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By: Jonathan Handy

  • Consultant in Intensive Care Medicine,Royal Marsden Hospital,Honorary Senior Lecturer,Imperial College London

The predictive value of longitudinal neuropsychologic assessment in the early detection of brain tumor recurrence medications help dog sleep night generic 10mg donepezil free shipping. A critical review of the clinical effects of therapeutic irradiation damage to symptoms 8 weeks order donepezil 5 mg mastercard the brain: the roots of controversy medications with weight loss side effects donepezil 5 mg cheap. Late cognitive and radiographic changes related to symptoms bipolar generic donepezil 10mg overnight delivery radiotherapy: Initial prospective findings. Effects of chemotherapy on neurocognitive function in children with acute lymphoblastic leukemia: A critical review of the literature. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. Individual change after epilepsy surgery: Practice effects and base-rate information. Neuropsychological function in adults after high dose fractionated radiation therapy of skull base tumors. Neuropsychometric evaluation of long-term survivors of adult brain tumours: Relationship with tumour and treatment parameters. Gamma knife radiosurgery for brain metastases: Do patients benefit from adjuvant external-beam radiotherapy? Brain metastasis in pediatric extracranial solid tumors: Survey and literature review. Therapeutic schedules influence the pattern of intellectual decline after irradiation of posterior fossa tumors. Neurobehavioral status and health-related quality of life in newly diagnosed highgrade glioma patients. Survival and neurologic outcomes in a randomized trial of motexafin gadolinium and whole-brain radiation therapy in brain metastases. Cognitive function as a predictor of survival in patients with recurrent malignant glioma. Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-Year results. Radiosurgery and whole-brain radiation therapy for brain metastases: Either or both as the optimal treatment. Reynolds intellectual assessment scales and Reynolds intellectual screening test professional manual. Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery. Gamma Knife stereotactic radiosurgery for intracranial metastases from conventionally radioresistant primary cancers: Outcome analysis of survival and control of brain disease. Steering Committee of the National Cancer Institute of Canada and the Canadian Cancer Society (2005). Prophylactic cranial irradiation in locally advanced non-small-cell lung cancer after multimodality treatment: Long-term follow-up and investigations of late neuropsychologic effects. Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients. A longitudinal neuropsychological study of partial brain radiation in adults with brain tumors. Neuropsychological dysfunction associated with cancer and cancer therapies: A conceptual review of an emerging target. Key Points and Chapter Summary Neurotoxicity is a significant cause of neuropsychological impairment Because any nervous system structure or function can be damaged by neurotoxicants, neurotoxicity can be the origin of many common neurologic and psychologic symptoms Many types of neurotoxicity are not well recognized among health professionals. The identification of neuropsychological and/or behavioral deficits related to neurotoxic exposure requires awareness and knowledge of neuropsychology and neurotoxicology. Singer Definitions Neurotoxicity describes the harmful effects of neurotoxicants (neurotoxic substances and agents) on the nervous system, which can adversely affect cognitive, emotional, behavioral and physical domains.

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An example of an environmental effect is that fat in foods appears to the treatment 2014 generic 10mg donepezil with mastercard provide a protective environment for pathogens medicine examples cheap 10 mg donepezil mastercard, enabling them to medications 5113 purchase donepezil 5 mg survive in inhospitable surroundings brazilian keratin treatment buy donepezil 5mg on-line. Principles of good practice for Monte Carlo simulation have been published to guide risk assessors in developing sound risk assessment models (Burmaster and Anderson, 1994). The major output of R C is a series of distributions of the frequency and severity of illness for the subpopulations of interest. Often, risk assessors may estimate illness for certain subpopulations under a baseline (as is) scenario and with interventions or possible system failures. Such a process bridges risk assessment and risk management activities and might include developing the concept of comparative risk, the comparison of simulation results for the baseline (as is) and various potential mitigation scenarios most relevant to policy makers. This type of analysis provides information about the relative contribution of different interventions to risk reduction that is necessary to support policy making. A key analytical aspect of R C is the performance of sensitivity and uncertainty analyses to determine what variables most strongly affect the uncertainty of the risk estimate. Standard statistical procedures such as goodness of fit testing and construction of confidence intervals for predictions can be used. However, because risk assessment models are often so complex, other procedures that are nonparametric are used for validation (Bowker, 1993). The most effective way of validating the model is comparing the estimates derived from the model with an independent source of data. The problem is that often there are questions concerning the validity of the independent source of data. The principles are for the most part readily understood and include the following concepts: Analysis should be consistent with the state of the art; analysis should be checked for accuracy; assumptions should be clearly pointed out; and superfluous assumptions should be discarded. However, one standard or principle does create some difficulty, the principle that "Calculations are presented in such a form that they can be checked by others interested in verifying the results. The first is that often the mathematical and statistical procedures used are so complex that, unless the computer programming is independently recreated, the results cannot be verified. In reality, verification of the analysis is just not possible for most interested parties. A second potential problem with this principle is that managers and risk assessors, in an attempt to adhere to this principle, may simplify procedures and adopt less than state-of-the-art methodologies, contradicting the first principle. Our preferred statement of the principle is that methodologies, including mathematical derivations and justification of statistical procedures, should be presented in a clear and coinplete fashion and in accordance with standard practices of the mathematical and statistical professions. Developing Risk Communication Risk assessment is highly technical and not without controversy. The conimunication of the results is difficult and decisions made as a result of a risk assessment could be controversial. Because of the complexities of a risk assessment, the uncertainty of the results, and the large stakes involved in the decisions, distrust may arise among the various stakeholders and risk analysis professionals. The expanded risk characterization process thus can incorporate social, behavioral, economic, and ethical aspects of risk. R C is a prelude to decision making and depends upon an iterative analyticaldeliberative process. The above definition represents an all-inclusive process, and seems to imply an ongoing process. Of particular interest to us in this chapter is the deliberative process as part of the risk characterization. First, for a risk assessment, scenarios must be defined at the beginning of the process, consistent with our definition of risk being conditional on well-defined scenarios. In fact, the latter possibility represents a difficulty that needs to be dealt with from the beginning. The decision-matrix tables, however, would not restrict possible decisions based on the results. In a practical sense, the risk assessment needs to have a clear demarcation point for decision making.

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Fruit wastes fermentation for phenolic antioxidants production and their application in manufacture of edible coatings and films medications not covered by medicare buy cheap donepezil 10mg on-line. Inulinase production in a batch bioreactor using agroindustrial residues as the substrate: experimental data and modeling treatment with cold medical term donepezil 5 mg without a prescription. Effects of limonene and essential oil from Citrus aurantium on gastric mucosa: role of prostaglandins and gastric mucus secretion medicine pill identification order donepezil 10mg line. Biochemical perspectives of xylitol extracted from indigenous agricultural by-product mung bean (Vigna radiata) hulls in a rat model symptoms 4 days after ovulation cheap 10mg donepezil overnight delivery. Characteristics and use of okara, the soybean residue from soy milk production ­ a review. Sustainable utilization of oil palm wastes for bioactive phytochemicals for the benefit of the oil palm and nutraceutical industries. Monitoring of the microbiota profile in nukadoko, a naturally fermented rice bran bed for pickling vegetables. Effect of temperature on chitin and astaxanthin recoveries from shrimp waste using lactic acid bacteria. Bio-conversion of apple pomace into ethanol and acetic acid: enzymatic hydrolysis and fermentation. Diversity in growth and protein degradation by dairy relevant lactic acid bacteria species in reconstituted whey. Whey fermentation by thermophilic lactic acid bacteria: evolution of carbohydrates and protein content. Co-solvent selection for supercritical fluid extraction of astaxanthin and other carotenoids from Penaeus monodon waste. Production and immobilization of enzymes by solid-state fermentation of agroindustrial waste. Use of spent osmotic solutions for the production of fructooligosaccharides by Aspergillus oryzae N74. Fermentative recovery of lipids and proteins from freshwater fish head waste with reference to antimicrobial and antioxidant properties of protein hydrolysate. Xylooligosaccharides as prebiotics from agricultural by-products: production and applications. Fermentation of Food Wastes for Generation of Nutraceuticals Chapter 30 733 Shi, M. Bioactivity of the crude polysaccharides from fermented soybean curd residue by Flammulina velutipes. Effect of ultrasonic extraction conditions on antioxidative and immunomodulatory activities of a Ganoderma lucidum polysaccharide originated from fermented soybean curd residue. Reduction of biogenic amines and aflatoxins in Doenjang samples fermented with various Meju as starter cultures. The effect of enzyme-assisted maceration on bioactivity, quality and yield of essential oil from waste carrot (Daucus carota) seeds. Changes in extractive components and microbial proliferation during fermentation of fish sauce from underutilized fish species and quality of final products. Evaluation of bread crumbs as a potential carbon source for the growth of thraustochytrid species for oil and omega-3 production. Formulation of fermentation media from flour-rich waste streams for microbial lipid production by Lipomyces starkeyi. Apple pomace as a substrate for fungal chitosan production in an airlift bioreactor. Sequential extraction of polysaccharides from enzymatically hydrolyzed okara byproduct: physicochemical properties and in vitro fermentability. Phenolic profile and antioxidant activity of extracts prepared from fermented heat-stabilized defatted rice bran. Enhancement of the antioxidant capacity of soy whey by fermentation with Lactobacillus plantarum B1­6. Study on furundu, a traditional Sudanese fermented roselle (Hibiscus sabdariffa L. Statistical optimization of culture conditions for milk-clotting enzyme production by Bacillus amyloliquefaciens using wheat bran-an agro-industry waste.

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Unfortunately medicine 6 times a day buy donepezil 10mg on-line, although many consumers believe that "natural" and "harmless" are synonymous treatment zinc overdose purchase donepezil 5mg free shipping, this is not necessarily true symptoms testicular cancer generic 5 mg donepezil visa. Natural substances that are considered harmless can be harmful when consumed in large amounts (Butterworth medicine 1800s 10mg donepezil free shipping, 1994). Cyndi Thomson of the American Dietetic Association describes a study at the University of Arizona in which beta carotene supplements, which are thought to be harmless at high levels, actually interfered with vitamin E levels in the participants (Kuhn, 1998). The fortification of flour, which dates to the 1940s, included three water-soluble vitamins (thiamin, riboflavin, niacin) and iron. The Michigan salt fortification program reduced the rates of goiter in school children by more than 50,000, resulting in a widespread voluntary fortification program (Mertz, 1997). The fortification of whole milk with vitamin A is voluntary, whereas fortification of low-fat and skim milk is mandatory because of the removal of fat-soluble vitamins during processing (Tanner et al. Government and private agencies worked together on the vitamin D fortification project and by 1947 rickets had almost disappeared (Shank and Wilkening, 1986). Another fortification issue involves iron, because it remains a worldwide nutritional problem. The best solution to the iron deficiency problem remains fortification of foods, but problems may exist because of sensory and bioavailability problems. Foods that are currently fortified with iron include flour, breakfast cereals, chocolate drink powders, and beverages (Hurrell and Cook, 1990). Fat-soluble vitamins require proper lipid digestion, absorption, and liver functions for utilization. Vitamins serve as essential components of enzymes or coenzymes, which are necessary for proper metabolism and life. Vitamins may be important in preventing chronic diseases including cancer, heart disease, and cataracts (Butterworth, 1994). Vitamins are instrumental in preventing spina bifida and neural tube defects and lowering cholesterol levels (Butterworth, 1994). Most vitamins or vitamin precursors must be supplied by diet, because the body is unable to synthesize them (Geise, 1995). Vitamin A Vitamin A is a fat-soluble vitamin and represents a group of substances necessary for reproduction, cellular differentiation, the immune system, gene regulation, and eyesight (Rutten, 1998). Vitamin A is the generic term for any compound with beta-ionone structure having the biological activity of all-tvms retinol (Gerster, 1997). Precursor forms of vitamin A are carotenoids that take on the biological activity of vitamin A after intestinal conversion to retinol (Gerster, 1997). The most significant carotenoids include beta carotene, alpha carotene, and cryptoxanthin (Gerster, 1997). The conversion of beta carotene to vitamin A (in the intestine) is regulated; excess vitamin A is not absorbed. Preformed vitamin A includes retinol, retinal, and various retinyl esters (Bendich and Langseth, 1989). One result of vitamin A deficiency is xerophthalmia, whose main symptom is night blindness (Bendich and Langseth, 1989). An example of vitamin A toxicity was documented in Arctic and Antarctic explorers who consumed polar bear liver, which can contain up to 600 mg of retinol per 100 g of liver. When the explorers consumed this high level of vitamin A they demonstrated symptoms of vitamin A hypervitaminosis. The symptoms included drowsiness, headache, vomiting, and extensive peeling of the skin (Rutten, 1998). The potential for overexposure to vitamin A exists because high-dose dietary supplements are available without prescription. Therefore, toxicity associated with vitamin A can result from high intakes of dietary supplements or from the consumption of liver from animals or fish (Gerster, 1997). Toxicity is based on the ingestion of retinol or retinyl esters and not from provitamin A forms such as beta-carotene (Hathcock, 1997). Acute vitamin A toxicity is defined as a single dose of >150,000 pg R E (retinol equivalents) in adults. Acute hypervitaminosis cases usually result from overuse of dietary supplements (Bendich and Langseth, 1989). Chronic hypervitaminosis is more commonly diagnosed as acute exposures and often goes unrecognized (Bendich and Langseth, 1989). The symptoms of hypervitaminosis include loss of appetite, dry, itchy skin, hair loss, weakness, headache, bone thickening, enlarged liver and spleen, nausea, vomiting, and blurred vision (Gerster, 1997).


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