trations reduce the oscillation in hemoglobin levels outside the optimal range of hemoglobin as defined by best practice guide- lines, which is often seen with existing short-acting compounds (epoetin, darbepoetin). Such excursions are associated with ad- verse events and considered to contribute to further deterio- ration of cardiac and renal functions. It is believed that less fre- quent administrations represent a significant gain in quality of life for patients but also allow overworked nephrologists and nurses to concentrate on the other serious medical conditions affecting many of these patients such as hypertension, diabetes, chronic heart failure and obesity. The principle of Improved efficacy of proteins can be achieved pegylation: Pegasys with the help of specific modifications. It is essential to select the proper moiety that will confer Main avenues of research 43 to the active protein the de- A pegylated protein: Pegasys sired properties. The choice of linker is also very impor- tant as its rigidity (or lack thereof) will influence the ultimate properties of the new medicine. Roche has successfully applied this principle to develop a drug for the treatment of hepati- tis C and B. In this method the drug is enveloped in one or two highly branched molecules of polyethylene glycol. It has been used for de- cades for treating hepatitis C, a widespread infection which causes inflammation of the liver. To date no treatment exists that is able to eradicate the hepatitis C virus from the body.
Many of these patients now survive for longer periods and feldene 20mg amex, thus buy feldene 20 mg cheap, more attention must be paid to radiation effects from a long term perspective . In the past, radiation oncologists focused mainly on curing cancers with little consideration for secondary cancer. Recently, the situation has been changing; while high precision photon radiotherapy methods are superior to conventional radiotherapy in the dose distribution delivered to the tumour, a large volume of surrounding normal tissues may be exposed to low levels of dose. Ion beam radiotherapy with protons or carbon ions further contributes to localizing the dose to the tumour, and the extra dose received in surrounding normal tissues is further reduced. The increasing use of radiation in young patients requires evidence of age dependent biological effects of radiation . Late deterministic effects after radiotherapy, such as retardation of growth, hormonal deficiencies, organ dysfunctions, and intellectual and cognitive functions are more severe in children than in adults. It should also be noted that children have distinctly different organ susceptibility from adults . Protection of personnel Protection of occupational staff can be achieved according to the general principles of radiation protection [13, 14]. Specific consideration should be given to the management of the treatment facility and devices for each method. The use of a high energy accelerator for ion beam radiotherapy requires a control of activated devices and air in the treatment room to avoid unnecessary radiation exposure of staff members. Exposure of patients’ family members is also a concern, but is sufficiently low in ion beam radiotherapy . It is now expanding rapidly within the medical community, with significant benefits to patients. In addition to the general guidance for radiation protection of patients, unique problems specific to each treatment method have to be solved for the efficient and safe use of new technology in radiotherapy. Education, sufficient knowledge and training of personnel involved in the treatment procedure are essential for patient protection. Health care professionals should also be aware of the possible risks and consider the necessary procedures for patient protection when new technologies are introduced in clinical practice. The discussion will cover the process from the decision to treat until the patient has completed the radiotherapy course. Prescription The prescription is one of the most important steps in the process and should be one of the first substeps, and in this case it is shown in parallel with the imaging sessions. Based on the information from previous steps in the health care process, and together with information that can be collected during the patient’s visit, radiation oncologists have to decide according to the department’s guidelines about which protocol the patient should be treated with. The guidelines and the protocol should include information about total dose, fractionation (dose per fraction, timing, e. Tools Guidelines and protocols should be evidence based when possible, and detailed to facilitate further development in the consecutive steps in the process. During the development of protocols, one must also include priorities for all these dose–volume criteria to facilitate the planning but especially the plan review process. In Table 1, an example of priorities is given for treatment of prostate cancer patients. It is also advantageous if there is a consensus in the radiotherapy world regarding naming conventions. The Global Clinical Trials Quality Assurance 1 of Radiation Therapy Harmonisation Group has published a suggestion that would be favourable if it were adopted by professional organizations within radiation oncology, and if it were disseminated to all radiation oncologists, medical physicists, dosimetrists and radiation therapy technologists. Imaging Imaging for radiation therapy used to be performed using a ‘simulator’ where two orthogonal X ray projections were produced. Together with other X ray examinations and anatomical atlases, a cross-section (sometimes several) was applied to construct typical target volumes and organs at risk. Today, a full spectrum of imaging devices is available, sometimes even at the radiotherapy department. The protocol should also ensure that the patient’s position is correct both macroscopically, i. In an environment where several imaging devices are available, the registration tools and methods must also be assured. This is a large task for a department, especially gaining an understanding of devices used in other departments. This probably leads to an increase in cooperation between imaging and therapy staff, e. Volumes The delineation of the volumes in radiotherapy that will be used for treatment planning and/or optimized intensity modulated radiotherapy is one of the most crucial steps in the whole radiotherapy process. Several papers in the literature have shown the spread among radiation oncologist delineation of target volumes. Planning Many hazards exist in planning; thus, thorough protocols and guidelines must exist that describe the process for most of the treatments given at the department.
In these cases buy feldene 20mg without prescription, the recommendation has been assigned to the activity deemed to have the major share discount feldene 20mg free shipping. Develop common principles and legal frameworks that enable sharing of patient-level data for rese- arch in a way that is ethical and acceptable to pati- The colour-coding is as follows: ents and the public. Promote the development of high quality sustain- Challenge 1 – Developing Aware- able databases including clinical, health and well- ness and Empowerment being information. Develop and promote models for individual res- ponsibility, ownership and sharing of personal he- 12. Develop mobile health applications to maximise engagement of patients with their treatment pa- 13. Create a European ‘big data’ framework and adapt rectly to benefts for individual citizens and society. Encourage a systematic early dialogue between in- Clinical Research and Beyond novators, patients and decision-makers throughout all regulatory steps to provide guidance and clarity. Develop methods to better integrate and evalua- te the information provided by genomic, epige- 27. Facilitate partnerships and innovation networks to netic, transcriptomic, proteomic, metabolomic and encourage cross-disciplinary and cross-border col- microbiome analyses. Support research in preclinical models to validate hypotheses resulting from molecular analyses of 28. Provide support and guidance for companies to patient samples and treatment outcomes. Promote collaborative pre-competitive and trans-disciplinary research in all disease areas to gain trustworthy and objective information. Support developmWent of new clinical trial de- personal health data that facilitate accurate and signs and promote integration with concomitant on-going assessment of highly dynamic health in- preclinical testing. Encourage a citizen-driven framework for the ad- option of electronic health records. Promote engagement and close collaboration bet- to the Market ween patients, stakeholders and healthcare actors across sciences, sectors and borders. Optimise individual drug therapies and poly-phar- patients – regardless of economic or geographic macy especially in the case of multi-morbidity. A report on grès de la génétique : vers une médecine de précisi- business opportunities in Personalised Medicine on? Les enjeux scientifques, technologiques, sociaux in Northern Ireland by the Northern Ireland Scien- et éthiques de la médecine personnalisée], January ce Industry Panel of the Department of Enterpri- 2014. Europe 2020, the Digital line medicine: the ethics of ‚personalised healthca- Agenda, the Innovation Union and Horizon 2020. Vision more precise medicine for the diagnosis, treatment and Roadmap, https://connect. Keeling; Pharmacogenomics (2013), cine in Europe: a look at the European Commission’s 14(1), 89–102. Priority Medicine for Eu- ne research”, Future Medicine, Personalized Medicine rope and the World Update Report, 2013, www. Advice for 2016/2017 of the Quality Assurance, Provision and use of Genome-ba- Horizon 2020 Advisory Group for Societal Challenge sed Information Technologies: the 2012 Declaration 1, “Health, Demographic Change and Wellbeing”, July of Rome. Public Health Geno- Horgan, Etienne Richer, Angela Brand, Ulrike Bußhof mics 2014;17:287–98. An index of barriers for in medicine: main obstacles to reaching this vision the implementation of personalised medicine and from today’s perspective. An in- rities – A survey among 27 European countries on novative model for performance-based pricing. The contribution of he- ments for pharmaceuticals: The European experience: alth technology assessment, health needs assess- http://ec. Contact PerMed coordination: Wolfgang Ballensiefen and Ulrike Busshof E-Mail: Wolfgang. We therefore accept no liability for the accessibility or contents of such websites and no liability for damages that may arise as a result of the use of such content. Christy The Incredible Proven Natural Miracle Cure That Medical Science has Never Revealed! Library of Congress Catalog Card No: 94-071171 3 The medical information and all procedures mentioned and contained in this book are not intended to be used or construed as a substitute for professional medical care and advice by your physician. People who read this book and make decisions regarding their health or medical care which they believe are based on ideas contained in this book, do so as their constitutional right. Please do not use this book if you are unwilling to assume responsibility for results that arise from the use of any of the suggestions, preparations or procedures in the book. 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