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By: Leonard S. Lilly, MD

  • Professor of Medicine, Harvard Medical School, Chief, Brigham and Women's/Faulkner Cardiology, Brigham and Women's Hospital, Boston, Massachusetts


The evidence is not conclusive because the study is ecologic and uses approximations for both radiation dose and iodine deficiency impotence juice recipe purchase 50 mg caverta overnight delivery. In their case-control study in Belarus and Russia erectile dysfunction treatment in lucknow order 50mg caverta free shipping, Cardis and colleagues (2005) also investigated the effects of iodine deficiency and its interaction with radiation exposure in the risk of thyroid cancer impotence emedicine buy 100mg caverta with mastercard. It is noted that administration of potassium iodide as a dietary supplement significantly reduced the risk of radiation-induced thyroid cancer shakeology erectile dysfunction generic 50 mg caverta. Finally, relatively little has been published regarding thyroid outcomes other than thyroid cancer, although one study has reported an elevated risk of benign thyroid tumors (Ivanov and others 2003). There have been reports of increases in autoimmune disease and antithyroid antibodies following childhood exposure to Chernobyl (Lomat and others 1997; Vykhovanets and others, 1997; Pacini and others 1998; Vermiglio and others 1999). However, a study by the Sasakawa Foundation, which screened 114,000 children, found no association between a surrogate for thyroid dose garding the quantitative relationship between radiation dose to the thyroid from Chernobyl and the risk of thyroid cancer. There are only three published population-based casecontrol studies of thyroid cancer in children that utilize individual estimates of radiation dose and provide quantitative information on thyroid cancer risk (Table 9-3B). Although a strong relationship between estimated radiation dose and thyroid cancer was found, thyroid doses were inferred for children from estimates for adults who lived in the same villages. Based on 26 cases and 52 controls and using a log-linear dose-response model treating estimated individual thyroid radiation dose as a continuous variable, the trend of increasing risk with increasing dose was statistically significant (one-sided p =. The third is a population-based, casecontrol study of thyroid cancer carried out in contaminated regions of Belarus and the Russian Federation (Cardis and others, 2005). The study included 276 cases and 1300 matched controls aged less than 15 years at the time of the accident. A clear linear doseresponse relationship was observed up to about 1 Gy, followed by a marked flattening. Collectively, data from these studies suggest that exposure to radiation from Chernobyl is associated with an increased risk of thyroid cancer and that the relationship is dose dependent. These findings are consistent with descriptive reports from contaminated areas of Ukraine and Belarus, and the quantitative estimate of thyroid cancer risk is generally consistent with estimates from other radiation-exposed populations. A number of the studies have also focused on the potentially modifying influence of a number of host and environmental factors. Results from studies of atomic bomb survivors and persons exposed to external irradiation have shown that exposure at the youngest ages is associated with the greatest risk of thyroid cancer. The available data on exposure from the Chernobyl accident are largely in agreement with this observation. One study of thyroid cancer diagnosed in adolescents and adults in the Bryansk region of Russia reported a small excess of thyroid cancer among adults (Ivanov and others 2003), but the excess was not correlated Copyright National Academy of Sciences. Leukemia the evidence from epidemiologic studies regarding the risk of leukemia in populations exposed to radiation from Chernobyl comes from studies of recovery operation workers, some of whom were exposed at a high or moderate dose levels and dose rates (depending on when and where they worked), and the general population who have been subject to low-dose-rate exposure (primarily from 137Cs) for a number of years and will continue to be exposed in the future. Resident populations were exposed at all ages, but studies of residents are primarily of persons exposed as children and/or in utero. Several studies have investigated the risk of leukemia in children exposed to Chernobyl fallout in utero. The initial study compared rates for temporal cohorts born during "exposed" and "unexposed" periods in Greece and found a 2. In a study in Belarus (Ivanov and others 1998), where levels of contamination are higher by a factor of 10 or more, the results were similar to the Greek study but the trend was weaker. A more recent small study published by Noshchenko and colleagues (2001) compared leukemia incidence during 1986 to 1996 among children born in 1986 and thus exposed in utero in Zhitomir, a contaminated region, to children born in Poltava, a relatively uncontaminated region. Focusing on the risk of leukemia by age of diagnosis in 6-month intervals in relation to estimated doses from the Chernobyl fallout received in utero, preliminary results suggest a small increase in risk in infant leukemia and leukemia diagnosed between 24 and 29 months. Thus, at present the available evidence from ecologic studies does not convincingly indicate an increased risk of leukemia among persons exposed in utero to radiation from Chernobyl. However, the statistical power of these studies is low for detecting moderate-sized associations, and the exposure measures are crude. Consequently, there is neither strong evidence for or against an association between in utero exposure to Chernobyl fallout and an increased risk of leukemia.

The term `fitness is often used to erectile dysfunction therapy purchase 100 mg caverta overnight delivery refer to erectile dysfunction treatment massage buy caverta 50mg on-line the extent to erectile dysfunction doctor london generic caverta 50 mg which organisms are adapted to erectile dysfunction medications cost purchase 50 mg caverta visa their environment. Fitness is the capacity of an organism to survive and transmit its genotype to its offspring. In some years, populations become so large that lemmings may emigrate in one group from overcrowded areas. The reason for the oscillating population size is not known for certain, although it has been suggested that food supply or food quality may be the main cause. Once the population size has decreased, food supplies begin to recover, and the population size rises again. There are quite large numbers of rabbits of different colours, such as black and white. Selection pressures increase the chances of some alleles being passed on to the next generation, and decrease the chances of others. In this case, the alleles for agouti coat have a selective advantage over the alleles for white. The alleles for agouti will remain the commoner alleles in the population, while the alleles for white will remain very rare. The effects of such selection pressures on the frequency of alleles in a population is called natural selection. Natural selection raises the frequency of alleles conferring an advantage, and reduces the frequency of alleles conferring a disadvantage. Agouti rabbits are the bestadapted rabbits to survive predation, so the agouti allele remains the most common coat colour allele in rabbit populations. Unless something changes, then natural selection will ensure that this continues to be the case. However, if a new environmental factor or a new allele appears, then allele frequencies may also change. A third type of selection, called disruptive selection, can occur when conditions favour both extremes of a population. This type of selection maintains different phenotypes (polymorphism) in a population (Figure 17. Body mass selection against animals of middle size d Numbers in population Body mass Figure 17. Very small or very large individuals are less likely to survive and reproduce than those whose size lies nearer the centre of the range. This type of selection, which tends to keep the variation in a characteristic centred around the same mean value, is called stabilising selection. Graph c shows what would happen if selection acted against smaller individuals but not larger ones. This type of selection, which results in a change in a characteristic in a particular direction, is called directional selection. Graph d shows the result of selection that favours both large and small individuals, but acts against those whose size is in the middle of the range. Fossils of a virtually identical animal have been found in rocks 200 million years old. Natural selection has acted to keep the features of this organism the same over all this time. The climate becomes much colder, so that snow covers the ground for almost all of the year. Assuming that rabbits can cope with these conditions, white rabbits now have a selective advantage during seasons when snow lies on the ground, as they are better camouflaged (like the hare in Figure 17. Rabbits with white fur are more likely to survive and reproduce, passing on their alleles for white fur to their offspring. The frequency of the allele for white coat increases at the expense of the allele for agouti.

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You have 30 minutes to erectile dysfunction medication for diabetes 100 mg caverta with amex complete Part 1 and 20 minutes to causes of erectile dysfunction in young adults caverta 50mg with visa design and rehearse your advertisement erectile dysfunction drugs malaysia generic 100mg caverta overnight delivery, which will be delivered in plenary and should last no more than 2 minutes impotence with beta blockers cheap 100mg caverta with visa. She notices a group of five men who are chained at the ankles sitting on the ground. Case Study 2 Shuaib is in charge of teacher training at the Ministry of Education. He and his staff are conducting a survey among teachers to assess their attitudes to educating children with disabilities. In reviewing responses to the survey, he notices that a number of the negative responses regarding the possibility of including children with disabilities concern children with albinism. Several responses seemed to indicate that the teachers believed that children with albinism should not be educated in public schools for their own protection because of the beliefs by some in the community that their body parts could ward off evil spirits. She is interested in starting a support group for other parents of children with intellectual disabilities. Each woman found herself abandoned by her husband after their disabled child was born. Three of the women were shunned by their families and neighbours on the basis that their child was born with a disability because she was a "loose" woman. The fourth woman was told that the gods were angry with her and that is why she gave birth to a child with a disability. The women decide to meet again and want to change attitudes about disability in their community so that they and their children can live a decent life. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by health science practitioners for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. The fact that an organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Essentials of clinical immunology / Helen Chapel, Mansel Haeney, Siraj Misbah, Neil Snowden. Cover image: Tim Vernon / Science Photo Library Cover design by Visual Philosophy Set in 10/12 pt Adobe Garamond Pro by Toppan Best-set Premedia Limited 1 2014 Contents Preface to the Sixth Edition Preface to the First Edition How to Use Your Textbook About the Companion Website Key to Illustrations iv v vi ix x 1 BasicComponents:StructureandFunction 2 Infection 3 Immunodeficiency 4 AnaphylaxisandAllergy 5 Autoimmunity 6 LymphoproliferativeDisorders 7 ImmuneManipulation 8 Transplantation 9 KidneyDiseases 10 JointsandMuscles 11 SkinDiseases 12 EyeDiseases 13 ChestDiseases 14 GastrointestinalandLiverDiseases 15 EndocrinologyandDiabetes 16 Non-MalignantHaematologicalDiseases 17 Neuroimmunology 18 ImmunologicalDiseasesinPregnancy 19 TechniquesinClinicalImmunology Appendix: Further Resources Index 1 34 54 86 105 121 137 157 171 194 219 236 245 263 288 300 312 324 332 351 353 Preface to the Sixth Edition this is the last edition of the book in this format and the first as a digital edition; some progress since the first edition in 1984. During this time there have been fantastic advances in basic immunology and clinical applications, so that many of the earlier concepts are outmoded, redundant or just wrong. Keeping up to date is an increasingly time consuming and difficult task, not least to keep pruning exciting new findings in basic immunology that do not yet add much to our overall understanding of the important role of the immune system in health and disease. In addition, Neil Snowden has moved to full-time rheumatology and clinical administration and was not able to take part and Siraj Misbah has become Clinical Lead in Immunology and is active on any number of national and international committees. So that left only one of the four, who is therefore responsible for all the mistakes in this edition.

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This cell will give rise to low cost erectile dysfunction drugs purchase 50 mg caverta amex over two hundred different human cells erectile dysfunction email newsletter caverta 100 mg overnight delivery, all with the 100% identical genome within them during development erectile dysfunction medication insurance coverage discount 100 mg caverta. Expressing different genes makes cells different or specialized in function and shape erectile dysfunction treatment covered by medicare order caverta 50 mg fast delivery. The process of morphogenesis is the product of cell differentiation occurring during development. Cloning is the process of making 100% genetically identical organisms called Clones. Third Step: Take a somatic cell nucleus (Diploid) out of a somatic cell and put it in the egg cell. Fourth Step: Put the "egg" cell in a surrogate organism (female) to develop until birth. These cells have many possibilities as to what they will develop into as they develop. They also have no genes "locked up"; therefore, they can make any protein or enzyme. Adult) Embryonic are found in developing embryos and adult stem cells are found within developed tissues. Embryonic stem cells are more valuable in research because of the unlimited possibilities. Controlling the polarity of the Zygote helps to determine the Head and Tail or Root and Shoot. This "control" is accomplished by production of cytoplasmic determinant proteins and morphogens. This accumulation determines the poles of the cell and what each end will start development of in the organism. They are referred to as "maternal" because they are produced in the female egg cell. These genes produce proteins that influence what will happen in a particular segment of an organism. The more similar the sequence between organisms; the more closely related in terms of evolution they are. Such things as cloning, to new medicines, to making bacteria and yeast making human hormones, to making biological weapons such as Super Anthrax. Only one half (n) is considered the Genome, they essentially carry the same information (genes). This became the only species that the farmers could plant, as no new species were brought over afterwards. This is why some organisms have advantages over others within the same species in terms of survival and the ability to reproduce. Variety means there exists the possibility to evolve over time while living in an ever changing environment. Those with less hair survived and passed on those genes for less hair to their offspring as the environment became warmer over time. The mammoths with more hair died before they could reproduce; thereby, "wiping" out those genes and eventually causing the extinction of the old species. They come together to make diploid cells to "create" variation to increase survivability in a changing environment. The diploid parent organisms make haploid gametes (sperm or egg) by undergoing Meiosis. The diploid cells undergo Mitosis to keep making new diploid cells and thereby the organism. Fertilization, which is the fusion of egg and sperm together, must occur to be able to reproduce. Each "chromosome" is now called a "chromatid" in let it be known it was replicated. The other three cells degrade into structures called polar bodies during the process. For humans the total is about 8 Million possibilities for each parent with each division.

It requires menstruation to impotence cures caverta 50mg with amex release the sugar rich endometrium of the uterus erectile dysfunction age 33 caverta 50 mg amex, if no pregnancy occurs erectile dysfunction vitamin shoppe 100 mg caverta. This sugar will serve to erectile dysfunction tea best caverta 100 mg feed the developing fetus until an umbilical cord develops. It travels to the uterus to stimulate proliferation of the endometrium in the uterus. Cytoplasmic determinants (proteins in the cytoplasm) act as signals within the cells to control Mitosis. Pattern genes control the pattern (shape) of an organism while it is being developed. Positional genes control the position (location) of various structures, such as organs, bones, and muscles. Examples of apoptosis include the death of cells in-between digits such as fingers and toes. Conception) and Development Process (This is just Cell Signaling using direct contact. Acrosomal process develops after getting through the jelly coating and connecting with the egg. This allows the sperm to connect with the egg protein receptors "hands" for verification. The connection with the first sperm causes all the other receptor protein "hands" to be released from the egg and thus prevents multiple sperm from fertilizing. Sperm entering the egg causes the rate of Cellular Respiration (making E) and Protein synthesis to increase. The tail of the sperm (microtubules) is broken down to help "create" the spindle fibers for Mitosis. Cleavage (rapid cell division) occurs to create a morula (solid ball of stem cells). Morula continues to divide, but now hollows out to form a Blastula (hollow ball of cells) by blastulation. Blastula continues to develop into a three tissue structure called a gastrula by Gastrulation. Third layer is "created" by involution (cells moving inward from the outer surface) through the a hole in the structure called a Blastopore. The gastrula will hopefully (25% chance) implant in the uterus and continue to develop into an embryo. If something goes wrong during this period, the organism will be severely affected. Placenta (connection with the mother) will develop from cells on the bottom of gastrula called trophoblasts.

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