Podcasts about dtpa

Gadolinium contrast agents used in MRIs can cause severe toxicity in 1 out of 10,000 people, leaving patients with debilitating symptoms often misdiagnosed as other conditions. Dr. Richard Semelka, a world-renowned expert in MRI safety and gadolinium toxicity, exposes the alarming reality behind gadolinium deposition disease (GDD). This condition has left countless patients struggling with brain fog, burning skin pain, stabbing bone pain, muscle spasms, and chronic fatigue—often without answers from their doctors. In today's episode, Dr. Semelka explains how gadolinium toxicity happens, the warning signs to watch for, and the treatment protocols that work. He shares why traditional medicine is so slow to recognize this condition, the shocking prevalence of misdiagnoses, and how you can protect yourself from unnecessary gadolinium exposure.  Plus, learn how chelation therapy with DTPA can help remove this toxic metal and why certain supplements and lifestyle changes can support your body's recovery.   "There are people with gadolinium toxicity who have been admitted to mental health facilities as inpatients. ~ Dr. Richard Semelka   In This Episode: - Dr. Semelka's background and experience with GDD - How gadolinium enters the body and MRI concerns - Alternatives to gadolinium contrast scans - Key symptoms of gadolinium deposition disease - Who's most vulnerable to gadolinium toxicity - Treatment options and chelation therapy - Why chelation requires multiple sessions - Managing side effects of chelation - Anti-inflammatory supplements that help - Commonly misdiagnosed conditions - Patient stories and success with treatment For more information, visit https://www.myersdetox.com    Ready to detox heavy metals? Take the quiz: http://www.heavymetalsquiz.com    Resources Mentioned: Purity Woods Age-Defying Dream Cream: Get 27% off with code WENDY at: https://puritywoods.com/wendy  Puori PW1 Whey Protein: Get 20% off with code WENDY at: https://puori.com/wendy    About Dr. Richard Semelka: Dr. Richard Semelka is a world-renowned expert in MRI safety and medical imaging. As the leading authority on gadolinium toxicity, he ranks in the top 0.05% of scholars worldwide in his field (ranked #10 in MRI and #14 in medical imaging by Scholar GPS). Dr. Semelka treats patients with gadolinium toxicity from around the world and has pioneered effective chelation protocols. His work at gadtrack.org has helped thousands understand and address gadolinium deposition disease. Learn more at https://gadttrac.org or contact Dr. Semelka at https://www.richardsemelka.com/   Disclaimer The Myers Detox Podcast was created and hosted by Dr. Wendy Myers. This podcast is for information purposes only. Statements and views expressed on this podcast are not medical advice. This podcast, including Wendy Myers and the producers, disclaims responsibility for any possible adverse effects from using the information contained herein. The opinions of guests are their own, and this podcast does not endorse or accept responsibility for statements made by guests. This podcast does not make any representations or warranties about guests' qualifications or credibility. Individuals on this podcast may have a direct or indirect financial interest in products or services referred to herein. If you think you have a medical problem, consult a licensed physician.

We have frequently written on AGs interest in AI. In what Texas calls the ​“first-of-its-kind healthcare generative AI” settlement, the state resolved its investigation into Pieces Technologies' alleged misleading statements about accuracy of products deployed in major hospitals. Pieces claimed the product ​“summarizes, charts, and drafts clinical notes for your doctors and nurses…so they don't have to.” The company further claimed accuracy of a

Why You Should Listen:  In this episode, you will learn above the role of gadolinium in chronic conditions and about the entity of Gadolinium Deposition Disease. About My Guest: My guest for this episode is Dr. Richard Semelka.  Richard Semelka, MD has been in practice as a radiologist for 28 years and is a world authority in body MRI, safety in radiology, and gadolinium toxicity.  He is a leading published expert in radiology for body MRI and gadolinium toxicity and has made presentations at major meetings all over the world.  Dr. Semelka has written over 370 peer-reviewed papers and 16 text-books.  He is the first doctor to publish on the entity of Gadolinium Deposition Disease. Key Takeaways: What is gadolinium? What are the symptoms of Gadolinium Deposition Disease? Are certain populations at higher risk for GDD than others? Should gadolinium be treated before the immune priming event? How is gadolinium tested for? What is the primary route of gadolinium excretion? Are the symptoms toxigenic or immunogenic? Does gadolinium cross the blood brain barrier? Does gadolinium have an effect on the mast cells? How does gadolinium impact the mitochondria? Is there a correlation between methylation and response to gadolinium? Is supporting drainage pathways important? What are GAD removal and re-equilibration flares? How is gadolinium chelated from the body? Can glutathione be helpful in addressing gadolinium toxicity? Is there a role for sauna therapy? Connect With My Guest:  http://RichardSemelka.com Interview Date: July 10, 2024 Transcript: To review a transcript of this show, visit https://BetterHealthGuy.com/Episode203. Additional Information: To learn more, visit https://BetterHealthGuy.com. Disclaimer:  The content of this show is for informational purposes only and is not intended to diagnose, treat, or cure any illness or medical condition. Nothing in today's discussion is meant to serve as medical advice or as information to facilitate self-treatment. As always, please discuss any potential health-related decisions with your own personal medical authority. 

Shane McGuire shares a case where he turned a default judgment of $500,000.00 into a $2.5 million settlement. Sea Harbor, the insurance company, failed to show up at trial, resulting in a default judgment. Shane used the DTPA action instead of the utilizing the Stowers assignment option. During depositions, he uncovered evidence of the insurance company's refusal to pay claims. Ultimately, Shane negotiated a $2.5 million settlement for his client. In this conversation, the speaker discusses a case involving an insurance company and the strategies used to maximize the settlement. The speaker highlights the importance of understanding the insurance company's structure and policies, as well as leveraging the weaknesses in their defense.

No episódio de hoje do Check-up Semanal, confira as últimas notícias sobre: vacina DTPa vs DTPw; medicamento para depressão pós-parto; abordagem aos granulomas pulmonares; cifose torácica e vulvovaginite pré-púberes. Escute agora! Confira esse e outros posts no Portal PEBMED e siga nossas redes sociais! Facebook Instagram Linkedin Twitter

Delivery of Policy Starts the Running of the Statute of Limitations Wooten purchased seven Northwestern Mutual insurance policies. Three are disability income policies. Four are various whole-life policies. Wooten purchased and reviewed the last of the policies in December 2005. He sued claiming he was deceived about what he bought ten years before the suit. In Wrenn Wooten v. The Northwestern Mutual Life Insurance Company, Jimzara, And Patrick Matthews, No. 05-20-00798-CV, Court of Appeals of Texas, Fifth District, Dallas (July 31, 2023) the Court of Appeals resolved Wooten's complaint that the trial court's grant of summary judgments in favor of appelees, was wrong. BACKGROUND On April 17, 2018 Wooten sued. He alleged he was sold policies based on misrepresentations on coverage and benefits, wrongfully advised him, and concealed misrepresentations. Wooten bought the disability policies to provide income if he became He alleged a waiver-of-premium term would have allowed him to receive disability income without paying premiums. Wooten has not filed a disability claim under the policies. The suit alleged claims for fraud, negligent misrepresentation, breach of fiduciary duty, and violations of the Texas Insurance Code and the Texas Deceptive Trade Practices-Consumer Protection Act (DTPA). Wooten alleged he did not discover the injury "and/or" misconduct that forms the basis of this lawsuit until within two years of his filing the lawsuit. The trial court granted Northwestern Mutual's traditional motion for summary judgment. STATUTE OF LIMITATIONS Wooten alleged causes of action with two- and four-year periods of limitation. The statute of limitations for Wooten's claims for negligent misrepresentation and for violation of the Texas Insurance Code and the DTPA is two years. The court concluded that the appellees carried their summary judgment burden of conclusively proving Wooten's claims for violations of the Insurance Code and DTPA, negligent misrepresentation, and fraud accrued at the time Wooten purchased each policy. Much to the surprise of Mr. Wooten and most insureds,  an insured has a duty to read the policy, and failing to do so, is charged with knowledge of the policy's terms and conditions. Appellees conclusively demonstrated Wooten purchased his last Northwestern Mutual policy in December 2005. The longest applicable statute of limitations for his claims on that policy-and all his policies-is four years. The Discovery Rule Even in a breach of fiduciary duty case where a fiduciary's misconduct is inherently undiscoverable, a breach of fiduciary duty claim accrues when the claimant knows or in the exercise of ordinary diligence should know of the wrongful act and resulting injury. The Court of Appeals concluded that by 2005, at the latest, Wooten knew, or exercising reasonable diligence, should have known of the facts giving rise to the cause of action. An insurance agent has no duty to explain policy terms to an insured. Instead, an insured has a duty to read the policy, and failing to do so, is charged with knowledge of the policy terms and conditions. Therefore, appellees carried their summary judgment burden to conclusively prove Wooten's last claim accrued in December 2005 and to negate applicability of the common-law discovery rule to his common-law claims of fraud, negligent misrepresentation, and breach of fiduciary duty. ZALMA OPINION An insured has a duty to read a policy to confirm that it received the coverage the sales person represented. Although Wooten was neither dead or disabled, he sought damages against the insurer and sales persons when, ten years late, he found the policies did not cover the events he was promised. He sat on his rights well past the running of every applicable statute of limitations. (c) 2023 Barry Zalma & ClaimSchool, Inc. --- Support this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support

Contracts don't have to be equal, and the courts usually won't inquire too closely into the terms of consideration unless there is evidence of fraud. Take a look at Episode 123 of Business Law 101 for an overview of bargaining, deeds, and the DTPA. Thanks for joining me for this episode! I'm a Houston- based attorney, run an HR Consulting company called Claremont Management Group, and am a tenured professor at the University of St. Thomas. I've also written several non-fiction political commentary books: Bad Deal for America (2022) explores the Vegas-style corruption running rampant in Washington DC, while The Decline of America: 100 Years of Leadership Failures (2018) analyzes – and grades – the leadership qualities of the past 100 years of U.S. presidents. You can find my books on Amazon, and me on social media (Twitter @DSchein1, LinkedIn @DavidSchein, and Facebook, Instagram, & YouTube @AuthorDavidSchein). I'd love to hear from you! As always, the opinions expressed in this podcast are mine and my guests' and not the opinions of my university, my company, or the businesses with which I am connected.

Teve início nesta segunda-feira, dia 8, a campanha de vacinação contra poliomielite e multivacinação em Lauro Müller, que segue ação nacional do Ministério da Saúde. Serão oferecidas doses contra a poliomielite para crianças menores de 5 anos e feita a atualização da caderneta de vacinação de todo o público até 15 anos. Para crianças estarão disponíveis os seguintes imunizantes: Hepatite A e B, Penta (DTP/Hib/Hep B), Pneumocócica 10 valente, VIP (Vacina Inativada Poliomielite), VRH (Vacina Rotavírus Humano), Meningocócica C (conjugada), VOP (Vacina Oral Poliomielite), Febre amarela, Tríplice viral (Sarampo, Rubéola, Caxumba), Tetraviral (Sarampo, Rubéola, Caxumba, Varicela), DTP (tríplice bacteriana), Varicela e HPV quadrivalente (Papilomavírus Humano). Estarão disponíveis para os adolescentes, as vacinas HPV, dT (dupla adulto), Febre amarela, Tríplice viral, Hepatite B, dTpa e Meningocócica ACWY (conjugada). Todos os imunizantes que integram o Programa Nacional de Imunizações (PNI) são seguros e estão registrados pela Agência Nacional de Vigilância Sanitária (Anvisa). A campanha se estende até dia 09 de setembro. No próximo dia 20 acontece o Dia D. Em Lauro Müller, a aplicação das doses será da seguinte forma: a vacina contra a Poliomielite estará disponível em todas as Unidades de Saúde. Já a de multivacinação, apenas nas Unidades de Saúde do Centro e Arizona, que possuem sala de vacina. Pais e responsáveis devem procurar as unidades no horário das 8h às 12h e das 13h às 16h30. Durante entrevista ao Cruz de Malta Notícias desta segunda-feira, dia 8, a técnica em enfermagem do setor de vigilância epidemiológica municipal, Lúcia Ascari Laipelt Vargas, explicou como irá funcionar a vacinação em Lauro Müller. Ouça abaixo a entrevista completa:

A Video Explaining Insurance for Construction Defects Regarding Structural Failures https://zalma.com/blog Structural integrity failures can involve any of the following: concrete; masonry; carpentry; or foundations. Defects related to site preparation can be caused by any of the following: building on expansive soil or other defective soils incapable of properly supporting structures; building on contaminated soils; lack of a slab-on-grade foundation when the soils are acidic and can cause the deterioration of concrete; or building on improperly compacted soils, which can cause interior distress to cabinets and countertops, make doors difficult to open and cause structures to settle and cracking in stucco, drywall, plaster interior walls, windows, tile floors, concrete flatwork, slabs, and garage flooring. In Texas, when a completed home developed problems with a shifting foundation, a suit was filed alleging violations of the Texas Deceptive Trade Practices Act (DTPA) and negligence. On the first day of trial, the plaintiff settled with one defendant and proceeded against another. The District Court granted a directed verdict on the claim that there was a violation of the DTPA with a breach of an implied warranty of good-and-workmanlike performance. Only the plaintiff's negligence claim was submitted to the jury, which found no negligence on defendant's part. The district court rendered a take-nothing judgment. [Codner v. Arellano, 40 S.W.3d 666 (Tex.App. Dist.3 2001). See also Parmely v. Hildebrand, S.D. 83, 630 N.W.2d 509 (2001), where the seller was found to have made adequate disclosures about expansive soils at time of sale and was not liable for soil expansion damages.] The Ninth Circuit, dealing with the right to insurance for damages caused by expansive soil, found that under California law, a latent defect exclusion applies to third party negligence that is discoverable only through subsequent intensive expert investigation. Because there is no evidence that the contractor's negligence in this case was discoverable, short of an in-depth expert inspection after-the-fact, the Ninth Circuit concluded that State Farm was entitled to summary judgment on its exclusion for latent defects. [Winans v. State Farm Fire and Casualty Co., 968 F.2d 884 (9th Cir. 1992).] © 2021 – Barry Zalma --- Support this podcast: https://anchor.fm/barry-zalma/support

The exciting conclusion to Chapter Two: Renal Circulation and Glomerular Filtration Rate - Determinants of GFR - First step in making urine is separation of an ultrafiltrate - Governed by starling forces - Balance of hydraulic and osmotic forces - GFR = LpS (P gc – P us - Osmotic Pressure Cap p) - Normal GFR 95 in women, 120 in men - Cap Hydrolic pressure remains constant - glom cap Oncotic progressively rises - Due to filtration of protein free fluid (protein concentration rises in the capillary) - Filtration gradient begins at 13 mmHg and falls to zero after filtration of 20% or RPF! - GFR is capped at 20% of RPF called filtration equilibrium - So GFR is dependent on RPF, unless you can change glomerular hydraulic pressure - Glomerular hydraulic pressure is controlled by balance of twin arteriole (afferent and efferent) - Constriction of afferent arteriole reduces RPF, GFR, and glom pressure - Dilation of afferent arteriole increases RPF, GFR, and glom pressure - Constriction of the efferent arteriole increases Glom pressure, increasing GFR - Besides glom hydrostatic pressure the other starlings forces are rarely relevant to changes in GFRLetty says: referred to this NEJM review article later JC thought she was referring to something else -see #2- and then Roger referred to this again)Normotensive Acute Renal Failure from Gary Abuelo in NEJM 2007. https://www.nejm.org/doi/10.1056/NEJMra064398 (note in this article, Dr. Abuelo acknowledges the newer terminology of the time, AKI rather than ARF but chooses not to embrace it). In figure 2, he highlights the classic examples of how autoregulation can be affected. In the table, additional examples are provided but all within the framework of alterations related to autoregulation and the interplay between the two resistance vessels.- Regulation of GFR - Autoregulation - The ability to keep glomerular pressure constant over wide range of systemic arterial pressure - When pressure < 70 autoregulation fails and GFR will fall with decreases in systemic pressure - When pressure falls below 40-50 GFR ceases - At least some of this autoregulation is mediated with Ang2. Giving ACEi markedly disrupts autoregulation - Nitric oxide, not important - TGF - Chloride in macula densa - Blocked by furosemide - Group affect of nephrons - Ang 2 sensitizes - Adenosine mediates - Function of TGF - 90% of filtrate is reabsobed in PT and LOH - 10% is reabsobed dismally - Need to control the amount of fluid delivered distally to prevent overwhelming the resorptive capacity of the distal nephron - Talks about acute renal success without naming it (but did reference it) - Mentions glucosuria blunts TGF. Hmmm... - Neurohormonal influences - Volume changes in ang2, sympathetic NS - Role of PGE - Interesting discussion of change of the nephrons perfumed with volume depletion, shifting of blood from outer coretex to inner medullary cortical gloms with their long loops - Dopamine and ANP both increased with volume up - Dopamine causes vasodilation of afferent and efferent arteriole - ANP causes afferent vasodilation and efferent vasodilation constriction, increasing GFR without affecting RPF - Glomerular hemodynamics and renal failure - Decreased glomerular mass results in hyperfiltration of remaining gloms - Mediated through afferent vasodilationJC talks about this classic study in critical care: High vs. Low blood pressure target in Septic Shock. https://www.nejm.org/doi/pdf/10.1056/NEJMoa1312173In this multi-center open label trial of 776 patients randomized to either a MAP of 65-70 or 80-85 with the primary endpoint of mortality. There was no difference in mortality at 28 days between the two groups (but a small difference in AKI in the patients who had chronic HTN- in the higher BP target, there was a decrease in need for RRT; there was also a higher incidence of afib in the high target group overall). - Results in compensation and stable GFR in short term, long term maladaptive - Reason for ACEi- Clinical Evaluation of Renal Circulation - Concept of clearance and measurement of GFR - GFR as an index of functioning renal mass - Had a patient today s/p nephrotomy, 72 years old, Cr0.9!Melanie referred to this article in Circulation which demonstrates that SGLT2 inhibitors do decrease single nephron GFR (in mice) and that this is related to a decrease in the afferent arteriole diameter and then they show that this is related to a local increase in adenosine. Kidokoro K, Cherney DZI et al. Evaluation of glomerular hemodynamic function by empagliflozin in diabetic mice using in vivo imaging Circulation 140 (4) 2019https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.118.037418 - Fall in GFR earlier and only sign of renal disease - Serial monitoring is used to assess severity and follow the course of disease - GFR is useful for dosing drugs - How to measure GFR - Consider fructose polysaccharide inulin (love the parenthetical, not insulin) - Inulin filtered = inulin excreted - Filtered inulin = plasma inulin concentration x GFR - Inulin excreted = urine concentration x urine volume - Use Alber a to get GFR = [Urine]insulin x urine volume / [plasma]inulin - GFR = inulin clearance - There is not an available assay for inulin - Creatinine clearance - Freely filtered - Not reanbsorbed - Not metabolized - Small amount excreted - CrCl exceeds GFR by 10-20%Roger says the SGLT2 inhibitor story is about the afferent arteriole and he thought it reminded him of the MDRD study and the concept that the lower protein intake would be protective and delay the progression of CKD. The concept was that low protein diets would decrease glomerular pressure by decreasing the intake of amino acids that lead to arteriolar vasodilation and increased GFR. Klaur S, Levey AS et al. The effects of Dietary Protein Restirciton and blood-pressure control on the progression of chronic renal disease. NEJM 1994 330:877-884. https://www.nejm.org/doi/full/10.1056/nejm199403313301301 - Compensated for by noncreatinine chromogens (acetone proteins, as Orbi acid, pyruvate) that over estimate Cr by 10-20% - Cr Cl = [Urine]cr x urine volume / [Plasma]cr - Two major limitations - Incomplete collections - 20-25 mg/kg in adult men - 15-20 mg/kg in adult womenThe term “Acute renal success” comes from Thurau K and Boylan JW. Acute renal success. The unexpected logic of oliguria in acute renal failure. Am J Med 1976 61(3): 3038-15. - Falls by 50% from age 50 to 90 to 10 mg/kg - Increased tubular secretion with decreased kidney function - GFR of 40-80 cr secretion may account for as much as 35% of creatinine excretion - In some cases CrCl can exceed GFR by a factor of 2 - Give cimetidine 1200 mg! - It is important to appreciate however that exact knowledge of GFR is not required. More important to know if GFR is changing - Why is radio labeling the solution DTPA and iothalamate? - Talks about the reality of progressive disease despite stable GFR and CrCl - On to plasma Cr and GFRIf you think placing dialysis lines is too easy, here is a wonderful review of micropuncture technique in the kidneys by Volker Vallon.Micropuncturing the Nephron. Pflugers Arch 2009 458(1): 189-201. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954491/ - Creatinine excretion = creatinine production (and this is constant) - Creatinine excretion = [Cr] x GFR = constant - If GFR falls in half, creatinine excretion will fall in half, while creatinine production remains the same, so creatinine will rise and rise until [Cr] x GFR = creatinine production and then it will level off. - Changes in creatinine load - High protein diet can increase it - Vegetarian diet can decrease itJC brought up studies on fenoldopam, of which there are many. This is one such study in patients undergoing cardiac surgery. JAMA 2014 Bove T et al. Effect of fenoldopam on use of renal replacement therapy among patients with acute kidney injury after cardiac surgery: a randomized clinical trial https://pubmed.ncbi.nlm.nih.gov/25265449/ - Cooked meat can increase Cr by 1 mg/dL - Talks about need for steady state to assess GFR - Talks about the curvilinear relationship - Then he talks Cockcroft GaultThe one, the only: The Cockcroft Gault: Prediction of creatinine clearance from serum creatinine. Nephron 16: 31–41, 1976 https://pubmed.ncbi.nlm.nih.gov/1244564/ - Cirrhosis masks kidney insufficiency, low meat intake, low BUN production - Can someone explain what we are supposed to take from figure 2-12 - Stable Cr does not mean stable kidney diseaseRoger describes the study design for the seminal paper on the use of ACE inhibitors to slow the decline in renal function in diabetic kidney disease (then called diabetic nephropathy) and the decision to use the doubling of the serum creatinine as an endpoint. Lewis EJ The effect of Angiotensin-converting-enzyme inhibition on diabetic nephropathy NEJM 1993 https://www.nejm.org/doi/full/10.1056/NEJM199311113292004 - Ketoacidosis can raise the Cr 0.5 to 2.0mg/dL - On to BUN - Destination of amino acids produces ammonia - We detoxify ammonia by converting to urea - Increased with increased protein load - Increased catabolismMelanie mentioned an old study on ingestion of expired blood: Cohen TD. Induced azotemia in humans following massive protein and blood ingestion and the mechanism of azotemia in gastrointestinal hemorrhage. AM J Med Sci 1956 https://pubmed.ncbi.nlm.nih.gov/13302213/ - Tetracycline causes decreased anabolism - Trauma - Steroids - Urea excretion is variable and tied to hydration and FF - Renal plasma flow and PAH

This week, Executive Vice President John Byrne, and Creative Director Elliot Berman of the AML RightSource staff talk about the introduction of the Domestic Terrorism Prevention Act, the comments by Janet Yellen about the risks of crypto or virtual currencies, and the issuance by FinCEN of frequently asked question about SAR filing. They discuss how the DTPA is a direct response to the incursion at the Capitol and how Yellen’s comments are aligned with those by financial regulators in other countries.

Dr Fei Sim is a Senior Lecturer and the Coordinator of International Engagement in the School of Pharmacy and Biomedical Sciences at Curtin University, Western Australia. Fei holds a Doctoral degree in Pharmacy, is a practising pharmacist, a community pharmacy owner, a pharmacist immuniser and an Accredited Mental Health First Aid Instructor. Fei has served as the WA State President of the Pharmaceutical Society of Australia since 2017. Fei serves on a number of profession and academic-related committees, and is fully committed to the pharmacy profession and is passionate about the future of the profession through growth of professional services to attain the highest level of contemporary pharmacist practice. Through her teaching and research activities as an academic, Fei is committed to motivating and inspiring students to become excellent and competent future pharmacists, and encouraging them to have the courage and aspiration to be future leaders in the primary healthcare team. Fei has led and is involved in a number of research projects and trials aiming to provide evidence to support the great contribution of pharmacists, including in the area of immunisation, mental health, minor ailments management and diabetes. Her teaching awards, the 2018 PSA WA Early Career Pharmacist Award and the 2019 PSA Early Career Pharmacist of the Year Award are testimony to her commitment to patient care, learning and teaching, leadership in pharmacy, innovation and initiative in pharmacy service delivery, as well as peer and professional engagement. Episode 10 Vaccination | Whooping Cough In this episode, Fei discusses the pertussis (dTpa) vaccine and its benefits for at-risk individuals, including pregnant women and young children. 5 Indispensable tips Make sure you are vaccinated Encourage others to get vaccinated. Ask each other Get up to date and current information. Speak to your pharmacist If you experience any side effects from the vaccine, speak to your pharmacist If you have whooping cough, you can help stop the disease spreading by staying away from childcare, school, work or other places where you could spread the infection. Cover you mouth and nose when you sneeze/cough and practise hand hygiene (wash your hands thoroughly and often!). See omnystudio.com/listener for privacy information.

A gravidez é um momento de grandes transformações para a mulher. Durante o período da gestação, o corpo vai se modificando até o momento do parto. Em relação à gestante, o Sistema Único de Saúde disponibiliza atendimento desde o pré-natal até o momento do parto nas unidades básicas de saúde e hospitais. Além das consultas, que são fundamentais, outra iniciativa importante que precisa acontecer durante o período da gravidez é a vacinação. E se vacinar é uma atitude que pode ajudar a proteger também o bebê, como explica a coordenadora substituta do Programa Nacional de Imunizações do Ministério da Saúde, Ana Goretti. “Na gestação a mulher também tem que se prevenir. Nós temos um calendário específico para gestantes, que incluem a vacina contra hepatite B, a vacina relacionada à questão da difteria, tétano e coqueluche (que a gente chama de DTPA) porque uma vacina acelular, aonde não tem problema a gestante fazer o uso dessa vacina e que vai prevenir não só a essas gestantes de ter coqueluche, como também, especialmente, como ela passa pela placenta, ela vai prevenir o seu bebê de ter essa doença - que nos primeiros meses de vida pode ser letal para os nossos bebês pequenininhos”. A gestante deve procurar a unidade de atenção básica mais próxima de sua residência. Lá ela vai ser avaliada e incluída nas consultas de pre natal. Este acompanhamento de pré-natal serve para assegurar o desenvolvimento saudável da gestação, permitindo um parto com menores riscos para a mãe e para o bebê. Para saber mais, acesse saude.gov.br/gravidez Reportagem, Janary Damacena.

Travis Crabtree brings a unique perspective to his litigation, technology, media and marketing practice. Travis graduated from the University of Missouri School of Journalism and spent several years in television news before embarking on a law career. Travis explores the emerging legal issues and trends for the internet, marketing, technology, intellectual property and online media on his blog, eMediaLaw.com. His technology practice focuses on media communications, online defamation, privacy, domain name disputes, policy and governmental compliance, software licensing and audits, copyrights and trademarks, and related transactional documents for start-ups and technology companies. In addition, Travis represents plaintiffs and defendants in complex business matters including cases involving defamation, open records issues, antitrust, RICO, the False Claims Act, shareholder derivatives, minority shareholder oppression, corporate officer/director fiduciary cases, partnership disputes, trade secrets, the DTPA, employment and class actions in both state and federal court. His commercial litigation experience allows him to counsel clients at all stages of conflict from avoiding disputes, to resolving disputes, trials and appeals. Most importantly, Travis’s courtroom experience helps him keep his clients out of the courtroom if he can, but aggressively represented if that is what it takes.

Ein Problem bei der Behandlung von Gehirntumoren sind Resttumorzellen, die am Rande des Tumors gesundes Hirngewebe infiltrieren und operativ nicht entfernt werden können. Einen viel versprechenden Ansatz für die Therapie maligner Gliome stellt die lokale Applikation radioaktiv markierter monoklonaler Antikörper bzw. Antikörper-Fragmente dar, die gegen tumorspezifische Oberflächenmoleküle gerichtet sind. Ziel war es daher, monoklonale Antikörper (mAk) und gentechnisch hergestellte Fab-Fragmente gegen die tumorassoziierte Isoform 1 des humanen Tenascin C (hTNC-1) für die Diagnostik bzw. die Radioimmuntherapie (RIT) von Gliomen zu entwickeln. Die mAk wurden durch Immunisierung von Balb/c Mäusen mit einer der alternativ gespleißten FNIII-Domänen, die für hTNC-1 spezifisch ist, generiert. Diese FNIII-Domäne wurde hierzu gentechnisch hergestellt. Die Immortalisierung und klonale Selektion der erfolgreich herangereiften murinen B-Lymphozyten wurde, angelehnt an das von Kenett und Mitarbeitern entwickelte Protokoll, durchgeführt (Kennett, et al., 1978). Der Antikörper wurde aus den konditionierten Zellkulturmedien des entsprechenden Hybridoma Zellklons mit geringem Aufwand aufgereinigt. Die cDNA-Sequenzen der CH1- und der VH1-Domäne der H- und der L-Kette des neu generierten mAk wurden hierfür in den bakteriellen Expressionvektor pASK85-D1.3 kloniert und gentechnisch hergestellt. Die Fab-Produktion in E. coli konnte so im Labormaßstab etabliert werden. Nach in vitro Evaluation wurden die mAk und Fab-Fragmente mit Indium-111-DTPA radiomarkiert und in U87MG-tragenden SCID-Mäusen getestet. Der mAk mit der höchsten Avidität (WGGD4-B4) wies eine spezifische Bindung mit hoher Affinität (KD ~ 35 nM ± 16 nM) an WHO°III und WHO°IV Gliome auf. Gesunde Hirnareale werden mit diesem mAk nicht adressiert. Die an U87-MG-Tumoren tragende SCID-Mäusen durchgeführten Untersuchungen zeigten für den mAk WGGD4-B4 einen Anstieg der Aktivität im Tumor bis zu 72 h p.i., mit mittleren Anreicherungen von 11% der ID/g Tumor. Anschließend erfolgt eine langsame Dissoziation (~9% ID/g Tumor nach 120h p.i.). Die Aktivität in den Referenzgeweben (z.B. Muskel) blieb zu jedem gemessenen Zeitpunkt niedrig (Muskel

Einleitung: Der Stellenwert der MRT bei der Detektion und Diagnostik von fokalen Leberläsionen wurde in zahlreichen Vergleichsstudien bestätigt. Neue Sequenz-Techniken wurden zur Optimierung der Bildgebung entwickelt. Die Anwendung schneller T1-gewichteter artefaktarmer Sequenzen für die Detektion und Diagnostik von fokalen Leberläsionen hat mittlerweile Einzug in die Routinediagnostik gehalten. Die aufgrund ihrer langen Untersuchungszeit gegenüber Bewegungsartefakten anfälligere konventionelle SE-Bildgebung konnte jedoch bisher nicht durch die schnelle Gradient-Echo-Bildgebung ersetzt werden. Erst die Einführung von Oberflächenspulen, wie die in dieser Studie angewendete zirkulär-polarisierte array-Abdomenspule, ermöglichte ein der konventionellen SE-Bildgebung vergleichbares Signal- und Kontrast-zu-Rausch-Verhältnis für die GRE-Bildgebung. Seit Einführung der MRT-Kontrastmittel kommt diesen auch eine wachsende Bedeutung bei der Untersuchung der Leber zu. Zur kontrastmittelverstärkten Bildgebung der Leber standen zunächst unspezifische Kontrastmittel wie z.B. Gd-DTPA zur Verfügung. Probleme bei der Detektion von fokalen Leberläsionen entstanden vor allem durch die unspezifische und extrazelluläre Verteilung des Kontrastmittels in die Läsion und in das gesunde Leberparenchym. Hierdurch kann es, je nach Vaskularisierung der Läsion, sogar zu einer Verschlechterung des Tumorkontrastes kommen. Material und Methode: In der vorliegenden Arbeit wurde die Wertigkeit des neuen leberspezifischen paramagnetischen Kontrastmittels Gd-EOB-DTPA für die MRT von fokalen Leber-läsionen anhand einer T1-gewichteten konventionellen SE-Sequenz und einem Gradient-Echo-Schnellbildverfahren vom Typ FLASH (fast-low-angel-shot) überprüft. Neben der verwendeten Sequenztechnik wurde der Einfluss einer optional erhältlichen, zirkular-polarisierten array-Abdomenoberflächenspule der Firma Siemens AG Erlangen auf die native und kontrastmittelverstärkte Bildgebung untersucht. Die Untersuchung fand im Rahmen einer multizentrischen Phase II Studie der Schering AG statt. In unserer Klinik wurden 23 Patienten mit fokalen Leberläsionen untersucht. Ergebnisse: Das Kontrastmittel zeigte in unserem Patientenkollektiv eine gute Verträglichkeit. Allergische Reaktionen wurden nicht beobachtet. Als quantitativ messbares Kriterium der Bildqualität wurde das Signal-zu-Rausch- sowie das Kontrast-zu-Rauschverhältnis vor und nach Bolusgabe von 12,5 , 25 und 50 µmol/kg Gd-EOB-DTPA erfasst. In einer randomisierten verblindeten Begutachtung der Bildsequenzen durch zwei erfahrene Radiologen wurde die Erkennbarkeit (Detektion) und die diagnostische Sicherheit festgestellt sowie eine qualitative Bewertung hinsichtlich der häufigsten Bildartefakte vorgenommen. Unsere Ergebnisse bestätigen die diagnostische Bedeutsamkeit von Gd-EOB-DTPA in der Detektion von fokalen Leberläsionen. Die erhobenen quantitativen und qualitativen Daten zeigen nach Kontrastmittelgabe eine deutlich bessere Abgrenzbarkeit der Läsionen aufgrund ihres erhöhten K/R sowie eine höhere Anzahl erkennbarer Läsionen. Eine Dosis von 12,5 µmol/kg Gd-EOB-DTPA war in unserem Patienten kollektiv ausreichend für die suffiziente Detektion von Lebermetastasen. Die höheren Dosen erbrachten in unserer Studie keine weitere Verbesserung der Detektion und Darstellung der Läsionen. Zur Detektion von Lebermetastasen sollte die Untersuchung 20-45 min nach Kontrastmittelapplikation erfolgen. Hier konnte für alle verwendeten Sequenz-Spulen-Kombinationen eine erhöhte Detektionsrate fokaler Leberläsionen im Vergleich zur Nativuntersuchung festgestellt werden. So zeigte die konventionelle SE-Sequenz eine Erhöhung der Detektionsrate richtig positiv erkannter Läsionen kleiner 1 cm um 46% nach Kontrastmittelapplikation. Die GRE-Sequenz mit Körperspule zeigte hier eine Steigerung um 26,9% und mit Oberflächenspule eine Steigerung der Erkennbarkeit kleiner Läsionen um 19,2 %. Trotz der verbesserten Darstellung nach Kontrastmittelapplikation zeigen die GRE-Sequenzen durch ihre kurze Akquisititionszeit (Atem angehalten) in der qualitativen Auswertung bessere Ergebnisse hinsichtlich der diagnostischen Sicherheit als die SE-Sequenz. So war die diagnostische Sicherheit der SE-Sequenz in 52% der beurteilten Bildsequenzen durch Artefakte negativ beeinflusst. Die GRE-Sequenz mit Körperspule war nur zu 28% und mit Oberflächenspule nur zu 11% in ihrer diagnostischen Sicherheit durch Artefakte beeinträchtigt. Hinsichtlich der Signal-zu-Rausch- und Kontrast-zu-Rausch-Verhältnisse zeigte die GRE-Sequenz mit Körperspule in der Nativbildgebung vergleichbare Ergebnisse wie die konventionelle SE Sequenz. In der kontrastmittelverstärkten Bildgebung erreichen die schnellen GRE-Sequenzen jedoch signifikant bessere Ergebnisse als die SE-Sequenz. Somit kann gerade in der kontrastmittelverstärkten Bildgebung auf die zeitintensive und artefaktanfällige konventionelle SE-Sequenz verzichtet werden. Durch die Verwendung der zirkulär polarisierten Oberflächenspule kann durch die Reduktion des Hintergrundrauschens eine weitere Verbesserung der Signal-zu-Rausch- und Kontrast-zu-Rausch-Verhältnisse für die GRE-Sequenzen erzielt werden. Zur Analyse der Gewebsperfusion kann eine dynamische Untersuchung vorgeschaltet werden. Sie kann durch die Perfusionscharakteristik diagnostische Hinweise auf die Tumorart geben. Aufgrund der leberzellspezifischen Eigenschaft von Gd-EOB-DTPA ist neben der Vaskularisation der Läsion auch der histologische Ursprung der Läsion (lebereigen vs. leberfremd) für die Kontrastmittelaufnahme von Bedeutung. So zeigten in unserem Kollektiv die untersuchten Metastasen eine deutlich geringere Kontrast-mittelaufnahme als die untersuchten fokal nodulären Hyperplasien oder hepato-zellulären Karzinome. Diese Unterschiede in der Kontrastmittelaufnahme konnten auch 20 und 45 Minuten nach KM-Applikation beobachtet werden. Aufgrund der geringen Fallzahl der einzelnen Läsionen sind hier jedoch weitere Untersuchungen nötig. Zusammenfassung: Die Kernspintomographische Untersuchung von fokalen Leberläsionen mit Gd-EOB-DTPA in Verbindung mit schnellen GRE-Sequenzen kann zu einer verbesserten Darstellung von fokalen Leberläsionen führen. Eine genauere Evaluierung der diagnostischen Wertigkeit und Einsatz des Kontrastmittels für spezielle Fragestellungen wird in den folgenden klinischen Studien der Phase III überprüft werden müssen.

Possibilities of early diagnosis of osteomyelitis by magnetic resonance tomography - experimental studies in rabbits Correlation of MR-images and macroscopic sections demonstrates, that anatomical structures of rabbits can be excellently visualized by MRT. Clinically used MR-systems are able to provide satisfactory resolution. Following experimentally induced osteomyelitis infected bone marrow can be detected by decreased signal on native T1-weighted and increased signal on T2-weighted images. After administration of gadolinium-DTPA marked enhancement can be observed. Detection of soft-tissue infection is superior on T2-wheigted scans showing high signal intensity. After administration of gadolinium DTPA rim enhacement provides good differentiation of abscessmembrane. Especially in earlier stages of disease (3 to 5, 8 to 12 and 12 to 19 days post infection) the sensitivity of native MRT (80%, 100%, about 67%) is superior compared to other diagnostic modalities, e.g. radiography (about 29%, about 46%, 50%), CT-scan (about 29%, about 13%, about 17%) and scintigraphy (60%, about 78%, 100%). Gadolinium-DTPA increases sensitivity (100%, 100%, 100%). At the end of the observation period bone scintigraphy provides the same sensitivity. MRT, however, is superior in detecting involvement of bone marrow and soft-tissue infection. Compared to scintigraphy and MRT radiography and CT-scan shows lower sensitivity during the whole observation period. Regional differences in detecting osteomyelitis can be recognized unsing MRT, less using other modalities. In early stages of the disease most infectious lesions are detected in the proximal femur. Explanation can be a different involvement of the femur, but also a different diagnostic potential of MRT concerning different anatomical regions. All in all MRT is an excellent tool in the diagnosis of osteomyelitis and is superior to other imaging modalities. Application of contrast material provides further improvement in sensitivity. In the clinical use fat suppression and STIR-sequence have provided further improvement. The role of MRT as a diagnostic instrument in osteomyelitis is established in clinical medicine and seems promising in veterinary medicine.