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K. Trano. Central Christian College of Kansas.

Resistant starch does not appear to provide the cholesterol-lowering effects of viscous fiber pantoprazole 40 mg with mastercard gastritis symptoms pain back, but rather acts more like nonviscous fiber (Jenkins et al discount pantoprazole 40 mg with mastercard gastritis diet cooking. Neither Jenkins and coworkers (1998) nor Heijnen and coworkers (1996) showed a lowering effect of resistant starch on serum lipids buy discount pantoprazole 40mg on-line gastritis diet leaflet. Adding resistant starch to bread at various levels (0, 5, 10, and 20 percent) was shown to reduce the glycemic index in a dose-dependent manner (100, 96, 74, and 53) (Brown et al. Clinical Effects of Inadequate Intake Dietary and Functional Fibers are not essential nutrients, so inadequate intakes do not result in biochemical or clinical symptoms of a deficiency. Clearly one cannot measure blood fiber concentra- tion since, by definition, fiber is not absorbed. Instead, the potential health benefits of fiber consumption, which may be compromised by a lack of fiber in the diet, have been reviewed. Throughout each section and the discussion of each indicator, a delineation is made between Dietary Fiber and Functional Fiber. The definition of Dietary Fiber in this report states that it must be “intrinsic and intact in plants. In contrast, Functional Fiber (which consists of isolated, nondigestible carbo- hydrates that have beneficial physiological effects in humans), by defini- tion, must show that the beneficial physiological effect in humans is due to the isolated or synthesized fiber itself. A number of epidemiological studies have been conducted to evaluate the relationship between fiber intake and risk of chronic disease. While Functional Fibers, such as pectins and gums, are added to foods as ingredi- ents, these levels are minimal and therefore fiber intakes that are estimated from food composition tables generally represent Dietary Fiber. In the Health Professionals Follow-up Study, the relative risk for fatal coronary disease and total myocardial infarction were 0. Specifically, these three studies—which used multivariate models to control for energy, saturated fat, alcohol, body mass index, and various vitamins—showed a strong relationship between cereal fibers and a weak or no relationship between vegetable and fruit fibers. In terms of setting intake recommenda- tions and actual numbers as a primary determinant of fiber requirements, these studies are most useful as they are adequately powered, divide Dietary Fiber into quintiles of intake, and provide data on energy intake (Pietinen et al. The Health Professionals Follow-up Study reported a 19 percent decrease in risk for total myocardial infarction per 10-g/d increase of Dietary Fiber and a 29 percent decrease per 10-g/d increase of cereal fiber (Rimm et al. All but one are small trials; often these interventions are performed in people with high initial serum cholesterol concentrations. Both the oat bran and bean diets significantly decreased serum total cholesterol concentrations by 19 percent. A review of the oat bran and bean fiber intervention trials where Dietary Fiber supplementation was combined with a low fat diet shows that reductions in serum total choles- terol concentrations ranged from 8 to 26 percent (Anderson and Gustafson, 1988; Anderson et al. Smaller portions of oat bran or oat meal (60 g, dry measure) have been shown to decrease serum total cholesterol concentra- tions by approximately 8 to 11 percent (Bartram et al. Other viscous fibers, in addition to those from oats and beans, have also been shown to decrease serum cholesterol concentrations. For example, Jenkins and coworkers (1975) reported the hypocholesterolemic effect of guar gum (Functional Fiber), which is often added to foods. Since that time, there have been a number of studies with guar gum supplemen- tation that resulted in a reduction in serum cholesterol concentrations of between 11 and 15 percent (Anderson and Tietyen-Clark, 1986). Resistant starch does not appear to provide the cholesterol-lowering effects of viscous fibers, but rather acts more like nonviscous fibers (Jenkins et al. Neither Heijnen and coworkers (1996) nor Jenkins and coworkers (1998) showed a lipid-lowering effect of resistant starch on serum lipid concentrations. It should also be noted that the effect of fiber on decreasing serum cholesterol concentration is not due to its replacement of fat in the diet. In a prospective, randomized, controlled trial with a low fat and a low fat plus high Dietary Fiber groups, the group consuming high Dietary Fiber exhibited a greater average reduction (13 percent) in serum total cholesterol concentration than the low fat (9 percent) and the usual diet (7 percent) groups (Anderson et al. Mathur and coworkers (1968) conducted a study in 20 men supplemented with Bengal gram. For example, Anderson and coworkers (1991) randomly allocated 20 hypercholesterolemic men to either a wheat bran or oat bran diet. After 21 days, oat bran signifi- cantly decreased serum total cholesterol concentration by 12. The diets containing the viscous fibers led to significantly lower plasma cholesterol concentrations. These individuals were encouraged to increase grain fiber intake by increasing consumption of whole meal bread, high fiber breakfast cereals, and wheat bran, which resulted in an increased grain fiber intake from 9 to 17 g/d in the intervention group. Increasing the intake of Dietary Fiber by increasing the consumption of fruits and vegetables can attenuate plasma triacylglycerol concentrations. Obarzanek and coworkers (2001) showed that increasing Dietary Fiber intake from 11 to 30 g/d as a result of increased consumption of fruits, vegetables, and whole grains prevented a rise in plasma triacylglycerol concentrations in those fed a low fat diet, especially in those individuals with initially high concentrations. Plasma triacylglycerol concentrations were significantly reduced (Chandalia et al. These studies suggest that Dietary Fiber prevents the rise in plasma triacylglycerol concentrations that occurs when consuming a low fat, high carbohydrate diet (see Chapter 11). The amount of cholesterol reduction appears to be related to the amount of fiber consumed, although only a few studies report dose– response data. A meta-analysis of 20 trials that used high doses of oat bran, which is rich in viscous Dietary Fiber, showed that the reductions in serum cholesterol concentrations ranged from 0. Although the calculations above are hypothetical and are based on a number of assumptions, (including the linearity of response of fiber con- sumption to risk reduction), the finding that the degree of risk reductions per gram of fiber consumed are within a reasonable range of each other are suggestive that the results of the clinical trials for viscous fibers are supportive of the epidemiological finding. This suggests that mechanisms in addition to cholesterol-lowering may be involved. The lowering of serum cholesterol concentration by viscous Dietary or Functional Fibers is thought to involve changes in cholesterol or bile acid absorption, hepatic produc- tion of lipoproteins, or peripheral clearance of lipoproteins (Chen and Anderson, 1986). Viscous fibers may interfere with the absorption and enterohepatic recirculation of bile acids and cholesterol in the intestine, forcing the liver to synthesize more cholesterol to meet the need for bile acid synthesis, and thus decreasing circulating cholesterol. This cannot be the sole explanation, however, since not all viscous fibers increase fecal bile acid excretion, and the magnitude of the increase, when present, is often small. In addition to delaying or interfering with the absorption of cholesterol and bile acids, viscous fibers may delay the absorption of macro- nutrients, including fat and carbohydrate. Delayed carbohydrate absorp- tion, in turn, could lead to increased insulin sensitivity (Hallfrisch et al. Further discussion is provided in the later section, “Findings by Life Stage and Gender Group. In this study, fiber from fruit, vegetable, and leguminous sources, but not cereal fiber, was associated with a reduced risk of duodenal ulcer.

The ultimate goal of studying the human microbiome is to better understand the impact of microbial variation across individuals and populations and to use this information to target the human microbiome with antibiotics purchase 20 mg pantoprazole free shipping gastritis diet , probiotics discount pantoprazole 40mg mastercard chronic gastritis medscape, and prebiotics as therapies for specific disorders purchase 40 mg pantoprazole with mastercard gastritis diet quality. While this field is in its infancy, growing knowledge of the human microbiome and its function will enable disease classification and medicine to encompass both humans and their resident microbes. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 22 individuals. Lifestyle interventions alone are ineffective in these individuals at reducing the likelihood of early-onset cardiovascular disease (Huijgen et al. Consequently, the ability to identify the patients that carry the non-functional receptor makes it possible to proceed directly to the use of statin drugs at an early age, rather than first attempting to control cholesterol with diet and exercise. There is strong evidence that the early use of statin drugs in these individuals can provide a therapeutic benefit. These mutations predispose to cancer, particularly breast and ovarian cancer (King et al. Women who carry these mutations can reduce their risk of death from cancer through increased cancer screening or through prophylactic surgeries to remove their breasts or ovaries (Roukos and Briasoulis 2007); until these mutations were identified it was not possible to determine who carried the mutations or to take proactive steps to manage risk. In addition, epidemiological studies and other data have raised the possibility that H. The human genome and microbiome projects are only two examples of emerging biological information that has the potential to inform health care. It is similarly likely that other molecular data (such as epigenetic or metabolomic data), information on the patient’s history of exposure to environmental agents, and psychosocial or behavioral information will all need to be incorporated into a Knowledge Network and New Taxonomy that would enhance the diagnosis and treatment of disease. Traditionally, lung cancers have been divided into two main types based on the tumors’ histological appearance: small- cell lung cancer and non-small-cell lung cancer. Non-small-cell lung cancer is comprised of three sub-groups, each of them defined by histology, including adenocarcinoma, squamous- cell carcinoma, and large cell carcinoma. Since 2004, knowledge of the molecular drivers of non-small-cell lung cancer has exploded (Figure 2-1). Drivers are mutations in genes that contribute to inappropriate cellular proliferation. If the inappropriate function of the mutant protein is shut down, dramatic anti-tumor effects can ensue. These receptors were known to send signals that promote cellular proliferation and survival, and increased signaling was thought to contribute to some cancers. However, the dramatic tumor shrinkage in some patients was enough for Food and Drug Administration approval in 2003, even though the molecular basis for the response was then unknown. Without the ability to recognize the responding patients as a biologically distinct subset, these agents were tried unsuccessfully on a broad range of lung-cancer patients, doing nothing for most patients other than increasing costs and side effects. In retrospect, some clinical trials with these agents probably failed because the actual responders represented too small a proportion of the patients in the trials (Pao and Miller 2005). This made it possible to predict which patients would respond to the therapy and to administer the therapy only to this subset of patients. This led to the design of much more effective clinical trials as well as reduced treatment costs and increased treatment effectiveness. Since then, many studies have further divided lung cancers into subsets that can be defined by driver mutations. Not all of these driver mutations can currently be targeted with drugs and cancer cells are quick to develop resistance to targeted drugs even when they are available. Nonetheless, this new information makes it possible to develop new targeted therapies that can extend and improve the quality of life for cancer patients. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 24 Source: Pao and Girard 2011 Figure 2-2: Knowledge of non-small-cell lung cancer has evolved substantially in recent decades. The traditional characterization of lung cancers based on histology has been replaced over the past 20 years by classifications based on driver mutations. However, the sophistication of this system for molecular classification has improved with the advent of more genetic information and the identification of many more driver mutations. Similar approaches could improve the diagnosis, classification, and treatment of many other diseases. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 25 The Urgent Need to Better Understand Phenotype-Genotype Correlations While dramatic progress in understanding the relationship between molecular features and phenotype is being made, there is an urgent need to understand these links better and to develop strategies to deal with their implications for athe individual patient. Of these, 1,167 were judged by the database’s curators as likely to be clinically significant, while most of the rest were categorized as of “unknown” clinical significance. Among the mutations that are believed to be clinically significant, some are thought to confer a higher risk of cancer than others (Gayther et al. To what extent does their mutation increase their risks of breast and ovarian cancer and how do these risks change with age? All of these real-life decisions carry heavy personal consequences as well as implications for health care costs. These treatment decisions do not need to be made based on such fragmentary information. It would be possible to assess the extent to which prophylactic surgeries reduced risk. It would be possible to assess the effectiveness of increased cancer screening, the best ways to screen these patients, and the complications that arise from the inevitable false-positive results that come from increased screening. Efforts along these lines have so far been based on modest numbers of patients or cohorts that are not fully representative of the larger population because it has not been practical to integrate genetic information, treatment decisions, and outcomes data for large numbers of unselected patients. However, recent advances in genomic and information technologies now make it possible to systematically address these issues by integrating large data sets that already exist. Even if only a subset of this variation has significant implications for disease risk or treatment response we have the potential to improve the detection, diagnosis, and treatment of disease dramatically by large-scale efforts to assess phenotype-genotype correlations. By integrating patient genotype with health information and outcomes data a New Taxonomy could identify many new genetic variants with significant implications for health care. There is every reason to expect that the genetic influences on most common diseases will be complex. In each patient, variants in multiple genes will affect disease onset, progression, and response to treatment, and long-term environmental modulation of these processes will be the rule rather than the exception. Toward Precision Medicine: Building a Knowledge Network for Biomedical Research and a New Taxonomy of Disease 26 advances in our ability to understand epigenetic, environmental, microbial, and social contributions to disease risk and progression. Under these circumstances, there is an obvious need to categorize diseases with finer granularity, greater reference to the underlying biology, and in the context of a dynamic Knowledge Network that has the capacity to integrate the new information on many levels. Unraveling these diverse influences on human diseases will be a major scientific challenge of the 21st century. Prospective studies are particularly valuable because the occurrence or treatment of disease may alter the levels of the biochemical factors so that inference based on levels measured in a series of already diagnosed cases may be biased.

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Chemotherapy pantoprazole 40 mg without prescription gastritis diet 911, the most common method of cancer treatment purchase pantoprazole 40 mg without a prescription gastritis diet 9000, is targeted not only for cancer cells but all rapidly dividing cells buy pantoprazole 40 mg overnight delivery gastritis je. This includes intestinal cells, bone marrow, mucosal cells, and stomach cells, among others. The use of chemotherapy as cancer treatment suppresses the immune system and may cause sickness and even other cancers, which is why site-specific delivery is so important in modern medicine. For one, a gene known as invasin was added allowing the bacteria to pass through the membrane of human cells, something it was previously unable to. Secondly, the researchers added a gene called listeriolysin O, a gene which turns the bacteria into a sort of ticking time bomb and causes the gene to spill its contents once it has entered the membrane of its destination cell. By use of testing in mouse tumors the combination was successful in killing more than 90% of cancer cells present, a very impressive amount. The proteins act to specifically target the claudin-3 and claudin-4 epithelial receptors present in breast, prostate, lung, endometrial, thyroid, and pancreatic cancer tumors. Clostridium is ideal for acting as a target inside of tumors since it is anaerobic and thrives in the hypoxic environment which is present on the interior of tumors. Doxorubicin, when injected encapsulated into mice with colorectal tumors caused the death of each mouse within two weeks. However when doxorubicin was encapsulated in liposomes (Figure 1) and Clostridium was present in the colorectal tumors, healthy cells were not targeted by the drug, and the anti-cancer agent was successful in eradicating a majority of the tumors. Liposomase lyses the liposome once it enters the boundary of the tumor eradicating the tumor. So called “synthetic biology” may one day allow the easy manipulation of bacteria for medical use. These bacteria can be mix and matched with desired characteristics such as membrane signal sequences, macromolecule synthesis pathways, and chemical structure (Voigt, 2010). As Voigt describes the idea, they are looking to “create a programming language for cells so that you could write a program for a cell in the same way that you would for a computer or for a robot. In a visually awe-inspiring example of the abilities of synthetic biology, Voigt’s lab has used variants of E. Another application of synthetic biology in the medical field is the understanding of the human genome and using this to form personalized therapeutic recommendations for cancer patients. The company, Alacris Theranostics which was founded by renowned geneticist George Church, looks to use a computer system for modeling the biological network of a tumor and compare this to the normal tissues of the patient, displaying the genetic flaws in the tumor base pairs (Alacris Theranostics 2010). By identifying and characterizing somatic mutations, copy number variants, translocations, expression changes, and splice variants, Alacris will be able to recommend an appropriate therapy for the patient. Alacris is making it possible for individualized cancer treatment rather than continuing with the sometime ineffective treatments of cancer used today. Bacterium, as stated before, can be replicated in large amounts in very short periods of time. Therefore when researchers find bacterium which provides medically important macromolecules such as proteins the production of a mass amount of said protein does not take an extensive amount of time. With current advances such as Voight’s synthetic biology this process may even take less time. One bacterial protein which is of use to the medical community is the Botulinum toxin. Produced by the bacterium Clostridium Botulinum, the neurotoxin is commonly used by physicians in Botox treatments for cosmetic procedure. Botulinum toxin type A, the first microbial toxin ever used for human medical treatment, serves as a treatment for a variety of strabismus (lazy-eye), blepharospasm (eyelid spasm), and hemifacial spasm (Erbguth,2004). By injecting the neurotoxin directly into the muscle, Botulinum toxin type A blocks the release of the neurotransmitter acetylcholine at myoneural junctions chemically suppressing hyperactive muscle disorders. Historical notes on botulism, Clostridium botulinum, botulinum toxin, and the idea of the therapeutic use of the toxin. Programming cells: towards an automated ‘Genetic Compiler’, Current Opinion in Biotechnology, Volume 21, Issue 4, August 2010, Pages 572-581 10 Chapter 3: Fungi in Modern Medicine Everyone has heard of penicillin, the fungal mold which can treat all sorts of infections, but this is simply a snowflake on the tip of the iceberg that is the modern day use of fungi in medicine. Though not as useful as bacteria in regards to modification of structural characteristics and their use as entire organisms, the large focus of Fungi in medicine is the molecules which fungi naturally produce are vast and effective in fighting diseases. Molecules such as polysaccharides and complexes formed with polysaccharides have been found to exhibit antitumor and immunostimulating properties. The mushroom Trametes versicolor (Figure 3) produces a polysaccharide called polysaccharide-K and is known to act in a variety of anti-cancer mechanisms (Suto, 1994). Polysaccharide-K acts by a variety of mechanisms including the suppression of tumor detachment, cell matrix degrading enzymes, tumor growth by inhibition of angiogenesis, expression of oncogenes, and the reduction of free radicals. Animal research conducted with polysaccharide-K has shown that it has the ability to increase the survival time in test subjects with spontaneous metastasis lung cancer, and it suppresses lesion growth of liver cancer in test subjects. Paclitaxel acts by stabilizing the microtubule of the mitotic spindle and prevents the movement of chromosomes to the metaphase plate which occurs in normal mitosis (Zhao, 2004). The mitotic block caused by Paclitaxel eventually leads to the apoptosis of the cell and thus the eradication of cancer cells. Through chemical synthesis researchers were able to produce the immunosuppressive drug fingolimod. Fingolimod was a milestone drug because it was the first disease modifying drug designed to be taken orally which was approved by the Food and Drug Administration (Horga, 2008). Fingolimod is used to reduce relapse and delay the progression of relapsing multiple sclerosis. The synthetic drug acts by building up stores of lymphocytes in lymph nodes and preventing the lymphocytes from interacting with the central nervous system and causing the auto-immune responses present in patients with multiple sclerosis. Patients taking Fingolimod was found to reduce patient relapse rates to less than 50% of those taking the placebo. According to the Center for Disease Control malaria infects between 300-500 million people each and every year, resulting in more than 1 million fatalities. Professor Angray Kang uses the fungus Metarhizium Anisopliae to kill the malaria parasite in the mosquito before it can be passed on to humans (Fang, 2011). Contact between the mosquito and the fungus causes the fungus to bore into the mosquito through the cuticle. Through genetic engineering, the fungus releases an antibody into the hemolymph which attacks the malarial parasite, causing the malarial spores clump together preventing them from entering the mosquito’s salivary glands. If the spores cannot reach the salivary glands they cannot be passed on to infect humans.

Prevention  Wash hands after using the toilet and changing diapers and before preparing food or eating generic pantoprazole 40 mg fast delivery biliary gastritis diet. Haemophilus influenzae type b (Hib) can cause a number of serious illnesses buy pantoprazole 40mg without a prescription chronic gastritis mayo, but it is not related to influenza or “stomach flu” purchase 40mg pantoprazole with mastercard diffuse gastritis definition. Cellulitis - A tender, rapid swelling of the skin, usually on the cheek or around the eye; may also have an ear infection on the same side; also a low-grade fever. Epiglottitis - Fever, trouble swallowing, tiredness, difficult and rapid breathing (often confused with viral croup, which is a milder infection and lasts longer). Invasive disease most commonly occurs in children who are too young to have completed their vaccination series. A person can also get infected from touching these secretions and then touching their mouth, eyes, or nose. All children between the ages of 2 months and 5 years who are in a licensed childcare setting are required to have Hib vaccine or they must have a legal exemption. Type b If you think your child Symptoms has Hib: Your child may have a fever with any of these conditions. The infection occurs most commonly in children less than 10 years of age and most often in the summer and fall months. Blister-like rash occurs in the mouth, on the sides of the tongue, inside the cheeks, and on the gums. Blister-like rash may occur on the palms and fingers of the hands and on the soles of the feet. The disease is usually self- limited, but in rare cases has been fatal in infants. It also is spread through droplets that are expelled from the nose and mouth of an infected person during sneezing and coughing and by direct contact with respiratory secretions. Wash hands thoroughly with soap and warm running water after using the bathroom, after changing diapers, after handling anything soiled with feces or secretions from the nose or mouth, and before preparing food or eating. Staff should closely monitor or assist all children, as appropriate, with handwashing after children have used the bathroom or been diapered. Disease If you think your child Symptoms has Hand, Foot, and Mouth Disease: Your child may have a runny nose, low-grade fever, and sometimes a sore throat. Childcare and School: If your child is infected, it may take 3 to 6 days for symptoms Yes, until fever is gone to start. This includes toilets (potty chairs), sinks, mouthed toys, and diaper changing areas. There are two other kinds of lice that infest people, but they do not live on the head. Head lice are very small (less than 1/8" long, about this size [--]), brownish-colored insects that live on human heads and lay their eggs (nits) close to the scalp. The eggs are tiny (about the size of the eye of a small needle) and gray or white in color. Look for: 1) crawling lice in the hair, usually few in number; 2) eggs (nits) glued to the hair, often found behind the ears and at the back of the neck; and 3) scratch marks on the head or back of the neck at the hairline. Children do not need to be sent home immediately if lice are detected; however they should not return until effective treatment is given. Removing the nits (nitpicking) is an essential part of the treatment for controlling the spread of head lice. The nits are glued onto the hair shaft as they are laid and require effort to remove. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. If all nits within ½" of the scalp are not removed, some may hatch and the child will be infested again. Bedding, when not in use for naptime, can be stored in individual plastic bags or storage boxes. When a child returns from a sleepover, check the child’s head and launder any bedding that they brought home. Clothing or backpacks that cannot be washed or dried, linens, and stuffed toys can be dry cleaned or sealed in plastic bags for 2 weeks. More information about head lice can be found on the Centers for Disease Control and Prevention website at: http://www. Look for: 1) crawling lice in the  Tell your childcare hair, usually there aren’t very many; 2) eggs (nits) glued to provider or call the the hair, often found behind the ears and at the back of the school. If all nits within ½" of the Lice do not jump or fly; they crawl and can fall off the head. With certain Childcare and School: products a second treatment is recommended 7 to 10 days later. Lice treatment products are not 100% Yes, until first treatment effective in killing lice, especially nits. To remove the nits, use a metal nit comb, cat flea comb, or your fingernails to slide eggs off the hair shafts, or use scissors to cut the hair shafts that have nits glued to them. If all nits within ½” of the scalp are not removed, some may hatch and your child will get head lice again. Clean all hair items by soaking in the lice treatment product for 10 minutes or cleaning with hot, soapy or boiling water for 5 minutes. Check your child’s head after a sleepover and wash all bedding brought home from the sleepover. Clothing, stuffed toys, linens or backpacks that cannot be washed or dried can be dry cleaned or sealed in plastic for 2 weeks. Among reported cases, the most frequent source of infection is household or sexual contact with a person who has hepatitis A, followed by attending or working in childcare settings, recent international travel, or connection with suspected food or waterborne outbreaks. Dark (tea or cola-colored) urine, light-colored feces, and jaundice (yellowing of eyes or skin) may appear a few days later. Older children and adults with hepatitis A usually have symptoms, often including jaundice.

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