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Michael Scott Berkoben, MD

• Professor of Medicine

https://medicine.duke.edu/faculty/michael-scott-berkoben-md

Separately label and submit the are then mounted on glass slides for micro central portion and end sections heart attack quiz questions order indapamide us. Place 10% neutral buffered formalin and the specimen into a centrifuge tube lined by a celloidin bag blood pressure medications with the least side effects 2.5 mg indapamide visa. Decant the supernatant blood pressure medication guide buy 2.5 mg indapamide otc, remove the celloidin bag blood pressure terms order indapamide 2.5mg on-line, and tie the bag with a string just Given the easy accessibility of the eye arterial occlusion buy cheap indapamide 1.5 mg on-line, small tis above the pellet arteria d8 buy discount indapamide 1.5 mg line. Fix the specimen again in forma sue samples for diagnostic purposes are readily lin for at least 30 minutes. The specimen may 200 Surgical Pathology Dissection now be submitted for routine paraf n processing and where are they in relation to external land and sectioning. If in Your Surgical Pathology in the posterior chamber, is it in the capsular Report on the Eye bag or in the sulcus (between the ciliary body and the root of the iris) Describe the horizontal and vertical dimensions of the its type, location, size, color, margins, and cornea What ocular structures (surgical incisions, corneal opaci cation, iris or are involved X I e n d crin e stem T hyroid 3 Thyroidectomies of the thyroid and to localize any focal lesions before cutting the specimen. Paint the outer surfaces of the thyroid with ink; One major task of the surgical pathologist evalu and in the case of hemithyroidectomy, remove ating a thyroid specimen is to identify the infre the isthmic margin as a thin shave section. Thorough inspection capsule is often best demonstrated by cutting and appropriate sampling of the thyroid is central perpendicular to the long axis of each individual to the diagnosis and subsequent treatment of lobe. Assess whether the thyroid is diffusely or In some specimens, a small triangular midline focally abnormal. The two most common con ned to the thyroid, or does it extend beyond resections of the thyroid are total thyroidectomy, the capsule of the thyroid into the surrounding in which the entire gland is removed intact, and soft tissues Is the lesion cystic or solid, soft or hemithyroidectomy, in which a single lobe is re hard, well demarcated or poorly de ned Orien isolated lesion is identi ed, record its size and tation of these specimens is seldom problematic. Keep in mind that the presence of a and medial aspects of the gland, and the poste discrete nodule does not exclude the presence rior surfaces of the lateral lobes have a concave of additional lesions. Gentle palpation of each slice will some Once the specimen has been oriented, it times revealsmall but rm carcinomasthat arenot should be weighed and measured. Be sure to note Imprints of the tumor allow quick and easy the presence and appearance of any extrathy evaluation of its cytologic features and will roidal tissues. In particular, inspect the posterior nicely supplement the histologic ndings of a aspect of the specimen for parathyroid glands frozen section. Simply touch the surface of a glass and lymph nodes, and inspect the anterior slide to the cut surface of the tumor, or smear aspect for fragments of adherent skeletal muscle. These 202 203 204 Surgical Pathology Dissection slides can be used for Diff-Quik or hematoxylin these glands may appear grossly normal, each and eosin staining. How can I avoid tangential sections of a round sues; and (4) the presence of parathyroids, lymph nodule Tangential sections through a round nodes, and normal-appearing thyroid paren nodule may give the artifactual microscopic im chyma (one or two sections from each lobe). Although capsule, it becomes increasingly dif cult to avoid these general guidelines should direct the sam as one approaches the rounded ends of the nodule pling of any thyroid lesions, two frequently asked while bread-loa ng the specimen. One method questions deserve special consideration: to minimize tangential sectioning is to cut these rounded ends like a pie rather than a loaf of 1. This question often arises in cases tumor nodule, place the at surface of each end of multinodular goiters and encapsulated nod on the cutting board, and then, as illustrated, ules. In multinodular goiters, the thyroid is often direct each cut perpendicular to the tumor massively enlarged, and its cut surface may show capsule as though you were dividing a pie into numerous nodules, hemorrhage, calci cation, equal pieces. In these instances, try to avoid the common error of submitting too Regional neck lymph nodes are usually removed many sections. Instead, document the nding separately by the surgeon and submitted as sepa with a photograph and a detailed gross descrip rate specimens. Sampling a multinodular goiter should be ented, and each level should be carefully dissected limited to one or two sections selectively taken (see Chapter 10). Each lymph node identi ed from the periphery of each nodule (up to ve should be submitted for histologic evaluation. Conversely, the more common error when sampling encapsulated nodules is to submit too few sections. Your primary task in Important Issues to Address sampling these lesions is to make sure that areas in Your Surgical Pathology of transcapsular or vascular invasion are not Report on Thyroidectomies missed. Whenever possible, Record the number of lymph nodes with metas the location of the gland(s) should be spec tases and the total number of lymph nodes ex i ed. P arath yroid lan d s 3 Parathyroidectomies specimens, since their size may be critical in distinguishing between an isolated adenoma Parathyroid glands are usually removed from and diffuse hyperplasia. During the re moval of these glands, the surgeon often needs With these two questions in mind, the dissec help identifying parathyroid tissue, determining tion of parathyroid tissue is simple. Measure and whether the parathyroid tissue is proliferative, weigh the specimen, and note its gross appear and distinguishing between hyperplasia involv ance including its shape and color. Use a scale ing multiple glands and a neoplasm con ned to that is accurate to the nearest milligram. For the surgical pathologist, these portion of the gland has been harvested by the issues translate into two simple questions that surgeon for the purpose of autotransplantation, can be promptly addressed: (1) Is parathyroid ask the surgeon to estimate the weight of the tissue present Because the oval, encapsulated nodules that have a homo parathyroids may lie hidden deep in the paren geneous red-brown cut surface. This gross chyma of these organs, they should be rapidly appearance of the parathyroid is not speci c yet thoroughly dissected and inspected. In these and may resemble a lymph node or a thyroid cases, weigh the entire specimen before dis nodule. Fortunately, this distinction can be secting it, and then weigh the potential parathy made with speed and relative ease by resorting roid gland alone once any associated tissues have to frozen section evaluation and/or with a been delicately removed. Bisect the parathyroid, touch imprint from the surface of the encapsu and note the appearance of its cut surface. Perhaps the biggest oversight hormone assay is being increasingly used intra when evaluating parathyroid tissue is for operatively to guide the surgical management of getting to weigh the tissue. While histologic primary hyperparathyroidism, in many practices examination is important in con rming the surgeons still request frozen sections to con rm presence of a parathyroid gland, the histologic the removal of parathyroid tissue. Touch imprints ndings may not reliably distinguish between of the cut surface of the specimen (immediately normal and proliferative parathyroid tissue. Therefore, it is critical that from thyroid and lymphoid tissue, and they every specimen potentially representing para often serve as a valuable adjunct to the frozen thyroid tissue be accurately weighed. Remember to weigh additional ber to sample other tissues that may be part of 206 37. In the rare logic features, is the tissue most consistent case of a parathyroid carcinoma, sections should with normal parathyroid tissue, multiglan be submitted in an attempt to document local inva dularhyperplasia, oranadenoma These sections should demon mind that the distinction between multi strate the relationship of the tumor to its capsule glandular hyperplasia and an adenoma re and to any adjacent structures. This vein exits the adrenal at the junction of the body and the head of the gland Extrinsic hormonal in uences and intrinsic and is usually visible to the naked eye, especially pathologic processes have profound and predict when lled and distended by tumor. For example, the pathogenesis sure to ink the soft tissues overlying any areas of hypercortisolism is frequently suggested by where tumor bulges from the surface of the adre the size and color of the adrenal cortex, and nal, since these areas represent soft tissue mar the distinction between benign and potentially gins. The malignant cortical neoplasms is often based on entire specimen should then be measured and the dimensions and weight of the tumor. Distinguishing between a benign and fore, careful examination of the gross specimen malignant adrenal neoplasm is often done by plays an important role in recognizing and inter weight. It is therefore critical that you accu preting pathologic processes involving the adre rately weigh the intact fresh specimen before it is nal gland. For tumors between 50 and 100 g we quires a certain familiarity with the anatomy and recommend that you carefully remove any extra weight of the normal adrenal gland. As illus neous soft tissue not near margins closely ap trated, the right adrenal gland has the shape of proached by the tumor before weighing. If the a pyramid and the left adrenal gland the shape gland appears enlarged, determine and docu of a crescent. The average weight of each is ap ment whether this enlargement is due to a solitary proximately 4 g in the adult. Specimen orientation is easily Extended resections of primary adrenal tumors achieved by locating the concave surface of the may also include portions of adjacent kidney, specimen. The presence and the adrenal abuts the ipsilateral kidney, and thus appearance of these structures should be noted, it represents the inferolateral aspect of the speci and their relationships to the adrenal tumor men. Unless otherwise indicated, the adrenal should the head is the thickest and broadest portion of always be sectioned in the transverse plane. The plane of sectioning optimizes evaluation of the middle third represents the body. The thinnest relative sizes of the cortical and medullary com and most lateral third represents the tail. Serially section the adrenal gland the kidney, blood does not enter the adrenal at a at 2 to 3-mm intervals perpendicular to the single vascular pedicle. Most though the adrenal gland is removed as a single of these vessels are too small to appreciate structure, it is both structurally and function grossly. In contrast, the adrenal is drained by a ally compartmentalized into a steroid-secreting 208 209 210 Surgical Pathology Dissection cortex and a chromaf n-positive medulla. This forget to take sections from the surgical margins, compartmentalization will become most appar including an appropriate margin from all struc ent when the adrenal is sectioned. Large band is sharply demarcated from the outer adrenal tumors should be sampled to include all yellow-brown cortex. The inner zone of the cortex components contributing to its often variegated is typically brown, while the outer zone of the appearance on cut section. The inner zone corres adrenal gland and for specimens that do not ponds to the lipofuscin-laden zona reticularis and have a discrete lesion, submit a representative the outer zone to the lipid-laden zona glomeru section from the head, body, and tail. Does it extend beyond are present should, of course, be sampled for the adrenal and into adjacent tissues Before the specimen is xed in formalin, ask yourself if fresh tissue should be specially pro cessed. For example, adrenal cortical neoplasms Important Issues to Address are sometimes evaluated for steroid content. Viable fresh tissue from these tumors can be in Your Surgical Pathology snap frozen in liquid nitrogen and stored in a Report on Adrenalectomies 70 C freezer for easy retrieval if tissue is later needed for biochemical analysis. Is the tumor benign, malignant, tion for special tissue processing is if the tumor or of uncertain malignant potential Has the tumor me fresh tissue should be set aside for cytogenetic, tastasized to regional lymph nodes Is the com adrenal, to the tumor capsule, and to any associ partment uniformly enlarged, or is the enlarge ated soft tissues and visceral organs. Ensure that all pediatric tumors are promptly A number of tumors are unique to children. This may entail pro tumors frequently require special processing to cessing during off-hours by on-call personnel. Submit tissue for electron microscopy if appro that pathologic material be sent to review patholo priate. It is good practice to put a small piece of every pediatric tumor in glutaraldehyde. This gists to verify the diagnosis and to further classify can then be embedded, and the decision of the tumor. Additional fresh and frozen tissue whether to section and process can be made is often required for biologic studies, which are at a later time. This material can be submitted for cyto knowledge is accumulated and protocols change, genetic analysis, ow cytometry, or mailed to a tissue requirements change. Therefore, patholo reference laboratory for special studies (such gists who are processing pediatric tumors need as ploidy, gene ampli cation studies, or uo to work closely with their pediatric oncologists to rescence in situ hybridization).

In terms of allelic effect on phenotype pulse pressure between aorta and capillaries buy genuine indapamide on-line, in sharp contrast to ground of the patients blood pressure journal free download buy indapamide 2.5 mg without prescription. The identification of such genetic factors is crucial as targeted therapies are currently under development blood pressure chart template australia indapamide 1.5 mg generic. Genome-wide association analyses identified a locus influencing the ratio urinary calcium/ urinary sodium blood pressure chart by weight buy indapamide without a prescription. Kaneva; of Genetics and Cell Biology arteria nasi externa order indapamide 2.5mg with mastercard, San Raffaele Scientific Institute heart attack protocol order indapamide pills in toronto, Milan, Italy, 5Institute for 1Molecular Medicine Center, Dept. Pavia, Italy, 10Department of Internal Medicine, Lausanne University Hospital, Lausanne, these conditions constitute a broad range of disorders resulting from the 11 Switzerland, Institute of Physiology, Zurich Center for Integrative Human Physiology, abnormal renal development in embryogenesis. The children were diagnosed with diffe biomarkers for various cardiovascular and renal disorders. Their protein products are implicated in applying a linear regression with additive model on normalized traits ad cell signaling, cytoskeleton formation, transcription regulation and extracel justed for age, sex and population structure. To the best of our knowledge, this is the first 1E-5 in 34 loci were selected for replication, and subsequently meta-ana study to identify a possible link between mutations affecting these genes lyzed. Further studies need to be carried out in order to confirm their recognized genome-wide significant threshold of 1E-8 (five phenotypes), involvement in the pathogenesis of these disorders. Kaneva: order to determine which gene of the locus is causative for the trait variati None. Benmerah1, 2, 3, pathological conditions diagnosed in 1 out of 500 newborns worldwide. Saunier; ding the mechanisms of their pathology as well as for reliable consultation, 1Inserm U983, Paris, France, 2Imagine Institute, Paris, France, 3Universite Paris prognosis and treatment. The aim of this study was to identify disease with hypertrophic septum and paucity of the bile ducts. Determination of the of the vermis, pancreatic cysts/fibrosis and abnormal genitalia in addition haplotypes was performed by genotyping three short tandem repeats flan to multicystic kidney dysplasia and situs inversus. Six different mutations were two compound mutations showed defect in ciliogenesis compared to fibro identified, four of them novel, p. These findings are consistent with the existence of a founder siological basis if this phenotypic variability. Testing for the presence of this mutation should be the first genetic screening in Spanish patients. Pierides, Institut Pasteur de Tunis, Laboratoire de Genomique Biomedicale et Oncogenetique, C. Deltas1; Tunis, Tunisia, 2Molecular Medicine Research Center and Laboratory of Molecular 1 2 3 3 University of Cyprus, Nicosia, Cyprus, University of Nicosia, Nicosia, Cyprus, Limassol and Medical Genetics, Nicosia, Cyprus, Pediatric Department, Farhat Hachad General Hospital, Limassol, Cyprus, 4Nicosia General Hospital, Nicosia, Cyprus, Hospital, Sousse, Tunisia, 4Pediatric Department, Hedi Chaker Hospital, Sfax, Tunisia, 5 6 5 6 University of Crete, Heraklion, Greece, Private Clinical Laboratory, Ammochostos, Department of Pediatrics, Tahar Sfar Hospital, Mahdia, Tunisia, Service de pediatrie, Cyprus, 7University of Melburne, Melburne, Australia, 8University of Cologne, Cologne, Hopital Sahloul, Sousse, Sousse, Tunisia. Both autosomal dominant and recessive forms have been mary hematuric diseases, such as Thin Basement Membrane Nephropathy described; the latter is also associated with sensorineural hearing loss. Phenotypic heterogeneity could be explained Methods: Twenty five Tunisian families were analyzed for mutations in the by the existence of modifier genes. Five different mutations were found, with microalbuminuria in this population (p=1. Ben Halim: sociation results from three independent sample groups and functional stu None. Orsola-Malpighi University Hospital, 2Inserm U983 Institut Imagine, Paris, France, 3Universite Paris Descartes Sorbonne Bologna, Italy, 2Dept. In summary we identified 5 new pathogenic mutations in stic algorithm, useful to drive the genetic screening. Genotype-phenotype analyses established corre rent cholangitis (Senior-Locken Syndrome). The disease results from the failure of the renal tubules to identified five individuals with deletions in the 2p14p15 region (66. Otx1 null mice have prepubescent After liberalization of water intake, we have seen the disappearance of fever transient growth retardation and gonadal defects attributed to low levels of and hypotonia, restarting of normal caloric intakes and spontaneous norma pituitary hormones. Two patients have short stature and three have gonadal lization of sodium and other electrolytes. Employment (full or part-time); Signifcant; the mutation that we found has never been described before. Genetics, Canakkale, Turkey, 2Department of Medical Genetics, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, 3Department of Public Health, Faculty of Medicine, the co-incidence of an inherited balanced translocation through 2q37. This raises the possibility that the t(2;3) that requiring long-term haemodialysis. Conclu sponsible for tight junction formation in epithelia, and it seems likely the sions: the current results indicate that germ-line mutations in both genetic mis-regulation of these genes is the true cause of the syndrome. It is spectrum of kidney development defects responsible for pediatric end-stage resistant to steroid treatment and usually progresses to end-stage renal di renal disease and mortality. Approximately 20-30% of cases are caused indicates the existence of a genetic component. Genetic testing confirmed that both were compound heterozygotes in two fetuses from a family with bilateral renal agenesis. Q215X results in premature termination of the to skipping of exon 28, resulting in a protein with in frame deletion of 33 protein4. Experiments tely counsel a family with an autosomal recessive condition, which initially are in progress to formally demonstrate the causative effect of these mutati appears to be an autosomal dominant pedigree. Manchester, Manchester, United Kingdom, 2Centre for Paediatric and Child Health, 3 M. Obeidova: University of Manchester, Manchester, United Kingdom, Department of Urology, Ankara None. Steichen-Gersdorf1; Hospital, Jena, Germany, Structural Genomics Consortium, University of Oxford, Oxford, 1 2 United Kingdom, 13Protein Expression Facility, University of Manchester, Manchester, Department of Pediatrics, Innsbruck, Austria, Helmholz Zentrum Munchen, Munchen, Germany, 3Helmholz Zentrum Munchen, Technische Universitat, Munchen, Germany. Mutations in any of the five known condition from other forms of urinary voiding dysfunction. Further, through exome sequencing and autozygosity mapping, genu valgus and bone pain since the age of ten years. Silay: concomitant mild phenotype of generalized arterial calcification of infancy. The frameshift is predicted to result in a mutant protein which is quencing selected samples were used during this mutation detection. Renal cysts were present in level of liver enzymes, serum viral load, and presence of steatosis and mode 10/28 pts. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; inventors on the C-insertion genotyping assay under patent review, fled by the Broad Institute. We have found plete responders to colchicine, it was the highest in the non-responders. This study was conducted to investigate the functional charac Institute of Microbiology and Immunology, Ljubljana, Slovenia. We therefore analysed expression of miR-122, miR-126, miR nofluorescence were performed. Ospedali Galliera, Genoa, Italy, 22Department of Diagnostic Services, Laboratory None. C282Y and H1069Q alleles could be influencing susceptibility to hepatitis C virus. Jirsa; 2 1Laboratory of Experimental Hepatology, Institute for Clinical and Experimental M. Onset is observed within the first few weeks of life leading to malabsorption and failure to thrive, and is associated with Background: the 5T variant is a stretch of five contiguous thymidines at the great suffering and high mortality. This process seems to be influ sequencing detected two different deletion alleles, S and L. Full segregation was found among the Iraqi Materials and methods: We describe the cases of 4 children (aged 12, 10, patients with autosomal recessive patterns of inheritance, while the deleti 6 and 3 years) affected by recurrent idiopathic pancreatitis. The shared 1476bp deletion does not of pancreatitis was made by the presence of typical abdominal pain, serum encompass any known genes; however, it does include a predicted enhancer. Conclusions: the high prevalence of 5T carriers makes the assessment of Ruzzo: None. Toward the genetic basis of oesophageal atresia: clinical and molecular study by next generation sequencing E. Significant the most frequent genetic cause of congenital intestinal obstruction. These findings may be related to their different sex-dependent penetrance, are identified in about 50% of familial cases. The same mutation was identified in the unaffected mother but the electropherographic signal intensity of the mutant allele was low, suggesting a mosaic mutation. As the somatic mosaic mutation in the mother was detected 5 6 1, 2 3 2 1, 2 Lee, S. The aim of this study was to identify genes which may contribute to these processes in asthmatic airways. Laish3; Institute of Biochemistry and Genetics Ufa Scientific Center, Ufa, Russian Federation. An oxidant-antioxidant imbalance in the lung contributes to the Background: Telomerase is an enzyme complex that lengthens telomeres. These mutations, always found in the heterozygous antibody, a marker of early thyroid development and anti-T4 antibody for state, are responsible for a dominant hypopituitarism with variable expres final differentiation. Martin Pena: this study, performed in the largest cohort of patients so far screened for None. Speakers Bureau/Honoraria (speakers bureau, symposia, his parents were shown to be heterozygous carriers. Consultant/Advisory Board; Modest; in exon 9 and creates a frameshift starting at codon His421 and leading to Novartis. It also lies in the mitochondrial or consultant and pending grants as well as grants already received); Modest; Novartis. Ownership Interest (stock, stock options, patent or other intellectual property); Modest; Novartis. Other Research Support (supplies, equipment, receipt of drugs or other in-kind support); Modest; Novartis. Speakers Bureau/Honoraria deficiency Identification and functional characterization of new (speakers bureau, symposia, and expert witness); Modest; Novartis. These include 7 novel mutations the region contains 10 genes encoding ciliary proteins, a putative mutation (2 frameshifts, 5 missense). Most i(Xp)chromosomes occur as a mosaic (~26, 000), an endogamous nomadic group distinct from the Roma gypsies. Patients with this mosaic genotype have ovarian failure Our study involves five affected children from three different families. We report two patients who presented with proportio each recessive disorder in the Irish Traveller population is caused by a com nate short stature without stigmata of Turner syndrome. Both patients also mon homozygous mutation, we hypothesised that the three families shared had hypergonadotropic hypogonadism. Exome sequencing was performed for one Conventional cytogenetic analysis in lymphocytes revealed the presence of affected child from each family. Analysis of electron microscopy results supported the genetic patient 1 the i(Xp)chromosome was demonstrated in all cells next to a nor findings; each family has a different type of ciliary defect suggesting a diffe mal X-chromosome, while in patient 2 a mosaic was seen in which 10% of rent disease gene. The findings have led to a change in study design and the the cells harboured a 45, X karyotype, and in 90% of the cells a karyotype exome data from each family is now being analysed independently. The degree of inactivation is population, which is surprising given the limited population size. Both patients were treated with growth hormone, while patient 1 also re ceived low dose estrogens. Hanukoglu3; 1Department of Clinical Genetics, University Hospitals of Leicester, Leicester, United Kingdom, 2Department of Endocrinology, University Hospitals of Leicester, Leicester, P04. In a consguineous Bedouin family with 2 affected and 6 healthy Case history siblings we have searched for the mutation causing the disease. A 20-week antenatal scan showed severe sity of alleles at known polymorphic markers adjacent to these genes. Continued placental insufficiency further searched for homozygous regions consistent with linkage by geno and oligohydramnios led to an emergency delivery at 28 weeks. Carel5, 6, or consultant and pending grants as well as grants already received); Modest; J. Speakers Bureau/Honoraria (speakers bureau, Here, we studied a new phenotype in three brothers born from first cousins symposia, and expert witness); Modest; Pfzer. Speakers Bureau/Honoraria (speakers bureau, symposia, and expert witness); Modest; Pfzer, Lilly, Ipsen and Ferring. Consultant/Advisory Board; Modest; Tercica, Ipsen, Pfzer, Prolor, Teva and hypothyroidism and partial hypogonadotrophic hypogonadism. These data open a new door to understand the with the majority of affected children dying within 3 months of age. Research Grant (principal investigator, collaborator or consultant and th pending grants as well as grants already received); Modest; Servier. The parents Copy number variants in patients with short stature were found to be heterozygous for this deletion. Kottler1; these variants explain only about 10% of the phenotypic variation in height. We identified seven new mutations and a large deletion encompassing ray genotyping (Illumina Cardio-Metabo BeadChip consisting of ~200, 000 exons 9 to 11. All received vitamin D dent linkage signals were found, each one in a single family: on chromosome supplementation. Endocrinology and Department of Nephrology, Leiden University Medical Center, Leiden, Bonafe2, M. Orsola-Malpighi University Hospital, Bologna, levant for treatment of patients and for monitoring of their healthy family members.

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If protein intake is excessive hypertension symptoms high blood pressure purchase indapamide with visa, insulin secretions increase to help with its degradation blood pressure 50 cheap indapamide 2.5 mg on-line. Other very harmful effects that may occur as a result of eating meat are generated indirectly by the tragic conditions to which farm animals are exposed during their short lives blood pressure levels women best indapamide 2.5mg. They spend their entire lives in cramped and cruel surroundings prehypertension and exercise buy discount indapamide 2.5 mg line, merely to die a brutal death blood pressure too high order indapamide 2.5 mg amex. High rise chicken farms breed animals that have never been exposed to fresh air or allowed to take as much as one step blood pressure 9860 generic 1.5 mg indapamide fast delivery. This not only greatly upsets their body chemistry but also causes malformations and the growth of malignant tumors. In the United States, chicken with airsacculitis (a pneumonia-like disease), which causes pus-laden mucus to collect in the lungs, are permitted to be sold. Other examples of common diseases include eye cancer and abscessed livers among cows. Carcasses contaminated with rodent feces, cockroaches, and rust are routinely found in meat-packing companies, but meat inspectors are very lax about enforcing regulations because this would effectively close down the whole industry. Modern research on diseases such as cancer and diabetes is mostly focused on how to combat the effects of an unbalanced lifestyle and unhealthy eating habits. Billions of dollars are spent on discovering everything about the symptoms of these diseases, with little or no attention being paid to their underlying causes. By contrast, some people have adopted vegetarianism as a way of life and subsequently have significantly lower disease rates, especially of cancer, diabetes and heart disease. Vegetarians do not claim to understand the mechanisms of or treatments for these diseases, yet through the elimination of 174 Timeless Secrets of Health and Rejuvenation meat from they diets, they have attained a significant degree of success in preventing and conquering these illnesses. Benefits of a Vegetarian Diet A major study conducted in California revealed that the cancer rate among Mormons, who are known to eat very little meat, was 50 percent lower than that of the normal population. Researchers in an even more comprehensive, carefully controlled study compared 50, 000 vegetarians of the religious group, Seventh Day Adventists, with the same number of non-vegetarians of the same age and gender. The members of the vegetarian group had an astonishingly low rate of cancer of all types, their life expectancy was notably longer, and they suffered significantly less from cardiovascular disease than those in the control group. Overall, life expectancy ranking of the United States compared with the rest of the world dropped from position 19 in 1999 to position 42 in 2007. The stark increase of obesity and related vascular diseases can be blamed for this trend. And both these chronic conditions are largely caused by the consumption of animal protein. There was an immediate drop in national mortality rates from circulatory diseases during the period of meat shortage. Mortality rates returned to pre-war levels when the population fully resumed meat consumption. Studies from the University of Belgium that tested endurance, strength and the rate of recovery from physical exhaustion in vegetarians, clearly showed that vegetarians had far superior scores in all three categories. A study at Yale University proved that vegetarians have nearly twice the stamina of meat eaters. Other findings confirmed that during endurance tests, the vegetarians were able to perform two to three times longer than the meat eaters before reaching a point of complete exhaustion. They also needed only one-fifth the time to recover from fatigue after each test than did their meat-eating counterparts. The super-strong elephant, gorilla, rhinoceros and horse all sustain their great physical strength and stamina by eating only vegetation. Based on present evidence, there is nothing to suggest that meat is beneficial to our health. The fact that populations like the Eskimos (Inuits) can survive on a meat diet without suffering heart disease is known. An important observation has been made relative to the rapid shortening of the average lifetime by Dr. Another major benefit of the vegetarian diet is that, statistically, vegetarians are thinner and healthier. On the average, vegetarians weigh about 20 pounds less than their meat-eating counterparts. But obesity besets 175 Timeless Secrets of Health and Rejuvenation poor countries, too, from Brazil to China. They are also less prone to obesity, high cholesterol, diabetes and heart disease. Food For Thought According to Harvard nutritionist Jean Mayer, we would have enough food for the entire developing world if we ate half as much meat. Reducing meat production by merely 10 percent could release enough grain and other natural foods to feed 60 million people! Given the current trend, by 2050, the increases in meat production will have reached a point where we could feed 4 billion extra people with the plant food that is now being used to raise cattle. Only 10 percent of the protein and calories we feed to our livestock are recovered in the meat we eat. In the case of the United States, for the 20 million tons of humanly edible and nutritious protein that is fed to livestock yearly (apart from the waste products and drugs), only about 2 million tons of meat protein are obtained; and out of that amount, less than 27 percent can be utilized by the human body. An acre of beans or peas produces ten times more protein, and an acre of spinach twenty-eight times more protein. Given the current shortage of fossil fuels on the planet, meat production may soon become unaffordable. In other words, emissions from livestock have become a significant source of atmospheric methane. As of 1990, domestic animals currently account for about 15 percent of the annual anthropogenic methane emissions, and the number has been steadily increasing ever since. In the same way, precious rain forests have had to give way to satisfy the demand for more meat in the world. To produce one pound of chicken, 176 Timeless Secrets of Health and Rejuvenation 1, 800 pounds of water are needed. Large chicken slaughtering plants, in fact, expend up to 100 million gallons of water daily, enough to supply a city of 25, 000 people! Roxasone is used to promote growth, kill parasites and improve the color of chicken meat. Under certain conditions, which can occur within live chickens or on farm land, this compound converts into more toxic forms of inorganic arsenic. This form of arsenic has been linked to bladder, lung, skin, kidney and colon cancers, and low-level exposure can lead to partial paralysis and diabetes. Over 70 percent of the 9 billion broiler chickens produced annually in the United States are fed roxarsone. The meat production process is so wasteful and costly that, in order to survive, the meat industry needs hundreds of millions of dollars in tax subsidies every year. This trend has not been different in the United States and is worsening each year. All this is precious money lost, thereby heavily burdening every national economy. Any wars fought in the future will revolve about energy, food and water, all three of which are heavily wasted through meat production. The worldwide increase of meat consumption is driving the world closer and closer to the brink of international conflict. Besides the above reasons for avoiding dead and coagulated protein foods, tests on both wild and farm-raised fish have revealed that their levels of toxic chemicals and metals are endangering the lives of pregnant mothers, developing fetuses and young children. We are exposed to numerous other sources of indoor and outdoor pollution almost all the time, not to mention the chemicals contained in most foods today. Our immune system simply cannot afford such high concentrations of toxins as found in fish without developing a toxemia situation. Specifically, tests on farmed salmon uncovered high levels of toxins linked to cancer and birth defects. A study released in the journal, Environmental Science & Technology, found much higher levels of some chemicals in farmed salmon compared with wild salmon. The study, which is being considered the most thorough analysis of farmed and wild salmon to date, found in most cases that consuming more than one serving of farmed salmon per month could pose unacceptable cancer risks. Farmed salmon are frequently fed antibiotics, which contribute to the growth of drug-resistant bacteria. In addition, chemical are often added to their food to color their flesh pink to resemble their wild cousins. Sales have increased up to 15 percent a year as more people eat oily fish to prevent heart attacks, or so they are made to believe. While farm-raised catfish, trout, haddock, salmon, flounder and other fish are unsuitable for consumption due to the toxic additives in fishmeal, deep ocean fish are even more harmful than farmed fish due to their excessively high levels of mercury. Even if fish consumption were shown to prevent heart attacks (for which there is no proof), would it be justified and wise to propagate it as being a healthy food when it is known to cause other chronic or fatal diseases If in doubt, I suggest that you use Kinesiology muscle testing to determine whether fish is or is not conducive to your health and well-being. Vegetarian foods such as nuts, seeds, chia, avocado, beans, vegetables, have superior health benefits to fish, which is still a cadaver food. Cadavers, especially when their proteins are destroyed (coagulated) through heat, do very little to provide nourishment for the body. Mercury gets into water primarily through solid-waste incinerators, mines and power plants. In turn, small fish eat the zooplankton, and from there the mercury moves up through the aquatic food chain, with the large, deep ocean fish at the top of the chain carrying the highest mercury concentration. Even waterways that are far away from any ocean, such as the Elkhorn River in Nebraska or the Colorado River in the Western part of the United States, are known to have mercury-contaminated fish. For example, presently over 85 open net cage fish farms operate in the coastal waters of British Columbia, producing waste that is equivalent in volume to the raw sewage released from a city of 500, 000 inhabitants. Since I am constantly asked to give my input on this dieting system, I have decided to add my comments here. The book suggests that you use your blood type to determine which foods you 178 Timeless Secrets of Health and Rejuvenation should be eating. If you are of this type, you should be a vegetarian and avoid meat and dairy products. According to the author, people with Type B blood had ancestors that were nomads; therefore they should eat red meat and fish. Those with Type O blood had ancestors that were hunters and gatherers; this means they should eat lots of animal protein and few carbohydrates. Does this mean, for example, that all nomads used to have the blood type 0, and all farmers used to have type A blood There is little or no distinction made between individuals who have lived in the Andes, the tropical rain forests, or plains of Africa for hundreds of thousands of years. How far do we go in the bloodline of our ancestors to determine our dietary needs When the last ice age began, many vegetarians living in formerly tropical lands were suddenly forced to eat animals in order to survive. Others in the all-year-round tropical places of the Earth continued with vegetarian foods until quite recently. When I went on the high protein diet (very similar to the type O diet plan) at age five, I felt great for about 18 months, as do so many others who go on the popular Atkins diet. Then I started developing stones in my liver, a dangerous arrhythmia and juvenile rheumatoid arthritis, among other diseases. Ten years later I switched to a balanced vegan diet, and most of my illnesses went away within a matter of weeks. However, I still had to live with the many stones that had been produced in my liver and gallbladder as a result of what is known today as the O-type blood diet.

Additionally blood pressure chart lower number generic 2.5 mg indapamide visa, fructose does not stimulate the release of certain appetite-suppressing hormones arteria3d mayan city pack discount indapamide 1.5mg with mastercard, like insulin prehypertension in 30s cheap indapamide 2.5mg without a prescription, as glucose does arrhythmia guidelines 2011 purchase indapamide once a day. Thus arrhythmia quiz online discount indapamide 1.5mg without prescription, a diet high in fructose could potentially stimulate fat deposition and weight gain pulse pressure 30 mmhg indapamide 2.5 mg fast delivery. In human studies, excessive fructose intake has sometimes been associated with weight gain, but results are inconsistent. Moreover, other studies show that some fructose in the diet actually improves glucose metabolism especially in people with Type 2 diabetes. In fact, people with diabetes were once advised to use fructose as an alternative sweetener to table sugar. Overall, there is no good evidence that moderate fructose consumption contributes to weight gain and chronic disease. At this time conclusive evidence is not available on whether fructose is any worse than any other added sugar in increasing the risk for obesity, Type 2 diabetes, and cardiovascular disease. For instance, one 6-ounce container (170 grams) of flavored yogurt contains 20 grams (5 teaspoons) of added sugars. Over ten years ago the Surgeon General produced its first report dedicated to oral health, stating that oral health and health in general are not separate entities. The acid creates holes (cavities) in the teeth that can be extremely painful (Figure 4. Gums are also damaged by bacteria produced by acids, leading to gingivitis (characterized by inflamed and bleeding gums). Saliva is actually a natural mouthwash that neutralizes the acids and aids in building up teeth that have been damaged. Cavities are an epidemic health problem in the United States and are associated with poor diet, but other contributors include poor dental hygiene and the inaccessibility to regular oral One way to prevent gingivitis health care. In regards to sugary soft drinks, the American Dental Association says that drinking sugary soft drinks increases the risk of decay 19. Visit the site to determine drinks that are better for your oral and overall health. An idea: brew some raspberry tea, add some sparkling mineral water, a raspberry or two, some ice, and a mint leaf. Since the early 1990s, marketers of low-carbohydrate diets have bombarded us with the idea that eating fewer carbohydrates promotes weight loss and that these diets are superior to others in their effects on weight loss and overall health. Despite the claims these diets make, there is little scientific evidence to support that low-carbohydrate diets are significantly better than other diets in promoting long-term weight loss. A study in the Nutritional Journal concluded that all diets, (independent of carbohydrate, fat, and protein content) that incorporated an exercise regimen significantly decreased weight and waist circumference in obese women. Some studies do provide evidence that in comparison to other diets, low-carbohydrate diets improve insulin levels and other risk factors for Type 2 diabetes and cardiovascular disease. The overall scientific consensus is that consuming fewer calories in a balanced diet will promote health and stimulate weight loss, with significantly better results achieved when combined with regular exercise. There is a wealth of scientific evidence supporting that replacing refined grains with whole grains decreases the risk for obesity, Type 2 diabetes, and cardiovascular disease. Whole grains are great dietary sources of fiber, vitamins, minerals, healthy fats, and a vast amount of beneficial plant chemicals, all of which contribute to the effects of whole grains on health. Americans typically do not consume the recommended amount of whole grains, which is 50 percent or more of grains from whole grains (Figure 4. Colon Health A substantial health benefit of whole grain foods is that fiber actively supports digestion and optimizes colon health. Diverticulosis is a benign condition 21 characterized by out-pocketings of the colon. Diverticulitis occurs when the out pocketings in the lining of the colon become inflamed. Interestingly, diverticulitis did not make its medical debut until the early 1900s, and in 1971 was defined as a 20. According to the National Digestive Diseases characterized by out pocketings of the colon. Information Clearinghouse, 10 percent of Americans over the age of forty have diverticulosis, and 50 percent of people over the age of sixty have the 21. National Digestive Diseases Information Clearinghouse, a service of the out-pocketings in the lining of the colon become National Institute of Diabetes and Digestive and Kidney Diseases, National Institute inflamed. Ten to 25 percent of and alternating between people who have diverticulosis go on to develop diverticulitis. Symptoms include lower abdominal pain, nausea, and alternating between constipation and diarrhea. The chances of developing diverticulosis can be reduced with fiber intake because of what the breakdown products of the fiber do for the colon. The bacterial breakdown of fiber in the large intestine releases short-chain fatty acids. These molecules have been found to nourish colonic cells, inhibit colonic inflammation, and stimulate the immune system (thereby providing protection of the colon from harmful substances). Additionally, the bacterial indigestible fiber, mostly insoluble, increases stool bulk and softness increasing transit time in the large intestine and facilitating feces elimination. One phenomenon of consuming foods high in fiber is increased gas, since the byproducts of bacterial digestion of fiber are gases. There is some evidence that specific fiber types (such as inulin) may protect against colon cancer, but more studies are needed to conclusively determine how certain fiber types (and at what dose) inhibit colon cancer development. Read the study and have a classroom debate over the weight of evidence that supports that diets high in added sugars actually increase weight gain. Define the Acceptable Macronutrient Distribution Range for carbohydrates, the Adequate Intake for fiber, and recommended intake of added sugars. Identify three to five foods high in fiber and carbohydrates from whole, unrefined sources. In this chapter, you learned what carbohydrates are, the different types of carbohydrates in your diet, and that excess consumption of some types of carbohydrates cause disease while others decrease disease risk. Now that we know the benefits of eating the right carbohydrate, we will examine exactly how much should be eaten to promote health and prevent disease. This means that on a 2, 000 kilocalorie diet, a person should consume between 225 and 325 grams of carbohydrate each day. The recommendations for dietary fiber are based upon the intake levels known to prevent against heart disease. Fast-releasing carbohydrates are more prevalent in fruits, fruit juices, and dairy products, while slow-releasing carbohydrates are more plentiful in starchy vegetables, beans, and whole grains. Fast-releasing carbohydrates are also found in large amounts in processed foods, soft drinks, and sweets. On average, a serving of fruits, whole grains, or starches contains 15 grams of carbohydrates. A serving of dairy contains about 12 grams of carbohydrates, and a serving of vegetables contains about 5 grams of carbohydrates. In general, nutrient-dense carbohydrates are minimally processed and include whole-grain breads and cereals, low-fat dairy products, fruits, vegetables, and beans. In contrast, empty-calorie carbohydrate foods are highly processed and often contain added sugars and fats. Soft drinks, cakes, cookies, and candy are examples of empty-calorie carbohydrates. When choosing between two breads, pick the one that lists whole wheat (not wheat flour) as the first ingredient, and avoid those with other flour ingredients, such as white flour or corn flour. If you want to eat less processed foods then, in general, stay away from products with long ingredient lists. The Nutrition and Labeling Act of 1990 has defined for the food industry and consumers what these labels mean (Table 4. Personal Choices Carbohydrates are in most foods so you have a great variety of choices with which to meet the carbohydrates recommendations for a healthy diet. The 2010 Dietary Guidelines recommends eating more unrefined carbohydrates and more fiber, and reducing consumption of foods that are high in added sugars. The Acceptable Macronutrient Distribution Range for total carbohydrates is 45 to 65 percent. This involves choosing carbohydrate sources that are nutrient-dense, with more essential nutrients per calorie of energy. Discuss the usefulness (or lack thereof) of consuming foods containing sugar substitutes. In the food industry, both fast-releasing and slow-releasing carbohydrates are utilized to give foods a wide spectrum of functional attributes, including increased sweetness, viscosity, bulk, coating ability, solubility, consistency, texture, body, and browning capacity. The differences in chemical structure between the different carbohydrates confer their varied functional uses in foods. Starches, gums, and pectins are used as thickening agents in making jam, cakes, cookies, noodles, canned products, imitation cheeses, and a variety of other foods. Molecular gastronomists use slow-releasing carbohydrates, such as alginate, to give shape and texture to their fascinating food creations (see Note 4. Simple sugars are used not only for adding sweetness, but also to add texture, consistency, and browning. In ice cream, the combination of sucrose and corn syrup imparts sweetness as well as a glossy appearance and smooth texture. Sugar alcohols, such as xylitol, sorbitol, erythritol, and mannitol, are carbohydrates that occur naturally in some fruits and vegetables. However, they are industrially synthesized with yeast and other microbes for use as food additives. Artificial sweeteners and Stevia are not digested or absorbed in significant amounts and therefore are not a significant source of calories in the diet. Sugar alcohols are somewhat digested and absorbed and, on average, contribute about half of the calories as sucrose (4 kilocalories/gram). Benefits of Sugar Substitutes Consuming foods and beverages containing sugar substitutes may benefit health by reducing the consumption of simple sugars, which are higher in calories, cause tooth decay, and are potentially linked to chronic disease. Artificial sweeteners are basically nonnutrients though not all are completely calorie-free. However, because they are so intense in sweetness they are added in very small amounts to foods and beverages. Chewing gum with artificial sweeteners is the only proven way that artificial sweeteners promote oral health. There is limited scientific evidence that consuming products with artificial sweeteners decreases weight. In fact, some studies suggest the intense sweetness of these products increases appetite for sweet foods and may lead to increased weight gain. Also, there is very limited evidence that suggests artificial sweeteners lower blood-glucose levels. Additionally, many foods and beverages containing artificial sweeteners and sugar alcohols are still empty-calorie foods. Health Concerns the most common side effect of consuming products containing sugar substitutes is gastrointestinal upset, a result of their incomplete digestion. Since the introduction of sugar substitutes to the food and beverage markets, the public has expressed concern about their safety. In the early 1970s scientific studies were published that demonstrated that high doses of saccharine caused bladder tumors in rats. This information fueled the still ongoing debate of the health consequences of all artificial sweeteners. In actuality, the results from the early studies were completely irrelevant to humans. That pellet chronically irritated the bladder wall, eventually resulting in tumor development. Since this study, scientific investigation in rats, monkeys, and humans have not found any relationship between saccharine consumption and bladder cancer.

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