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Massage Therapy and Its Relationship With Diminished Backpain
Massage is actually a extensive term which could encompass a large selection of touch treatments and treatment options. The term may also be used to describe some other flow or motion that helps to relieve stress and/or anxiety. The complete body massage involves the whole four areas of their human body; the mind back, neck, shoulders , back and abdomen. There are numerous unique massage schools and styles accessible to study from and massage is a terrific therapeutic therapy for strengthening your overall wellness and well-being.
The procedure of myotherapy employs manipulation and touch to discharge muscle strain, relax and calm the nervous system and boost blood pressure lowering heart rate. Muscle strain and anxiety hormones are discharged through the myotherapy. A number of studies have shown that regular massage leads to reductions in blood pressure, lower cholesterol, reduced respiration rates and increased bloodflow into the muscles. Massage seats offer you quite a few distinct models, for example shiatsu, Swedish, reflexology, electrical power yoga, full body treatment, acupuncture and a lot much more.
Throughout a massage, the massage therapist will usually use touch, pressure and movement to manipulate and facilitate tight or stressed muscle groups. Massage seats include many distinctive characteristics that allow one to customize the massage experience that will help you eliminate tension from the joints and cut back the repercussions of strain on the cardiovascular system. Muscle tension and anxiety hormones are discharged through the myotherapy that contributes to diminished blood pressure, lowered cholesterol, lower respiration prices and greater blood flow into the muscle tissue. Studies have demonstrated that therapeutic massage therapy also contributes to declines in blood pressure, lower cholesterol, lower triglycerides, lower bad cholesterol and raised cholesterol.
Massage seats can be also helpful to those experiencing back pain. Straight back pain affects almost 90% of Americans at any point within their lives. Along to lower strain because of bad posture, tension and also other causes, low back pain might also be caused by weak muscle groups or overuse of joints. A therapist can employ massage-therapy tactics to strengthen weak or damaged spine muscle tissues, and to lower the amount of power utilized to the trunk to correct poor posture.
One among the most popular curative massage processes is myotherapy or heavy tissue therapeutic massage. This massage technique aims a certain issue area such as the spine neck, or shoulders. Myotherapy may also aim issue skin areas like the heels, knees, elbows and elbows. The myotherapy technique is carried out by an experienced therapist who has acquired specialized training in supplying curative massages. Even though this therapeutic massage therapy is usually advisable for those with chronic joint or muscle problems, various studies have shown that myotherapy might also be good for those who currently have muscle pain or tightness.
Yet another common therapeutic massage therapy is known as transcutaneous electric nerve stimulation (TENS). This procedure delivers short term relaxing relief for muscle strain. 동탄출장마사지 TENS makes use of especially designed devices that send electric pulses throughout the skin. These blockages induce muscle tension to diminish because they cause the muscle groups to contract lightly.
Studies have also shown that regular massage can lessen quantities of hormones. Many individuals experience a reduction in their levels of hormones whenever they undergo massage remedies. Massage could be particularly helpful for individuals who undergo a excellent deal of serious pain or stress on the plan of these own lives.
Massage may additionally assist individuals with low back pain. Therapeutic massage therapists are capable of using various massage methods to a target unique places of the backneck, or shoulders. Massage may also function as a member of rehabilitation for athletes. During rehab, a athlete is able to grow muscular strength, decrease the level of pain, and improve range of motion, among other added benefits. Many athletes use therapeutic massage as a portion of their curative program to cut back tension in the muscle tissue and soft tissue around the muscles. Normal therapeutic massage also can help to increase blood circulation, which can alleviate muscular aches and relieve back pain.


A laser is then utilized to remove a small sum of eye tissue. During the process, a femtosecond laser produces a thin flap in the face of the cornea. The laser is going to be adjusted for your individual prescription. Next, it is used to reshape the cornea underneath the flap and it is gently replaced. When you decide on the LenSx Laser, you will delight in an assortment of vital added benefits.
The eye is a complicated and delicate portion of the human body. Every eye have a special dimensions and shape. Which is why, every eye has to be carefully measured and mapped before cataract surgery. The human eye is made up of lots of sub parts. Several weeks before surgery you’re going to be prescribed several eye drops to use starting two days before surgery. Moreover, good eye exercising is a fundamental way on tips about how to naturally enhance your eyesight.
You should make an effort not to rub your eyes for many days. So whatever problem you have together with your eyes, you will make sure that an expert from area attention can help you. Valley Eye isn’t only about the therapy approach.
The Benefits of Laser Eye Associates
Cost Per Eye The reason the price of lasik eye surgery can’t be quoted as a 1 price fits all is due to the growth in the quantity of procedures being introduced. It’s extremely important to realize that the expense of eye surgery alone shouldn’t be the sole reason to look at if you’re searching for a doctor to do the surgery. The initial price of going through laser eye surgery may appear costly, but in the very long term it can be observed worth it financially and personally. The typical price of lasik eye surgery is dependent on a lot of factors but for far better peace of mind, obtaining a quote including everything from begin to end at the initial consultation makes good sense if you’re working on a strict budget. For that reason, it’s often a superb choice for patients who want laser vision correction but aren’t great candidates for LASIK. The usage of laser-assisted cataract surgery differs since it replaces or assists in the manual facet of standard cataract surgery. Other forms of eye problems may also be a consideration.
My experience with my physician and my LASIK surgery make it rather simple to recommends JEA to pals and family members. The associates will provide you with the chance to find advice from their specific experts about second viewpoints alongside consultations together with the other schedule that you need to abide by after you’ve undergone the therapy. Pocono Eye Associates is very happy to offer patients outstanding services supplied by our crew of ophthalmologists and optometrists. They is pleased to offer a wide range of medical and surgical eye care services. Eye Associates of Pinellas is here in order to help you attain that objective. Together with that, Valley Eye Associates is the best strategy to utilize for anybody who must secure a laser attention surgery in Wisconsin.
The Argument About Laser Eye Associates
Lasik surgery and PRK are two forms of laser vision correction methods employed by the specialist. LASIK eye surgery is easily the most popular kind of vision correction as it can effectively deal with a wide assortment of refractive disorders. It is a relatively safe procedure with a low rate of complications. The ideal way to figure out if you’re a candidate for LASIK eye surgery is to get in touch with Fava and Maria Eye Associates at 717-272-2010 for a totally free consultation.
In general it’s a brief surgery and doesn’t require the overnight stay in the hospitals. Due to technological advancements in the area of ophthalmology, most eye surgeries do not need a patient to be hospitalized. Additionally, corrective eye surgery may also be accomplished with a blade instead of a laser but we’ll concentrate on the laser costs only. Selecting the ideal eye surgery does not just involve the usage of high technology but also which sort of surgery is better for the sort of vision correction you want.
If you’re a candidate for laser eye surgery and you would like to understand which laser eye surgery is the very best, you should ask your health care provider or ophthalmologist in addition to finding out about the most recent eye surgery technology that has been created to earn laser eye operations safer, faster and more inclined to give an excellent vision correction result. Generally, laser eye surgery happens while the individual is awake, employing a local anesthetic to numb the eye. Clearly, if you’re seeking laser eye surgery, you own a vision problem and improving your vision is your objective. Then you ought to be aware that there are five common kinds of laser eye surgery that your surgeon may discuss with you during consultations. Despite its miraculous outcome, laser eye surgery isn’t always the ideal solution for a great many vision troubles. It is one of the fastest, easiest and most successful surgeries performed today.
The very first step to discover in the event that you require cataract surgery is an extensive eye exam. Conventional cataract surgery requires the creation of numerous smaller incisions made manually with a blade. In fact, it is one of the most often performed surgeries today. Your cataract eye surgery is then going to be complete and you are going to be left for a period to recuperate and make certain that you’re well.


Cytokine Response Associated with Hepatitis C Virus Clearance in HIV Coinfected Patients Initiating Peg Interferon-α Based Therapy
Truong Tam Nguyen1,2, Reihani Niloofar1, Pierre-Alain Rubbo1, Kuster Nils1, Karine Bollore1, Jacques Ducos5, Georges-Philippe Pageaux1,3, Jacques Reynes1,4, Philippe Van de Perre1,5 and Edouard Tuaillon1,5
1 Université Montpellier 1, INSERM U 1058, , 34394 Montpellier, France.
2 Pham Ngoc Thach University of Medicine, Thanh Thai, Ho Chi Minh City, Vietnam.
3 CHU Montpellier, Département d'Hépato-Gastro-Entérologie, 34295 Montpellier, France.
4 CHU Montpellier, Département des Maladies Infectieuses et Tropicales, 34295, France.
5 CHU Montpellier, Département de Bactériologie - Virologie, 34295 Montpellier, France.
Received: May 19, 2015
Accepted: November 9, 2015
Mediterr J Hematol Infect Dis 2016, 8(1): e2016003, DOI 10.4084/MJHID.2016.003
This article is available on PDF format at:
| This is an Open Access article distributed
under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Treatment of hepatitis C virus (HCV) infection based on peginterferon-α (pegIFNα) and ribavirin induces important changes in cytokine release and T cell activation.
Objective: Immune response to pegIFNα-ribavirin therapy was explored in patients coinfected by HCV and HIV.
Methods: Concentrations of 25 cytokines and CD8+ T cell activation were monitored in HCV/HIV coinfected patients classified as sustained virological responders (SVR, n=19) and non-responders (NR, n=11).
Results: High pretreatment concentrations of IP-10 (CXCL-10) and MCP-1 (CCL-2) were associated with a poor anti-HCV response. PegIFNα-ribavirin therapy increased CD8+ T cell activation and induced significant changes in levels of eleven cytokines related to both Th1 and Th2 responses in SVR (IL-1β, IL-1RA, IL-4, IL-5, IL-6, IL-7, IL-12p40/70, IL-13, IP-10, eotaxin, MCP-1) but of only six cytokines in NR (IL-1β, IL-2, IL-5, IL-12p40/70, IL-13, eotaxin). The highest rise in MIP-1β and MCP-1 levels was observed four weeks after anti-HCV treatment initiation in SVR compared to NR (p=0.002 and p=0.03, respectively), whereas a decrease in IL-8 concentration was associated with treatment failure (p= 0.052).
Conclusions: Higher and broader cytokine responses to pegIFNα-ribavirin therapy were observed in SVR patients compared to NR. Changes in IL-8, MIP-1β and MCP-1 serum concentrations may be associated with efficacy of pegIFNα- and ribavirin-based therapies in patients coinfected by HCV and HIV.
Infection by hepatitis C virus (HCV) and HIV shared common routes of
transmission and thus confections with the two viruses are frequent.
HCV infection is seen in 15–30% of HIV-infected patients in Western
Europe, with almost 20 000 HIV-infected individuals chronically
infected with HCV in France.[1,2] Since the
introduction of antiretroviral therapy (ART), HCV-related liver
diseases have become leading causes of morbidity and mortality in
Faster progression to cirrhosis has been observed in patients coinfected with HCV and HIV by comparison with subjects infected with HCV alone. HIV/HCV coinfection is also associated with higher HCV viral levels in serum. Finally, ART-related adverse events are more frequent in HCV/HIV coinfected individuals, with increased difficulties in optimally treating HIV infection.[7,8]
Until recently, a combination of pegIFN and ribavirin has been the standard-of-care for treatment of chronic HCV patients. In coinfected individuals pegINFα-ribavirin therapy is less efficacious than in single HCV infection.[9,10] Approximately 30% of patients receiving a combination of ribavirin with pegIFN have a sustained virological response when infected with HCV genotype 1 and 4. This rate increases to 60% when genotype 2 and 3 are involved. Most of the current anti-HCV therapeutic options remained based on pegIFN and/or ribavirin in addition to protease inhibitors or NS5A or NS5B inhibitors.
PegIFN constitutes an active immunotherapy triggering innate immune response and T cell activation. The cytokine response to pegIFNα-based regimens plays probably an important role in treatment outcome. IFNα stimulates Th1 cells and limits secretion of Th2 related cytokines such as IL-4 or IL-10. IFNα signals through Janus kinase signal transducer, an activator of transcription pathway, and induction of IFN-stimulated genes. Ribavirin synergies this effect by reducing IL-10 production, enhancing autocrine IFN-β and IL-8 secretion.[14-16] Several immune factors are predictive of virological response on pegIFNα-ribavirin-based therapy: pretreatment concentration of IFNα-inducible protein 10 (IP-10, also called CXCL-10), polymorphisms near the interleukin-28B gene coding for the IFNα-3, and CD4+ T cell count in HIV/HCV coinfected individuals.[18,19] Progressive impairment of immune functions and T cell exhaustion induced by prolonged exposure to virus antigens are fundamental features of HIV infection. Inhibitory networks, such as the programmed cell death protein-1 (PD-1) and IL-10 play a key role in this process.[20,21] PD-1 is upregulated on CD8+ and CD4+ T cells and mediates a dysfunction partially reversible on ART.[22-24] PD-1 signalling impacts the expression of both Th1 and Th2 cytokines but limits particularly the capacity of Th1 and IFNγ secretion by CD4+ and CD8+ T cells.
Although HCV clearance depends on immune response induced by pegIFNα-ribavirin therapy, the dynamics of cytokine response and T cell activation in individuals coinfected with HIV and HCV remain poorly characterized. In this study, we monitor serum concentration of 25 cytokines alongside with the level of CD8+ T cell activation in HIV/HCV coinfected patients initiating anti-HCV therapy.
Patients coinfected by HIV/HCV followed at Montpellier University
Hospital and initiating anti-HCV therapy were included consecutively
between January 2007 and January 2010 after providing written informed
consent. The study was approved by the local institution ethical
committee (DC-2011-1405). Chronic hepatitis was proved by the presence
of serum HCV antibodies and detectable viral RNA. HCV genotype, HCV and
HIV-1 viral loads, CD4+
T cell count, and liver enzyme levels were all determined using
standard procedures. All patients received pegIFNα2a 180 microg/week
plus ribavirin 800 to 1,200 mg daily; patients infected with HCV
genotype 2 and 3 received 800 mg daily and genotype 1 and 4 received a
weight based dose: 1,000 mg/day for persons less than 75 kg and 1200
mg/day over 75 kg.
Subjects were ranged into two distinct groups based on HCV response to therapy:
i) Sustained virological responders (SVR) when serum HCV RNA was undetectable 24 weeks after completing therapy, and
ii) non responders (NR) when HCV RNA decrease was < 2 log copies/mL at week 12 or when HCV RNA was detectable at the end of treatment.
iii) Patient relapsing in the 24 weeks period after therapeutic cessation were excluded from the study.
Routine laboratory testing: Serum HCV RNA was quantified using COBAS AmpliPrep/COBAS TaqMan HCV assay (Roche Diagnostic Systems). HCV genotypes were determined using INNO-LiPA HCV II test (Innogenetics). Alanine aminotransferase (ALT) dosages were executed using standard methods.
Quantitation of serum cytokine concentrations: Cytokines were quantified in serum samples obtained before initiation of treatment, and four weeks after the start of PegIFNα-based therapy. A multiplexed microbead assay was used according to manufacturer's instructions (cytokine twenty-five-plex kit, Life Technologies Ltd, Paisley, UK) and an FIDIS™ apparatus (BMD). Twenty five cytokines were quantified in duplicate: IL-1β, IL-1RA, IL-2, IL-2R, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12p40/70, IL-13, IL-15, IL-17, eotaxin, GM-CSF, IFN-α, IFN-γ, IP-10, MCP-1, MIG, MIP-1α, MIP-1β, RANTES, and TNF-α. Data were analyzed using the MLX-Booster program (BMD). Mean concentrations (pg/ml) of cytokines were all superior to the detection limits, defined as the mean background value plus 2 SD.
Analysis of CD8+/CD38bright T cells: Activation of CD8+ T cells was assessed by flow cytometry analysis on EDTA-treated fresh whole blood using FC 500 apparatus (Beckman Coulter, Miami, Florida). T cell activation was explored at day 0, week 4 and week 12 after initiation of pegIFNα-ribavirin therapy. The expression of CD38bright on CD8+ T cells was analyzed as previously described using a two-colour staining with anti-CD8 and anti-CD38 conjugated to fluorescein isothiocyanate (FITC) and phycoerythrin (PE), respectively (Beckman Coulter). The positive threshold for CD38bright analysis was established using the CellQuant CD38/CD8 kit for quantitation of CD38 cell surface expression (BioCytex, Marseille, France) and was defined as 8,500 CD38 binding sites/cells. The CD8+/CD38bright values were expressed as the percentage of CD38bright cells from the CD8+ T cell populations.
Statistical Analysis: The Mann–Whitney U test and Kruskal–Wallis test were used to analyze continuous variables where appropriate. The Friedman test was used to evaluate changes in serum cytokine levels over time. A mixed model was used to analyze the association between T cell activation during anti-HCV therapy and therapeutic response. Statistical analyses were done using SPSS software version 18.0J.
Clinical characteristics at baseline: Thirty HCV/HIV coinfected patients receiving pegIFNα-ribavirin
therapy were included in the study. Nineteen (63%) were classified as
SVR and eleven (37%) as NR. Patient characteristics are shown in Table 1.
Pretreatment levels of soluble and cellular inflammatory markers: IP-10 levels were higher in the NR group than in the SVR group, P=0.021 (Table 2). Individuals from the NR group also had higher pretreatment concentrations of MCP-1, P=0.0009. A trend for a higher serum concentration of IL-8 was also observed in patients of the NR group compared to the SVR group, P=0.106.
|Table 1. Patient characteristics|
|Table 2. Pre-treatment Cytokine concentrations in serum from SVR and NR patients|
Cytokines change after therapeutic initiation of HCV treatment: Initiation of anti-HCV treatment elicited IFNα rise in both SVR and NR patients (Figure 1 and Supplemental Table 1). This enhancement of IFNα in serum was similar in the two groups. Besides IFNα, the anti-HCV therapy induced a significant increase in the serum levels of eleven cytokines in SVR patients, including cytokines related to Th1-dominant immune responses (IL-12p40/70, IP-10), Th2-type cytokines (IL-4, IL-5, and IL-13), and pro-inflammatory cytokines (IL-1β, IL-1RA, IL-6, IL-7). By comparison, levels of only six cytokines rose in the NR group (Supplemental Table 1). Finally, when results were analyzed without consideration of the HCV therapeutic response (combining SVR and NR patients), we also observed an increase of IL-2, IL-10, and RANTES concentrations four weeks after initiation of anti-HCV treatment (Supplemental Table 1).
|Figure 1. Impact of anti-HCV therapy on cytokine concentrations in serum of NR and SVR. Fold-changes in cytokine levels following pegIFNα-ribavirin therapy initiation in SVR (white bars) and NR (gray bars). Results are expressed as fold changes in cytokine concentrations between week 0 (pretreatment) and week 4 (four weeks of pegIFNα-ribavirin therapy). *p=0.052, **p=0.029, ***p=0.0024.|
|Supplemental Table 1. Fold changes in serum cytokines level four week after initiation of pegIFN-ribavirin therapy.|
Comparison of the cytokine level changes induced by pegIFN-ribavirin between SVR and NR group: Changes in cytokines were compared among SVR and NR using the ratio between baseline and four weeks of treatment (Figure 1).
A sharp increase of MCP-1 and MIP-1β concentration was observed after
initiation of anti-HCV therapy in the SVR group whereas the value
decreased or remained stable in the NR group (p=0.0024 and p=0.029,
respectively). Furthermore, the IL-8 concentration remains stable after
a one-month period of pegIFNα-ribavirin
therapy in most of the patients responding to anti-HCV treatment,
whereas this concentration declined in NR patients (p=0.052).
Changes in T cell activation over the three-months period of therapy initiation: The impact of pegIFNα-ribavirin on T cell activation was explored at day 0, week 4 and week 12 (Figure 2). CD8+ T cell activation before the treatment tends to be higher in NR patients compared to the SVR patients, (p=0.066, Figure 2). Anti-HCV therapy induced a major increase in CD38bright expression on CD8 T+ cells in the two groups of patients (p<0.001). No significant differences were observed between the two groups in the slope of CD38 cell surface expression of CD8+ T cells suggesting that the over time changes of this activation marker not be associated with a better immune response to therapy.
|Figure 2. Changes in T cell activation over a 3-month period of pegIFN-ribavirin therapy. Fold-changes in CD38bright expression on CD8 T cells following pegIFNα-ribavirin therapy initiation in SVR (white bars) and NR (gray bars). A significant increase of CD38bright expression between two consecutive time periods is indicated: *p<0.001.|
Although the virological response to pegIFNα/ribavirin-based
therapy is intimately associated with the host immunity, the monitoring
of HCV treatment is based on the serum HCV-RNA level decay regardless
of the immune response. In this study, CD8+
T cell activation and levels of 25 cytokines were analyzed in HIV/HCV
coinfected patients with favourable versus unfavourable therapeutic
PegIFNα/ribavirin administration induced a dramatic change in serum cytokine concentrations and CD8+ T-cell activation level. We observed that the HCV clearance under pegIFNα/ribavirin therapy was associated with broader and higher cytokine responses in SVR than in NR.
Multianalyte assays make possible to analyze a wide an array of cytokines using a small sample volume rapidly. In the present study, the level of 25 cytokines and CD8+ T-cell activation were analyzed at baseline and week four after the initiation of pegIFNα/ribavirin therapy. Comparison between different multiplex bead assays has shown variable agreement among kits evidencing that absolute cytokine concentrations differ across commercial assays.[27,28] As a consequence, multisite comparisons between cytokine concentrations obtained with different methods are difficult to interpret because of the lack of standardization. However, these methods are useful for longitudinal studies, and a similar rank order of cytokine concentrations between samples is preserved between the different commercial kits. Hence, we considered comparisons based on fold change under pegIFNα-ribavirin therapy as a valuable method for identifying a predictor of therapeutic success or failure. Even if interferon-free regimen progressively substitute pegIFNα-containing regimen for treatment of hepatitis C it remains of particular importance to describe immune response after initiation of pegIFNα. Indeed, IFNα remains the only drug approved for treatment of chronic hepatitis D and the only treatment used for a limited period for hepatitis B.
Baseline serum concentration of IP-10 and MCP-1 (monocyte chemotactic protein 1) were higher in NR than in SVR. A significant increase was observed after treatment initiation in 15 out of 25 soluble biomarkers tested. The strongest increased was observed for IFNα as an expectable consequence of the anti-HCV therapy, with more than 4-fold rise between week 0 and week 4. Increase in cytokine concentrations after pegIFNα-ribavirin administration was observed for pro-inflammatory- and Th1-related cytokines such as IL-12 or IP-10, but also for Th2-related cytokines such as IL-4 or IL-13. Activation of T cells accompanied this phenomenon as shown by the increased cell surface expression of CD38 on CD8+ T cells.
Based on therapeutic outcome distinct cytokine patterns were identified. Differences in cytokine concentrations were observed at baseline and following anti-HCV initiation. In agreement with previous studies in individuals coinfected we observed the pretreatment serum level of IP-10 was higher in the NR group than in the SVR group. Circulating IP-10 concentration is well correlated with intrahepatic IP-10 messenger RNA expression during chronic HCV infection. The high baseline hepatic IFN-stimulated genes expression is associated with a lower chance to be SVR to IFN-based therapy when HIV-uninfected.[30-33] Interestingly, the pre-treatment MCP-1 concentration was also found at a higher concentration in the NR group. This pro-inflammatory chemokine is involved in the migration and infiltration of monocytes and CD4+ memory T lymphocytes. Intra-hepatic and serum MCP-1 levels are associated with liver inflammation and fibrosis during chronic HCV infection.[34,35] MCP-1 plays a significant role in the recruitment of monocytes by interacting with their cell-surface adhesion-molecules that are over expressed during chronic HCV infection. Association between MCP-1 baseline level, and response to pegIFNα-ribavirin therapy has been recently reported in HIV-uninfected patients. Both chronic HCV and HIV infections induce expression and release of MCP-1 in humans.[38,39] HIV proteins like gp120 and transactivator protein Tat[41,42] have shown strong immunomodulatory capacity through MCP-1 stimulation. MCP-1 has also been shown to promote Th2 responses by polarizing Th0 cells towards a Th2 phenotype and is thought to be one of the key factors involved in HIV pathogenesis. Hence, MCP-1 pretreatment level may be associated with the promotion of the Th1 dominant response and HCV clearance under pegIFNα-ribavirin therapy in HIV/HCV coinfected patients.
Cytokine response to pegIFNα/ribavirin therapy differed qualitatively between SVR and NR. The cytokine response appeared more restricted in NR than in SVR since only six versus 11 cytokines rise significantly following the commencement of anti-HCV therapy. As a possible consequence of high IP-10 and MCP-1 baseline level, the boost of circulating IP-10 and MCP-1 levels was not observed in the NR after four weeks of pegIFNα-ribavirin treatment. Circulating IP-10 is considered as a marker of the pre-therapeutic activation level of IFN-stimulated genes. The defect in IP-10 response observed four weeks after starting pegIFNα-ribavirin treatment can be viewed as a marker of the overexpression of IFN-stimulated genes leading to a poor capacity response to exogenous IFN injections.
Four weeks after initiation of pegIFNα-ribavirin, a higher MIP-1β (macrophage inflammatory protein-1β) and MCP-1 secretions were observed in SVR when compared to NR. Of interest, a trend for a paradoxical decrease of MIP-1β was also observed at the same time in the NR group. The concentration of MIP-1β was halved in the NR group at week four compared to baseline whereas MCP-1β level tends to increase in the SVR group. This observation is consistent with a previous study showing that HCV clearance is more frequent in patients experiencing strong MIP-1β and MIP-1β response to pegIFNα-based therapy.[45,46] MIP-1β (also named CCL4) is a chemokine linked to the Th1 response. MIP-1β is involved in T cell recruitment mediated by CCR5 and CCR1 in the liver of HCV infected patients. The amplitude of MCP-1 variation in response to pegIFNα/RBV is probably dependent on baseline MCP-1 level as for IP-10. IL-8 dynamic response to pegIFNα-ribavirin therapy also appears different in the two groups. IL-8 serum levels tend to be elevated at baseline in NR and to diminish following pegIFNα-ribavirin initiation. High IL-8 mRNA is involved in liver inflammation[47-49] and inhibition of the IFNα antiviral response in vitro. Pretreatment level of IL-8 has also been found associated with poor virological response to pegIFNα-ribavirin therapy. Evolution of IL-8 concentration may reflect the combined effect of pegIFN plus ribavirin since ribavirin induces its secretion through the activation of activator protein 1.
In this study, relapse patients were not included in the group of patients that did not recover from HCV under pegIFNα-ribavirin. Subjects who experience relapse had patterns of virological response different from NR with a rapid decline in HCV RNA during the first week of treatment.[52,53] Hence, relapse patients should be explored a part from NR and SNR groups.
Our study had limitations related to its retrospective nature and the small number of subjects included. HCV genotypes and fibrosis stage were not taken into account in the analysis and IL-28 polymorphism, which is also known to predict the hepatic responsiveness to IFN-based therapy, was not assessed. The study was not designed to establish clinical performances of immunological markers useful for HCV therapeutic prediction and/or monitoring but showed that different ongoing trends of cytokine response to pegIFNα/ribavirin can be observed in SVR and NR patients infected with HIV.
HIV/HCV coinfected patients, showing a high IP-10 and MCP-1 baseline level alongside with a reduced capacity to produce or to maintain broader secretion of cytokines, including MIP-1β, IL-4, IL-6 or IL-8, may have a poor response to regimens based on Peg-IFN and ribavirin. Anti-HCV treatment based on drugs having immunomodulating activities may benefits from immunomonitoring using multiplex techniques.
AcknowledgementsThis work has been supported by grants from Agence Nationale de Recherche sur le SIDA et les hépatites virales (ANRS), UMR Inserm U1058, and the Ministère Français de la Coopération for Ph.D. grants of Tam Truong Nguyen.
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DT1, Rizzetto M, Manns MP. Management of chronic hepatitis C patients
who have relapsed or not responded to pegylated interferon alfa plus
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Core Partner Pulls
Uploaded on October 23, 2013 by G_John
Purpose: Many swimmers lack anterior and posterior sagittal plane stability, demonstrated by poor dolphin kicking or excessive lumbar spine arching. This exercise is a regression from the hands over head partner pull: http://www.swimmingworldmagazine.com/lane9/news/ASCAEducation/33441.asp. Directions: Lie on your back and have your knees bent. Have a partner loop a towel around the back of the shins, then have tighten your abdominals and have your partner pull the towels in the direction of your upper thigh (femur). Try to not let your back arch during this exercise. Hold for approximately 5 seconds, for 5 - 10 repetitions.


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Thank you, Melinda
First off a couple of questions. Does your boyfriend drink? Does he have white spots on his fingernails? People who drink much are usually low on zinc, thanks to the alcohol. White spots on the fingernails can be an indication of a zinc deficiency. He might try 25 to 50 mgm. zinc supplement daily to see if it helps increase his libido.
Low testosterone-Hello Joyce, thank you for your response. Actually he cut down on his drinking when he met me :), he only drinks maybe once a week now. He did try zinc and magnesium a few weeks before they did the blood tests and found his low testosterone, because we read somewhere that it and magnesium might help. Have not looked to see if he has white spots on his nails, will do that. He has noticed a slight improvement from the testosterone medication Testim that his Dr. prescribed, but has also been on it only two weeks.
Melinda, does your boyfriend exercise? If not, or doesn't do much of it, this might be part of the problem. On the other hand if he cycles a lot (either stationary or other), that might also effect his testosterone levels. Studies have shown cycling can adversely effects sperm count, so maybe too testosterone levels (anyone know?) Also to be considered - if he keeps a laptop on his lap for many hours a day. Many factors could play into it. Please let us know what you find out!
In regards to the subject of low testosterone, things that I've found in reading other sites are as follows:
1. Too high an intake of estrogen-promoting foods (fenugreek, soy, soyproducts)
2. Plastic- bottled drink consumption (there were some news reports that during transport, certain types of plastic bottles were exposed to higher-than-room temprature, causing a molecular break-down of the plastic chemiclas that the human body would absorb and treat like the estrogens in 'the pill')
3. Like mentioned earlier, essential mineral deficiencies (zinc, calcium, magnesium, potassium
4. Vitamine deficiencies (vitamins a,c,e,d, b3 or niacin)
5. An inability to digest certain protiens causing amino acid deficiencies (amino acids are the building blocks for hormones. In testosterone's case, most notable are L-arginine, and L-carnitine.)
6. Other undiagnosed medical problems such as ednocrinological disorders (affect hormone production), diabetes, fibromialgia, auto-immune disorders, ect.
(Los Angeles, California)
The supplement Acetyl-L-Carnitine appears to help with low testosterone issues.
"Treating symptoms of age-related testosterone deficiency ("male menopause"). Taking acetyl-L-carnitine by mouth along with propionyl-L-carnitine seems to help symptoms related to declining male hormone levels. This combination taken for 6 months seems to improve sexual dysfunction, depression, and fatigue in much the same way the male hormone testosterone does."
(Los Angeles, Ca)
Great list of possible causes! I wanted to add that your #2 should be expanded to most heated single-use plastics, not just water bottles. Lots of people put these in their dishwashers or heat their food in them in the microwave, and this is a regular source of exposure to these estrogen-mimicking chemicals.
(North Olmsted Ohio)
I would not let a doctor prescribe any drug to increase testosterone, it will only stop the endocrine system from working and will also start shrinking his marbles. Try tongkat ali, pine pollen, etc. many herbs out there that will do the job without side effects.
Low Testosterone Remedies
Need a natural booster or remedies for low testosterone.
Hey there, does anyone have any tips on how to increase testosterone (for fertility) naturally?
Guys, if you want to increase the testosterone level take Chrysin (better with Bioperine), Muira Puama, Maca and Tribulus Terrestris. Desirable 7 Keto.
Check your blood free testosterone if you are over 50 years old. A level below minimum normal rank, o near, is dangerous for your heart health
Hey Luis from Cali, I researched the supplements you recommended for low testosterone. All of them have been proven that they do not raise testosterone hormones in the body. Only the sex drive. Not sure what the difference is lol. Have you taken these supplements and had a blood test? More info would be appreciated. Thx
low testosterone -- low thyroid will lower your testosterone big time! mine dropped to 204, should be around 600. i started on armour thyroid and my testosterone went up to 285 within a couple of months


The study was a randomized, double-blind, double-dummy trial for patients with sputum smear-positive tuberculosis with no prior history of treatment. Eligible patients were age 18 years or older who had clinical signs and symptoms of pulmonary tuberculosis, including an abnormal chest radiograph, and at least one sputum smear with acid fast bacilli visible by Ziehl-Neelsen staining. Potential study subjects underwent baseline screening that included blood counts, liver enzymes and kidney function testing, HIV serology, chest radiograph and culture and drug susceptibility testing for mycobacteria. Patients were excluded if they had a hemoglobin <7 g/dL, aspartate or alanine aminotransferase levels >3 times the upper limits of normal, serum creatinine >2 times the upper limit of normal, an electrocardiogram with a QTc >450 ms, were pregnant or nursing, if they had silicotuberculosis, if they had a history of severe adverse reactions to fluoroquinolones or any other study agent, or if they were HIV seropositive and had a CD4 cell count <200 mm3, as this would be an indication for antiretroviral therapy which could be affected by antituberculosis drug interactions. Initially enrolled patients were subsequently excluded if their baseline culture failed to grow M. tuberculosis or grew a strain of M. tuberculosis that was resistant to isoniazid, rifampin or ethambutol
Consenting patients were stratified by HIV serostatus and randomly assigned to treatment with one of two study regimens using permutated blocked randomization with treatment allocation concealed and allocation slips sealed in opaque envelopes opened after enrollment. Patients received either moxifloxacin 400 mg with an ethambutol placebo or moxifloxacin placebo plus ethambutol 15–20 mg/kg. The study was designed to ensure that all patients received an effective regimen for tuberculosis regardless of the contribution of the two experimental agents, moxifloxacin and ethambutol, and therefore all patients received isoniazid 300 mg, rifampicin 450 mg (weight <50 kg) or 600 mg (weight ≥50 kg), and pyrazinamide 20–25 mg/kg by directly observed therapy. Patients, study clinicians and study staff were unaware of the treatment assignments of patients, with the exception of the pharmacist who dispensed medication packets. All therapy was given by direct supervision either in the hospital clinic or in the community by study personnel, five days per week. At the end of eight weeks, all patients were placed on open-label treatment with isoniazid and rifampin three times weekly to complete another four months of therapy. Moxifloxacin and matching placebo was provided by Bayer Healthcare (West Haven, CT, USA) and ethambutol, ethambutol placebo, isoniazid, rifampin and pyrazinamide were provided by Farmanguinhos, Rio de Janeiro, Brazil. All study agents were produced under Good Manufacturing Process.
Patients had weekly clinic visits to assess clinical status and to monitor for adverse reactions. Liver enzymes, serum creatinine levels and complete blood counts were performed monthly, and an electrocardiogram was obtained at Weeks 2, 4, 6 and 8. A sputum specimen (spontaneous or induced) was obtained weekly for smear and culture. Sputum specimens were digested and decontaminated using the N-acetyl-L-cysteine-sodium hydroxide (NALC-NaOH) method (9
). Pellets were resuspended in a final volume of 2 ml and used immediately for inoculation of Löwenstein-Jensen culture medium. Löwenstein-Jensen slants were prepared from a commercial powder medium base (BD, Sparks, MD, USA), according to the manufacturer’s instructions. Two hundred microliters of each decontaminated respiratory specimen was inoculated onto each of two slants. Slants were incubated at 37°C in ambient CO2 and examined visually for growth twice weekly for 8 weeks. Growth on slants was quantified by number of visible colonies, and then examined by acid-fast staining to confirm the presence of mycobacteria; isolates were speciated using standard biochemical tests (10
). Drug susceptibility testing of all baseline cultures growing Mycobacterium tuberculosis
was performed using the proportions method (10
The primary endpoint of the study was the proportion of patients with negative sputum cultures after eight weeks of treatment. We assumed that the conversion rate in the control arm (ethambutol) would be 65% (8
), and that moxifloxacin would increase this by 20% to 85%. To achieve a power of 0.8 with an alpha of 0.05, we needed 70 evaluable patients in each arm of the trial. We aimed to enroll 85 per arm to allow for exclusions based on negative initial culture, growth of nontuberculous mycobacteria, or baseline drug resistance. The primary endpoint of the trial, culture conversion, was assessed in a modified intention to treat analysis where those whose baseline cultures were either negative, contaminated or contained drug-resistant M. tuberculosis
were excluded and where all missing week-8 results were considered to be failures (missing=failure). We also analyzed all patients with available Week 8 cultures (evaluable analysis). Multivariate logistic regression was performed using treatment allocation, selected baseline characteristics as covariates and culture conversion as the dependent variable. Time to conversion of sputum cultures to negative was estimated by the Kaplan-Meier method and the difference in median times was compared using the log-rank test. All analyses were performed using STATA Version 9 (STATA Corp., College Station, TX, USA).
Ethical review of the protocol was obtained from the Johns Hopkins Medicine Institutional Review Board and the Ethics Committee of the Federal University of Rio de Janeiro, the National Ethics Committee of the Ministry of Health (CONEP), Brasilia and the Agencia Nacional de Vigilancia Sanitaria (ANVISA), Brazil.
Role of the Funding Source
The study was funded by the Office of Orphan Product Development, United States Food and Drug Administration and was registered as a clinical trial at Clinicaltrials.gov
. Additional support for training was provided by the Fogarty International Center of the National Institutes of Health, and a career development grant helped support Dr. Chaisson’s participation. None of the funding agencies was involved in the design, conduct or analysis of the study. The Investigational New Drug Office of the Food and Drug Administration reviewed the protocol and made suggestions regarding the study design prior to initiation of the trial, but this was unrelated to any funding decisions. The decision to publish was made solely by the authors and the funding agencies did not review or approve the manuscript. Bayer Healthcare donated moxifloxacin and matching placebo for the trial, but had no input into the study design, execution or analysis.


Hill’s Pet Nutrition launches on 17 February a new national campaign to tackle the rise in obesity, placing a greater emphasis on helping pet parents take control of their animal’s nutrition and address the poor feeding habits amongst many owners, heightened by the pandemic.
As the UK navigates a third lockdown to curb the rapid spread of COVID-19, obesity has been identified by Vet Professionals as one of the top five welfare issues amongst UK pets, and lockdowns are not providing any relief. Yet worryingly, 8 in 10 (84 percent) of dog owners and almost three quarters (73 percent) of cat owners think their animal is an ideal weight.
Recognising the rising rates of “treat love” during lockdown (16 percent of dog owners and 17 percent cat owners have admitted to feeding their animals more treats over lockdown), the company’s new Weight Management campaign “Feed the Love, Lose the Weight” has been developed to raise awareness on the negative effects of too many treats, whilst educating pet owners on the full spectrum of aspects that make up their pet’s health and nutrition.
A suite of free tools and resources aim to help people take control of their pet’s nutrition, ranging from online BFI calculators, educational support and regular tips and guidance on how to maintain a healthy weight. The campaign also aims to support Vet Professionals start the often-neglected nutrition and diet conversation, not helped by the current lack of face-to-face interaction.
Michael Unsworth, Veterinary Affairs Manager at Hill’s explains:
“We know that at least 50 percent of pets in the UK are currently clinically overweight or obese, and that this is becoming a serious welfare issue. We also know that during lockdown periods exercise may be limited and bad food habits creep in, and if left untreated, can have a hugely detrimental effect on the animal’s health and quality of life going forward.
“People simply don’t realise there is a problem. Most pet owners do not have the education or the recognition to make these informed decisions themselves, and when it comes to their pets, owners can often have their blinkers on. As the animal’s advocate, we are committed to raising awareness of this serious issue and supporting pet parents through that education process. Our free resources will also allow Vet Pros to tackle this issue head on, without having to wait to see the animals in person. This is a growing epidemic that we as a country need to address right now, and this emotive and informative campaign will help drive awareness amongst owners all over the UK to be more mindful of their pet’s nutrition and eating habits.”
Two animated mini-movies brings the campaign to life, sharing the weight loss journey of “Poochini” and “Moto”. The movies follow two stories of owners who love their pets very much, but due to their own life hardships, over-feed their pets with “treat love” and “people food” that add up over time and cause them to become overweight. The short films highlight the change in their pets’ quality of life as their weight increases, and how a healthy meal plan can support their best friend to live their very best life.
The campaign will be rolled out across social media including YouTube to help raise awareness about pet obesity.
As well as the free resources and tools available online, Hill’s Pet Nutrition offers a range of scientifically proven foods to help aid weight loss and weight management in dogs and cats – for their breed and size – and at each stage of their life.
For more information about the new campaign, the free resource tools, or the weight management products available from Hill’s Pet Nutrition please email: firstname.lastname@example.org
Statistics are taken from the recent PAW report from PDSA.


Pharmax Pharmacy is here to provide you with the best value in pharmaceutical care in the area. Our professional staff will take the time necessary to work as part of your health care team so that you may make the best decisions possible regarding your personal and family health. We know you have options and seek to earn your health care business every day.
We are very excited about the new health clinic coming to Bonne Terre located at 60 Nesbit Drive, next door to Pharmax Pharmacy.
Pharmax Pharmacy participated in Bonne Terre's Annual Christmas Parade...and were awarded 2nd Place!
Pharmax Rewards Card, GNP Prescription Savings Club, Diabetic Supplies, Therapeutic-Diabetic Shoes, Durable Medical Equipment, Home Medical Care, Free Prescription Delivery to Your Home or Office, Convenient Drive-Thru Service, Medicare Part B Supplies, Medicare Part D Programs, Specialty Compounding & More...
We are becoming a Good Neighbor Pharmacy affiliate. This will enable us to participate in one of the largest group health insurance networks in the country. We will also be adding the GNP product line for quality and savings for our patients.
Be sure to get enough calcium in your diet. Eat fat-free yogurt, and skim milk, and various types of cheese. If you eat eggs make them soft boiled or poached- or heated at lower temps so that the enzymes stay viable. Consuming more dark leafy green vegetables is a must. Veggies such as parsley, cilantro, spinach, kale, Swiss chard, and dark lettuces are rich in Calcium. So many foods are calcium fortified today. Even orange juice, cereals, snack bars and ice creams are calcium-enriched. To be sure you are assimilating calcium eat foods that are also rich in magnesium and Vitamin D. Read labels. Magnesium rich foods are those that are vibrant in color such as dark green, bright yellow and orange (corn, melons, pineapple, prunes, figs, natural oils such as flax). Our skeletons hold up the human frame and the brain needs a signal that calls for calcium to keep them strong so working out with mild weights is a must, and exercising regularly is really important. ... more
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At some point in our lives, about 85 percent of us will see a doctor for back pain. But despite how common this type of pain is, doctors aren’t always able to pinpoint the cause. Likewise, prescribed medications or treatments can be hit-and-miss. Some medications, such as opioids, can even become dangerous.
That leaves many sufferers of back pain – particularly low back pain, which is incredibly common – seeking answers elsewhere. If you’re wondering whether chiropractic care can address low back pain, the answer is yes! And in recent years, more and more studies have supported this method of treatment.
A 2018 study published in JAMA Network Open reported on the results of chiropractic care for low back pain. Half of a study group of 750 active-duty military members were assigned to typical routine medical care, while the other half received the same mode of treatment plus chiropractic care.
After six weeks, the group that had received chiropractic care reported
- Lower intensity of pain
- Lower incidence of disability and more improvement in function
- Lower need for pain medication
- Higher levels of satisfaction with their treatment
These results can be especially encouraging to those who wish to avoid being sidelined for long periods of time due to pain, and who desire to be more proactive and involved in their own treatment.
For those who wish to avoid prescription pain medication, in particular, chiropractic care for low back pain can be invaluable. If you experience pain in your lower back, come see us first. We can address the cause of your pain, and administer treatments geared toward your specific situation.


Ingredients: Coconut oil, orange extract, glycerin, castor oil, jojoba oil & essential oil.
Benefits: Balances skin’s PH, removes toxins, relieves dryness, increases skin elasticity, delays signs of aging. Oranges have a high content of citric acid which aids in skin exfoliation and helps to dry out acne, improving the overall look of your skin.
Usage: Can be used on both face and body. Wet skin with normal water, gently apply the soap to create a lather and rinse clean. Store in a cool, dry place to avoid quick melting of the soap. Best before 12 months from date of manufacturing.


STATEN ISLAND, N.Y. --
Out of the Darkness: Suicide Prevention Walk
Oct. 6 in Clove Lakes Park, 1150 Clove Road, Sunnyside
Check-in: 9 a.m.; walk begins: 10 am.
To register: Visit afsp.org/out-of-the-darkness-walks
“I am very passionate about this walk because I feel it gives people a place to put their pain and it puts a face on the suicide not just a statistic,” said Susan Holden who has coordinated the walk for 7 years. Her sister committed suicide in 1997, and Ms. Holden runs the Survivors after Suicide support group that meets monthly.
“I also like to have students volunteer at the walk ...it Helps them see the devastation that suicide brings to families and friends. I hope that by seeing that they will choose to either get help or get help for someone they see who might be at risk.”
The walk is done in support of the American Foundation for Suicide Prevention to promote awareness and show support for family and friends of those who have died by suicide.
The Walk to Cure Diabetes
Oct. 6, College of Staten Island, 2800 Victory Blvd.
Check in:8:30 a.m. Walk begins: 10 a.m. Rain or shine.
Contact: JDRF NY Chapter,
e-mail: email@example.com or nyc.jdrf.org
Breast Cancer Research Walkathon
Oct. 5, College of Staten Island
Check in: Registration begins at 9 a.m. with a warm-up zumba; walk starts at 10 a.m. on the Great Lawn.
Perks: Participants will receive a SIBCRI T-shirt, lunch bag and breakfast snack. Students with CSI ID also receive a Health Action Kit.
For information: Call 718–982–2365; visit goo.gl/dLUDB
“I was overwhelmed when I saw all the people gathered in support. I just stood there and cried,” said Linda Aubry of her first walk. Her 34-old-son was diagnosed at 11. She has been a JDRF Staten Island board member for over 15 years.
“I can’t put a cure in my son’s hands, but I can do that and help raise money for research that develops new therapies and lessens the pain until a cure is found. When you get that diagnosis, you don’t know which way to turn. We just want people to know we are there to help them.”
Making Strides Against Breast Cancer
Oct. 20; Clove Lakes Park, 1150 Clove Road, Sunnyside
Check in:8 a.m.;
Walk begins:10 a.m.
“My first walk was the “Making Strides Against Breast Cancer” walk in October of 2007. The tag on my back read “3 month survivor!” Other survivors, who were strangers to me, came up to me and hugged me and told me how brave I was. I cried most of the walk. It was so surreal,” wrote Lourdes Lourdes Rivera-Olsen in a 2012 story for the Advance.
Staten Island’s largest walk and biggest fund-raiser for the American Cancer Society, the walk honors those who have battled breast cancer, spreads the word about what can be done to help prevent it, and raises money to find cures and support programs and services for those facing the disease.
Staten Island Walk Now for Autism Speaks
Oct. 27; College of Staten Island, 2800 Victory Blvd.
9 a.m.; walk begins at 10:30
Call 646-385-8534 or visit
“It’s such an overwhelming experience to see all these children, all these families come together to try to find an answer to why so many kids are affected by autism,’ said Teresa Flynn, the New Dorp resident who chairs the event with Susan Pugliese of Great Kills.
“You can bring your child and not worry if anyone is staring. They can be themselves. We have activities where they can run and play, and there aren’t long lines to wait on. A meltdown is not a problem,” said Ms. Flynn whose 12-year-old son is on the autism spectrum.
Last year’s inaugural walk on Oct. 28 at Midland Beach just evaded Hurricane Sandy; however, this year’s venue has been changed due to the storm’s aftermath to the College of Staten Island.
In addition to the walk, the day includes a Community Resource fair with educational sources, therapists, schools, recreational organizations, and creative child-friendly activities.
Autism Speaks is a national advocacy organization that works to increase awareness about the growing autism health crisis, fund innovative autism research and family services, and advocate for the needs of individuals with autism.


The ground-breaking I-SPY 2 trial of neoadjuvant treatment for locally advanced breast cancer established a new benchmark for efficiency of phase II clinical trials. Widely regarded as a pioneer of the ‘platform’ trial, I-SPY 2’s success continues to be a major influence on the development of next-generation trial designs in oncology and beyond.
I-SPY 2 breaks from the traditional randomized clinical trial model, employing an 'adaptive' clinical trial model designed to increase trial efficiency by minimizing the number of participants and time required to evaluated an experimental agent.
At consent, a new participant’s breast cancer is classified into one of 10 molecular subtypes. Then, for each participant in the trial:
1) I-SPY 2’s adaptive randomization engine assigns a participant to a study arm; it gives greater weight to arms that have been successful in the participant's tumor subtype.
2) The endpoint is assessed at time of surgery. Primary endpoint is RCB 0 or pathologic complete response meaning the tumor has disappeared completely.
3) Based on the participant's tumor subtype, outcome (i.e. MRI volume, pCR) and treatment received, the predictive probabilities of the agent in the various subtypes are updated in real time.
4) If predictive probabilities for an experimental agent reach a pre-determined level of efficacy in one or more molecular subtypes, it is declared a success (“graduates”). Alternatively, it may be stopped for futility after reaching a maximum number of participants. At any point new agents can enter the trial through a protocol amendment.
5) The participant's serial MRI measures, RCB scores and tumor subtype are used to update the prior probabilities of the randomization engine -- over time this refines the targeting of subsequent participants.


While it’s often assumed that bread is off-limits when you’re trying to lose belly fat, the right bread may actually expedite the process. Switching to sprouted bread can help out carb-lovers eager to get their fix without going up a belt size, thanks to the inulin content of sprouted grains. The results of a study published in Nutrition & Metabolism reveal that found that pre-diabetic study subjects whose diets were supplemented with inulin shaved off more belly fat and total weight than those whose meal plans didn’t pack this healthy prebiotic fiber.
According to an article on Live Strong, a study published in 2009 in Bioscience, Biotechnology & Biochemistry showed that drinking a daily dose of apple cider vinegar led to a lower waist circumference, abdominal fat mass , and body weight . Apple cider vinegar also contains a compound, which is called acetic acid. This acid may stimulate the ability to burn stomach fat of your body and inhibit the fat storage. You may mix apple cider vinegar with ginger or honey to get the best results in burning fat in your body.
But you'll lose the most fat by doing HIIT, or high-intensity interval training. This training technique involves working at full throttle for short intervals -- typically 10 seconds to a minute -- then recovering at a slow pace or resting for a minute or two. It increases your metabolism after a workout, since your muscles need to work hard to get "back to normal." HIIT also burns more belly fat than traditional, steady-pace cardio, according to Penn State University.
Keeping a toothbrush handy can do more than polish up that smile (and counter the effects of all that belly-slimming garlic); brushing your teeth throughout the day can also help you ditch that belly fat fast. A study conducted a sample of over 14,000 participants found that brushing after every meal was linked to lower weight. That minty toothpaste flavor not only clashes with virtually every food, brushing may also trigger a Pavlovian response that tells your brain the kitchen’s closed.
There are plenty of fun ways to get moving and exercise. The key is figuring out what you find fun and then going and doing it. Many find classes like cycling, Zumba, hip hop, step, boot camp to be great fun, while others find their fun hitting the trails, playing tennis, biking, swimming, or even just walking with their dog. Sometimes a personal trainer, a friend, or even an online program can make any format of fitness fun as well. Be open minded and try everything you can. You won't be disappointed.
Don’t let extra hours lounging in bed stand between you and a flatter stomach. While getting enough sleep can help boost your metabolic rate, sleeping in may undo any benefit you’d enjoy from catching a few extra winks. One Obesity study reveals that late sleepers who snoozed past 10:45 in the morning ate nearly 250 more calories over the course of the day, despite eating half as many fruits and vegetables as their early bird counterparts. Even worse, they chowed down on more salty, sugary, and trans-fat-laden fast food than those who woke up earlier. If you happen to head out of the house early, you’re in for an additional metabolic boost; researchers at Northwestern University have found that people exposed to just a short period of early morning sunlight had lower BMIs than their late-waking counterparts.
Don’t pass up on this cheap trick. “One of the most under-appreciated magic fat-burning elixirs is water,” says Ajia Cherry, ACE, CHC, CPT, personal trainer and Founder at Functional Innovative Training. “The more water you drink, the fuller you will feel, the easier it is to cut back on unnecessary calories. That’s an essential element of weight and fat loss,” she explains. Water is necessary to keep your metabolism functioning optimally. For even more of a kick, add a lemon to your glass. D-limonene, an antioxidant in lemon peel, has been shown to have a therapeutic effect on metabolic disorders in mice with high-fat-diet-induced obesity.
Belly fat, or visceral fat, is fat stored in and around your abdominal organs. It can increase your risks of cancer, high blood pressure, stroke, dementia, heart disease and diabetes. You cannot lose large quantities of weight or excess body fat within one week - especially visceral or belly fat. To get healthier and lose the dangerous belly fat, you'll need to change your diet, exercise routine and lifestyle over a longer period of time. However, during a week you can start to make some great, health-promoting changes to your lifestyle.
But just because belly fat comes off a bit more easily doesn’t make it less dangerous. In fact, it’s the exact opposite. “Belly fat is unfortunately the most dangerous location to store fat,” says Dr. Cheskin. Because belly fat—also known as visceral fat, or the deep abdominal fat that surrounds your organs—is more temporary, it’s more active in terms of circulating in the bloodstream. That means it’s likely to raise the amount of fat in your blood (known as blood lipid levels) and increase your blood sugar levels, which as a result raises your risk of heart disease and type 2 diabetes.
Agree with all the choices except one, SOYBEANS sadly the soybeans even from 50 years ago are different than the ones now, virtually almost all are GMC’s. Bad things can happen if ingested more than twice a week, for men excess estrogen which can lead to developing breasts etc, for women breast cancer is much more common. Fermenting them is the only way to solve the problem.
Some of the most well known marine veggies are nori, wakame, kombu, hijiki and arame. With Omega 3 fatty acids, sea veggies are perfect for combating inflammation. This is a potent means of fighting inflammation so that the body can prevent inflammation and flatten the belly. So remember to buy these fresh and organic rather than processed and filled with sodium.
A longtime enemy of doctors and dieters, pork has been coming around as a healthier alternative of late–as long as you choose the right cut. Your best bet is pork tenderloin. A three-ounce serving of pork tenderloin has slightly less fat than a skinless chicken breast; It has 24 grams of protein per serving and 83 milligrams of choline. In a study published in the journal Nutrients, scientists asked 144 overweight people to eat a diet rich in fresh lean pork. After three months, the group saw a significant reduction in waist size, BMI and belly fat, with no reduction in muscle mass! They speculate that the amino acid profile of pork protein may contribute to greater fat burning.
If you don’t have an established exercise routine, simply walking is the best first step toward weight loss. “Walking is a pretty good entry point for people,” says Gagliardi. This is particularly true if you have been out of the gym for a while and want to ease back into a workout routine. One small study published in The Journal of Exercise Nutrition & Biochemistry found that obese women who did a walking program for 50 to 70 minutes three days per week for 12 weeks significantly slashed their visceral fat compared to a sedentary control group.
That’s because women tend to store more temporary fat in their bellies. “The fat stores are gained and lost,” says Lawrence Cheskin, MD, chair of the department of nutrition and food studies at George Mason University and director of the Johns Hopkins Weight Management Center. “By and large, belly fat comes off easier in the sense that it comes off first. That’s where a good amount of the fat is lost from.”
Sunny side up, scrambled, hard-boiled, or fried—it doesn’t matter. A pan, spatula, and carton of eggs are all you need to fry some serious flab. Eggs are one of the best sources of choline, a major fat-burning nutrient that helps turn off the genes responsible for belly-fat storage. Bonus: eggs are a great source of lean protein, which can set the fat-burning pace for your entire day when eaten for breakfast. In a study of 21 men published in the journal Nutrition Research, half were fed a breakfast of bagels while half ate eggs. The egg group were observed to have a lower response to ghrelin, were less hungry three hours later and consumed fewer calories for the next 24 hours!


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