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Prof.I.Riposan - Chairman, Romanian Foundry Technical Association ATTR ; The actual Romanian territory the old Dacia ; had been a great attraction for its metal inheritance since old times, being known the fact that the roman army transported big amounts of gold from the conquered Dacia 106 ac ; . On the other hand, Romania has an old tradition in the ferrous metallurgy, initiated in the early Hallstatt age. Ferrous metallurgy, practiced even since the 1 st millennium bc., was intensely continued in further periods, going through several flourishing stages, the first blast furnaces conform to the actual concept ; having been installed in 1718. By the end of the 19 th century over 60 blast furnaces were functioning, in over 40 places, mainly in the western part of the country. Nowadays, Romania produces over 6.0 mil.t cruel steel annually with a growing potential of 10.0 mil.t ; , over 250, 000 t Al with potential growth of 340, 000 t by 2007 ; and over 100, 000 t Cu + Therefore, casting production in Romania is based on a long tradition in metallurgy, in both iron and steel castings production and nonferrous casting production. Romanian metalcasting production has reached the maximum of 1.5-1.6 mil.t year during 1987-1989, taking the 9 th place in the world casting production in 1989, with over 60 kg citizen, in conformance with the national industry development programs, specific to the centralized economy at that time. After December 1989 events and the translation to the open market economy, casting production was lowered to 0.8-1.0 mil.t year during 1990-1994, to 0.4-0.6 mil.t year during 1995-1997, eventually leveling off at 400, 000 t year after 1997 over 17 kg citizen ; . see Table 1 ; There have been several objective reasons for reducing casting production during the past years, due to the industrial restructuring process, such as: The decrease in the requirement of ingot moulds and bottom plates for the steel industry, from over 350, 000 t year down to under 50, 000 t year, due to both the decrease of cruel steel production from 15-16 mil.t year to 6 mil.t year ; and the substantial increase of continuous casting techniques usage; The dramatical decrease of steel casting production, from values exceeding 350, 000 t year in 1989 as much as France and Germany cumulated production, 3 times higher than England production and one third of the USA production ; , down to values of 60, 000-70, 000 t year during the last years; The decrease of grey cast iron bath tubs and radiators production, field which caused the loss of over 100, 000 t year castings; The drop in the requirement of castings from lower grades grey irons, as well as thick wall castings including tubes ; . Consequently, major changes have been registered as concerns the metalcasting production structure, in the past few years see Table 1.
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122 MUOZ C. Trace elements and immunity. Euroconference Nutrition, Immune Functions and Health. Paris France ; , June 9-10, 2005 In: Cavaillon JM., editor. Nutrition, immune functions and health. Paris: Institute Pasteur; 2005; p. 120-126. Major trace elements such as iron, zinc and copper are essential minerals for energy production and cellular proliferation processes. They modulate several components of immunity and influence the susceptibility of the host to infection. The effect of individual trace element is difficult to evaluate due to frequent concomitant deficits in other micronutrients. We have used a human model of pure iron deficiency adult women with gynecologic bleeding - to study some mechanisms of impaired immune response in these subjects. The effect of mineral supplementation trials on immunocompetence and frequency of infections in deficient individuals, and its relevance in public health will be reviewed, for instance, ramipril diabetes.

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S65 33. Heart Outcomes Prevention Evaluation HOPE ; Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. Lancet. 2000; 355: 253-259. Lindholm LH, Ibsen H, Dahlf B, et al. Cardiovascular morbidity and mortality in patients with diabetes in the Losartan Intervention for Endpoint reduction in hypertension study LIFE ; : a randomised trial against atenolol. Lancet. 2002; 359: 1004-1010. UK Prospective Diabetes Study Group. Efficacy of atenolol and captopril in reducing risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 39. BMJ. 1998; 317: 713-720. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT ; . JAMA. 2002; 288: 2981-2997. The ALLHAT Officers and Coordinators for the ALLHAT Collaborative Research Group. Major cardiovascular events in hypertensive patients randomized to doxazosin vs chlorthalidone. The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial ALLHAT ; . JAMA. 2000; 283: 1967-1975. Tuomilehto J, Rastenyte D, Birkenhger WH, et al. Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med. 1999; 340: 677-684. DiMinno G, Silver MJ, Cerbone AM, et al. Trial of repeated low-dose aspirin in diabetic angiopathy. Blood. 1986; 68: 886-891. Halushka PV, Rogers RC, Loadholt CB, et al. Increased platelet thromboxane synthesis in diabetes mellitus. J Lab Clin Med. 1981; 97: 87-96. Dav G, Catalano I, Averna M, et al. Thromboxane biosynthesis and platelet function in type II diabetes mellitus. N Engl J Med. 1990; 322: 1769-1774. Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1989; 321: 129-135. ETDRS Investigators. Aspirin effects on mortality and morbidity in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study report 14. JAMA. 1992; 268: 1292-1300. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994; 308: 81-106. Antithrombotic Trialists' Collaboration. Collaborative metaanalysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002; 324: 71-86 and retin-a.

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105 CASE REPORTS OF MANAGEMENT OF SKIN NECROSIS IN TWO ASPLENIC PATIENTS WHO DEVELOPED PURPURA FULMINANS Roselle E. Crombie, MD MPH, Philip E. Fidler, MD, John T. Schulz MD PhD; Bridgeport Hospital Yale New Haven System, Andrew J. Pannetieri Burn Unit, 267 Grant Street, Bridgeport, CT 06610 Introduction: Thrombotic occlusion of dermal arterioles produces widespread full-thickness skin necrosis in patients with purpura fulminans and, consequently, these patients are often cared for in burn units, where both there critical care and surgical needs can be addressed. We recently encountered two patients with purpura fulminans. Curiously, both of these adult patients were asplenic. While asplenia is known to predispose a patient to overwhelming sepsis, there is little literature on the association of asplenia and purpura fulminans. Here we present our two patients and discuss the possible role of asplenia as a risk factor for purpura fulminans. Case Reports: Patient #1 had disseminated streptococcal sepsis. PMH included non-Hodgkins lymphoma and underwent bone marrow transplant then splenectomy. She subsequently developed necrosis of her bilateral hands, feet, toes and tip of her nose. Patient #2 was a 57yo female with pneumococcal sepsis history of asplenia, MGUS, thyroid disease, TIA and depression. This patient also developed ischemic extremities and skin necrosis. Results: Both patients had significant digital necrosis progressing with their disease eventually requiring amputations. Both patients required excision and engraftment of other areas of necrosis. Conclusions: Asplenia increases the susceptibility to overwhelming sepsis. Our patients developed not only overwhelming sepsis, but Purpura fulminans. Admittedly, purpura fulminans accompanies some episodes of severe sepsis, most commonly those associated with Neisseria meningitidis. Our patients shared premorbid asplenia, rather than the same infecting microbe, suggesting that asplenia may increase vulnerability to development of purpura fulminans in the septic patient. Further studies with purpura fulminans must be done to see if asplenia is indeed a risk factor for this disease. 106 IMPAIRED NOTCH SIGNALING SIGNIFICANTLY DELAYS WOUND HEALING 1 Srinivasulu Chigurupati * , 2Tiruma V Arumugam, 2Shafaq Jameel, 2Mohamed R Mughal, 2Mark P Mattson, 1Suresh Poosala 1 Comparative Medicine Section, National Institute on Aging Intramural Research Program, 5600 Nathan Shock Drive, Baltimore, Maryland 21224, USA.2 Laboratory of Neurosciences, National Institute on Aging Intramural Research Program, 5600 Nathan Shock Drive, Baltimore, Maryland 21224, USA. E-mail: chigurupatis mail.nih.gov, Phone: 410-558-8289, Fax: 410558-8323 The evolutionarily conserved Notch-mediated intercellular signaling pathway is critically involved in cell fate decisions during development of many tissues and organs. Angiogenesis, the formation of new blood vessels, plays a central role in number of physiological and pathological conditions including wound healing which involves a switch in endothelial cell phenotype from quiescence to proliferation, migration and network formation, and back to quiescence. In the present study we employed in vivo and cell culture models to elucidate the role of Notch signaling in wound healing. Inhibition of Notch signaling in Notch antisense transgenic mice, and in normal mice treated with the g secretase inhibitor N-[N- 3, 5Difluorophenylacetyl ; - S ; -alanyl]- S ; -phenylglycine tert-butyl ester DAPT ; , resulted in a significant delay in the healing of full-thickness dermal wounds. To further examine the role of Notch signaling in cells involved in wound healing, we evaluated the effects of Notch inhibition on the behaviors of human umbilical vascular endothelial cells HUVEC ; in a scratch wound healing test, a cell proliferation assay, cell migration assay and a tube formation assay in Matrigel. Treatment of HUVEC with DAPT inhibited scratch wound healing, cell proliferation and cell migration. Tube morphogenesis was also significantly disrupted by DAPT treatment. These results suggest that Notch signaling is involved in wound healing and tissue repair, therefore we conclude that targeting the Notch pathway might provide a novel strategy for wound repair and treatment. 107 IN VIVO EXPRESSION OF VEGF-R2 DURING EARLY SKELETAL ISCHEMIA-REPERFUSION INJURY M. Hofmann, R. Mittermayr, T. Morton, S. Pfeifer, M. van Griensven, H. Redl Ludwig Boltzmann Institute for Experimental and Clinical Traumatology Research Center of the AUVA, Vienna, Austria Introduction: Different strategies were developed to reduce ischemia reperfusion injury. One of the concepts includes therapeutic angiogenesis with VEGF and its receptor as pivotal players. This study investigates the in vivo expression of VEGF-R2 during early murine hindlimb ischemia reperfusion and its alteration via VEGF165 released from a fibrin biomatrix FS ; . Material and Methods: Male female transgenic FVB N-Tg Vegfr2luc ; Xen mice n 12 group ; were used for non-invasive, realtime assessment of the VEGF-R2 Flk-1 KDR ; induction. Ischemia was induced by tension controlled 250g ; tourniquet to the hindlimb and verified by laser Doppler imaging LDI, Moor Instruments Inc. ; technique. Ischemia was maintained for 2 hours with subsequent reperfusion for 4 or 24 hours. Control animals received no treatment whereas the animals of the FS VEGF groups received 0 or 20ng VEGF final FS clot 0.2ml in total ; in their hindlimb subcutaneously, to distribute evenly around the muscle 9.
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Source: adapted from: Screening for type 2 diabetes. Report of the World Health Organization and International Diabetes Federation meeting. Geneva, World Health Organization, 2003 document WHO NMH MNC 03.1, : who.int diabetes publications en screening mnc03 , accessed 30 September 2005 and rivastigmine.

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Percentage of patients with adverse events possibly probably related to study drug placebo-controlled aire ; mortality study other adverse experiences reported in controlled clinical trials in less than 1% of ramipril patients ; , or rarer events seen in postmarketing experience, include the following in some, a causal relationship to drug use is uncertain.
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Following his discharge from hospital, Mr. Smith is maintained on acetylsalicylic acid 81 mg daily for secondary prevention of myocardial infarction. He also remains on: ramipril 5 mg daily metoprolol 50 mg twice daily hydrochlorothiazide 25 mg daily simvastatin 40 mg daily He remains in atrial fibrillation, and based on his risk profile for thromboembolic stroke age approaching 75, history of hypertension ; , a decision is made to initiate long-term anticoagulation with warfarin therapy. It is expected that warfarin may further reduce his future risk of infarction or cardiovascular mortality. International normalized ratio will be maintained within the 2.0-3.0 range, and, while Mr. Smith is capable of strict medical adherence, frequent monitoring is recommended to minimize the risk of future bleeding complications. Given his initial acute coronary syndrome presentation with significant chest pain and cardiac enzyme elevation, the addition of clopidogrel to his antithrombotic regimen is considered. However, it is felt that potential benefits may be outweighed by the compounded risk for hemorrhage due to the requirements for warfarin. Table 2. Comparison of Urine Toxicology with Self-reporting of Drug Abuse and simvastatin.

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The average stock on our Buy List is poised to release spectacular earning growth. To put it into perspective, I'm selling Commercial Metals this month because its latest earnings were only up 41%. The average stock on the Buy List has over 30% sales growth and 90% earnings growth, yet it still trades at barely 14 times this year's earnings. These spectacular growth-to-price earnings ratios will attract more institutional buying pressure. Until trading volume improves, we're in a stockpicker's market. I suspect that the big catalyst that will ignite the market will be the final realization that the Federal Reserve is finished raising interest rates. The 0.25% increase by the Fed on June 30 might be the last rate increase that we'll see for a while. Although the Fed may raise rates one more time, I don't see them raising rates any higher. Under no circumstances does the Fed want to raise short-term rates higher than long-term rates. Since banks like to borrow short-term and invest long-term, this would erase their operating margins. The Fed is ultimately in charge of the health of U.S. banking system, so the last thing they want to do is harm the very industry that they're in charge of protecting. That's why I'm so confident that the recent series of rates hikes is finally drawing to a close. The other reason that I'm so confident is that inflation has cooled off. When the dollar was weak, it resulted in a lot of commodity inflation. The prices for commodities like cement, copper, lumber, oil and steel soared. Now that the dollar is rallying, most commodity prices have stabilized. I expect that oil, for instance, hope study ramipril.
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APPROVED NAME BRAND NAME SYNONYM PROPOSED INDICATION Valsartan. Diovan Novartis ; . N A. Treatment of heart failure in patients receiving usual therapy such as diuretics, digitalis and either ACE inhibitors or -blockers; presence of all these standard therapies is not mandatory. Capsules containing 40mg, 80mg or 160mg valsartan. Submitted to the MCA for this additional indication May 2001, possible UK launch early 2002. Already licensed for the treatment of hypertension. Angiotensin-II receptor antagonists BNF 2.5.5.2 ; . Dosage used in Val-HeFT study: Initially 40mg twice daily for two weeks, dose doubled every two weeks to target dose of 160mg twice daily. Current licensed dose for hypertension: 80mg once daily in most patients, can be increased to 160mg once daily lower 40mg starting dose in certain patient groups see Summary of Product Characteristics ; . COST COURSE The target dose of 160mg twice daily is 39.38 for 28 days, this would be the maximum cost MIMS September 2001 ; . Assuming a target population of 800 to 1600 people per 100, 000 for ACE inhibitors by April 2003, up to 10% 80 to 160 per 100, 000 ; may be switched to valsartan because they are intolerant to ACE inhibitors. It is difficult to estimate the usage of valsartan as adjuvant therapy to ACE inhibitors. Cost of 28 days treatment Drug Tariff MIMS September 2001 ; Captopril 50mg tds * Enalapril 10-20mg bd * Ramipril 10mg od * Bisoprolol Cardicor ; 1.25-10mg od Carvedilol Eucardic ; 3.125-25mg bd Spironolactone 25mg od Digoxin 62.5-500micrograms daily.

Could this be a side effect of the heart medications or could it be another condition and starlix. In that study ramipril was associated with a reduction in the incidence of diabetes. For the angiotensin-converting enzyme ace ; inhibitors, the following should be considered: allergies - tell your doctor if you have ever had any unusual or allergic reaction to benazepril, captopril, enalapril, fosinopril, lisinopril, quinapril, or ramipril and sumatriptan and ramipril.
HOPE STUDY investigated the role of an angiotensin-converting-enzyme inhibitor, ramipril, in patients who were at high risk for cardiovascular events but who did not have left ventricular dysfunction or heart failure. A total of 9297 high-risk patients 55 years of age or older ; who had evidence of vascular disease or diabetes plus one other cardiovascular risk factor and who were not known to have a low ejection fraction or heart failure were randomly assigned to receive ramipril 10 mg once per day orally ; or matching placebo for a mean of five years. The primary outcome was a composite of myocardial infarction, stroke, or death from cardiovascular causes. The trial was a two-by-two factorial study evaluating both ramipril and vitamin E. The effects of vitamin E are reported in a companion paper. ts. A total of 651 patients who were assigned to receive ramipril 14.0 percent ; reached the primary end point, as compared with 826 patients who were assigned to receive placebo 17.8 percent ; relative risk, 0.78; 95 percent confidence interval, 0.70 to 0.86; P 0.001 ; . Treatment with ramipril reduced the rates of death from cardiovascular causes 6.1 percent, as compared with 8.1 percent in the placebo group; relative risk, 0.74; P 0.001 ; , myocardial infarction 9.9 percent vs. 12.3 percent; relative risk, 0.80; P 0.001 ; , stroke 3.4 percent vs. 4.9 percent; relative risk, 0.68; P 0.001 ; , death from any cause 10.4 percent vs. 12.2 percent; relative risk, 0.84; P 0.005 ; , revascularization procedures 16.0 percent vs. 18.3percent; relative risk, 0.85; P 0.002 ; , cardiac arrest 0.8 percent vs. 1.3 percent; relative risk, 0.63; P 0.03 ; , heart failure 9.0 percent vs. 11.5 percent; relative risk, 0.77; P 0.001 ; , and complications related to diabetes related to diabetes 6.4 percent vs. 7.6 percent; relative risk, 0.84; P 0.03 ; . Conclusions. Ramipril reduced the rates of death, myocardial infarction, and stroke in a broad range of high-risk patients who are not known to have a low ejection fraction or heart failure. N Engl J Med 2000; 342: 145-53.

Camentos y vacunas y otras informaciones elaboradas con la intencin de ayudar en la buena prctica mdica. Principales Estudios Clnicos de 2003 Anualmente, los editores de Journal Watch escogen los contenidos ms importantes que son publicados en un nmero especial. La relevancia de los temas tanto desde la perspectiva mdica como desde la del paciente son los criterios fundamentales de seleccin. Estos artculos son a veces fruto de un solo trabajo o de un grupo de ellos, pero siempre responden a los ltimos avances y descubrimientos mdicos. En el ao 2003, segn expuso el Dr. Anthony L. Komaroff editor fundador de Journal Watch y profesor de Medicina en la Harvard Medical School de Boston ; en la videoconferencia, los hitos cientficos y mdicos fueron el SRAS Sndrome Respiratorio Agudo Severo ; , las dietas bajas en carbohidratos vs. ba and tadalafil.
There are a wide variety of allergy medications. Food is available everywhere. People are bombarded with food ads. There are few opportunities for exercise. The poor are hit especially hard: It's not easy to find a safe place to exercise. Some neighborhood grocery stores are poorly stocked with healthy foods, and fresh fruits and vegetables are expensive.
1. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM; Valsartan in Acute Myocardial Infarction Trial Investigators. Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003; 349: 1893906. Vantrimpont P, Rouleau JL, Wun CC, Ciampi A, Klein M, Sussex B, Arnold JM, Moye L, Pfeffer M; SAVE Investigators. Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement SAVE ; Study. J Coll Cardiol 1997; 29: 229 The Acute Infarction Ramipril Efficacy AIRE ; Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 8218. Buch P, Rasmussen S, Abildstrom SZ, Kober L, Carlsen J, Torp-Ped C. The long-term impact of the angiotensin-converting enzyme inhibitor trandolapril on mortality and hospital admissions in patients with left ventricular dysfunction after a myocardial infarction: follow-up to 12 years. Eur Heart J 2005; 26: 14552. Cohn JN, Tognoni G, Glazer RD, Spormann D, Hester A.Rationale and design of the Valsartan Heart Failure Trial: a large multinational trial to assess the effects of valsartan, an angiotensin-receptor blocker, on morbidity and mortality in chronic congestive heart failure. J Card Fail 1999; 5: 15560. Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J, Yusuf S, Pocock S; CHARM Investigators and Committees. Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall programme. Lancet 2003; 362: 75966. ISIS-1 First International Study of Infarct Survival ; Collaborative Group. Mechanisms for the early mortality reduction produced by beta-blockade started early in acute myocardial infarction: ISIS-1. Lancet 1988; 23: 9213. The Beta-Blocker Pooling Project Research Group. The Beta-Blocker Pooling Project BBPP ; : subgroup findings from randomized trials in post infarction patients. Eur Heart J 1988; 9: 816.

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