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Nathan Goodyear

Evidence-based medicine - Wikipedia, the free encyclopedia - 1 views

en.wikipedia.org/...Evidence-based_medicine

evidence-based medicine

shared by Nathan Goodyear on 01 Aug 11 - Cached
  • Nathan Goodyear on 01 Aug 11
     
    What is "evidence-based medicine"?   Most recommendations and clinical practices are based on the lowest level of evidence: essentially opinion-based therapy.
Nathan Goodyear

PLOS ONE: Increased Risk of Non-Fatal Myocardial Infarction Following Testosterone Ther... - 0 views

www.plosone.org/...10.1371%2Fjournal.pone.0085805

Testosterone therapy cardiovascular disease men male hormones

shared by Nathan Goodyear on 30 Jan 14 - No Cached
  • For all TT prescription subjects combined, the post/pre prescription rate ratio for MI (RR)was 1.36
  • In men aged 65 years and older the RR was 2.19 (1.27, 3.77), while in men under age 65 years the RR was 1.17
  • increasing RR with increasing age.
  • ...20 more annotations...
  • The RRs were 0.95 (0.54, 1.67) under 55 years
  • 1.35 (0.77, 2.38) at 55–59
  • 1.29 (0.71, 2.35) at 60–64,
  • 1.35 (0.44, 4.18) at 65–69, 1.62
  • 3.43 (1.54, 7.66) at 75 years and older
  • The adjusted post/pre RR for PDE5I across all ages was 1.08
  • For TT prescription, in men under age 65 years, the RR was 2.90 (1.49, 5.62) for those with a history of heart disease and 0.90 (0.61, 1.34) for those without
  • In men aged 65 year and older, the RR was 2.16 (0.92, 5.10) for those with a history of heart disease and 2.21 (1.09, 4.45) for those without.
  • Among men aged 65 years and older, we observed a two-fold increase in the risk of MI in the 90 days after filling an initial TT prescription
  • Among younger men with a history of heart disease, we observed a two to three-fold increased risk of MI in the 90 days following an initial TT prescription and no excess risk in younger men without such a history
  • Among older men, the two-fold increased risk was associated with TT prescription regardless of cardiovascular disease history
  • our own findings appear consistent with a higher frequency of thrombotic events following TT prescription among men with more extensive coronary vascular disease.
  • Our findings are consistent with a recent meta-analysis of placebo-controlled randomized trials of testosterone therapy lasting 12 or more weeks among mainly older men, which reported that testosterone therapy increased the risk of adverse cardiovascular-related events (OR = 1.54, 95%CI:1.09, 2.18), as well as serious adverse cardiovascular-related events (OR = 1.61, 95%CI:1.01, 2.56) which included myocardial infarction along with other conditions
  • This association appeared unrelated to average baseline testosterone level (p = 0.70) but varied by source of funding (p = 0.03), with a stronger summary effect in a meta-analysis of studies not funded by the pharmaceutical industry (OR = 2.06, 95%CI:1.34, 3.17) compared with studies funded by the pharmaceutical industry
    • Nathan Goodyear
      Nathan Goodyear on 30 Jan 14
       
      This supports prior analysis that studies done by pharmaceutical corps will be more favorable to their product(s) than those independently funded.  This is called bias.
  • the evidence supports an association between testosterone therapy and risk of serious, adverse cardiovascular-related events–including non-fatal myocardial infarction–in men
  • there is some evidence that low endogenous testosterone levels may also be positively associated with cardiovascular events
  • effects of endogenous and exogenous testosterone may differ. Exogenous testosterone (TT) is associated with physiologic changes that predispose to clotting and thrombotic disorders including increased blood pressure [18], polycythemia [19], reductions in HDL cholesterol [18], [20], and hyperviscosity of the blood and platelet aggregation. [20]–[23]; TT also increases circulating estrogens [24], [25] which may play a role in the observed excess of adverse cardiovascular-related events, given that estrogen therapy has been associated with this excess in both men and women
  • did not include information on the serologic or diagnostic indications for treatment.
  • no association between PDE5I prescriptions and the risk of MI
  • Recently TT has been increasing extraordinarily rapidly, including among younger men and among those without hormone measurement
  • Nathan Goodyear on 30 Jan 14
     
    New cohort study finds increased risk of Testosterone in men > 65 and those : these are based in marketing-based medicine not evidence based medicine.
Nathan Goodyear

Healthy Plant-Based Diets Are Associated with Lower Risk of All-Cause Mortality in US A... - 0 views

www.ncbi.nlm.nih.gov/...PMC6669955

plant-based diet plant-based nutrition plant-based diet nutrition mortality

shared by Nathan Goodyear on 22 Aug 21 - No Cached
  • Nathan Goodyear on 22 Aug 21
     
    Plant based diet associated with a reduction in overall all-cause mortality.
Nathan Goodyear

Missing clinical trial data | BMJ - 0 views

www.bmj.com/bmj.d8158

evidence-based medicine

shared by Nathan Goodyear on 05 Jan 12 - No Cached
  • Nathan Goodyear on 05 Jan 12
     
    There are alot of problems with evidence-based medicine.  Don't for one minute think that a "study" can be without major flaws and biases.  In fact, alot  of the studies reported by the press are based on poorly designed and manipulated studies.  Probably 50% of the studies that I read I disgard after evaluating the study design and statistics.
Nathan Goodyear

Update on Medical Practices That Should Be Questioned in 2015. - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...26551354

evidence-based medicine medicine

shared by Nathan Goodyear on 24 Nov 15 - No Cached
  • Nathan Goodyear on 24 Nov 15
     
    Some of evidence-based medicine is found to be not so evidence-based.  Only abstract available.  
Nathan Goodyear

Evidence based medicine: what it is and what it isn't | BMJ - 0 views

www.bmj.com/...71.full

evidence based medicine

shared by Nathan Goodyear on 10 Dec 11 - No Cached
  • Nathan Goodyear on 10 Dec 11
     
    What is evidence based medicine. 
Nathan Goodyear

The prevalence of Hypogonad... [J Diabetes Complications. 2014 Mar-Apr] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...24388552

low T Testosterone diabetes men male hormone hormones

shared by Nathan Goodyear on 31 Mar 14 - No Cached
  • Nathan Goodyear on 31 Mar 14
     
    In a study of Jordanian men, low Diabetes is clearly associated with low Testosterone.  The study found a 24.3% incidence based on lab testing and a 19.8% incidence based on symptoms.
brandnew12

Home Remedies: Longevity Tips - Kindle edition by John Okeniyi. Health, Fitness & D... - 0 views

www.amazon.com/B00QYI7SBQ

shared by brandnew12 on 14 Dec 14 - No Cached
  • brandnew12 on 14 Dec 14
     
    Are you struggling with the fact that you really don't know anything about how to get into shape? If you're busy living in yesterday's errors, many of your decisions will be founded on guilt and shame instead of what you really want (and need) to accomplish to achieve your goals. Real change comes from day-to-day choices and becoming mindful and basing your choices on what you need now (rather than what you did or didn't do yesterday) will make your exercise life much more passable. What if I can offer you a solution that will help you to attain greatness, to become a success and learn about the best ways to get in shape? In this book, you will learn about: - Navigate the Astral Plane - MIRROR MADNESS - The Health Zen - Vitamin Vitality - Native American Healing - Boost your Health with Gua Sha - Beautiful Body Essential - Secret of Food Combination - Lose Weight Fasting - Child Diet - many other useful things!
  • brandnew12 on 14 Dec 14
     
    Are you struggling with the fact that you really don't know anything about how to get into shape? If you're busy living in yesterday's errors, many of your decisions will be founded on guilt and shame instead of what you really want (and need) to accomplish to achieve your goals. Real change comes from day-to-day choices and becoming mindful and basing your choices on what you need now (rather than what you did or didn't do yesterday) will make your exercise life much more passable. What if I can offer you a solution that will help you to attain greatness, to become a success and learn about the best ways to get in shape? In this book, you will learn about: - Navigate the Astral Plane - MIRROR MADNESS - The Health Zen - Vitamin Vitality - Native American Healing - Boost your Health with Gua Sha - Beautiful Body Essential - Secret of Food Combination - Lose Weight Fasting - Child Diet - many other useful things!
  • brandnew12 on 14 Dec 14
     
    Are you struggling with the fact that you really don't know anything about how to get into shape? If you're busy living in yesterday's errors, many of your decisions will be founded on guilt and shame instead of what you really want (and need) to accomplish to achieve your goals. Real change comes from day-to-day choices and becoming mindful and basing your choices on what you need now (rather than what you did or didn't do yesterday) will make your exercise life much more passable. What if I can offer you a solution that will help you to attain greatness, to become a success and learn about the best ways to get in shape? In this book, you will learn about: - Navigate the Astral Plane - MIRROR MADNESS - The Health Zen - Vitamin Vitality - Native American Healing - Boost your Health with Gua Sha - Beautiful Body Essential - Secret of Food Combination - Lose Weight Fasting - Child Diet - many other useful things!
Nathan Goodyear

The effect of a low-fat, plant-based lifestyle intervention (CHIP) on serum HDL levels ... - 0 views

www.ncbi.nlm.nih.gov/...PMC3849684

diet nutrition metabolic syndrome metabolism plant-based low fat diet low-fat HDL

shared by Nathan Goodyear on 16 Aug 14 - No Cached
  • Nathan Goodyear on 16 Aug 14
     
    Study finds a decrease in metabolic syndrome parameters with a low-fat, plant-based diet.  Also of note, HDL decreased.
Nathan Goodyear

A plant-based diet for type 2 diabetes... [Diabetes Educ. 2010 Jan-Feb] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...20185610

diabetes diet nutrition plant-based glucose type 3 diabetes

shared by Nathan Goodyear on 16 Aug 14 - No Cached
  • Nathan Goodyear on 16 Aug 14
     
    low fat, but particularly a plant-based diet reduces body weight and improves glucose control.
wheelchairindia9

J6 Power Wheelchair - 0 views

www.wheelchairindia.com/...J6-Power-Wheelchair

J6 Power Wheelchair Quantum Wheelchair Quantum Power Chairs J6 Power Chair Pride J6 Wheelchair Quantum Motorized Wheelchairs J6 Power Wheelchair Price J6 Wheelchair

shared by wheelchairindia9 on 02 Mar 16 - No Cached
  • wheelchairindia9 on 02 Mar 16
     
    J6 Power Wheelchair The compact J6 is the ultimate choice for users who demand the superb stability of Mid-Wheel 6 design and tight-quarter maneuverability. Highly adaptable, the J6 accepts a wide range of seating and electronics options while its powerful drive train delivers high-performance torque. J6 Power Wheelchair Features: Mid-Wheel 6 allows six wheels on the ground for maximum stability. Compatible with TRU-Balance Tilt. OMNI-Casters (nylon, spherical-shaped casters) on front and rear prevent wheel hang-ups. Side-mounted, easily accessible freewheel levers. ATX Suspension (Active-Trac with extra stability) incorporates front OMNI-Casters for enhanced. Performance over more varied terrain. Easy front access to batteries. J6 Power Wheelchair Specifications: Drive Wheels: 10" Solid Optional: 10" Pneumatic Caster Wheels Front: 5" Solid Rear: 6" Solid Anti-Tip Wheels N/A Maximum Speed^4/^: Up to 4 mph Ground Clearance: 2.5" (frame) Turning Radius^5/^: 22" Overall Length: 34.74" without foot riggings Base Width: 23.19" Seating Sizes: TRU-Balance® 2 Synergy/Static: W: 10-20" D: 10-20" Power Tilt: W: 14-20" D: 14-20" Lift & Tilt: N/A Seat-to-Floor Heights: TRU-Balance® 2 Synergy/Static8: 16.5" - 17.5" Power Tilt8: 16.875" Lift & Tilt8: N/A Manual Tilt/Recline^10/^: Yes Battery Size^6/^: U-1 Battery Weight^14/^: 23.4 lbs. Available Electronics^12/^: 70A Q-Logic 2 NE 70A Q-Logic 2 NE+ 70A Q-Logic 2 EX Battery Charger 5A Off-board Motor Packages 2-Pole 4 mph Weight Capacity^7/^: 300 lbs.9 Base Weight: 100.2 lbs
Nathan Goodyear

Plant-Based Nutritional Supplementation Attenuates LPS-Induced Low-Grade Systemic Activ... - 0 views

www.ncbi.nlm.nih.gov/...PMC7826722

TLR4 inflammation LPS metabolic endotoxemia plant-based nutrition plant-based diet plant-based

shared by Nathan Goodyear on 03 Sep 21 - No Cached
  • consumption of this particular diet for at least a 2-month period helped to reduce the outcomes of both acute and chronic inflammation induced by LPS.
  • chronic inflammation compromised both glucose and insulin tolerance, which is normally seen in certain chronic metabolic diseases
  • LPS resulted in an increase in neopterin levels, which is a marker for immune system activation
  • ...6 more annotations...
  • diet enriched in fruits and vegetables (and consequently phytochemicals) was able to reverse the process and maintain and even elevate insulin sensitivity and glucose tolerance
  • LPS-mediated effects are related to an increase in TLR4 levels that triggers the activation of nuclear factor-kB (NF-kB), a transcription factor that activates a cascade of inflammatory mediators [41]. These factors control the transcription of inflammatory mediators, such as IL-1β, IL-6, TNF-α, TNF-β, INF-α, INFβ, INF-γ
  • Inflammation can alter insulin action and give rise to diabetes and obesity by blocking insulin receptor downstream events, impairing insulin receptor substrate 1 (IRS-1) activation and phosphatidylinositol 3-kinase-dependent (PI3K) pathways, therefore compromising insulin signaling
  • systemic inflammation (generated by LPS) also increased neopterin levels in the urine and resulted in altered neuronal activity by decreasing dopamine (DA) metabolism
  • an increase in neopterin levels has been recognized a sensitive biomarker for immune system activation
  • Our experiments denoted that these diets were able to diminish inflammatory mediators and oxidative damage
Nathan Goodyear

A glyphosate-based herbicide induces necros... [Toxicol In Vitro. 2011] - PubMed - NCBI - 0 views

www.ncbi.nlm.nih.gov/...22200534

glyphosate low T testosterone men

shared by Nathan Goodyear on 10 Jan 12 - No Cached
  • Nathan Goodyear on 10 Jan 12
     
    low exposure to glyphosate-based herbicide (round up) decreases Testosterone production by 35%.   This occurs at very low exposure levels of 1 ppm.  In a rat study, large doses causes ACUTE rat TESTICULAR TOXICITY. I think both men and women should be very careful around this chemical
Nathan Goodyear

Obesity - Inducible Toll-like Receptor and NF-[kappa]B Regulatory Pathway Expression in... - 0 views

www.nature.com/...oby200825a.html

TLR-4 TLR Toll-like receptors NF-kapppB inflammation obesity

shared by Nathan Goodyear on 19 Jan 12 - No Cached
  • TLRs are functionally inducible and associated with downstream NF-B activation and proinflammatory cytokine production.
  • TLRs represent a family of receptors that are critical to the innate immune response against foreign pathogens and microorganisms
  • LPS has been shown to induce proinflammatory chemokine gene expression in differentiated human adipocytes through TLR and NF-B action
  • ...2 more annotations...
  • Stimulation of TLRs initiates intracellular signaling cascades resulting in downstream NF-B and mitogen-activated protein kinase activation and production of proinflammatory chemokines associated with mechanisms of metabolic dysfunction and cardiovascular disease progression.
  • Elevated fatty acids levels associated with obesity activate TLR4 signaling in fat cells and macrophages, and induce insulin resistance in murine models
  • Nathan Goodyear on 19 Jan 12
     
    TLR, especially TLR-4, is directly involved in NF-KappaB activation and release of inflammatory cytokines
Sundhar krishna

Pituitary Tumor Removal India at Affordable Cost - 0 views

www.biggestclassifieds.com/index.php

endoscope skull base surgery endocrinologist craniotomy neuro ophthalmologist pituitary gland tumours glomus tumors adenoma removal nasal cerebello pontine angle tumour sphenoid sinus treatment endoscopic csf leak repair fungal sinusitis fibrous dysplasia

shared by Sundhar krishna on 19 Jul 12 - No Cached
  • Sundhar krishna on 19 Jul 12
     
    Krishna Eye and Ent is one of the best hospital for skull base surgery India. We offer treatment for tumors like pituitary gland tumours, glomus tumors, cerebello pontine angle tumour and treatment for fungal sinusitis, endoscopic csf leak repair.
Nathan Goodyear

ScienceDirect.com - Vaccine - Review of the United States universal varicella vaccinati... - 0 views

www.sciencedirect.com/...S0264410X12007761

varicella vaccine chicken pox vaccination shingles

shared by Nathan Goodyear on 30 Jul 12 - No Cached
  • Nathan Goodyear on 30 Jul 12
     
    Recent publication slams varicella vaccine as not cost effective, poorly effective in the prevention of chicken pox, based on flawed assumptions, CDC promoted 2 poorly designed studies, actually increased the incidence of shingles, and is less effective than natural immunity.  So, what is the reason to get the chicken pox vaccine again???
Nathan Goodyear

Testosterone and glucose metabolism in men: current concepts and controversies - 0 views

joe.endocrinology-journals.org/...R37.full

Low T Testosterone metabolic syndrome MetS Diabetes men male glucose hormone hormones g

shared by Nathan Goodyear on 04 Feb 14 - No Cached
  • Around 50% of ageing, obese men presenting to the diabetes clinic have lowered testosterone levels relative to reference ranges based on healthy young men
  • The absence of high-level evidence in this area is illustrated by the Endocrine Society testosterone therapy in men with androgen deficiency clinical practice guidelines (Bhasin et al. 2010), which are appropriate for, but not specific to men with metabolic disorders. All 32 recommendations made in these guidelines are based on either very low or low quality evidence.
  • A key concept relates to making a distinction between replacement and pharmacological testosterone therapy
  • ...59 more annotations...
  • The presence of symptoms was more closely linked to increasing age than to testosterone levels
  • Findings similar to type 2 diabetes were reported for men with the metabolic syndrome, which were associated with reductions in total testosterone of −2.2 nmol/l (95% CI −2.41 to 1.94) and in free testosterone
  • low testosterone is more predictive of the metabolic syndrome in lean men
  • Cross-sectional studies uniformly show that 30–50% of men with type 2 diabetes have lowered circulating testosterone levels, relative to references based on healthy young men
  • In a recent cross-sectional study of 240 middle-aged men (mean age 54 years) with either type 2 diabetes, type 1 diabetes or without diabetes (Ng Tang Fui et al. 2013b), increasing BMI and age were dominant drivers of low total and free testosterone respectively.
  • both diabetes and the metabolic syndrome are associated with a modest reduction in testosterone, in magnitude comparable with the effect of 10 years of ageing
  • In a cross-sectional study of 490 men with type 2 diabetes, there was a strong independent association of low testosterone with anaemia
  • In men, low testosterone is a marker of poor health, and may improve our ability to predict risk
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      probably the most important point made in this article
  • low testosterone identifies men with an adverse metabolic phenotype
  • Diabetic men with low testosterone are significantly more likely to be obese or insulin resistant
  • increased inflammation, evidenced by higher CRP levels
  • Bioavailable but not free testosterone was independently predictive of mortality
  • It remains possible that low testosterone is a consequence of insulin resistance, or simply a biomarker, co-existing because of in-common risk factors.
  • In prospective studies, reviewed in detail elsewhere (Grossmann et al. 2010) the inverse association of low testosterone with metabolic syndrome or diabetes is less consistent for free testosterone compared with total testosterone
  • In a study from the Framingham cohort, SHBG but not testosterone was prospectively and independently associated with incident metabolic syndrome
  • low SHBG (Ding et al. 2009) but not testosterone (Haring et al. 2013) with an increased risk of future diabetes
  • In cross-sectional studies of men with (Grossmann et al. 2008) and without (Bonnet et al. 2013) diabetes, SHBG but not testosterone was inversely associated with worse glycaemic control
  • SHBG may have biological actions beyond serving as a carrier protein for and regulator of circulating sex steroids
  • In men with diabetes, free testosterone, if measured by gold standard equilibrium dialysis (Dhindsa et al. 2004), is reduced
    • Nathan Goodyear
      Nathan Goodyear on 04 Feb 14
       
      expensive, laborious process filled with variables
  • Low free testosterone remains inversely associated with insulin resistance, independent of SHBG (Grossmann et al. 2008). This suggests that the low testosterone–dysglycaemia association is not solely a consequence of low SHBG.
  • Experimental evidence reviewed below suggests that visceral adipose tissue is an important intermediate (rather than a confounder) in the inverse association of testosterone with insulin resistance and metabolic disorders.
  • testosterone promotes the commitment of pluripotent stem cells into the myogenic lineage and inhibits their differentiation into adipocytes
  • testosterone regulates the metabolic functions of mature adipocytes (Xu et al. 1991, Marin et al. 1995) and myocytes (Pitteloud et al. 2005) in ways that reduce insulin resistance.
  • Pre-clinical evidence (reviewed in Rao et al. (2013)) suggests that at the cellular level, testosterone may improve glucose metabolism by modulating the expression of the glucose-transported Glut4 and the insulin receptor, as well as by regulating key enzymes involved in glycolysis.
  • More recently testosterone has been shown to protect murine pancreatic β cells against glucotoxicity-induced apoptosis
  • Interestingly, a reciprocal feedback also appears to exist, given that not only chronic (Cameron et al. 1990, Allan 2013) but also, as shown more recently (Iranmanesh et al. 2012, Caronia et al. 2013), acute hyperglycaemia can lower testosterone levels.
  • There is also evidence that testosterone regulates insulin sensitivity directly and acutely
  • In men with prostate cancer commencing androgen deprivation therapy, both total as well as, although not in all studies (Smith 2004), visceral fat mass increases (Hamilton et al. 2011) within 3 months
  • More prolonged (>12 months) androgen deprivation therapy has been associated with increased risk of diabetes in several large observational registry studies
  • Testosterone has also been shown to reduce the concentration of pro-inflammatory cytokines in some, but not all studies, reviewed recently in Kelly & Jones (2013). It is not know whether this effect is independent of testosterone-induced changes in body composition.
  • the observations discussed in this section suggest that it is the decrease in testosterone that causes insulin resistance and diabetes. One important caveat remains: the strongest evidence that low testosterone is the cause rather than consequence of insulin resistance comes from men with prostate cancer (Grossmann & Zajac 2011a) or biochemical castration, and from mice lacking the androgen receptor.
  • Several large prospective studies have shown that weight gain or development of type 2 diabetes is major drivers of the age-related decline in testosterone levels
  • there is increasing evidence that healthy ageing by itself is generally not associated with marked reductions in testosterone
  • Circulating testosterone, on an average 30%, is lower in obese compared with lean men
  • increased visceral fat is an important component in the association of low testosterone and insulin resistance
  • The vast majority of men with metabolic disorders have functional gonadal axis suppression with modest reductions in testosterone levels
  • obesity is a dominant risk factor
  • men with Klinefelter syndrome have an increased risk of metabolic disorders. Interestingly, greater body fat mass is already present before puberty
  • Only 5% of men with type 2 diabetes have elevated LH levels
  • inhibition of the gonadal axis predominantly takes place in the hypothalamus, especially with more severe obesity
  • Metabolic factors, such as leptin, insulin (via deficiency or resistance) and ghrelin are believed to act at the ventromedial and arcuate nuclei of the hypothalamus to inhibit gonadotropin-releasing hormone (GNRH) secretion from GNRH neurons situated in the preoptic area
  • kisspeptin has emerged as one of the most potent secretagogues of GNRH release
  • hypothesis that obesity-mediated inhibition of kisspeptin signalling contributes to the suppression of the HPT axis, infusion of a bioactive kisspeptin fragment has been recently shown to robustly increase LH pulsatility, LH levels and circulating testosterone in hypotestosteronaemic men with type 2 diabetes
  • A smaller study with a similar experimental design found that acute testosterone withdrawal reduced insulin sensitivity independent of body weight, whereas oestradiol withdrawal had no effects
  • suppression of the diabesity-associated HPT axis is functional, and may hence be reversible
  • Obesity and dysglycaemia and associated comorbidities such as obstructive sleep apnoea (Hoyos et al. 2012b) are important contributors to the suppression of the HPT axis
  • weight gain and development of diabetes accelerate the age-related decline in testosterone
  • Modifiable risk factors such as obesity and co-morbidities are more strongly associated with a decline in circulating testosterone levels than age alone
  • 55% of symptomatic androgen deficiency reverted to a normal testosterone or an asymptomatic state after 8-year follow-up, suggesting that androgen deficiency is not a stable state
  • Weight loss can reactivate the hypothalamic–pituitary–testicular axis
  • Leptin treatment resolves hypogonadism in leptin-deficient men
  • The hypothalamic–pituitary–testicular axis remains responsive to treatment with aromatase inhibitors or selective oestrogen receptor modulators in obese men
  • Kisspeptin treatment increases LH secretion, pulse frequency and circulating testosterone levels in hypotestosteronaemic men with type 2 diabetes
  • change in BMI was associated with the change in testosterone (Corona et al. 2013a,b).
  • weight loss can lead to genuine reactivation of the gonadal axis by reversal of obesity-associated hypothalamic suppression
  • There is pre-clinical and observational evidence that chronic hyperglycaemia can inhibit the HPT axis
  • in men who improved their glycaemic control over time, testosterone levels increased. By contrast, in those men in whom glycaemic control worsened, testosterone decreased
  • testosterone levels should be measured after successful weight loss to identify men with an insufficient rise in their testosterone levels. Such men may have HPT axis pathology unrelated to their obesity, which will require appropriate evaluation and management.
  • Nathan Goodyear on 04 Feb 14
     
    Article discusses the expanding evidence of low T and Metabolic syndrome.
wheelchairindia9

Karma KP 10-2 Power Wheelchair - 0 views

disabilityproduct.in/...Karma-KP-10-2-Power-Wheelchair

Karma KP 10.2 Power Wheelchair base & battery quickly detach battery pack change Power Wheelchair Adjustable armrest

shared by wheelchairindia9 on 10 Sep 15 - No Cached
  • wheelchairindia9 on 10 Sep 15
     
    Karma KP 10.2 Power Wheelchair Features: Seat, base & battery quickly detach for easy storage and transportation Come with captain seat With seat platform, the captain seat can be moved forward or backward using tools which is included Adjustable armrest width and height Footrests can be moved forward or backward for optimum placement Quick release battery pack for easy storage and battery pack change
Nathan Goodyear

Adenoid cystic carcinoma: current therapy and potential therapeutic advances based on g... - 0 views

www.ncbi.nlm.nih.gov/...PMC4741919

adenoid cystic carcinoma

shared by Nathan Goodyear on 03 Oct 18 - No Cached
  • Cisplatin and 5-FU or CAP (cisplatin, doxorubicin, and cyclophosphamide) regimens can be used for combination chemotherapy
  • patients with advanced salivary gland malignancy treated with the CAP regimen achieved partial response (PR) or stable disease (SD) rates of 67% (8 out of 12 patients)
  • Agents commonly given as monotherapy for treating ACC are cisplatin, mitoxantrone, epirubicin, vinorelbine, paclitaxel, and gemcitabine. However, few of these agents have shown efficacy
  • ...23 more annotations...
  • single agent mitoxantrone or vinorelbine were recommended as reasonable choices
  • ACC is subdivided into 3 histological groups based on solid components of the tumor including cribriform, tubular, and solid
  • Cribriform and tubular ACCs usually exhibit a more indolent course, whereas the solid subtype is associated with worse prognosis
  • ACC consists of two different cell types: inner luminal epithelial cells and outer myoepithelial cells
  • epithelial cells express c-kit, cox-2 and Bcl-2
  • myoepithelial cells express EGFR and MYB
  • a balanced translocation of the v-myb avian myeloblastosis viral oncogene homolog-nuclear factor I/B (MYB-NFIB) is considered to be a signature molecular event of ACC oncogenesis
  • As a transcription factor, MYB is known to modulate multiple genetic downstream targets involved in oncogenesis, such as cox-2, c-kit, Bcl-2 and BclX
  • Various signaling cascades are essential for cancer cells to survive and grow. The PI3K/Akt/mTOR pathway is one of them
  • This pathway regulates cell survival and growth and is upregulated in many cancers
  • Mutations in genes associated with DNA repair are frequently found in familial cancer syndromes, such as hereditary breast-ovarian cancer syndrome (HBOC), hereditary non-polyposis colorectal cancer (HNPCC, also called Lynch syndrome) and Li-Fraumeni syndrome [30, 31]. These mutations were also reported in non-hereditary cancers
  • 70% of ACC samples (58 of 84) were found to have genetic alterations in the MYB/MYC pathway, indicating that changes in this pathway are crucial in ACC pathogenesis
  • The second most frequently mutated pathway was involved in chromatin remodeling (epigenetic modification), a pathway that includes multiple histone related proteins, and was altered in 44% of samples
  • C-kit
  • VEGF, iNOS and NF-κB were noted to be highly expressed in ACC cells as compared to normal salivary gland cells
  • members of the SOX family, such as SOX 4 and SOX10, are overexpressed in ACC
  • FABP7 (Fatty acid binding protein 7) and AQP1 (Aquaporin 1) tend to be overexpressed in ACC cell lines
  • considerable variability in HER2 overexpression ranging from 0–58% in patients with ACC
  • the study with cetuximab and concurrent chemoradiation or chemotherapy showed the highest ORR (total 43%, 9.5% CR and 33% PR), but this regimen was only given to the EGFR positive patients
  • Cancer immunotherapy can be classified into 3 major groups. Active immunization using anti-tumor vaccines to induce and recruit T cells, passive immunization based on monoclonal antibodies, and adoptive cell transfer to expand tumor-reactive autologous T cells ex vivo and then reintroduce these cells into the same individual
  • LAK cells showed cytotoxicity against ACC cells
  • cytokine-induced cell apoptosis and the cytotoxic effect of the LAK cells contributed to tumor regression
  • molecular finding of the MYB-NFIB fusion gene has the greatest potential to target what appears to be a fundamental event in disease pathogenesis
  • Nathan Goodyear on 03 Oct 18
     
    good review of adenoid cystic carcinoma
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