VHIR Seminar led by Daniel De Backer, PhD., from the Dpt of Intensive Care Erasme University Hospital Brussels - Belgium.
Abstract: Multiple studies have shown that alterations in microcirculatory perfusion are frequently observed in patients with septic shock. These alterations are characterized by heterogeneity of perfusion with capillaries with stop flow in close vicinity to well perfused capillaries. What are the consequences of these alterations? The presence of stop flow capillaries favours development of zones of tissue hypoxia, even though total perfusion to the organ is preserved. In addition, the heterogeneity in perfusion is associated with inadequate matching of flow to metabolism and is hence less well tolerated by tissues than an homogeneous decrease in perfusion. In patients with septic shock, the severity of the microvascular alterations was associated with development of organ dysfunction and an increase risk of death.
Different mechanisms have been implicated in the development of these alterations including loss of communication between vascular segments, impaired endothelial reactivity, alterations in red and white blood cells rheology, alteration in endothelial glycocalyx, platelet aggregation and microthrombosis. In view of the various mechanisms implicated in the development of these alterations, it is unlikely that therapies used in usual hemodynamic resuscitation. Novel therapies should aim at improving the matching of perfusion to metabolism rather than further increasing flow in the already perfused vessels or non selectively dilating microvessels.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
DIABETES AND ITS ANAESTHETIC IMPLICATIONSSelva Kumar
This presentation deals with diabetes mellitus and its anaesthetic implications. All about preoperative investigations and intra-operative management are discussed.
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
Assessment of haemodynamics a critically ill patient and its management has always been a matter if debate. Over time a lot of studies and therapeutic interventions have been carried out. This presentation is a review of such interventions and their impact on the outcome.
comprehensive presentation on 2D echo use in ICu set up. helpful in finding causes of shock and also in monitoring of fluid status in critically ill patients.
The role of the endothelium as a mediator of critical illnessSMACC Conference
Endothelium was once thought to be an inert organ. However, it plays an important role in multiple functions. These include coagulation, inflammation and determination of vascular permeability.
He then gives a brief overview of the endothelial arrangement, function of the glycocalyx layer and how an injury causing a loss of the protective layer results in holes in the endothelium. The inflammatory cells enter via these holes and causes oedema in the affected organs leading to multiple pathologies.
Danny then explains the role of endothelium in controlling cell barrier function.
Activation of cortactin protein and the myosin light-chain kinase (MLCK) enzymes activate stress fibres resulting in pulling of endothelial cells thereby increasing its permeability.
Danny discusses the role of endothelial dysfunction in acute respiratory distress syndrome (ARDS) at macrovascular, microvascular and molecular levels. Macrovascular thrombosis is related to an increase in severity of ARDS, pulmonary hypertension, and mortality.
At a microvascular level there is a loss of vascularity and increased blood vessel thickness. At a microscopic level, endothelial cells appear swollen and damaged in ARDS. Endothelial dysfunction drives organ dysfunction and mortality. Changes in various endothelial markers like increased von Willebrand factor (vWF), decreased protein C and increased pulmonary dead space correlate with increased mortality.
Studies show that endothelial dysfunction is a more specific and sensitive method to predict mortality of critically ill patients when compared to SOFA score, SAPS 2 score and WCC. Danny discusses ventilator strategies for endothelial cells in ARDS patients. Lowering the tidal volume of ventilators and employing recruitment manoeuvres are such strategies.
Both of these cause a decrease in oedema by reducing endothelial permeability. He then shares the various potential pharmacological treatments for treating endothelial damage. These include statins and spingosine-1-phosphate (S1P). Different studies on the effect of statins in ARDS show contradicting result.
However, targeted therapies can be designed by studying the phenotypes and molecular basis of ARDS in each patient.
The role of the endothelium as a mediator of critical illness by Danny McAuley
Finally, for more like this, head to our podcast page. #CodaPodcast
This presentation discusses the latest evidence for blood transfusion triggers in the intensive care unit of various clinical condition including severe sepsis, GI bleed, post surgical cases, and post cardiac surgery among other cnditions
The differences between a cow and a monkey are clear. It is easy to tell a moth from a mosquito. So why are there still scientific studies that mix them up? The answer is simple: hundreds of cell lines stored and used by modern laboratories have been wrongly identified. Some pig cells are labelled as coming from a chicken; cell lines advertised as human have been shown to contain material from hamsters, rats, mice and monkeys. Problems have already been found with more than 400 cell lines. (Cited from Nature 520 (2015)).
An increasing number of scientific publications (i.e. Nature journals) are now sistematically asking for cell line authentication at the moment of paper submission. To help researchers to meet this requirement, UAT is starting to offer a new service for human cell line authentication.
Se realiza una revisión sobre los diversos mecanismos neuroendocrinos que ocurren en la madre y en el recién nacido, y que están relacionados con el inicio y consolidación del apego entre ambos. Se expone el papel que diferentes hormonas y neurotransmisores juegan en la regulación del vínculo en relación con el parto, el postparto inmediato y la lactancia. La interferencia en el inicio del apego entre madre e hijo puede tener potenciales efectos a largo plazo en el comportamiento y en el afecto del recién nacido. La influencia que determinados aspectos relacionados con el parto (como la realización de una cesárea electiva, la administración de hormonas durante el parto, el nacimiento prematuro, la separación madre-hijo o la alimentación mediante biberón) puedan tener sobre el mecanismo neuroendocrino del vínculo y sus consecuencias son objeto de esta revisión
16/03/2015 Seminario VHIR
Dr. Sergio Sosa-Estani. Director del Instituto Nacional de Parasitología "Dr. Mario Fatala Chabén", investigador del Consejo Nacional de Investigaciones Científicas y Técnicas (Conicet). Buenos Aires, Argentina.
Director del Instituto Nacional de Parasitología-Dr. Mario Fatala Chaben en Argentina. El instituto está involucrado en un extenso programa de investigación, incluso como un referente regional en el diagnóstico, prevención y control de enfermedades prevalentes y emergentes en Argentina, tales como la enfermedad de Chagas, Leishmaniasis y otras.
Sosa-Estani desempeñó como director de la Unidad de Vector Borne de Control de Enfermedades del Ministerio de Salud de Argentina. Tiene más de 50 publicaciones a su nombre, y es el investigador principal o co-investigador en diez proyectos de investigación en curso o finalizados.
Presentation carried out by Casandra Riera, researcher from the Translational Bioinformatics group at VHIR, for the course "Identification and analysis of sequence variants in sequencing
projects: fundamentals and tools"
Presentation carried out by Xavier de la Cruz, head of the Translational Bioinformatics group at VHIR, at the course: Identification and analysis of sequence variants in sequencing projects: fundamentals and tools.
Presentation carried out by Sophia Derdak, from the Data Analysis Team at CNAG, at the course "Identification and analysis of sequence variants in sequencing projects: fundamentals and tools".
Presentation carried out by Sergi Beltran Agulló, from the CNAG, at the course: Identification and analysis of sequence variants in sequencing projects: fundamentals and tools .
Presentation carried out by CNAG's director, Ivo Gut, at the course: Identification and analysis of sequence variants in sequencing projects: fundamentals and tools.
Watch the video of the presentation on Youtube:https://www.youtube.com/watch?v=E6CmOWR8klI&feature=youtu.be
Seasonal influenza continues to cause yearly epidemics resulting in severe disease and a significant number of deaths despite available vaccines and antivirals. Even more concerning is the ability of influenza virus to cause pandemics every 10-50 years. In the last years, we and other have characterized several features associated with virus virulence and tropism. In addition, new developments suggest the possibility of universal influenza virus vaccines that induce protective antibodies against conserved regions.
La recerca bàsica i traslacional en malalties rares és fonamental per entendre la fisiologia humana i per desenvolupar teràpies innovadores sovint útils també per malalties molt més prevalents. L’anèmia de Fanconi, caracteritzada per disfunció de la medul·la òssia i predisposició tumoral, n’és un exemple edificant. El primer transplantament de cordó umbilical de la història de la medicina fou en un pacient Fanconi. El primer nen medicament va néixer per curar un pacient Fanconi. El primer cop que s’han generat teixits sans per auto-transplantament curant, desprogramant i re-diferenciant cèl·lules de la pell d’un malalt ha estat en anèmia de Fanconi. I els primers assajos clínics de teràpia gènica s’estan desenvolupat també en malalties de la sang com l’anèmia de Fanconi. Aquests són alguns exemples de com l’estudi de malalties rares por transcendir més enllà del pacient afecte en benefici de tota la societat.
Prof. Milan Macek. Professor of Medical and Molecular Genetics Chairman of Department of Biology and Medical Genetics Division of Clinical Molecular Genetics and the National Cystic Fibrosis Centre- University Hospital Motol and 2nd School of Medicine -Charles University Prague- Czech Republic.
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There is an increasing need to manage cost-effectiveness issues of novel or relatively expensive technologies that are currently in use or being proposed for the treatment of rare diseases. Cystic fibrosis (CF), where so called „CFTR modulating therapies“ rendered by several novel orphan medicinal products (e.g. ivacaftor, lumacaftor) are rapidly being introduced into clinical practice, will be used as a model. Health-economic evaluations of rising pharmacotherapeutic costs, as the major driver of overall cost, have to be part of the cost analysis of chronic and progressive (rare) diseases like CF that may require lifelong therapy. Total costs include not only direct healthcare costs but also the cost of lost productivity by both patients and family caregivers. When considering the results of cost-effectiveness analysis of new technologies associated with the management of CF, it is unreasonable to expect that the incremental cost-effectiveness ratio to be less than the generally applied thresholds (willingness to pay) for other common diseases. This issue is further compounded by mutation specific therapies for a subset of the overal cohort of CF patients. Therefore, when assessing CF and other rare diseases, such analyses should include complex health technology assessment approaches, which evaluate comparative treatment effectiveness (novel and established), as well as wider social benefits and ethical aspects. We will present the experience of the Prague CF center in terms of costs of illness studies and pharmacoeconomical approaches to studying children and adolescents with this disease.
La disponibilidad de un sistema de multiplicación del virus de la hepatitis C (VHC) infeccioso en cultivos celulares está permitiendo investigar nuevos factores de respuesta a tratamientos antivíricos en condiciones controladas. Se presentará evidencia de que el fitness vírico puede ser un factor de multiresistencia a inhibidores y quese pueden obtener eficientes reducciones de carga viral empleando diseños secuenciales de administración de inhibidores que incluyan ribavirina. Se discutirán posibilidades de aplicación clínica.
The research interest of the investigator has focused on the molecular and cellular pathogenesis of sepsis. In particular, he has worked on soluble proteins involved in the innate recognition of bacteria such as soluble CD14 and MD-2, as well as in the Toll-like receptors activated by Gram-negative and Gram-positive bacteria. Another area of study is the molecular pathogenesis and cell signaling of ventilator-induced lung injury, and lung inflammation in the context of acute respiratory distress syndrome. He has also identified and tested biomarkers in the field of clinical sepsis.
Watch the presentation on Youtube: https://www.youtube.com/watch?v=CyWN7JlhlmI&
Enfermedad minoritaria, terapias nuevas. Una patología que afecta a menos de cinco personas por cada 10.000 habitantes es considerada una enfermedad rara o minoritaria. 35 millones de europeos se ven afectados por alguna de ellas. El 80% son de origen genético y conseguir un diagnóstico rápido es vital para asegurar la calidad de vida futura. La clave, una vez más, es apostar y potenciar la investigación biomédica. Se revisarán los resultados obtenidos los últimos 14 años, en el marco científico y regulador impulsado por la UE desde el año 2000. Sin embargo, se analizarán las dificultades y oportunidades para impulsar la investigación traslacional en estas enfermedades.
Sigue la presentación en Youtube: https://www.youtube.com/watch?v=d4U4a8xFCzA&
Seminario por el Sr. Juan Carrión: Presidente de la Federación Española de Enfermedades Raras (FEDER).
Desde FEDER se trabaja diariamente para promover y defender los derechos de 3 millones de personas con enfermedades raras. De esta forma, durante la ponencia trasladaremos las principales necesidades de las familias para lograr una adecuada atención social y sanitaria, así como cuáles son las líneas prioritarias que impulsamos desde FEDER en la búsqueda de soluciones ante los problemas que nos afectan.
Ver el vídeo del seminario aquí: https://www.youtube.com/watch?v=h091vwp40d0&feature=youtu.be
Watch the video of the presentation on Youtube: https://www.youtube.com/watch?v=WRegqg5yvRs
El Dr Welte té nombroses publicacions en àrees diverses relacionades amb el malalt crític. Particularment interessants són els seus estudis en relació al trasplantament pulmonar, així com els seus estudis sobre pneumònia i sèpsia. Així mateix, participa activament en la xarxa alemanya Capnetz, emprada per a l'elaboració d'estudis multicèntrics relacionats amb la pneumònia adquirida a la comunitat.
Rare diseases Conferences at Fundación ARECES-VHIR
Research in rare diseases is a very active and promising field. Nevertheless,even if it is not always obvious, requirements of the pharmaceutical regulations may be seen as a source of hurdles for a successful progress in medical science. The presentation will discuss how the regulatory framework can promote research and steer its translation into safe and efficacious products for rare diseases.
Watch the video of the seminar on Youtube: https://www.youtube.com/watch?v=dIYCC8cljt8
I will discuss the formation and subsequent growth of IRDiRC into an organization with nearly 40 public and private funder members who have collectively pledged over 1 billion euros for rare disease research. I will also present the goals of IRDiRC, the plan that has been developed to achieve them, and the progress that has been made thus far. Finally, I will explore how additional organizations can take part in this international collaborative effort
Over the last decades, more than 35 different definitions have been used to describe acute kidney injury (AKI). Multiple definitions for AKI have obviously led to a great disparity in the reported incidence and mortality of AKI making it difficult or even impossible to compare the various published studies focusing on AKI. Therefore, it became crucial to establish a consensual and accurate definition of AKI that could desirably be used worldwide. Recent consensus criteria for AKI definition and classification [the Risk Injury Failure Loss of kidney function End-stage kidney disease (RIFLE) and the Acute Kidney Injury Network (AKIN) classifications] have led to more consistent estimates of its epidemiology. This review will present and critically discuss current literature about AKI diagnosis and epidemiology.
More from Vall d'Hebron Institute of Research (VHIR) (20)
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
2. • Microcirculatory perfusion is a key
determinant of tissue perfusion.
• Microvascular perfusion is under control of
different mechanisms than systemic
hemodynamics.
• O2 transport is driven at microcirculatory
level by diffusion more than by convection.
TISSUE PERFUSION: Key points
3. Trzeciak et al
Crit Care 9:S20;2005
The density of capillaries is a primary
determinant of tissue oxygenation
4. Saldivar-E et al
AJP 285:H2064;2003
The density of capillaries is a primary
determinant of tissue oxygenation
Adaptation to chronic hypoxia is characterized by an
increased capillary density
5. MICROCIRCULATION
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8 L
.
. . .
Determinants of microvascular blood flow
Blood flow is adapted to local metabolic
needs through local vasodilation and
upstream changes in vasomotor tone
15. Hoffmann et al
CCM 32,1011;2004
Hamster skinfold LPS
DECREASED CAPILLARY DENSITY IN
EXPERIMENTAL SEPSIS
ENDOTOXIC SHOCK MODEL
16. ANOVA: in sepsis all times p<0.0001 vs baseline
Evolution of sublingual microcirculation in septic shock
Verdant et al
CCM 37;2875,2009
Sham
Sepsis
Pigs
Cholangitis
17. Evolution of microcirculation in unresuscitated septic shock
Pranskunas A et al
Crit Care 16:R83;2012
Pigs
E Coli infusion
22. EXPERIMENTAL STUDIES IN SEPSIS
Microvascular blood flow alterations are frequent
decreased vascular density
absent or intermittent flow in capillaries
heterogeneity between areas
DDB USI
Branemark et Urbaschek Angiology 18:667;1967
Lam et al. JCI 94: 2077; 1994
Farquhar et al. J Surg Res 61: 190; 1996
Madorin et al CCM 27:394;1999
Ellis et al AJP 282:H156;2002
Verdant et al CCM 37:2875;2009
Secor et al ICM 2010
Different models (LPS, CLP, live bacteria,…)
Various species (rats, mice, hamsters, pigs, sheep…)
Various organs (skin, gut, liver, lung, kidney, heart, brain…)
28. Loss of neural control Tyml-K et al
AJP 281:H1397;2001
Change in diameter
and
communication
rate (CR500)
between 500 µm
distant
microvessels
(retrograde
communication)
B: cremaster muscle (mice)
C: Endothelial microlayer
29. Enhanced response to vasoconstrictor substances Pannen B et al
AJP 26:180;2001
CTRL
HEM
CTRL + ET
HEM + ET
Rats
44. Emergency department
Trzeciak et al
Ann Em Med 49:1579;2007
N=26
0
0,1
0,2
0,3
0,4
0,5
0,6
0,7
Heterogeneity index
CTRL SEPSIS
P<0.01
45. Alterations of sublingual
microcirculation in
patients with sepsis
• De Backer et al AJRCCM 2002
• Spronk et al Lancet 2002
• Sakr et al CCM 2004
• De Backer et al CCM 2006
• De Backer et al CCM 2006
• Creteur et al ICM 2006
• Boerma et al CCM 2007
• Trzeciak et al Ann Emerg Med 2007
• Sakr et al CCM 2007
• Trzeciak et al ICM 2008
• Boerma et al ICM 2008
• Dubin et al Crit Care 2009
• Buchele et al CCM 2009
• Boerma et al CCM 2010
• Ospina et al ICM 2010
• Spanos et al Shock 2010
• Pottecher et al ICM 2010
• Morelli et al Crit Care 2010
• Ruiz et al Crit Care 2010
• Dubin et al J Crit Care 2010
• Morelli et al ICM 2011
• Edul et al CCM 2012
• Kanvundis et al ICM 2012
• Hernandez et al CCRP 2012
• Pranskunas et al ICM 2013
• ↓ total vascular density
• ↓ perfusion of capillaries
(no flow or intermittent flow)
• Preserved venular perfusion
• Heterogeneity between areas
( close by a few microns)
46. baseline StO2 (%) delta StO2 (%)
slope (%/sec)
0
1
2
3
4
5
6
7
8
sepsis
n = 72
volunteers
n = 18
icu control
n = 18
Slope(%/sec)
*
* p < 0.001 vs volunteers and ICU control
Creteur et al
ICM 2007
Endothelial reacitivity is
impaired in sepsis
47. Alterations of NIRS vasoreactivity test in patients with sepsis
• Girardis et al ICM 2003
• De Blasi et al ICM 2005
• Pareznik et al ICM 2006
• Podbregar et al Crit Care 2007
• Doerschung et al JAP 2007
• Creteur et al ICM 2007
• Skarda et al Shock 2007
• Nanas et al Aenesth Intens Care 2009
• Payen et al Crit Care 2009
• Donati et al Crit Care 2009
• Mesquida et al ICM 2009
• Mozina et al Crit Catre 2010
• Georger et al ICM 2010
• Shapiro et al Crit Care 2011
• Soga T et al Emerg Med J 2013
50. Edul et al
CCM 2012
Vessel density, proportion of perfused vessels and heterogeneity
but not velocity differ between survivors and non survivors
N=3N=15
55. 33 pts with septic shock
Trzeciak et al
ICM 34:2210; 2008
• 1st SDF evaluation within 3 hours after EGDT initiation
• 2nd SDF evaluation 3 to 6 hours after EGDT initiation
• SOFA changes between 0 and 24 h
56. DDB USI
EVOLUTION OF MICROCIRCULATORY ALTERATIONS
IN SEPTIC PATIENTS
Death after shock
ANOVA
p<0.01* * *
Sakr et al
CCM 32:1825;2004
57. Top et al
CCM 39:8; 2011
Persistent microcirculatory alterations in pediatric sepsis
N=3N=15
58. 0
1
2
3
4
5
6
7
8
Baseline 24hrs 48 hrs
Nonsurvivors (24/52)
Survivors (28/52)
*
*analysis of variance: p < 0.01
Slope(%/sec)
n = 52 septic patients Creteur et al
ICM 2007
Alterations of NIRS vasoreactivity test in patients with sepsis
59. Vallee F et al
Chest 138:1062;2012
Septic
shock
(n=46)
Ear Lobe PCO2
60. But isn’t it just the consequence of
the altered global hemodynamics ?
Subtitle: could you detect it using hemodynamic
measurements, clinical assessment or biomarkers?
65. Ellis C et al
AJP 282:H156;2002
In perfused capillaries, O2 extraction is INCREASED in sepsis
Single perfused capillary
66. Cardiomyocytes
rats
Bateman et al
AJP 293/H448;2007
During LPS, ICAM-1
expression and HIF gene
induction are heterogeneous,
and inversely related to flow.
68. Alteration in redox potential are proportional
to microcirculatory alterations
Wu L et al
AJP 292:F261; 2007
Mice / LPS
Peritubular capillaries
69. Microcirculatory alterations are associated
with renal hypoxia (co-localized with NADH)
Wu L et al
AJP 292:F261; 2007
CTRL
LPS
Peritubular capillaries
Mice
NADHHypoxia
70. Fink T et al
Shock 2013
Liver microvascular perfusion and
redox state are inversely related
Rats / Fecal peritonitis / pretreatment / absence of shock
72. R
2
= 0,80
0
20
40
60
80
100
20 40 60 80
Baseline
% well perfused capillaries
PslCO2gap
=> Microcirculatory alterations are primary events rather than
secondary to altered cellular metabolism.
Creteur et al
ICM 32:516;2006
Expected
(flow adapted to metabolism)
Stagnation of waste products
73. b-adrenoceptor stimulation improved liver
microvascular perfusion and redox state
Rats / Fecal peritonitis
Fink T et al
Shock 2013
Sham Sepsis DobuSham Sepsis Dobu
74. Change in Lactate
%
Change in capillary perfusion
mEq/L
DOBU 5 mcg/kg.min
-1
-0,8
-0,6
-0,4
-0,2
0
0,2
0,4
0 10 20 30 40 50
De Backer et al
CCM 34:403;2006
76. Influence of timing of fluid resuscitation
Rats
LPS
Legrand et al
ICM 37:1534; 2011
77. 20
30
40
50
60
70
80
90
100
Baseline Fluids
Late stage
(>48h)
N=23
Early stage
(<24h)
N=37
Proportion of perfused small vessels
%
$ p<0.01 fluids vs baseline and + p<0.01 late vs early
+
$
Microvascular effects of fluid challenge in patients with septic shock
Ospina et al
ICM 35:949;2010
78. Sensitivity Specificity Pos pred
val
Neg pred
val
Correct
classifica
tion
MAP 0.55 0.50 0.42 0.64 0.52
CI 0.42 0.68 0.42 0.68 0.58
DPP 0.50 0.56 0.42 0.64 0.53
The microvascular response to fluids cannot be
predicted by global hemodynamic changes
(including indices of fluid responsiveness) !
Ospina et al
ICM 35:949;2010
79. 20
30
40
50
60
70
80
90
100
Late, RL
Late, alb
Early, RL
Early, alb
Baseline After fluids
Proportion of perfused vessels
$ p<0.01 fluids vs baseline Coll vs cryst p = NS
%
$ $
The time of administration but not the type of fluid
influenced the microvascular response
Ospina et al
ICM 35:949;2010
94. Red blood cell White blood cell/platelet
Arterioles Capillaries
BETA
(vasodilatation)
BETA
(WBC / PLT)
Decrease rolling et
adhesion
Effects of adrenergic agents on the microcirculation
102. Impact of vasopressors on the microcirculation
(Norepinephrine vs Vasopressine)
Hamster, control condition
Friesenecker et al
Crit Care 10:R75;2006
103. Maier-S et al
BJA 2009
Phenylephrine impairs microvascular perfusion in CPB
104. Impact of vasopressors on the microcirculation
Rats, LPS, gut muscularis
Nacul F et al
Anesth Analg
110:447;2010
No fluids
Doses:
NE 5 mcg/kg.min
EPI 5 mcg/kg.min
PHE 10 mcg/kg.min
DOPA 20 mcg/kg.min
Dobu 12 mcg.kg.min
Normotensive sepsis
105. Red blood cell White blood cell/platelet
Arterioles Capillaries
BETA
(vasodilatation)
BETA
(WBC / PLT)
Decrease rolling et
adhesion
Effects of adrenergic agents on the microcirculation
ALPHA
(vasoconstriction)
108. Impact of vasopressors on the microcirculation
(Norepinephrine vs Vasopressin)
Rats, LPS
Baseline value
Shock value
Nakajima et al
CCM 34:1847;2006
MAP 46 71 70 mmHg
109. Fries et al
CCM 36:1886; 2008
Norepinephrine
improved slightly
microvascular
perfusion but not
µPO2
Rats / CLP
Buccal mucosa
110. Correction of hypotension improves
microvascular reactivity (NIRS)
MAP 54 => 77 mmHg
Georger et al
ICM 36:1882;2010
111. DDB USI
What is the optimal blood pressure
target for the microcirculation ?
112. Jhanji et al
CCM 37:1961;2009
p<0.05
p=0.45
N=16
Impact of MAP/NE on microvascular perfusion
113. Dubin et al
Crit Care 2009
N=20
Impact of MAP/NE on microvascular perfusion
114. Thooft et al
Crit Care 2011
Impact of MAP/NE on microvascular perfusion
Density of perfused small vessels
65 (baseline) 75 85 65
6
8
10
12
level of mean arterial pressure, mmHg
FCDsmallvessels,n/mm
*
*
115. Thooft et al
Crit Care 2011
Impact of MAP/NE on microvascular perfusion
65 (baseline) 75 85 65
0
100
200
300
400
500
* *
level of mean arterial pressure, mmHg
AscendingSlope%/min
* *
116. • Vasopressor agents have a dual effect on the
microcirculation: on the one hand vasopressors
decrease microvascular perfusion by constriction of
precapillary sphincters.
• On the other hand, achievement of a minimal
perfusion pressure is needed to preserve organ blood
flow and microcirculatory perfusion.
• Optimal pressure targets are variable and should
be individualized.
Vasopressors and the microcirculation
118. 65
70
75
80
85
90
95
100
BASE
Proportion of perfused vessels
(all vessels)
++ p <0.01 vs base
TOPICAL ACETYLCHOLINE
(10-2 M)
Patients with septic shock (n = 11)
%
DDB USI
MICROCIRCULATORY ALTERATIONS IN SEPTIC PATIENTS
De Backer et al
AJRCCM 166:98;2002
119. Spronk et al
Lancet 360:1395;2002
Effects of nitroglycerin
8 pts with septic shock
120. Boerma E et al
CCM 38:93-100;2010
Effects of nitroglycerin
70 pts with severe sepsis
121. Effects of nitroglycerin
70 pts with severe sepsis
But can normal be more normal than normal ?
Boerma E et al
CCM 38:93-100;2010
122. Proportion of Perfused Small Vessels
BA
SELIN
E
BEFO
R
E
D
R
U
G
SH
O
C
K
N
E
1H
N
E
2H
0
20
40
60
80
100
ENALAPRILAT
PLACEBO
Enalaprilat
Placebo
n=8
n=8
n=8
n=8
n=6
n=7
n=7
n=7
n=6
n=7
* p<0.05 vs baseline and before drug
p=0.83 for trend in enalaprilat group
p=0.006 for trend in placebo group
p=0.48 for group/time interaction
* *
PPVsmallvessels,%
ACE inhibitors?
Salgado D et al
Shock 2011
Sheep
CLP
But no impact on
• outcome
• organ function
125. Vitamin C
Tyml K et al
CCM 33,1823;2005
Rat / muscle
CLP
Ascorbate 7.6g/100g BW
1h or 24h post CLP
126. Vitamin C
The effect is related to endothelial NOS
Tyml K et al
CCM 2008
Mice / muscle
Feces in peritoneum
Ascorbate 10-200 mg/kg
6h post peritonitis
128. He X et al
CCM 20:2833; 2012
Sheep
CLP
BH4 (tetrahydrobiopterin)
129. He X et al
CCM 20:2833; 2012
Sheep
CLP
BH4 (tetrahydrobiopterin)
Improved
• outcome
• organ function
130. • Multiple experimental and clinical studies suggest
that microvascular alterations play a key role in the
pathophysiology of sepsis and in the development of
sepsis-induced organ failure.
CONCLUSIONS
• These alterations are due to several factors
(endothelial dysfunction, interaction with circulating
cells) that make unlikely that classical hemodynamic
resuscitation can be effective in restoring an adequate
microcirculation.
• Modulation of endothelial NO synthase seems
promizing.