#Ulcer Index Calculation

[signode-blog]

Ulcer Index

Unraveling the Ulcer Index: A Comprehensive Guide to Understanding and Utilizing Market Volatility Introduction: In the fast-paced world of investing, understanding market volatility is paramount to success. One tool that aids investors in this endeavor is the Ulcer Index. This comprehensive guide aims to demystify the Ulcer Index, shedding light on its significance, calculation, and practical…

[prnlive]

Gary Null’s Show Notes 03 30 23

If you listen to Gary’s show, you know that he begins with the latest findings in natural approaches to health and nutrition. Starting this week, we will make some of those findings available each weekday to subscribers to the Gary Null Newsletter.

Researcher uncovers link between ultra-processed foods and Crohn's disease

A good night’s sleep may make it easier to stick to exercise and diet goals, study found 

Why smiles (and frowns) are contagious 

Researcher uncovers link between ultra-processed foods and Crohn's disease

McMaster University (Ontario), March 3, 2023

McMaster University professor Neeraj Narula has discovered that consuming large amounts of ultra-processed foods (UPFs) can increase the risk of Crohn's disease, but not ulcerative colitis (UC).

Researchers gleaned their results by analyzing data from five previous studies conducted between 2020 and 2022 with a total of more than one million participants, more than half of whom were female.

Narula's study defined UPFs as those with chemical modifications such as artificial flavors or colors. Examples include processed meats such as chicken nuggets, sodas, sauces, certain breakfast cereals, refined sweetened foods, commercially prepared breads and pre-packaged candies, among others.

"The causes of inflammatory bowel diseases (IBDs) are relatively unknown, and we have theorized that a combination of genetic, environmental and microbial factors are implicated. UPFs shift your microbiome towards dysbiosis, leading the immune system to react against certain microorganisms in the bowel and triggering an inflammatory pathway that leads to Crohn's disease."

Narula said that Crohn's disease is also linked to non-Mediterranean diets, high consumption of red meats, as well as diets low in fiber, zinc and potassium.

"Aside from Crohn's disease, such foods carry other health risks including diabetes, high blood pressure and cardiovascular disease," said Narula.

A good night’s sleep may make it easier to stick to exercise and diet goals, study found

University of Pittsburgh, March 2, 2023

People who reported getting regular, uninterrupted sleep did a better job sticking to their exercise and diet plans while trying to lose weight, according to preliminary research. 

“Focusing on obtaining good sleep — seven to nine hours at night with a regular wake time along with waking refreshed and being alert throughout the day — may be an important behavior that helps people stick with their physical activity and dietary modification goals,” said Christopher E. Kline, Ph.D., an associate professor in the department of health and human development at the University of Pittsburgh. “A previous study of ours reported that better sleep health was associated with a significantly greater loss of body weight and fat among participants in a year-long, behavioral weight loss program.”

The researchers examined whether good sleep health was related to how well people adhered to the various lifestyle modifications prescribed in a 12-month weight loss program. The weight-loss program included 125 adults (average age of 50 years, 91% female, 81% white) who met criteria for overweight or obesity (body mass index of 27-44) without any medical conditions requiring medical supervision of their diet or physical activity.

Sleep habits were measured at the beginning of the program, at 6 months and at 12 months, through patient questionnaires, a sleep diary and 7-day readings from a wrist-worn device that recorded sleep, waking activity and rest. These measures were used to score each participant as “good” or “poor” on six measures of sleep: regularity; satisfaction; alertness; timing; efficiency (the percentage of time spent in bed when actually asleep); and duration. A composite sleep health score of 0-6 was calculated for each participant, with one point for each “good” measure of sleep health, with higher scores indicating better levels of sleep health.

After adjusting the sleep health scores for age, gender, race and whether or not there was a partner sharing the bed, the researchers found that better sleep health was associated with higher rates of attendance at group interval sessions, adherence to caloric intake goals and improvement in time spent performing moderate-vigorous physical activity. They found:

• Participants attended 79% of group sessions in the first six months and 62% of group sessions in the second six months.

• Participants met their daily caloric intake goals on 36% of days in the first six months and 21% in the second six months.

• Participants increased their total daily time spent in moderate-vigorous activity by 8.7 minutes in the first six months, however, their total time spent decreased by 3.7 minutes in the second six months.

The decrease in group session attendance, caloric intake and in time spent in moderate-vigorous activity in the second six months was expected, Kline said. “As one continues in a long-term behavioral weight loss intervention, it’s normal for the adherence to weight loss behaviors to decrease,” he said.

Improving one’s sleep health is something everyone can do to improve their cardiovascular health and is a key component of the American Heart Association’s Life’s Essential 8. Sleep was added in 2022 as the eighth component of optimal cardiovascular health, which includes eating healthy food, being physically active, not smoking, getting enough sleep, maintaining a healthy weight and controlling cholesterol, blood sugar and blood pressure levels. Cardiovascular disease claims more lives each year in the U.S. than all forms of cancer and chronic lower respiratory disease combined, according to the 2023 Statistical Update from the American Heart Association.

Why smiles (and frowns) are contagious 

University of Wisconsin, February 11, 2023

Smile! It makes everyone in the room feel better because they, consciously or unconsciously, are smiling with you. Growing evidence shows that an instinct for facial mimicry allows us to empathize with and even experience other people's feelings. If we can't mirror another person's face, it limits our ability to read and properly react to their expressions. A Review of this emotional mirroring appears inTrends in Cognitive Sciences.

In their paper, Paula Niedenthal and Adrienne Wood, social psychologists at the University of Wisconsin, and colleagues describe how people in social situations simulate others' facial expressions to create emotional responses in themselves. For example, if you're with a friend who looks sad, you might "try on" that sad face yourself—without realizing you're doing so. In "trying on" your friend's expression, it helps you to recognize what they're feeling by associating it with times in the past when you made that expression. Humans extract this emotional meaning from facial expressions in a matter of only a few hundred milliseconds.

"You reflect on your emotional feelings and then you generate some sort of recognition judgment, and the most important thing that results is that you take the appropriate action—you approach the person or you avoid the person," Niedenthal says. "Your own emotional reaction to the face changes your perception of how you see the face, in such a way that provides you more information about what it means."

A person's ability to recognize and "share" others' emotions can be inhibited when they can't mimic faces, even from something as simple as long-term pacifier use. This is a common complaint for people with central or peripheral motor diseases, like facial paralysis from a stroke or Bell's palsy—or even due to nerve damage from plastic surgery. Niedenthal notes that the same would not be true for people with congenital paralysis, because if you've never had the ability to mimic facial expressions, you will have developed compensatory ways of interpreting emotions.

About Gary Null

An internationally renowned expert in the field of health and nutrition, Gary Null, Ph.D is the author of over 70 best-selling books on healthy living and the director of over 100 critically acclaimed full-feature documentary films on natural health, self-empowerment and the environment. He is the host of ‘The Progressive Commentary Hour” and “The Gary Null Show”, the country’s longest running nationally syndicated health radio talk show which can be heard daily on here on the Progressive Radio Network.

Throughout his career, Gary Null has made hundreds of radio and television broadcasts throughout the country as an environmentalist, consumer advocate, investigative reporter and nutrition educator. More than 28 different Gary Null television specials have appeared on PBS stations throughout the nation, inspiring and motivating millions of viewers. He originated and completed more than one hundred major investigations on health issues resulting in the use of material by 20/20 and 60 Minutes. Dr. Null started this network to provide his followers with a media outlet for health and advocacy. For more of Dr. Null’s Work visit the Gary Null’s Work Section or Blog.GaryNull.com In addition to the Progressive Radio Network, Dr. Null has a full line of all-natural home and healthcare products that can be purchased at his Online Store.

Find articles, videos, back radio broadcasts, books, and more at GaryNull.com.

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Disclaimer

While we have thoroughly researched the information we provide, and indicate its sources, information in this Gary Null Newsletter, and all Gary Null Newsletters, is for educational and informational purposes only, and is not intended to diagnose, treat, cure or prevent any disease or other condition. Consult your medical professional before choosing any treatment or course of action. Gary Null Newsletters are not liable for risks or issues associated with using or acting upon the information it provides.

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[harbourfronttechnologies]

Has Technical Analysis Become More Popular Than Ever?

Technical analysis is a technique that attempts to forecast future price movements by analyzing past price data and market trends. Technical analysts believe that all relevant information about a security is reflected in its price, and therefore believe that studying price changes can provide valuable insights into where the security is headed.

Technical indicators are mathematical calculations based on price, volume, or open interest figures. They are used to try and predict future market trends by analyzing past data. Technical indicators are often used by traders to help make decisions about when to buy or sell a security.

Reference [1] investigated the use of the Percent Bollinger (%b) indicator for trading.  The Percent Bollinger indicator is a technical indicator that is derived from Bollinger Bands. Bollinger Bands are a volatility indicator that consists of three bands: an upper band, a lower band, and a middle band. The Percent Bollinger indicator is calculated by taking the difference between the security's price and the lower Bollinger Band and dividing it by the difference between the upper and lower Bollinger Bands.

The article pointed out,

This paper investigates the profitability of technical analysis in a portfolio of integrated oil and gas companies. Using data of 21 individual companies for the period 01/07/2011 to 30/06/2021, we examine the Percent Bollinger (%b) technical trading rule against the benchmark buy-and-hold (B&H) policy. Our results show that the %b generates positive returns, lower drawdowns and smaller ulcer index as compared to the B&H. Risk-return trade-off analysis confirms the superiority of the technical strategy, where it produces greater ulcer performance index, Sharpe and Sortino ratios. These metrics confirm that returns from the technical rule are not characterized by higher risks. Our findings suggest that stock prices of these oil and gas companies neither fully nor rapidly capture historical price patterns, allowing traders to exploit and earn abnormal returns. The results are inconsistent with weak form market efficiency.

The results are interesting, but it appears that the authors have drawn their conclusion using in-sample testing only.

What we found noteworthy is that the paper showed the increasing volume of academic research on technical analysis. Why is that? Because of the rise of social media, computing power, or something else?

Let us know what you think in the comments below or in the discussion forum.

References

[1] Safwan Mohd Nor, and Nur Haiza Muhammad Zawawi, Technical trading profitability: Evidence from international oil and gas companies, AIP Conference Proceedings 2644, 030036 (2022)

Originally Published Here: Has Technical Analysis Become More Popular Than Ever?

from Harbourfront Technologies - Feed https://harbourfronts.com/technical-analysis-become-popular/

[dido55034]

The Immediate and Long-Term Effects of Obesity

The Immediate and Long-Term Effects of Obesity

For those who are overweight, the term “obese” can be a scary word. Despite that fear, understanding obesity and its medical implications are vital to recovery. Excess weight limits our health, our longevity and our quality of life. For many, coming to clear terms with obesity has proven to be the crucial factor in empowering them to change their life’s path.

Defining Obesity The medical community looks to an objective mathematical equation to assess health – a patient’s body mass index, or BMI. That figure embodies the relationship between height and weight—and often health:

When BMIs become higher than 25, they cross into the overweight zone. This is an area that increases the negative impact of weight on a person’s health. When BMIs reach or breach 30, they enter the obese zone, an area prone to chronic medical conditions and diseases that become difficult to control. To confirm your BMI, you can check a chart or calculate it by dividing your weight in pounds by your height in inches squared and multiplying that figure by 703.

Immediate Effects of Obesity When a body consumes more calories than it can use, it begins converting those calories into fat. Each fat cell weighs very little – less than 1 microgram. Together, however, masses of them can burden your limbs and surround internal organs, making every action and process more difficult to complete. In the short term, excess weight often results in:

Shortness of breath during easy or routine activities High cholesterol High blood pressure Prediabetes—blood glucose levels are elevated but not yet to diabetic levels Joint pain and inflammation, especially in the knees Aches, headaches, vague pains, and physical discomfort Indigestion and digestive problems Infertility and complications during pregnancy like gestational diabetes and blood clots Restricted mobility Fatigue Psychological distress Physical incompatibility with surroundings Excess weight affects every aspect of life. Your body is constantly struggling to function even while you try to keep up with family, friends, and coworkers. You end up feeling tired and achy because every one of your body’s systems is being overworked.

The Mobility Factor Perhaps the most devastating effect of obesity is the loss of mobility. If you can’t move, you burn fewer calories. Your metabolism slows, resulting in increased weight gain. Meanwhile, each pound you carry exerts a force on your bones.

With obesity, excess weight exerts a force on more than your knees. Every part of the skeletal system bears more weight than it was intended to handle. Meanwhile, you become increasingly isolated as your mobility restricts the activities you can participate in.

Long-Term Effects of Obesity Over time, short-term effects become chronic conditions and diseases. Lack of mobility only adds to the severity of problems like:

Hypertension, arteriosclerosis, and heart disease Diabetes mellitus Venous stasis disease and venous ulcers Stroke Osteoarthritis Pulmonary conditions like chronic obstructive pulmonary disease (COPD) Sleep disorders like sleep apnea Digestive disorders like gastroesophageal reflux disease (GERD) Gall bladder disorders Nonalcoholic steatohepatitis, or nonalcoholic fatty liver disease Incontinence Cancer, particularly of the colon, kidneys, gall bladder, breast, and uterus Depression Social isolation and discrimination 10 to 15-year decrease in lifespan When Diet and Exercise Aren’t Enough Sometimes, diet and exercise just aren’t enough – especially once medical issues decrease your mobility. When BMI is excessive, and your health hangs in the balance, surgical weight loss procedures may be able to help. These are approved medical procedures that have demonstrated repeated success in helping men and women lose weight and resolve serious, chronic health issues.

My Solution: https://amzn.to/3QHFW3J

[woundpros-releford-dr-bill]

What Is Ankle-Brachial Index And How Does It Diagnose Peripheral Arterial Disease?

Around 8 million people in the United States are reportedly suffering from peripheral arterial disease. It occurs due to stenosis and atherosclerosis in the vessels of the lower limbs which leads to decreased blood flow. The majority of people with the peripheral arterial disease are asymptomatic with severe disease characterized by pain during activity. As PAD is one of the leading indications for amputation, early detection and intervention is invaluable in limb salvage. The ankle-brachial index is an inexpensive, noninvasive diagnostic tool used by a variety of healthcare providers including podiatrists, wound care specialists, vascular surgeons, and specialist nurses.

What Is Ankle-Brachial Pressure Index?

The Ankle-Brachial Index was first described in the 1950s by Windsor. It is a non-invasive diagnostic modality that is used in screening and early diagnosis of peripheral arterial disease (PAD). It is a ratio between systolic blood pressure measured at the ankle and the systolic blood pressure measured at the arm. The comparison of blood pressures at these two points allows for the detection of stenosis in lower limb arteries. The stenosis of the vessels could be caused either due to atherosclerosis or compression from tissues. Even though there are slight variations in ABI (ankle-brachial index) depending on parameters like ethnicity, gender, and age, the overall reliability of ABI in the prediction of PAD is fairly consistent.

Although ABI is mainly used for the diagnosis of peripheral arterial disease, the ankle-brachial index can be helpful in monitoring wound healing and management of ischemic ulcers. In the setting of trauma, the ankle-brachial index can be helpful in the prediction of lower-limb arterial injury. To use ABI as a diagnostic tool, clinicians need to be aware of the normal values and classification of ankle-brachial index values. These include:

Normal ABI: 0.9 to 0.13

Mild ischemia: 0.8 to 0.9

Moderate ischemia: 0.7 to 0.8

Severe ischemia: 0.6 to 0.7

Critical ischemia: Less than 0.5

Values less than 0.9 are diagnostic of peripheral arterial disease. As patients with these ABI values are at a higher cardiovascular risk, they should be referred for further investigations. Low ABI values are also associated with ischemic ulcers, and therefore a measurement of ABI values can be helpful for podiatrists and wound care specialists in monitoring wound healing.

How Is Ankle-Brachial Index Measured?

The ankle-brachial index is measured after the patient has rested for at least 10 minutes in a supine position. This position is preferred over the seated position as it helps to alleviate the hydrostatic pressure. The patient should not be on any sedative or anesthetic agent as it can affect the accuracy of ABI measurement. The BP cuff which is at least 40% of the limb circumference is inflated over the brachial artery in the upper arm. A Doppler ultrasound or a stethoscope is applied to the brachial artery to note the cessation of arterial blood flow. The method is repeated over the arm, and the highest of the two readings is used in the calculation of the ankle-brachial index.

For the measurement of ankle systolic blood pressure, the BP cuff is applied above the level of the malleoli and blood flow is detected in either the dorsalis pedis artery or the posterior tibial artery. The choice of artery depends on the artery with the highest systolic blood pressure. The process is repeated on the other leg, and the value obtained is used in the calculation of the ankle-brachial index.

Diagnosis of PAD Using Ankle-Brachial Index

According to the recommendations by American Heart Association, clinicians should evaluate patients for suspected peripheral arterial disease if they are over 50 with a history of smoking, or the age of 70. This is because the majority of patients with the peripheral arterial disease (PAD) have no symptoms at rest, and can benefit from early screening. This is corroborated with findings from a screening study that detected PAD in 50% of asymptomatic patients using the ankle-brachial index.

The ankle-brachial index can detect proximal stenosis better than the distal one, and is most reliable for the detection of 50% stenosis. Low ankle-brachial index values are also associated with increased risk of cardiovascular disease, stroke, and mortality. It should be kept in mind that the NICE UK guidelines do not recommend the use of the ankle-brachial index in diabetic patients as the measurements obtained can be unreliable due to stiffening of the arteries.

Contraindications To Measurement Of Ankle-Brachial Index

The ankle-brachial index is an excellent diagnostic tool for the evaluation and screening of peripheral arterial disease. It can also help predict the risk of amputation and can be used in wound care for monitoring the progression of ischemic ulcers. However, the presence of certain conditions can limit the application of the ankle-brachial index. These include:

Deep Venous Thrombosis (DVT): The measurement of ankle-brachial index should be avoided in patients with suspected DVT according to the recommendations by American Heart Association. This is because there is a risk of embolization by compression with a BP cuff.

Severe Pain: In the presence of severe leg pain, ABI measurements should be avoided. High pressure can be extremely uncomfortable for the patients and can aggravate the pain.

[juniperpublisherscasestudies]

Juniper Publishers- Open Access Journal of Case Studies

Estimation of Superficial Venous Reflux with Duplex Ultrasound and Foot Volumetry

Authored by Helene Zachrisson

Abstract

Objective: To evaluate quantitative duplex ultrasound (DUS) parameters of reflux in patients with isolated great saphenous vein insufficiency.

Methods: 20 limbs were studied. DUS derived reflux time (RT, sec), peak reflux velocity (PRV, cm/s) and reflux volume flow (ml/min) were evaluated and related to expelled volume (EV, ml) and half refilling time (T50, sec) measured by water-based foot volumetry with and without compression of superficial veins.

Results: Reflux volume flow correlated significantly to all hemodynamic parameters assessed by foot volumetry, i.e., EV (p = 0.003), ΔEV (p = 0.006), T50 (p = 0.004) and ΔT50 (p = 0.011). PRV displayed a weaker correlation to foot volumetry parameters EV (p = 0.027) and T50 (p = 0.008). No significant correlation was found between RT and foot volumetry.

Conclusion: These results indicate that reflux volume flow may be a potential parameter in future attempts to quantify reflux using DUS in patients with isolated great saphenous vein insufficiency.

Keywords: Venous insufficiency; Foot volumetry; Duplex ultrasound; Pathophysiology; Anatomical distribution

Introduction

Chronic venous insufficiency is a common condition with clinical signs ranging from minor telangiectasias, varicose veins, edema to more severe stages with skin manifestations as eczema, lipodermatosclerosis and venous ulcers [1-3]. The diagnosis relies on physical examination (C of the CEAP classification, “Clinical Etiology Anatomy Pathophysiology”) [4] as well as noninvasive testing [3,5]. Duplex ultrasound (DUS) is considered to be gold standard and provides diagnostic information about the anatomical distribution of the disease [3,6]. A retrograde flow (reflux time, RT) of more than 0.5 seconds is generally used to define the presence of reflux [6]. However, individual RT does not seem to reflect the magnitude of reflux and the correlation between severity of disease or hemodynamic state and RT is limited [7]. Based on this it has been suggested that RT may be used for detection of reflux but other DUS derived parameters are needed for quantifying venous insufficiency [7,8]. Previous attempts to quantify reflux using DUS has involved peak reflux velocity (m/s), calculated reflux volume flow (ml/min) and reflux volume (ml) [7], however, the optimal method for quantifying reflux by DUS is still unclear [9]. Quantitative information of global venous hemodynamics can be derived from plethysmographic measurements such as strain gauge, photo, air as well as foot volumetry [10-12]. We have shown that it is possible to predict post-interventional outcome in Great Saphenous Vein Incompetence using strain-gauge plethysmography [10].

Foot volumetry may provide accurate information on the magnitude of global venous reflux as well as correlate to C in the CEAP classification [4,12]. The aim of the study was to evaluate DUS derived reflux parameters in patients with isolated great saphenous vein insufficiency (GSV) compared to quantifying plethysmographic measurements using foot volumetry.

Material and Methods

46 consecutive patients referred to Department of Clinical Physiology, Linköping University Hospital for evaluation of venous insufficiency in the lower limb were evaluated according to the study protocol. All patients were investigated with both Duplex ultrasound (DUS) and water-based foot volumetry. Six patients presented with small saphenous vein (SSV) insufficiency. Patients with mixed and/or isolated SSV insufficiency were excluded from the study. Finally, eighteen patients with isolated great saphenous vein (GSV) insufficiency (13 women and 5 men, mean age 59 years, range 40 – 90 years), two with bilateral GSV insufficiency (20 legs) were included in the study. Demographical and clinical data (C in CEAP) [4] is presented in Table 1. The study was approved by the regional ethical review board in Linköping, Sweden, and written informed consent was provided by each participant.

Duplex ultrasound

DUS examinations were performed with ACUSON S2000 system (Siemens Medical Solutions, Malvern, PA, USA) with 9 and 18MHz transducers. The 9MHz transducer was used for assessment of reflux. Patients were examined in the sitting position and superficial (saphenous veins and tributaries), perforator and deep veins (femoral, common femoral, deep femoral, popliteal, and calf veins) were scanned in both longitudinal and transverse planes. A distal manual compression was used to determine the valvular integrity. Normal veins were defined as veins with no reflux, normal reflux time (RT, duration < 0.5sec), or a very short reflux area (between 2 or 3 valves). If a pathologic reflux was detected, i.e., RT > 0.5sec, spectral Doppler measurements was performed along the vein in the longitudinal plane at 60o angle. Measurements were made in the insufficient GSV at the distal thigh level. At least three measurements were conducted at each point (proximal, mid and distal part on the thigh) and the mean value was used in the calculations. The anatomical extent of reflux was carefully noted, and no perforator reflux was noted on the calf or thigh level. Spectral flow velocity and vessel diameter was measured where the vein was straight, and turbulent areas were disregarded. The magnitude of reflux was quantified in several ways. i.e., RT (sec), peak reflux velocity (PRV, m/s) and time average velocity (TAV, m/s) during the first second of reflux. The vessel lumen was considered circular and the cross-sectional area was calculated as the area of a circle (A = Πr2 ) . Thus, reflux volume flow (ml/min) was calculated according to the following:

reflux volume flow (ml / min) = TAV (m / s) × A (cm2 ) × 60.

Hence, three DUS derived parameters were studied: RT (sec), PRV (m/s) and reflux volume flow (ml/min).

Foot volumetry

Global venous hemodynamics were evaluated with water- based foot volumetry [13]. The foot volumeter consisted of an open, water-filled box, which enabled measurements of volume changes during exercise [13]. Patients performed 20 knee bends at the rate of one every two seconds, and after the exercise phase was completed the patients remained completely still during the refilling phase. Expelled volume (EV, ml), and the time taken in seconds for 50% (T50) of the venous volume to be refilled was evaluated both with and without compression of superficial veins either above or below knee. A 10cm wide tourniquet was inflated to 60mmHg to achieve superficial compression.

Statistics

Values are expressed as mean ± SD unless otherwise stated. Spearman correlation coefficient (rho) were calculated for non-parametric linear association between different DUS parameters and foot volumetry measurements. p-values < 0.05 were considered significant. Statistical analyses were carried out using SPSS 24.0 for Windows (Armonk, NY: IBM Corp.).

Results

Isolated great saphenous vein (GSV) insufficiency was detected in 20 legs. DUS measurements displayed a mean vessel diameter of 4.2 ± 2.0mm. RT was 3.3 ± 1.3sec, PRV 45 ± 19cm/s, TAV 13.0 ± 6.9cm/s, and calculated reflux volume flow 128 ± 114ml/ min. EV was 13.6 ± 7.9ml, and T50 was 7.3 ± 6.4sec during foot volumetry without superficial compression. EV increased to 20.1 ± 8.1ml, and T50 increased to 13.0 ± 6.2sec after superficial occlusion. The calculated difference between foot volumetry measurements with and without superficial occlusion, i.e., ΔEV and ΔT50 were 6.5 ± 9.6ml and 5.8 ± 5.0sec respectively.

Table 2 shows the correlation between different DUS derived parameters and foot volumetry measurements. Reflux volume flow correlated negatively with foot volumetry parameters EV (rho = -0.626, p = 0.003) and T50 (rho = -0.613, p = 0.004). Reflux volume flow correlated positively with ΔEV (rho = 0.588, p = 0.006) and ΔT50 (rho = 0.554, p = 0.011). A negative correlation was also found between PRV and EV (rho = -0.493, p = 0.027) as well with T50 (rho = -0.574, p = 0.008). No correlation was detected between RT and foot volumetry parameters. Figure 1 shows reflux volume flow divided into three groups, mild refux (< 30ml/min), moderate reflux (30-100ml/min) and severe reflux (> 100ml/ min). This classification demonstrated a correlation with EV (rho = -0.519, p = 0.019), ΔEV (rho = 0.504, p = 0.023), T50 (rho = -0.589, p = 0.006) and ΔT50 (rho = 0.460, p = 0.041).

Discussion

This study was designed to evaluate different DUS parameters describing reflux in patients with isolated GSV and relate them to alterations in global venous hemodynamics based on water-based foot volumetry. The main findings were that particularly DUS derived reflux volume flow significantly related to global hemodynamic measurements during foot volumetry. Thus, the present study supports previous findings that reflux volume flow may be a potential parameter in future attempts to quantify reflux using DUS in patients with isolated GSV insufficiency.

DUS is a well-established method in the diagnosis of CVI and is able to measure several reflux components [6]. There has been numerous attempts to use one or more of these components as indexes for global reflux severity, although the most useful and reliable parameter for quantification of superficial reflux is still under debate. On the other hand, dynamic measurements of volume changes with plethysmographic methods may provide accurate quantitative information about whole limb venous haemodynamics and abnormalities in the reflux phase [10-12]. Foot volumetry was used in this study and previous findings suggest that it may provide accurate information on the magnitude of global venous reflux as well as correlate both to the clinical severity of the disease and the ambulatory venous pressure [12,14]. A further advantage with foot volumetry is that the method uses a dynamic and quite heavy situation, kneeling, which is supposed to simulate walking. In order to investigate the relation between DUS parameters and global reflux occlusion of the superficial system was accomplished with a tourniquet to evaluate the magnitude of superficial reflux in each patient.

RT was initially viewed as potential quantitative parameter and earlier studies found that patients with ulceration demonstrated a longer total mean RT than those without ulcers [15]. In the present study, no association was found between RT and any parameter of global reflux derived from foot volumetry. This is consistent with more recent studies who have shown RT to be a poor quantifier of individual reflux as well as an inadequate parameter to discriminate between disease severity [7,8,16]. Taken together, RT may primary be viewed as a qualitative parameter. Other parameters, such as, PRV has been found to provide a better quantitative evaluation compared to RT, e.g., PRV > 30cm/s has in previous studies been suggested as a risk factor for venous ulceration and patients with skin changes presented with significant higher PRV [17,18]. In line with this we found that PRV was associated to foot volumetric parameters EV as well as T50.

The parameters derived from DUS that showed best correlation with foot volumetry measurements was volume flow. Reflux volume flow was related to EV and T50 at baseline as well as to changes in global reflux after occlusion of the superficial veins evaluated by ΔEV and ΔT50. Assessment of retrograde flow volume has previously shown that reflux greater than 10ml/sec is related to a high incidence of skin changes [19] and volume flow also seems to correlate with the hemodynamic state measured with air plethysmography [7,8]. Although the association to clinical severity is still uncertain [7] our result suggest that reflux volume flow may provide a reflection of the magnitude of venous incompetence. In an attempt to classify the results of reflux volume flow in mild, moderate and severe reflux a correlation was found with all volumetric parameters, i.e., EV, ΔEV, T50 and ΔT50, when volume flow was divided into < 30ml/min (mild), 30-100ml/min (moderate) and > 100ml/min (severe). This characterization seems to agree with previous studies showing that normal values of EV and T50 appears to center around 16ml and 20sec respectively, although higher age may be associated with lower EV and T50 [14]. Based on the proposed groups, a gradual decrease in both EV and T50 can be seen as reflux volume flow was classified as moderate or severe. Correspondingly, no obvious improvement at group level was found in ΔEV and ΔT50 when volume flow was classified as mild reflux. However, in both moderate and severe reflux, ΔEV and ΔT50 displayed a gradual improvement. This kind of semi classification may be helpful in early diagnostics as well as postoperative follow up.

The purpose of this study was to compare different segmental DUS derived parameters in order to understand which of these parameters best reflected global hemodynamic changes in patients with GSV insufficiency. Based on this, reflux volume flow seemed to provide the most reliable results. Nonetheless, it should be noticed that the information provided by DUS cannot replace the global evaluation derived plethysmografic investigations, especially in patients with a more complex disease, such as, mixed deep and superficial incompetence.

Limitations

The present material is small and further studies are also needed to evaluate the suggested classification in relation to other parameters of global venous reflux as well as the relation between clinical severity and both DUS and plethysmographic data.

We recently developed for selective occlusion of superficial veins validated by ascending phlebology [10]. and this model must be evaluated in larger studies. Thus, larger populations need to be performed to assess DUS derived reflux volume flow with other parameters of global venous reflux and its correlation to clinical severity.

Conclusion

In the present study reflux volume flow appeared to best reflect the magnitude of venous incompetence. Further, a semi quantification derived from DUS investigation in individual vein segments is suggested by using limits for mild reflux < 30ml/min, moderate reflux 30-100ml/min and severe reflux > 100ml/min. Further and larger studies combining DUS and plethysmographic methods are needed to confirm the results as well as to evaluate the possible benefits of quantify reflux with DUS in the clinical practice.

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[valgasnewsthings]

In laboratory for gastropanel.

 And am share about still blood test ,which using today in gastroenterology. As calling a gastropanel, complex analysis,which allow to check a condition for stomach mucus,and finds Helicobacter pylori.As testing advising for patients,which are hard enduring gastroscopy and avoiding her by a reasons and gastropanel provides a definition are four indexes.

A first is immunoglobulin as talks about,that organism infected by pylori,pepsinogen rising in stomach ulcer and small bowel, and lowered in in atrophic gastritis.

Pepsinogen 2 nd as stat for condition a mucus stomach membrane, and gastrin 17 is stat for level a stomach secretion as salted acidity. And he is raised in chronic gastritis with a high acidity and lowered in mucus atrophy. And by a calculation stats that,this analyses helps diagnose infection of pylori, atrophic gastritis, gastro-oesophageal reflux and ulcer diseases,risk for stomach cancer displaying and other diseases.And blood on the gastropanel takes from vein on an empty stomach,and after this you are drink 100 ml. of sol. with a high containing soy protein and in 20 min.doing a repeating test. And ready to analyses having a few peculiarities.As before week till testing ,patient stopping remedies taking,which affecting on the stomach secretion,and before a day avoiding using remedies and neutralizing salted acidity,and on a morning avoiding smoking.

And gastropanel gives just a indirect signs for gastrointestinal pathologies,and for a right diagnosis needing combining with a doing esophagogastroduodenoscopy .And if patient having vomiting reflex,thus testing doing with narcosis,and just after a full testing is prescribing a full value  cure.

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Ulcer Index - How to Forecast Shorts and Filter Volatile Trades

Ulcer Index – How to Forecast Shorts and Filter Volatile Trades

24 May 2019 , Al Hill Overview of the Ulcer Index The Ulcer Index measures the amount of risk on a trade. Hence the name ulcer for the pain and stress these moves can inflict on the less skilled trader. In this article, we will test the indicator to see how well it can forecast extremes in the market. How to Calculate the Ulcer Index The index is all about calculating the level of risk by…

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Nutrition and Diet Weight Loss

The human body needs many nutrients for a healthy diet. Eating random food just to satiate the stomach and suppress the sense of hunger leads to an unbalanced and unhealthy diet, which causes many ailments. Inadequate or inadequate some nutrients may lead to deficiency of vitamins and minerals that the body needs, and may cause many different ailments, and consuming excessive and unbalanced foods may cause excess weight and organ fat. You can get help from a specialist dietician to eat a healthy and balanced diet, and request a proper diet plan for your own metabolism.

What is Diet?

It is a healthy nutrition program prepared by professional dieticians according to your body type and needs so that you do not risk your health by consuming more or less of the foods you consume in daily life. In general, by calculating the body mass index according to gender, age and weight criteria, a diet list is created to consume the nutrients you need after your ideal weight is determined. Your dietician may request different examinations and analyses when deemed necessary. At this point, it is useful to state the foods that you can never give up while eating with your dietician. While adding indispensable foods to your diet list, some foods are removed from the list for your proper and balanced diet, so you can eat healthy.

Who Is A Dietitian Called?

People who graduate from the 4-year nutrition and dietetics department of universities are called dieticians. Dieticians are not only interested in losing weight, but also examining the effects of nutrients on the human body. They can develop diet products by making nutritional analyses or prepare a diet program in accordance with the diseases of the people.

Healthy Weight Loss

In order not to be from your health while losing your excess weight, you should follow the diet lists prepared with a dietician. Incorrect programs implemented with hearsay information can lead to many health problems. To lose weight, you should pay attention to the following steps:

The     diet list should be tailor-made by a dietician.

The     diet program should be constantly updated by the dietician.

Shocked     diets should definitely be avoided.

No     main and snacks should be skipped in the personally prepared program.

Exercise     programs applied together with the diet help to lose weight faster and     healthier.

Personal Nutrition Plan

Diet lists that are useful for someone else may not weaken you, or they may cause muscle loss as your body will be deprived of the nutrients it needs. Each diet is prepared by a professional dietitian according to one’s own body features. So you can take control of your weight in a healthy way. These lists are prepared considering your body and personal demands.

Childhood Nutrition

Balanced and healthy nutrition is extremely important for children of growth age. Ensuring the growth and development of children and maintaining these habits is provided by protecting them from diseases such as hypercholesterolemia and type 2 diabetes. It is quite inconvenient for children to provide the high energy they need from foods and beverages that are high in calories. Consumption of carbonated beverages, as well as fast food, opens up potential health problems. Healthy and balanced nutrition of children of growing age is important for their mental and physical development. The height and weight of the children should be checked at regular intervals and whether they are in the right percentile according to the age range.

Nutrition During Pregnancy and Breastfeeding

Foods consumed during pregnancy are important for the development of the baby. Although it is normal to take 9-12 kg during this period, expectant mothers who start pregnancy over their normal weight should be more careful. However, trying to lose weight in this process is not correct behaviour. It is healthier for you and your baby to ask your dietitian to create a special program for you to eat healthy and adequate nutrition.

All three months of pregnancy are called trimesters, and the type of nutrition is different for all three periods. In general, it is normal not to gain weight in the first 3 months of pregnancy, that is, in the 1st trimester. You can prevent weight gain during this period with a proper nutrition program prepared by your dietitian. With the development of the baby in the 2nd trimester, the needs of the expectant mother change and additional calorie needs arise. During this period, storing fat in the body is considered a healthy condition. In the third trimester, in the last period of pregnancy, weight gain continues. This period is the period when the baby in the womb is growing and developing the fastest. With the right nutrition program, all needs of the baby and mother are met in a healthy way. Pregnancy Throughout your diet, your dietitian allows you to take the necessary nutrients and calories by changing the nutrition program and prevents unnecessary weight gain.

Diabetes Nutrition

Type 1 diabetes is mostly diabetes that occurs in childhood and youth. In addition to adequate and balanced nutrition, physical activity is also important. If you have this disease, it is important to learn from your dietician how to eat a balanced and proper diet in order to be healthy and increase your quality of life. In type 2 diabetes, diets of people with and without weight problems are prepared by the dietician. According to the needs of the body, protein, carbohydrate and fat requirements are planned and an appropriate program is created.

Weight Loss Plans for Overweight People

Excessive weakness and inability to gain weight are also harmful to health. Sugar and carbohydrate intake, which is applied unconsciously to gain weight, is not healthy. It is important to get professional help from a dietitian in the process, which can range from muscle and bone density reduction and organ damage, and follow the prepared schedule regularly. Usually, the following methods help gain weight:

Eating     more frequently and balanced by increasing the number of meals.

Not     to consume liquids before and during meals.

Consume     dried fruit.

Adding     additional foods such as walnuts, olives and cheese to the salad.

Special Nutrition for Stomach and Intestinal Patients

Healthy nutrition, which is one of the sines qua non of healthy life, plays a big role in the prevention or treatment of acute and chronic gastric and intestinal diseases. For stomach ailments such as indigestion, gastritis, ulcers, or intestinal disorders such as colitis, diarrhea and absorption disorder, your dietitian prepares a nutrition program by identifying the types of food you should and should not consume. It raises awareness of how these foods should be consumed and what you should and should not do after eating.

Inpatient Nutrition and Diet Services

Diet services applied to inpatients for different reasons in the hospital are applied by the dietician at the request of the physician. Nutritional programs that are specially prepared according to the person’s disease, gender, age and body structure help the treatment. During the routine checks on the patient, the nutrition program is changed and rearranged, followed by dietitian control during the hospital stay and the patient is informed. When the patient is discharged, the patient is followed by a suitable diet program.

Eating a balanced and healthy diet is effective in protecting the body health of people of all ages and preventing possible diseases. Thanks to the nutrition programs specially prepared by professional dietitians, unnecessary fat storage is prevented while taking all the nutrients the body needs. Do not forget to have your checks regularly to lead a healthy life and eat well.

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What is Diabetes Mellitus Lifestyle and Habits

It is a major, and a non-communicable disease results when your body does not make enough insulin or cannot use the insulin it produces. Of which most common being type 2.It can lead to number of health issues, few including

Heart diseases,

Stroke,

Kidney disease,

Blindness,

Nerve damage,

Leg and foot amputations.

Minor changes in your lifestyle can greatly decrease your chances of getting this disease. Therefore, in order to prevent the condition, few actions should be taken regarding the modifiable factors that influence the

development-lifestyle and natural diet of diabetes

Objectives of dietary treatment of diabetes mellitus

The Aims of dietary treatment of diabetes are following:

achieve the optimal blood glucose concentrations and blood lipid concentrations.

to provide appropriate energy for a reasonable weight, normal growth, and development, including during the pregnancy and lactation.

prevent, delay, and treat the diabetes-related complications.

improve health through balancing the nutrition.

The usually recommended daily energy intake for the non-obese diabetic patient is between 1500 and 2500 calories per day, the average allowance of the calorie intake being 2000 k calories per dayThe recommendation for the overweight diabetic patient should be between 800 and 1500 k calories per day, while the underweight (like that of growing children and adolescents) should be allowed at least about 2500 k calories/day. Accordingly this calorie planning the dietary chart with the diabetes controlling foods and follow dietary guide lines to control diabetes. Diets that are high in lots of insoluble fiber may offer the best protection against this metabolic disease. The Fruits and vegetables are high in cellulose-a type of insoluble fiber. Diets that are high in this fiber may able to help in the management of diabetes. Soluble fiber delay glucose absorption from our small intestine and thus helps to prevent the spike in blood glucose levels that follow a meal or snack. This can be done by

the alternative food substitutes for diabetics

.3 simple steps to managing your blood sugar with diet:

Begin a vegan diet: Avoid animal products

                                           Animal products contain fat like especially saturated fat, which are linked to the heart disease, insulin resistance, and other certain forms of cancer. These products also contain huge cholesterol and, of course, animal protein.

                                What is Diabetes mellitus lifestyle and habits!

Aim for 40 grams of fiber a day, in diet planning but start slowly. Load up on lots of beans, vegetables, and fruits. Choose the whole grains (like that of barley, oats, millet, whole-wheat, etc.). Aim for at least about 3 grams per serving on the food labels and at least 10 grams per the meal.

Avoid added vegetable oils and other high-fat food

Although most of the vegetable oils are in some ways healthier than the animal fats, you will still want to keep them to a some minimum. All the fats and the oils are highly concentrated in calories. A gram of any fat or oil will contains 9 calories, and compared with that of only 4 calories for a gram of carbohydrate, these calories counting can be done by the

calorie calculator/ counter

. Avoid foods like fried in oil, or oily toppings, and olives, avocados, and peanut butter which are high calorie content. Aim for no more than 2-3 grams of the fat per serving of food.

 Favor foods with a low glycemic index

The glycemic index identifies foods that increase the blood sugar rapidly.

Things to avoid in dietary planning:

Reduce salt (“sodium”) in diet

High blood pressure may also be present or co exist with your diabetes. Limiting some salt you eat can help to keep your blood pressure low. Decrease the amount of salt you are adding during cooking and reducing salt in recipes, before adding salt at the table, taste first, try seasoning your food with (salt-free) herbs or spices, and garlic. Can try Lemon juice brings out the natural saltiness of foods. Avoid the processed foods that are high in salt (sodium chloride) such as present in the canned or packaged foods or condiments such as the mustard, watch for “Na” (sodium) on the food labels. Chips or pretzels, and other such snacks are very high in salt, and check with your physician before using salt substitutes.

Alcohol

Limit the alcohol to less than 2 drinks per day (1 drink = 12 oz beer = 1.5 oz liquor = 4 oz wine)

Drinking alcohol is not recommended at all if you have high triglycerides (blood fats) or have high blood pressure or have liver problems, are pregnant or breastfeeding

Caffeine

Drink not more than four (4) cups of coffee or caffeine-containing beverages per day.

ROLE OF PHYSICAL ACTIVITY OR EXERCISE

Your regular physical activity helps your body cells to take up more glucose and thus lower blood glucose levels.

Your doctor and dietitian will help you to balance your physical activity with your anti diabetic medication and diabetic meal plan. If you are not physically active now, your doctor may recommend that you to increase your physical activity.

Important benefits of the regular aerobic exercise program in diabetes management include:

Decreased need for the insulin,

While Decrease risk of the obesity,

By Decreasing risk for the heart disease

Decreases the total cholesterol,

Improves the ratio of the low-density lipoprotein (LDL) to high-density lipoprotein cholesterol (HDL),

Reduces the blood triglycerides.

Decrease the blood pressure and lower the stress levels. .

Among all the walking is one of the easiest and the healthiest ways to exercise.

Few interesting facts about diabetes:

Merely having a sweet tooth or eating "too much" sugar, however, doesn't cause diabetes in a healthy person. The reality is your risk of diabetes increases due to many interrelated factors.

The risk of diabetes further increases for someone who has an immediate family member with diabetes, so eating too much sugar alone won't give you diabetes.

Diabetes, once developed, is a lifelong condition. While it can't be cured completely, it can be managed.With proper diabetes management, including medications and lifestyle modifications, you can lead a normal and fulfilling life.

Diabetes is not restricted to the older age group. In fact, three-fourths of the people with diabetes belong to the working-age group. Many children and adolescents have type 1 diabetes, too.

It's a common notion that having diabetes and getting started on treatment means you have to refrain from absolutely all sweets. However, with well-controlled blood glucose levels and regular exercise, it's generally safe to have a sweet once in a while.

Research suggests that some cases of diabetes and depression share similar biological origins. Hormonal imbalance as well as high blood glucose in diabetes causes an imbalance in the neurotransmitters, ultimately causing depression.

Unlike full-blown diabetes, prediabetes causes slightly high blood glucose levels. Without proper care, prediabetes can lead to a diabetes diagnosis and the serious issues that come with it. To preempt this development, it's important to keep an eye on your blood glucose levels.

Foot-related problems in diabetes occur due to poor blood circulation, damage to the nerves and slower healing. Proper diabetes care and regular inspection of your feet can help to avoid such problems.

Despite being particular about your medications, diet and exercise, your blood glucose levels may be high and your doctor may tell you to start taking insulin. (source)

Ways to avoid complications of diabetes:

Members of your diabetes care team — doctor or primary care provider, diabetes nurse educator, and dietitian, for example — can help you learn the basics of diabetes care and offer support along the way. But it's up to you to manage your condition.

Smoking increases your risk of type 2 diabetes and the risk of various diabetes complications, including: Reduced blood flow in the legs and feet, which can lead to infections, ulcers and possible removal of a body part by surgery (amputation) Heart disease Stroke Eye disease, which can lead to blindness Nerve damage Kidney disease Premature death

High cholesterol is a concern, too, since the damage is often worse and more rapid when you have diabetes. When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions.

Schedule two to four diabetes checkups a year, in addition to your yearly physical and routine eye exams.

Diabetes makes it more likely you'll get certain illnesses. Routine vaccines can help prevent them. Ask your doctor about: Flu vaccine.  Pneumonia vaccine.  Hepatitis B vaccine.  tetanus shot (usually given every 10 years). 

Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day with a fluoride toothpaste, floss your teeth once a day and schedule dental exams at least twice a year.

To prevent foot problems: Wash your feet daily in lukewarm water. Avoid soaking your feet, as this can lead to dry skin. Dry your feet gently, especially between the toes. Moisturize your feet and ankles with lotion or petroleum jelly. Do not put oils or creams between your toes — the extra moisture can lead to infection. Check your feet daily for calluses, blisters, sores, redness or swelling. Consult your doctor if you have a sore or other foot problem that doesn't start to heal within a few days. If you have a foot ulcer — an open sore — see your doctor right away. Don't go barefoot, indoors or outdoors.

If you have diabetes and other cardiovascular risk factors, such as smoking or high blood pressure, your doctor may recommend taking a low dose of aspirin every day to help reduce your risk of heart attack and stroke.

Alcohol can cause high or low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation, which means no more than one drink a day for women of all ages and men older than 65 and two drinks a day for men age 65 and younger.

If you're stressed, it's easy to neglect your usual diabetes care routine. To manage your stress, set limits. Prioritize your tasks. Learn relaxation techniques.

Get plenty of sleep. And above all, stay positive. Diabetes care is within your control.(source)

list of foods to be avoided by diabetes mellites:

Sodas and sweet drinks are high in carbs, which increase blood sugar. Also, their high fructose content has been linked to insulin resistance.

Trans fats are unsaturated fats that have been chemically altered to increase their stability. They have been linked to inflammation, insulin resistance, increased belly fat and heart disease.

White bread, pasta and rice are high in carbs yet low in fiber. This combination can result in high blood sugar levels.

Fruit-flavored yogurts are usually low in fat but high in sugar, which can lead to higher blood sugar and insulin levels.

Breakfast cereals are high in carbs but low in protein. A high-protein, low-carb breakfast is the best option for diabetes and appetite control.

Flavored coffee drinks are very high in liquid carbs, which can raise blood sugar levels and fail to satisfy your hunger.

Honey, agave nectar and maple syrup are not as processed as white table sugar, but they may have similar effects on blood sugar, insulin and inflammatory markers.

Packaged snacks are typically highly processed foods made from refined flour that can quickly raise your blood sugar levels.

Unsweetened fruit juice contains at least as much sugar as sodas do. Its high fructose content can worsen insulin resistance, promote weight gain and increase the risk of heart disease.

French fries are fried in unhealthy oils that may promote inflammation and increase the risk of heart disease and cancer.(source)

For more related articles regarding diabetes:

The lists of foods to be avoided by diabetes and their alternatives

Diabetes & Diet: Few best foods to control diabetes

How to reduce weight in a healthy way?

The role of glycemic index in control of diabetes mellitu

Get more health tips:

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Uridine Triacetate: the First Ever Chemoprotectant for 5-Fluorouacil Toxicity

Authored by  Krishnan V*

Abstract

Antimetabolites 5-Fluorouracil and capecitabine are used in many cancers including breast, colon, anal canal, etc. Toxicity of these agents is mild to severe and may be fatal, toxicity more common in high dose chemotherapy and patients with dihydropyromidine deficiency patients. Uridine triacetate approved as first ever chemoprotectant molecule to prevent 5-Fluorouracil and capecitabine toxicity.

Keywords: Flurouracil overdose; capecitabine adverse effects; chemoprotectant; uridine triacetate

Introduction

5 -Flurouracil (5-FU) is one the common anticancer drug belonging to antimetabolite category. Its Anatomical Therapeutic Calcification code is L01BC02 and its chemical formula is C4H3FN2O2. It is S phase specific agent, affects DNA synthesis and replication. It inhibits thymidylate synthesis enzyme and thereby conversion of deoxyuridine monophosphate to thymidine triphosphate.

Since its introduction in cancer chemotherapy, 5-FU used in various cancers. Currently it's a part of gastric cancer, breast cancer, colon cancer (FOLFOX regimen-Flurouracil, leukovorin, oxaliplatin) and (FOLIRNOX regimen-flurouracil, leukovorin, irinotecan, oxaliplatin) etc . Its congeners, floxuridine used intra-arterially in hepatic metastasis and capecitabine used in recurrent breast colon and breast cancer. 5-FU as a neoadjuvant therapy along with irradiation used in anal cancer, premalignant skin conditions and basal cell carcinoma, Adverse effects of 5-FU are considerable; they are severe gastric ulceration and fatal mucosal bleeding, severe leukopenia, hand foot syndrome, acute myocardial damage and acute cerebellar toxicity. 5-FU is one the low therapeutic index agent and requires careful precise intravenous administration. Toxic effects can be seen in normal individuals and more severe in patients with dihydropyrimidine dehydrogenase deficiency with more than eight percent mortality [1].

Uridine triacetate; clinical trials and FDA approval

This drug was granted approval by United states-Food and drug administration (US-FDA) as an orphan drug for patients with documented 5-FU toxicity or those who are exposed to high dose of 5-FU. It should be administered within 96 hours of signs and symptoms for optimum benefits. This molecule was evaluated in two trials comprising adult and pediatric patients of 135 sample sizes who were exposed to 5-FU or capecitabine and developed signs of toxicity. Success rate was more than ninety percent than the historical control where 5-FU toxicity mortality was severe and mortality rate was about 80 -85 percent [2] (Figure 1).

Uridine Triacetate; Pharmacodynamics

5-FU is converted in the body as as triphosphate derivative (FUTP). This derivative combines with ribonucleic acid (RNA) and form toxic intermediates which cause cell cycle arrest. Uridine from urdine triacetate is competitive to FUTP incorporation and thereby prevents the formation of toxic intermediates [3].

Uridine Triacetate; Clinical Pharmacokinetics

Its chemical formula is C15H18N2O9. It triacetate can be administered orally and available as oral granules in a sachet. It is s prodrug converted into active form by deacetylation and concentration maximum is attained is within two to three hours and it is also excreted faster from the body with a half of 4.5-5 hours. Dose for adults is 10g every 6 hours, can be given fifteen to twenty doses and pediatric dose must be calculated based on standard formula 6g/m2. It does not cause renal and hepatic impairment and can be used safely in renal or hepatic insufficiency patients; however there no evidence available till date to support its use in pregnancy and lactating mother [3].

UridineTriacetate; Post Marketing Status

Post marketing surveillance did not receive any serious adverse effects uridine triacetate. The common side effects are vomiting diarrhea and mild rashes. Wa, et al. [4] a leading gastrointestinal oncologist recently said on GI cancers and drug development program at San Francisco, Uritidine triactetae is expected to reduce more than ninety five percent of deaths from 5-Fu or capecitabine grade 3 to grade 5 toxicity. Few other reports are also encouraging the use of uridine triacetate [4-6]

Conclusion

Uridine triacetate discovery tends to ameliorate all theadverse effects of 5-FU without compromising its efficacyenables more efficient use of 5-FU with good patient compliance.

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In-Vitro Studies of Bio-Silver Nanoparticles in Cytotoxicity and Anti- Inflammatory- Juniper Publishers

Introduction

Nowadays, nanotechnology is a most promising amphitheatre for generating new applications in biotechnology and Nanomedicine [1]. Among several nanoproducts, a most prominent nanoproduct is nano silver. Silver nanoparticles (AgNPs) have become increasingly popular as an antibiotic agent in textiles and wound dressings, medical devices and appliances, such as refrigerators and washing machines [2]. AgNPs have been used for antimicrobial, antifungal, antioxidant, anticancer, and anti-inflammatory effects [3].

Green chemistry/Green synthesis is the design of chemical products or process that minimize the use hazardous chemical products and eliminate the environmental pollution. Therefore, green synthesis of metallic nanoparticles from biological sources instead of any other chemical products and from different methodologies is the promising and challenging field. Due to this reason, biological method has been prepared not only that it’s simple but cost effective too.

In several reports it is reported biological synthesis of silver nanoparticles by plants and their antimicrobial studies, but here the divergent attitude of mycosynthesis of silver nanoparticles by mushrooms, especially medicinal mushroom such as Ganoderma lucidum and their anti-inflammatory and cytotoxicity studies.

Several diversity of naturally occurring mushrooms is found to have promising antioxidant and anticancer properties and prolong the longevity [4]. Mushrooms are mostly known to have anti-inflammatory, cardiovascular, antitumor, antiviral, antibacterial, hepatoprotective and hypotensive activities in biological systems [5-7]. Studies in the edible and medicinal mushroom has revealed lots of beneficial therapeutic properties of them. In our study Ganoderma lucidum (Fr.) Karst. (Ganodermataceae),basidiomycetous fungi, has been widely used for the general promotion of health and longevity in Asian countries for centuries [8]. This edible mushroom was considered to preserve the human vitality and to promote longevity not only that the dried powder of mushroom was used as a cancer chemotherapy agent in ancient China [9]. In addition, Ganoderma lucidum has been used to treat various other disorders such as allergy, arthritis, bronchitis,gastric ulcer, hyperglycemia, hypertension, chronic hepatitis, hepatopathy, insomnia, nephritis, neurasthenia,scleroderma, inflammation, and cancer [10-14].

    Materials and Methods

Extraction of mushroom extract

Ganoderma lucidum mushroom obtained was washed several times with deionized water.

68g of finely blended sample was boiled for 2-5min in 300mL water and filtered. The filtrate is cooled to room temperature and used as reducing agent and stabilizer [15].

Synthesis of AgNPs

35mg AgNO3 is dissolved in 250mL water. To obtain silver colloids 6ml of mushroom was added in 30ml of AgNO3 solution. The formation of Ag nanoparticles is indicated by light yellow-brown colour and the reduction is completed in 30m. The formation of nanoparticles was examined under UV-visible spectrophotometer [15].

Characterization of the nanoparticles

The particle was characterized by UV-visible studies for preliminary confirmation, and the particles were subjected to HR-TEM studies for their size determination, EDAX to determine the percentage of metals present and XRD was done for determination of size and crystalline nature.

Human ethic clearance

All procedures involving human samples were strictly conducted in accordance with approved guidelines by the Institutional Human Ethics Committee (Ref No: FLL/ IEC/04/2014) by Frontier Lifeline Hospital - Institutional Ethics Committee (Ref: FLLH-IEC, Reg No: ECR/200/INST/TN/2013) and in accordance to the regulatory guidelines prescribed by Ethical Guidelines for Biomedical Research on Human participants, ICMR, 2006; Good Clinical Practice & Guidelines for Clinical Trials on Pharmaceutical products in India, CDSCO, DGHS, MoHFW, Govt of India, including Schedule Y 2005 and its revisions.

    In-vitro anti-inflammatory

Membrane Stabilization assay

Preparation of haemoglobin rich red blood cells suspension: The blood was collected from healthy human voluntary who has not taken any NSAIDs (Non steroidal antiinflammatorry drugs ) for two weeks prior to the experiment and transferred to the centrifuge tubes.It was centrifuged at 3000rpm for 10 min and were washed three times with equal volume of saline.The volume of the blood was measured and reconstructed with 10% V/V suspension with normal saline [16-18].

Heat induced haemolysis assay: The reaction mixture 2ml (Sample A and sample B ) consisted of 1ml of test sample of different concentration (1.4,4.32,8.64,12.9,14.4,21.6 mg/l) and 1ml of 10% hRBCs suspension ,instead of test sample only saline was added to the control test tube.Aspirin (100μg/ ml) was used as standard drug.All the test tube containing reaction mixture was incubated in water bath at 56 0C for 30 minutes.After the incubation,it was cooled for 5min.Then the reaction mixture was centrifuged at 2500 rpm for 5 min and the absorbance of the supernatant was taken at 560nm using UVVis spectrophotometer [19,20]. The experiment was performed in triplicates and percentage inhibition of haemolysis was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Hypotonicity induced haemolysis assay: The reaction mixture 3ml (Sample A and B) consisted of 0.5ml of different concentration (1.4,4.32,8.64,12.9,14.4,21.6mg/l) and 2ml of hyposaline,0.5ml hRBCs suspension,in control test tube instead of test sample 0.5ml of phosphate buffer was added.Diclofenac sodium (100μg/ml) was used as standard drug. All the test tube were incubated at 37 0C for 30 minutes and centrifuged at 3000 rpm for 10 min.The absorbance of supernatant was taken at 560nm using UV-Vis spectrophotometer [21]. The percentage inhibition of haemolysis was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Protein denaturation

Inhibition of Albumin denaturation: The equal amount of 3ml reaction mixture (0.2ml egg albumin + 2.8ml phosphate buffer saline) was added to different concentration of test sample and make up the 2 ml of distilled water. In control test tube instead of test sample, PBS was added.Aspirin (100μg/ml) was used as standard drug. All the test tube were incubated at 370C for 15 minutes and incubated at 70 0C for 10 minutes. The samples were cooled for 5 minutes and absorbance was noted at 660nm using UV-Vis spectrophotometer [22]. The percentage inhibition of albumin denaturation was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Inhibition of BSA denaturation: The equal amount of 450μl BSA(1mg/ml) was added in different concentration (10,30,60,90,120,150μl/ml) of test samples and made up into 1ml of distilled water. All the rest of steps were followed according to the albumin denaturation [22].

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Proteinase inhibition assay: The test followed according to the modified method of [21]. The reaction mixture (2ml) containing 6μl trypsin, 1ml (20mM) tris HCl and along with different concentration of test samples.The mixture was incubated at 37 oC for 5 min after that 1 ml of 0.8% (w/v) casein was added. The mixture was incubated again for 20min, 2ml (70%) perchloric acid was added to arrest the reaction. Cloudy suspension was observed,it was centrifuged for 5 min and the supernatant was read at 210 nm using UV-Vis spectrophotometer. Control was run as same procedure but instead of test sample PBS was suspended [21]. The percentage of inhibition of antiprotienase was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

HET- CAM assay

Pellet preparation: 7.25mg sodium dodecyl sulfate was dissolved with or without concentration of chitosan and sacchachitosan transdermal films in 1ml of agarose solution. 10μl of gelling solution was used for pellet preparation.

Incubation [22,23]: The fertile hen eggs were incubated for 75h at 37 °C and relative humidity of 80%.The eggs were kept in horizontal position and rotated several times. Then open snub end after aspiration of 10ml of albumin from hole. Eggs were traced with scalpel and thereafter the shells were removed with forceps. One pellet per egg was put on newly formed chorio-allanthoic membrane, agarose pellet without SDS acts as negative control, agarose pellet with SDS acts as positive control and agarose pellet with SDS and tested sample acts as treatment. The aperture was covered with parafilm and eggs were returned into the incubator for 24h of incubation.

Interpretation [24]: The inhibition or membrane irritation was observed. Positive control egg, exist if the irritation of membrane induced by SDS. Negative control egg, exist no irritation of membrane. Treated group egg, exist various irritation according to concentrations used.

Three irritation reactions such as hemorrhage, lysis and coagulation were monitored and image was taken with the help of SONY 14.1megapixels video camera at 35cm above CAM. Time was recorded in seconds, from addition of SDS until the appearance of three irritation reaction.

Calculation [25,26]: Irritation index was calculated using following e equation.

IR=300x(IR)=5x(301-TL)+9x(301-TC)

Time (T) of hemorrhage (H), lysis (L), and coagulation (C) during a period of observation of 300 seconds. IR can take values between 0 and 21.

Relationship of starting irritation reaction was denoted by H’, L’, and C’.

Antioxidant assay

DPPH assay: The free radical scavenging activity of the fraction was measured in vitro by 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay.About 0.3 \mM solution of DPPH in ethanol was prepared and 1ml of this solution was added to 3 ml of the fraction dissolved in ethanol at different concentration.The mixture was thoroughly mixed,incubated at RT for 30 minutes.Then the reading was taken at 517 nm using UV-Vis spectrophotometer [27]. Ascorbic acid was used as standard drug.The percentage of inhibition of DPPH was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Lipid peroxidation assay: Liver was obtained and homogenized using phosphate buffer. Reaction mixture I consists of 1ml liver homogenized(10% W/V),1 ml different concentration of test sample.Lipid peroxidation was induced by 100μl (15mM) ferrous sulphate.Its incubated for 30 minutes at RT.0.1ml reaction mixture II (1% SDS & 0.1% thiobarbutric acid) added to all test tube and made up to 1 ml with distilled water and incubated for 1 hour at 95 oC, After butanol and pyridine was added in the ratio 2:1. The reaction was mixed thoroughly and centrifuged at 3000 rpm for 15 minutes to separate the layers. Organic layer was separated and read at 530nm using UV-Vis spectrophotometer [28]. The percentage of inhibition of lipid peroxidation was calculated as follows;

Percentage inhibition=(Abs control-Abs sample)X 100/Abs control

Cytotoxicity assay

Cell Line and Culture Conditions: Vero and HeLa cell line were purchased from the virology dept of king’s institute,Guindy,chennai . The cancer cell line was maintained in RPMI-1640 culture medium supplemented with 10% fetal bovine serum, 100μg/ml penicillin and 100 μg/ml streptomycin in a 5% carbon dioxide (CO2) cell incubator at 37 °C

MTT assay: The 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide dye reduction assay was performed to determine the cytotoxic effect of the AgNPs at various concentrations. The assay depends on the reduction of MTT by mitochondrial dehydrogenase, an enzyme present in the mitochondria of viable cells, to a blue formazan product. The cell concentration was adjusted to 1 × 105 cells/ml and plated onto 96-well flat bottom culture plates with various concentrations of AgNPs. All cultures were incubated for 24 hours at 37 °C in a humidified incubator. After 24 hours of incubation (37 °C, 5% CO2 in a humid atmosphere), 10ml of MTT (5mg/ml in PBS) was added to each well, and the plate was incubated for a further four hours at 37 °C. The resulting formazan was dissolved in 100 ml of dissolving buffer (provided as part of the kit) and absorbance of the solution was read at 595nm using an Elisa reader. All determinations were carried out in triplicate [29]. Concentrations of AgNPs showing 50% reduction in cell viability (i.e., IC50 values) was then calculated.

Apoptosis Assay - Ethidium Bromide / Acridine Orange Staining: The cells were stained to assess the level of apoptosis [30]. After the treatment period the cells were trypsinized and isolated. 25μl of cell suspension was mixed with 5μl acridine orange and 5μl of ethidium bromide. 10μl of the mixture was added to frosted glass slides and viewed under fluorescent microscope immediately. Cells were analyzed in fluorescent microscopy under 10X objective.

Statistical analysis

Data pertaining to antioxidants and anti-inflammations of silver nanoparticles were expressed as mean ± SEM, n = 6 and the data were analyzed by One-way ANOVA using GraphPad Prism version 6.00 for Windows (GraphPad Software, La Jolla California, USA). In all the analysis, P < 0.05 was considered as statistically significant.

    Results and Discussions

The study on biological synthesis of silver nanoparticles has been previously reported by us [31]. Further applications and cytotoxicity of synthesized silver nanoparticles has been reported in this work.The synthesis of silver nanoparticles from Ganoderma lucidum was confirmed and characterized by various analytical techniques such as UV-VIS spectroscopy,HR-TEM,ICPOES, XRD,EDAX and SAED (Figure 1-5, Table 1 & 2 ).

Several concentration ranging from 1ssmg to 21.6mg of synthesized silver nanoparticles sample was tested for their antioxidant activity in different in-vitro models. It was observed that free radical scavenged by the sample (standard.Ascorbic acid and tested.Silver nanoparticles) in their unique percentage of inhibition in a concentration dependent manner. Figure 6-7 reveals the reductive capacity of tested samples compared to that of standard [32-35].

In the DPPH method, the antioxidants present in the silver nanoparticles reacts with the stable DPPH (deep violet colour) and converts it into 1, 1 diphenyl-2-picrylhydrazine with discoloration. In the present study, the percentage of inhibition of free radicals at different concentrations ranging from 1-21.6 mg for the tested samples was calculated and compared with the standard ascorbic acid and the results are revealed in Figure 6. This is the common and successfully used method for investigating both hydrophilic and lipophilic antioxidant properties [36-38]. The inhibitory effect (IC-50) follows, SNPs (9.0±.001mg/ml) and Std. Ascorbic acid (7.0±.003mg/ml) respectively. The prominent results were observed with the Bio-silver nanoparticles that may be due to synergy effect of components such as Ganoderma lucidum and silver nanoparticles comparable to standard ascorbic acid.

Lipid peroxidation is a critical procedure in free radical pathology as it is cause damage to cells. The liver of hen was utilized as a source of polyunsaturated unsaturated fats for determining the degree of lipid peroxidation [39]. Malondialdehyde is lipid peroxidation product is a pointer of receptive oxygen species (ROS) generation in the tissue restraint of lipid peroxide development by tested sample (silver nanoparticles) and standard (ascorbic acid) appeared in Figure 7.

Anti-inflammatory assays

The HRBC membrane stabilization is one of the techniques followed to study the anti-inflammatory activity. Erythrocytes membrane is closely resemblance of lysosomal membrane [40,41]. Furthermore, stabilization of the lysosomal membrane depends on the sample and the concentrate, stabilization of lysosomal membrane is vital in constraining the inflammation response by preventing the release of initiated neutrophil, for example, bacterial proteins and proteases, which creates additional tissue irritation and damage upon extracellular discharge. The enzyme released during response results in various disorder especially with chronic and acute inflammation. The role of drug administrated showed the inhibition and stabilization of lysosomal membrane.

The inhibition of hypotonicity induced HRBC membrane lysis and the stabilization of the membrane by tested sample (silver nanoparticles) and standard sample (Diclofenac sodium) was taken as the measure of anti-inflammatory activity. The percentage of inhibiting lysis of membrane depends on tested sample,it was depended on concentration gradient the tested sample (Silver nanoparticles) were significant (P<0.05) to that of standard drug and has been illustrated at Figure 8. Silver nanoparticles showed the maximum protection of 58% at the concentration 21.6mg, whereas diclofenac sodium showed 69% at the concentration range of 15mg.

The tested samples were analysed to study the inhibiting reaction against the membrane lysis. From the results observed all the samples along with standard showed a good and statistically significant (P<0.05) protection of erythrocyte membrane from damage. The detailed report has been analysed and reported at Figure 9.

Protein denaturation is technique in which the protein loses their original form by the external stress or any other chemical compounds [42]. It is one of main cause during the inflammation process. As part of our investigation on the anti-inflammatory mechanism, different concentration of test sample along with standard were checked for the ability of inhibiting protein denaturation. It was effective in inhibiting the protein denaturation; checked with egg albumin and maximum protection was seen in tested sample (sacchachitosan transdermal film) 79.71% & 72.3% at the concentration range of 36.7mg/L, whereas 50% of inhibition was seen at range of 1-2mg/L, other samples shows the maximum inhibition activity such as follows GL;50.1 & 49.86% (15mg/ml), SNPs; 70.06% & 72.54% (21.6mg/ml), C; 64.32% & 67.63% (15mg/ml), Sc; 61.8 & 65.16% (15mg/ml) and CF; 73.24 & 73.23% (32.5mg/l) compared with std. diclofenac sodium; 61.78 & 74.32% (15mg/ ml). Each value represented (Figure 10 &11) the average mean ± SEM; N=6. All the samples were statistically compared with the standard ****P<0.001 considered extremely significant (oneway ANOVA followed by ordinary test was performed using GraphPad Prism version 6).

Serine proteinase is one of major enzyme released from neutrophils and plays a vital role in the development of tissue damage during inflammation response [43] and significant protection was given by proteinase inhibitors. Samples such as SNPs and standard diclofenaic sodium exhibited significant antiproteinase activity at different concentrations as illustrated in Figure 12. Samples showed maximum inhibition of SNPs; 77.18% (21.6mg/ml) and Diclofenac sodium; 74.36% (15mg/ml). It’s significant ****P<0.001 with standard (diclofenac sodium).

HET-CAM assay is a unique model to analyse the antiinflammatory role. The two concentrations such as low and high concentration of silver nanoparticles was taken to analyze the role of anti-inflammatory and the membrane irritation resistant. Haemorrhage, lysis and coagulation are the different parameters to be observed during this study.

The inhibitions of irritant reaction in the group of negative control (Induced-SDS) and in the treatment group (silver nanoparticles-SDS) are subjected to chorioallantoic membrane and the changes in CAM was observed and shown at Figure 13. The mean time for the initial irritation reaction in the membrane for each one from tested to control has been calculated and shown (Table 3). From the results; it clearly shows that low concentration gave less irritation compared to higher concentration. There was significant statistical difference between concentrations. Intensive studies of anti-inflammatory analyses are carried by different researchers [44-46] in context with different application. Accordingly, this study has revealed the scientific justification that silver nanoparticles posses antiinflammatory property. Hereby may be taken further for in-vivo wound healing activity Figure 14.

Cytotoxicity assay

3-(4, 5-Dimethylthiazol-2-yl)-2, 5-diphenyl tetrazolium bromide assay was performed to evaluate the cytotoxicity effect of silver nanoparticles against the African green monkey kidney cell (vero) and cervical cancer cell (HeLa). The different concentrations of samples were used to determine the cell viability after 24hrs incubation of cells with test samples. The cytotoxicity was dependent fully on concentration gradient as the concentration increased mild toxicity was observed at vero but in HeLa cytotoxicity level was higher and viability of cells are lesser (14). The data was analysed by two-way ANOVA followed by paired T tail test to determine significance difference and correlation between samples. From the results, we have observed that significant (P<0.05) difference and correlation (P>0.05) between cell viability and cell inhibition. Similar kind of studies was portrayed by [47], with different extract in to compare toxicity.Further AO-EB staining was performed to analysis the apotosis of cells, IC50 value (5.10±0.41mg/ml) of silver nanoparticles in HeLa cells reveals almost 60% Figure 15.

The apototosis and necrosis property of silver nanoparticles was assesd by IC 50 value against HeLa cells using acridine orange and ethidium bromide dual staining.It was incubated for 24h and picture was taken with fluorensce microscope.The treated cells showed early apoptotic cells with the appearance of fluorensce green nuclei due to nuclear fragmentation and chromatin condensation and necrotic cells indicated by orange coloured cells due to the condensation of nuclei; nuclear shrinkage and blebbing.Thus confirming apoptotic activity (see fig ). Similiar kind of results were followed with different cancereous cells [48- 50]. On comparison, the untreated (control) cells showed green color when stained with AO-EB, indicating their viability nature.

    Conclusion

The outcomes of our research work demonstrated that the biological synthesized silver nanoparticles have indicated less toxicity impact on normal cell line than cancerous cell line and have advocated the ramifications of silver nanoparticles in curing inflammations and tumour suspected afflictions. Additionally this investigation is a bench top model and may be explored further for the anti-inflammatory and wound recuperating application.

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echolocation, effectuation, effemination, elementation, emancipation, emargination, emasculation, embolization, endenization, energization, envenomation, equalisation, equalization, equivocation, etherization, exacerbation, exacervation, exaggeration, exasperation, exauguration, excalceation, excogitation, excruciation, exenteration, exercitation, exhilaration, existimation, expatriation, expeditation, extuberation, facilitation, faradization, felicitation, feminisation, feminization, finalisation, finalization, fluidization, focalisation, focalization, gamification, gasification, genetization, habilitation, hepatisation, hepatization, hominization, homologation, humanisation, humanization, humification, idealization, illimitation, illumination, immiseration, immoderation, immunisation, immunization, inactivation, inadaptation, inadequation, inauguration, incatenation, incineration, indenization, indigitation, infibulation, ingemination, inhabitation, innoculation, inordination, inosculation, insanitation, insemination, integumation, intimidation, intoleration, intoxication, invagination, invalidation, invigilation, invigoration, invultuation, islamization, japanimation, labanotation, laterization, latinisation, latinization, legalisation, legalization, legitimation, levorotation, localisation, localization, ludification, maderization, majorization, manipulation, maximization, memorisation, memorization, minification, minimisation, minimization, miseducation, mobilization, modification, monetisation, monetization, moralisation, moralization, morigeration, motorisation, motorization, mutarotation, nasalisation, nasalization, nazification, nebulization, nidification, nobilitation, notarization, notification, novelisation, novelization, nudification, obliteration, obnubilation, opsonisation, opsonization, optimisation, optimization, organisation, organization, ossification, pacification, palification, panelization, panification, paralyzation, penalisation, penalization, peroxidation, perpetuation, polarisation, polarization, purification, quantitation, ramification, rarification, ratification, re-education, reallocation, reamputation, recidivation, recuperation, redecoration, rededication, regeneration, rejuvenation, rememoration, remuneration, renomination, renumeration, renunciation, repatriation, repopulation, reregulation, resupination, revalidation, revegetation, robotization, romanization, rubification, salification, salinisation, salinization, sanitisation, sanitization, saudiization, sinicization, solarisation, solarization, solicitation, somatization, subagitation, suberization, tetanization, theorisation, theorization, tokenization, totalization, tripudiation, typification, umbilication, unionisation, unionization, upregulation, urbanisation, urbanization, valorisation, valorization, vaporisation, vaporization, vasodilation, vehiculation, verification, vesiculation, vigesimation, vilification, vinification, virilisation, virilization, vitalisation, vitalization, vituperation, vivification, vocalisation, vocalization, vociferation, abalienation, idealisation, reevaluation, rejuvination coach station, shore station, space station, backwardation, balkan nation, concentration, conflagration, confrontation, conspurcation, constellation, consternation, constupration, contemplation, contrectation, demonstration, dephlegmation, floccillation, fractionation, fragmentation, frequentation, gene mutation, ghettoisation, guesstimation, labefactation, montserratian, mortification, orchestration, paid vacation, pair creation, perlustration, perscrutation, power station, preadaptation, prestigiation, prosternation, reembarkation, reinnervation, remonstration, scintillation, seguestration, sequestration, sexploitation, strangulation, supplantation, transforation, translavation, translocation, transmutation, transpiration, transvasation, transvolation, acceptilation, accombination, accommodation, accreditation, admensuration, afforestation, agglomeration, agglutination, amelification, amplification, anglicization, annuitization, antilibration, appendication, appersonation, appropriation, approximation, argumentation, assassination, attemperation, authorisation, authorization, bacterization, balkanization, barbarisation, barbarization, brutalisation, brutalization, calcification, cannulization, caprification, carbonatation, carbonisation, carbonization, carburization, carnification, cartelization, casualization, cauterisation, cauterization, centesimation, cephalization, certification, chymification, cicatrization, cladification, clarification, cliticization, co-ordination, cocainization, cognomination, collaboration, commemoration, communication, communisation, communization, concameration, concatenation, confabulation, confederation, configuration, conglaciation, connumeration, consideration, consolidation, contamination, cornification, corroboration, craterization, customisation, customization, damnification, dandification, de-escalation, decapsulation, decortication, decrepitation, defibrination, deforestation, deglutination, deltafication, demethylation, densification, dentalization, derealization, desegregation, determination, diffarreation, dignification, discalceation, discoloration, disestimation, disfiguration, disjudication, disobligation, disoccupation, disordination, disreputation, dissemination, disseveration, dissimilation, dissimulation, distanciation, diverberation, documentation, dogmatization, dollarization, domestication, dramatisation, dramatization, dulcification, dysregulation, effascination, electrization, equilibration, euthanisation, euthanization, exauthoration, excerebration, expectoration, expostulation, expropriation, exsuscitation, extermination, extrapolation, extravagation, extravasation, factorisation, factorization, falsification, fasciculation, ferrugination, ferrumination, fertilisation, fertilization, fetishization, florification, formalisation, formulization, fortification, fossilisation, fossilization, galvanisation, galvanization, gemmification, ghettoization, glamorisation, glamorization, globalisation, globalization, glocalization, glorification, glycosylation, graticulation, gratification, hallucination, harmonisation, harmonization, haruspication, herborization, hornification, horrification, horripilation, hybridisation, hybridization, hydrogenation, hydroxylation, hypnotization, hypohydration, hypothecation, immasculation, impersonation, impreparation, improvisation, inapplication, incarceration, incommodation, incorporation, incrimination, infrigidation, ingravidation, ingurgitation, instantiation, insusurration, intercalation, interlucation, interlunation, intermication, intermination, intermutation, interpolation, interrelation, interrogation, intravasation, investigation, jollification, justification, labialisation, laevorotation, lemmatization, lignification, liquification, lithification, magnetisation, magnetization, magnification, malacissation, maladaptation, maleformation, mammonization, manifestation, martyrization, mechanisation, mechanization, mellification, mesmerization, metallization, metrification, micengenation, microperation, misallegation, misallocation, miscegenation, misestimation, modernisation, modernization, mollification, multilocation, mummification, mutualization, mystification, necessitation, nigrification, nitrification, noctivagation, nonlimitation, normalisation, normalization, nullification, objectivation, obsigillation, obtenebration, ornamentation, ostracization, palletization, participation, patrocination, patronization, pauperisation, pauperization, perambulation, peregrination, periclitation, perseveration, pervaporation, pervigilation, petrification, phonetization, pidginization, planification, plebification, pluralization, podzolization, pollicitation, pontification, preambulation, precipitation, preconization, prededication, predomination, preexcitation, prefiguration, premedication, premeditation, prenomination, prenunciation, preoccupation, prevarication, privatisation, privatization, progeneration, proliferation, prolification, prononciation, pronunciation, protuberation, pulverisation, pulverization, putrification, qualification, racialization, randomisation, randomization, reaffirmation, reaggravation, reapplication, recalculation, recalibration, reciprocation, recognization, recombination, recompilation, reconcilation, recrimination, rectification, reduplication, reexportation, refabrication, refocillation, reforestation, refrigeration, regermination, regimentation, regurgitation, reincarnation, reintegration, reliquidation, remastication, republication, resegregation, resuscitation, reverberation, rhetorication, routinization, ruggedisation, ruggedization, russification, sacralization, scarification, scorification, sedimentation, sensitisation, sensitization, sermocination, signalization, signification, socialisation, socialization, solemnisation, solemnization, specification, sporification, stabilisation, stabilization, stalinization, sterilisation, sterilization, subordination, subpopulation, subsidisation, subsidization, subtilization, suffumigation, summarisation, summarization, superfetation, supernatation, syllabication, symbolisation, symbolization, syphilization, systemisation, systemization, tantalization, teleportation, temporization, tenderization, terrorisation, terrorization, testification, thematization, thurification, trabeculation, triangulation, tribalisation, tribalization, trilateration, tuberculation, tussiculation, vacuolization, vandalization, vectorization, verbalisation, verbalization, verbification, verbigeration, vernalization, versification, victimisation, victimization, visualisation, visualization, vitrification, volcanization, vulcanisation, vulcanization, vulgarisation, vulgarization, winterization, zincification, zombification, acetification, acidification, actualisation, actualization, adipoceration, anatomization, animalisation, animalization, arabicization, aromatization, beatification, beneficiation, coalification, deaminization, demyelination, deodorization, deoxygenation, deterioration, economization, indianization, individuation, isomerization, italicization, labialization, linearization, maleficiation, mediatization, opacification, overvaluation, periodization, radiolocation, ratiocination, re-evaluation, reaffiliation, reexamination, renegotiation, reorientation, reunification, serialisation, serialization, sexualization, sovietization, variolization blaxploitation, blood relation, diphthongation, mistranslation, pair formation, petrol station, point mutation, preexpectation, premonstration, reinstallation, remote station, skin sensation, social station, subway station, transformation, transmigration, transportation, administration, african nation, aftersensation, aggrandization, authentication, bastardisation, bastardization, bowdlerisation, calamistration, carbunculation, castrametation, centralisation, centralization, centrifugation, channelisation, channelization, circumgyration, classification, commensuration, concelebration, concretization, concrimination, conduplication, conglomeration, conglutination, congratulation, consarcination, contemperation, contesseration, crystalization, decaffeination, decompensation, deconsecration, defenestration, defibrillation, depigmentation, deregistration, dethronization, dextrorotation, differentation, disaffirmation, disaggregation, disapprobation, discolouration, disconsolation, discretization, discrimination, disembarkation, disforestation, disinclination, disinfestation, disinformation, disintegration, disneyfication, distermination, downregulation, enthronisation, enthronization, esterification, eutrophication, exsanguination, finlandization, fluoridisation, fluoridization, fraternisation, fraternization, fructification, fundoplication, generalization, gentrification, grammatication, graphitization, grossification, hyperinflation, implementation, incontentation, incrementation, indoctrination, interbastation, intergradation, intermigration, interpellation, interpretation, interspiration, inthronization, legal relation, liberalization, lysogenisation, malobservation, manustupration, misapplication, miscalculation, miscollocation, miscomputation, misexplanation, misinformation, mongrelization, multiplication, naturalization, neutralisation, neutralization, noctambulation, noncooperation, nonexportation, nostrification, obstetrication, pasteurization, perterebration, plagiarisation, plagiarization, plasticization, pneumatization, predestination, prefabrication, prefecundation, preponderation, pressurisation, pressurization, prettification, pronounciation, quantification, re-embarkation, recalcitration, recommendation, recompensation, reconfirmation, reconsecration, refridgeration, reglementation, representation, repristination, retrogradation, sanctification, sanguification, scandalisation, scandalization, schematisation, schematization, schilerization, scrutinization, sensualization, set decoration, simplification, somnambulation, sophistication, specialisation, specialization, stigmatisation, stigmatization, stratification, stultification, subalternation, subinfeudation, substantiation, superlucration, superpurgation, symmetrization, tabloidization, tergiversation, testamentation, thermalization, transamination, transanimation, transvaluation, traumatisation, traumatization, tubal ligation, tyndallization, uninstallation, uterogestation, virtualization, weatherization, westernisation, westernization, aerosolization, alcoholization, alkalinization, ammonification, autoionization, automatization, autoregulation, autotoxication, axiomatization, beautification, beta radiation, biodegradation, calorification, capitalisation, capitalization, categorisation, categorization, decimalisation, decimalization, defeminization, dehumanisation, dehumanization, delocalization, demobilisation, demobilization, demonetization, demoralisation, demoralization, denazification, deossification, depolarisation, depolarization, desalinisation, desalinization, detoxification, devitalisation, devitalization, digitalisation, digitalization, disaffiliation, disambiguation, disassociation, disorientation, eburnification, emulsification, envenomization, epithelization, etherification, evangelisation, evangelization, exarticulation, federalisation, federalization, foreordination, gelatification, gelatinization, generalisation, generification, homogenisation, homogenization, humidification, identification, immobilisation, immobilization, incapacitation, incivilization, incoordination, indigenisation, indigenization, initialisation, initialization, inorganization, intermediation, interoperation, irregeneration, keratinisation, keratinization, lateralisation, lateralization, legitimisation, legitimization, lexicalization, liberalisation, literalization, lyophilisation, lyophilization, lysogenization, metabolization, militarisation, militarization, mineralization, misimagination, monopolisation, monopolization, naturalisation, nominalization, nonrepudiation, osmoregulation, overestimation, overmedication, overpopulation, overregulation, oversaturation, pasteurisation, politicization, polymerisation, polymerization, popularization, radicalization, re-examination, recanalization, recapitulation, reconciliation, regularisation, regularization, rehabilitation, reinvigoration, renidification, reorganisation, reorganization, repolarization, revitalisation, revitalization, revivification, rigidification, saponification, secularisation, secularization, securitisation, securitization, seminification, silicification, solidification, solubilization, superannuation, supererogation, superovulation, tabularization, topicalization, trivialisation, trivialization, ubiquitination, uncivilization, undervaluation, uniformization, vasodilatation, vietnamization, vitilitigation, volatilization comfort station, filling station, pumping station, raft foundation, service station, taste sensation, touch sensation, transplantation, weather station, beat generation, chondrification, circumvallation, complementation, contravallation, crystallisation, crystallization, deconcentration, defragmentation, depopulation in, discommendation, disconfirmation, dystrophication, electroporation, frenchification, instrumentation, job application, malconformation, malpresentation, nationalization, nonpresentation, phi correlation, phosphorylation, polish notation, prefix notation, preregistration, procrastination, prognostication, quadruplication, rationalization, re-presentation, reconcentration, self-estimation, self-mutilation, standardisation, standardization, star divination, subministration, suffix notation, supplementation, synchronisation, synchronization, the reformation, transactivation, transfiguratien, transfiguration, transliteration, ultrafiltration, verbal creation, wind generation, acclimatisation, acclimatization, acclimitization, adult education, alphabetisation, alphabetization, alpha radiation, autofecundation, autoinoculation, auto limitation, binary notation, bioaugmentation, cannibalization, catheterization, circularisation, circularization, commodification, commoditization, computerisation, computerization, corporatization, criminalization, daily variation, deacidification, decalcification, decarbonization, decarboxylation, decarburization, decentalisation, decertification, decontamination, dehydrogenation, demagnetization, democratisation, democratization, demutualization, demystification, denitrification, desacralization, desensitisation, desensitization, desertification, despecification, destabilization, destalinization, desulfurization, detribalisation, detribalization, devitrification, differentiation, disassimilation, discontinuation, disorganisation, disorganization, diversification, electrification, etherealization, european nation, excommunication, exemplification, experimentation, extemporisation, extemporization, externalisation, externalization, familiarization, formularization, fossilification, gamma radiation, granitification, historicization, hospitalisation, hospitalization, hypostasization, hypostatisation, hypostatization, immortalization, immortification, impatronization, inconsideration, indemnification, infantilization, insubordination, intensification, interdigitation, intermodulation, internalisation, internalization, lichenification, logic operation, malassimilation, marginalisation, marginalization, materialisation, mathematization, megacorporation, mercurification, nationalisation, neuromodulation, non-repudiation, objectification, objectivisation, objectivization, overt operation, overutilisation, parametrization, personalisation, personalization, personification, photoexcitation, politzerization, preachification, rationalisation, reafforestation, reauthorization, recertification, reconfiguration, reconsideration, reconsolidation, redetermination, regionalisation, regionalization, reharmonisation, reharmonization, rehypothecation, reincorporation, resocialization, retrocopulation, romanticisation, romanticization, self-evaluation, sexual relation, singularization, solar radiation, sublimification, suboptimization, suburbanization, subvocalization, superexaltation, superexcination, superordination, supersaturation, supparasitation, syllabification, underestimation, underpopulation, vascularisation, vascularization, americanisation, americanization, arterialization, bioaccumulation, colonialization, desexualization, diagonalization, exteriorisation, exteriorization, familiarisation, materialization, memorialization, miniaturization, mythologization, oligomerization, overelaboration, overutilization, radio radiation, underevaluation dressing station, heat prostration, loan translation, sampling station, christianization, compartmentation, contraindication, flabbergastation, gasoline station, grade separation, hypopigmentation, in that location, oil conservation, partner relation, pulse modulation, self-affirmation, self-degradation, self-pollination, self-reformation, self-replication, skew correlation, spatial relation, standing ovation, transculturation, with inspiration, with ostentation, with speculation, authentification, axis of rotation, characterisation, characterization, christianisation, circumambulation, circumdenudation, collectivisation, collectivization, compactification, complexification, containerisation, containerization, covert operation, cryopreservation, decentralisation, decentralization, decimal notation, declassification, dehumidification, depressurization, disaccommodation, disappropriation, discombobulation, disqualification, fictionalisation, fictionalization, free association, hemagglutination, indiscrimination, intercorporation, interpenetration, in collaboration, isoagglutination, legal separation, medical relation, microcirculation, misappropriation, miscommunication, nonparticipation, nonproliferation, overcompensation, parameterization, photorespiration, polycondensation, predetermination, prestidigitation, radappertization, re-afforestation, reclassification, reinterpretation, retrovaccination, saccharification, sectionalization, self-deprecation, spiritualization, superfecundation, thermoregulation, unsophistication, visual sensation, anathematization, binary operation, biomagnification, copolymerization, demilitarisation, demilitarization, demineralisation, demineralization, denaturalization, denuclearization, depoliticization, desynonymization, forisfamiliation, irreconciliation, marsupialization, oral examination, overexploitation, prequalification, recapitalization, serial operation, underutilization, universalization, auto-inoculation, editorialization across the nation, business relation, close corporation, cross-examination, heat of formation, painful sensation, rate of inflation, self-flagellation, self-preservation, shell corporation, soil conservation, tactile sensation, trust corporation, veiled accusation, artistic creation, biotransformation, blood coagulation, chemical notation, commercialization, conceptualisation, conceptualization, consubstantiation, control operation, de-baathification, dephosphorization, dephosphorylation, desynchronisation, desynchronization, giving medication, hemoconcentration, hyperalimentation, hyperpigmentation, interfenestration, line organization, machine operation, maladministration, misclassification, misinterpretation, misrepresentation, neutron radiation, non-proliferation, nondiscrimination, oral presentation, recrystallization, self-annihilation, self-organisation, self-organization, self-perpetuation, semantic relation, somatic sensation, special education, temporal relation, transelementation, transillumination, vacuum aspiration, academic relation, collateralization, commercialisation, contextualization, decriminalization, denationalization, depersonalization, final examination, hyposensitization, impersonalization, impersonification, individualisation, individualization, industrialisation, industrialization, logical operation, metacommunication, misidentification, natural elevation, occidentalization, particularization, pedestrianisation, peripheralization, pre-qualification, radio observation, recorporification, renationalization, revascularization, telecommunication, theatricalization, vernacularization, visible radiation, dematerialization, demythologization, epithelialization change of location, closed corporation, counterreformation, pressure sensation, active application, board of education, change orientation, credit application, cryptic coloration, disproportionation, dust contamination, field of operation, infantile fixation, inside information, law of gravitation, law of segregation, loan participation, magnitude relation, mental reservation, missionary station, naval installation, non-discrimination, printing operation, self-determination, self-fertilisation, self-fertilization, self-glorification, self-gratification, self-mortification, television station, transmogrification, transubstantiation, warning coloration, water conservation, water of hydration, without moderation, with consideration, with determination, antidiscrimination, auditory sensation, bourgeoisification, by experimentation, computer operation, data communication, electron radiation, evapotranspiration, infrared radiation, intercommunication, magnetic variation, military formation, optical aberration, overpressurization, overrepresentation, oversimplification, parallel operation, political relation, self-actualization, self-justification, sentimentalisation, sentimentalization, serial publication, underdetermination, fiduciary relation, majority operation, overcapitalization, overgeneralization, proletarianization, radiocommunication, territorialisation, territorialization machine translation, nervous prostration, bush administration, cross-fertilization, de jure segregation, feast of dedication, linguistic relation, observation station, private corporation, pseudohallucination, public presentation, self-congratulation, threshold operation, transesterification, transsubstantiation, cognitive operation, conventionalization, deindustrialization, departmentalization, doctor of education, inertial navigation, insider information, intellectualization, interstratification, logical implication, magnetic levitation, master of education, midterm examination, mischaracterization, multiplex operation, olfactory sensation, phacoemulsification, photodisintegration, professionalisation, professionalization, reindustrialization, scandinavian nation, social organization, suspended animation, ultracentrifugation, underrepresentation, under consideration, unspoken accusation, victory celebration, aegean civilization, auxiliary operation, cartilaginification, interior decoration, minoan civilization, reepithelialization, secondary education, undercapitalization background radiation, heat of condensation, mortgage application, angle of inclination, anthropomorphization, baptist denomination, celestial navigation, compartmentalisation, compartmentalization, concurrent operation, conditional relation, counterproliferation, de facto segregation, financial obligation, grammatical relation, guilt by association, heat of dissociation, heat of vaporization, indirect correlation, large-capitalisation, lukasiewicz notation, magnetic inclination, negative correlation, negative stimulation, photophosphorylation, physical restoration, police investigation, positive correlation, racial extermination, rate of acceleration, rate of depreciation, sequential operation, spherical aberration, spurious correlation, surface assimilation, vertical combination, vertical integration, amphibious operation, animal communication, arithmetic operation, institutionalisation, institutionalization, internationalisation, internationalization, musical organization, pecuniary obligation lecture demonstration, antitrust legislation, clandestine operation, criminal conversation, mental representation, north american nation, point of accumulation, practical application, professional relation, protective coloration, psychic communication, reagan administration, selective information, south american nation, sympathetic vibration, written communication, behavior modification, cardiac resuscitation, consecutive operation, digital communication, mathematical notation, mathematical relation, military installation, nonlinear correlation, economic mobilization, ultraviolet radiation part to whole relation, whole to part relation, workmen's compensation, clinton administration, demand for explanation, software documentation, source of illumination, telephone conversation, artificial respiration, asynchronous operation, economic strangulation, financial organization, holy day of obligation, horizontal combination, horizontal integration, intelligence operation, literal interpretation, postmortem examination, auditory communication, deinstitutionalization, mathematical operation, mycenaean civilization, secretary of education, simultaneous operation concrete representation, dark field illumination, feast of the dedication, reverse polish notation, central american nation, character assassination, department of education, internal representation, protestant denomination, psychical communication, symbolic representation, anabaptist denomination, anomalous communication, artificial insemination, myocardial inflammation, physical rehabilitation ultraviolet illumination, closely held corporation, dark ground illumination, kendall rank correlation, philanthropic foundation, amphibious demonstration, confidential information, linguistic communication, electronic communication, reasoning by elimination paramilitary organization, world health organization, letters of administration, unemployment compensation, articles of incorporation, demand for identification international organization, therapeutic rehabilitation, fourfold point correlation, right of first publication, privately held corporation, coefficient of correlation, hydrogen ion concentration correctional rehabilitation, binary arithmetic operation, freedom from discrimination, newton's law of gravitation, secretary of transportation certificate of incorporation, simulated military operation, department of transportation, el nino southern oscillation, savings and loan association floccinaucinihilipilification, through empirical observation federal housing administration, social security administration federal bureau of investigation, health maintenance organization international labor organization, kendall partial rank correlation food and agriculture organization, international finance corporation, international labour organization, world meteorological organization north atlantic treaty organization international maritime organization federal deposit insurance corporation, federal national mortgage association, international development association federal home loan mortgage corporation national aeronautics and space administration, international civil aviation organization, united nations educational scientific and cultural organization

[pediadoc7-blog]

Pediatric Ulcerative Colitis Activity Index (PUCAI) Calculator

The PUCAI is a 6-item disease activity index intended for use in pediatric UC clinical trials with a score range of 0–85. Paediatric Ulcerative Colitis Activity Index (PUCAI) Disease severity is defined by the following scores: severe: 65 or above. moderate: 35-64. To determine the Pediatric Ulcerative Colitis Activity Index (PUCAI) Check our Medical Calculator https://www.pediatriconcall.com/calculators/pediatric-ulcerative-colitis-activity-index

[brandonfullers]

Dual Ulcer Index MT5 Indicator

Ulcer index was originally meant to be used for something different than finding out the trend (the original calculation “… is a measure of the depth and duration of draw-downs in prices from earlier highs …“) but if we imagine that the calculation can be done in the opposite direction too (perfect in Forex where a symbol can not have a 0 value – if it exists it must have some value) then we can get something like this:

MT5 Indicators – Download Instructions

Dual Ulcer Index MT5 Indicator is a Metatrader 5 (MT5) indicator and the essence of the forex indicator is to transform the accumulated history data.

Dual Ulcer Index MT5 Indicator provides for an opportunity to detect various peculiarities and patterns in price dynamics which are invisible to the naked eye.

Based on this information, traders can assume further price movement and adjust their strategy accordingly.

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How to install Dual Ulcer Index MT5 Indicator.mq5?

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Copy Dual Ulcer Index MT5 Indicator.mq5 to your Metatrader 5 Directory / experts / indicators /

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Select the Chart where is the Indicator running in your Metatrader 5 Client

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Dual Ulcer Index MT5 Indicator

La entrada Dual Ulcer Index MT5 Indicator se publicó primero en Forex MT4 Indicators.

Dual Ulcer Index MT5 Indicator published first on https://alphaex-capital.blogspot.com/