This document summarizes recent research on the pathogenesis of spondyloarthritis (SpA). It discusses the role of HLA-B27, the link between gut inflammation and enthesitis, and organ-specific pathology such as enthesitis and new bone formation. Genetic factors like HLA-B27 are important in ankylosing spondylitis, while environmental triggers like gut microbes and mechanical stress also contribute. The cytokines TNFα, IL-17, IL-22, and IL-23 are major mediators of SpA. More research is still needed to better understand the complex interactions between genetic and environmental factors in SpA.
Orthopedic and rheumatological diseases are interlinked. Rheumatology is a crucial medical discipline that focuses on inflammation-related diseases. These diseases may affect the heart, bones, joints, muscles, and cause pain and dysregulation in various metabolic networks.
Orthopedic and rheumatological diseases are interlinked. Rheumatology is a crucial medical discipline that focuses on inflammation-related diseases. These diseases may affect the heart, bones, joints, muscles, and cause pain and dysregulation in various metabolic networks.
Vasculitis syndrome an approach -and-basic principles of treatmentSachin Verma
Vasculitides are a hetrogenous group of conditions characterized by inflammation and necrosis of blood vessels.
A broad group of syndromes may result from this process,since any type,size, and location of vessel may be involved.
Vasculitis syndrome an approach -and-basic principles of treatmentSachin Verma
Vasculitides are a hetrogenous group of conditions characterized by inflammation and necrosis of blood vessels.
A broad group of syndromes may result from this process,since any type,size, and location of vessel may be involved.
Managing Autoimmunity is an informative slide show of key points to healthy immune regulatory factors. These basic items: toxic load, diet, nutritional stores, immune triggers, glutathione stores and genetics converge to create or deny a certain immune level of activity. Delivered to the Functional Medicine Club at SCUHS
vasogenic shock also known as vasodilatory shock causes drastic effects in animals. vasogenic shock is due to increased vascular capacitance,while the blood volume is normal. Based on the causes,it can be grouped into septic,neurogenic and anaphylactic shock
A neuromuscular disorder that leads to weakness of skeletal muscles.
Symptoms
Causes
Prevention
Complications
Common tests & procedures
Neurological examination:
Repetitive nerve stimulation test:
Antibody test:
Pulmonary function tests (PFTs): To check any breathing difficulty.
CT scan: To rule out a presence of tumor in thymus.
Magnetic resonance imaging (MRI): MRI of the chest is performed to rule out a presence of tumor in thymus.
Edrophonium (Tensilon) test:
Medication
Procedures
Nutrition
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
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Update Pathogenesis of
Spondyloarthritis
James Cheng-Chung WEI, MD, PhD
Chief, Division of Allergy, Immunology and Rheumatology
Director, Chinese Medicine Clinical Trial Center
Associate Professor, Chung Shan Medical University
9. The Gut in SpA
Ileocolonoscopy and biopsy found
subclinical gut inflammation in about 50%
of patients with SpA
Symptomatic inflammatory bowel disease
(IBD) in 6.5% of SpA
Sacroiliitis and spondylitis occurs in 1 to
26% of patients with IBD
SpA and IBD: share similar gene(1q32, STAT3,
IL-12B, IL-23R), TH17, and innate immunity.
10. Gut Microbials in AS
•
•
•
•
An increased Klebsiella pneumonia in the fecal
cultures and anti-KP antibodies were associated
with degree of gut inflammation in AS
Chalmydia, Shigella, Salmonella, Yersinia, and
Campylobacter species are arthritogenic in ReA
Molecular mimicry between K.p. and self Crossreactive Antigens HLA-B27 & collagen
TLR and innate immunity play a role
Rashid T, Ebringer A. Discov Med. 2011 Sep;12(64):187-94
16. •
•
Enthesis is a special organ
with fibrocartilage
Mechanical stress may
expose self Ag like Versican
and Aggrecan
17. Systemic IL-23 Expression in vivo Induces Highly Specific
Entheseal Inflammation
Entheseal inflammation at day 6 after administration of 3 μg IL23mc (bottom row) as compared to control treatment with human
α1 anti-trypsin minicircle (hAATmc, top row) in B10.RIII mice.
* Entheseal tendon-bone interface.
Adapted from: Sherlock JP et al. Nat Med 2012;18:1069-76 (with permission)
Histology of periosteal disease and
osteoblast expansion at day 18 after
treatment in B10.RIII mice.
20. Gut, Enthesis, HLA-B27 & IL-23 in SpA
Zhu et al Nat Med 18:1077-1086, 2012
Hu and O’Connell Nat Med 18:1009-1010,2012
Sherlock et al Nat Med 18:1069-1076, 2012
22. Take home message
Enthesitis and new bone formation are major
pathology of SpA.
Genetic factors are highly important in AS,
esp. HLA-B27, ERAP-1, IL23R.
Environmental factors, esp. gut microbials,
mechanical stress and smoking play a role.
TNFα and IL-17/22/23 are major cytokines
mediating SpA.
This cartoon shows you the difference..
For RA, the pathology is synovitis and marginal erosion mediated by TNF and osteoclase
For SpA, the pathology stats from enthesitis, mediated by not only TNF, but also BMP/Wnt in later stage, causing new bone formation.
Enthesitis is the halmark of SpA, Actually, enthesis is a special organ
The insertion site is usually over stressed by trauma
This is an importen paper last year in Nature Medicine about The entheseal stress hypothesis shown that Systemic
After injection of IL23, at day 6, you can see severe inflammation in the enthesis, and then osteoblast expansion at day 18.
So, my summary about organ specific are
This is a very nice summary figure about pathogenesis of SpA.
In B27+ subjects, the unfodled protein response initiated by gut bicrobiome and biomechanical stress, casusing transcription of inflam cytokines, esp IL23.
IL-23 activate TH17 rxn in the enthesis and then cause inflam, and finally osteoproliferation
In summary, I made this cartoon for my own hypothesus.
SpA need a genetic background, such as..
After trigger by environmental factors, such as..
The immune dysregulation attack enthesis through Th17 and Th1 rxn
With different genetic and Environmental factors, pts may have different phenotype, such as SpA or IBD.