Thank you for visit nn5n Foundation, I just finish new feature, what allow you translate any object to any languageafter simple registration! Join to us! This website currently stay in beta version, and more functions will be very soon.
If you have any problem with use this website, please use button "Contact" and tell about this. Android Application iOS Application. News from 8 February Updated all languages, downloaded thousands new objects! Redesigned type icons. News from 4 April Thank you for visit nn5n Foundation, I just finish new feature, what allow you translate any object to any languageafter simple registration!
What is it? Why English on this description very strange? Is it Google translator? I not use Google translator for write this message. But I understand, my English can look strange.
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If you want, you can help me to improve information on website. I got inspiration after reading information on this website, can I use it for create something like: games, books, video?
But notice, for your users is will be legal copy your content also. I just finished work about big update. Now you can register on website, and do translation of current objects to any languages. Features for create new objects I will add in May Who create this website nn5n. My name is Mykhailo Radzievskyi, you can call me Mick.US Citizenship Test Questions with One Simple/Easy answer Each 2020
I indie developer, and photographer. I found SCP Foundation inand very like this stories. In I create application Offline Database for Android, what contain all information from original Wiki. Later I created iOS version.
Now I support all them with 10 languages, and I'm sure Foundation will grow to much more number languages. Is SCP Foundation real?
No, foundation not real and all stories also. When this website start work? First version this website started 31 January Unless otherwise stated, the content of this page is licensed under Creative Commons Attribution-ShareAlike 3.The Maryland highway system has several hundred former state highways.
These highways were constructed, maintained, or funded by the Maryland State Roads Commission or Maryland State Highway Administration and assigned a unique or temporally unique number. Some time after the highway was assigned, the highway was transferred to county or municipal maintenance and the number designation was removed from the particular stretch of road.
In some cases, a highway was renumbered in whole or in part. This list contains all or most of the state-numbered highways between and that have existed since highways were first numbered in but are no longer part of the state highway system or are state highways of a different number. Most former state highways have not had their numbers reused. However, many state highway numbers were used for a former highway and are currently in use.
Some numbers have been used three times. The former highways below whose numbers are used presently, those that were taken over in whole or in part by another highway, or have enough information to warrant a separate article contain links to those separate highway articles. Highway numbers that have two or more former uses are differentiated below by year ranges. This list does not include former Interstate or U. Highwayswhich are linked from their respective lists.
Maryland Route was the designation for Takoma Avenue, which ran 0. Maryland Route was the 2. Maryland Route was the designation for Raincliffe Road from the east town limit of Sykesville east toward Arrington Road in southeastern Carroll County. Maryland Route was the designation for Harney Road from Harney in northwestern Carroll County north to the Pennsylvania state line, where the highway continued as Pennsylvania Route Maryland Route was the designation for St.
Maryland Route was the designation for Turners Creek Road, which ran 3. Maryland Route was the designation for Wilkins Lane, which ran 1. Paul Street in Kensington in southern Montgomery County.
Maryland Route was the designation for the 0. Meade to east of the center of Odenton became MD Maryland Route was the designation for a pair of roads on the south side of the Bohemia River at Hack Point in southern Cecil County.
US was relocated on the south approach to the Bohemia Bridge in and The highway's northern end was at MD Maryland Route was the temporary designation for what is now U.
Maryland Route was the designation for Old Farmington Road, which ran 0. Maryland Route was the designation for Mill Street, which ran 0. Maryland Route was the designation for sections of old alignment of and spurs related to MD in central Cecil County.
All sections of MD except for MD no letter suffix and MD B were transferred from state to local maintenance in a road transfer agreement on December 27, From Wikipedia, the free encyclopedia. Wikipedia list article. Main article: Maryland Route Aetna considers measurement of plasma brain natriuretic peptide BNP medically necessary for the following indications:.
Plasma brain natriuretic peptide BNP is a amino acid polypeptide that contains a amino acid ring structure common to all natriuretic peptides. The cardiac ventricles are the major source of plasma BNP. This circulating peptide has been used as a marker to assist in the diagnosis of congestive heart failure. In general, plasma BNP levels correlate positively with the degree of left ventricular dysfunction, but they are sensitive to other biological factors such as age, sex, and diastolic dysfunction.
Level of Evidence: A. Level of Evidence: C. The guidelines explained that serum BNP levels have been shown to parallel the clinical severity of heart failure in broad populations Hunt et al, Levels are higher in hospitalized patients and tend to decrease during aggressive therapy for decompensation. The guidelines stated, however, that it can not be assumed that BNP levels can be used effectively as targets for adjustment of therapy in individual patients.
The guidelines explained that many patients taking optimal doses of medications continue to show markedly elevated levels of BNP, and some patients demonstrated BNP levels within the normal range despite advanced heart failure HF. The guidelines concluded that the use of BNP measurements to guide the titration of drug doses has not been shown to improve outcomes more effectively than achievement of the target doses drugs shown in clinical trials to prolong life.
The guidelines noted that ongoing trials will help to determine the role of serial BNP measurements in both diagnosis and management of heart failure. Regarding the use of BNP to assess prognosis, the guidelines stated that elevated BNP levels predict higher risk of heart failure and other events after myocardial infarction, whereas marked elevation in BNP levels during hospitalization for heart failure may predict re-hospitalization and death Hunt et al, Thus, measurement of plasma BNP may be medically necessary to differentiate dyspnea due to heart failure from pulmonary disease in the urgent care setting.
The value of measurements of BNP for the routine non-urgent diagnosis or for the management of patients with heart failure has not been established. The ICSI technology assessment states that care should be taken when measuring BNP within 2 to 4 hours after the onset of acute symptoms as false negatives may occur.
The ICSI technology assessment also concluded that the utility of BNP as a tool to optimize management of heart failure or measure treatment response has yet to be defined. In a review on the use of BNP as a potential marker of acute coronary syndromes, Body and Roberts stated that the clinical bottom line is that BNP shows promise as an early cardiac marker and may enhance prognostic stratification. Negative-predictive value and positive-predictive value may be unacceptably low to enable use as a sole cardiac marker.
Incorporation into a multi-marker strategy and serial estimations may be necessary. Sohne and associates determined the predictive value of elevated BNP levels for early recurrent venous thromboembolism with or without fatal outcome in hemodynamically stable patients with acute pulmonary embolism PE.
In addition, these researchers evaluated the potential clinical consequences of initiating thrombolytic therapy based on the BNP levels alone. A nested case-control study was performed within the framework of a large randomized-controlled trial totaling 2, hemodynamically stable patients with confirmed acute, symptomatic PE.
A total of 90 patients experienced a fatal or non-fatal recurrent venous thromboembolism during the first 3 months of follow-up cases ; patients with uneventful follow-up served as controls.
Blood for BNP levels was obtained at referral and assayed in a central laboratory. A BNP cut-off level of 1.The disposable capsule pH monitor Bravo pH Monitoring System is considered an acceptable alternative to standard catheter-based ambulatory pH monitoring for the medically necessary indications listed above except for evaluating vomiting for infants.
The Bravo pH Monitoring System is considered experimental and investigational for evaluating vomiting in infants because it has not been approved for use in this age group. Aetna considers airway pH monitoring for detection of laryngo-pharyngeal reflux and other indications experimental and investigational because its effectiveness for these indications has not been established.
Aetna considers mutichannel intraluminal impedance testing experimental and investigational for all other indications e. Esophageal pH recording provides quantitative data on both esophageal acid exposure and on the correlation between patient symptoms and reflux events.
Despite these strengths, the inherent weakness of the technique is its inability to prove causality between symptoms and acid reflux.
Alternatively, causality is reasonably assumed in clinical practice by the alleviation of suspected reflux symptoms during a therapeutic trial of a proton pump inhibitor PPI. For standard ambulatory esophageal pH monitoring, a nasogastric catheter fitted with a pH probe is inserted through the nose into the lower esophagus. The catheter is attached to a data logger that is worn on the body. The catheter is left in place for 24 to 48 hrs.
Over this period, the probe measures the amount of acid refluxing in the esophagus and the pattern of occurrence throughout the day. The patient reports any symptoms, such as pain, waterbrash, wheezing and coughing, and their timing. This helps the physician to determine if symptoms are related to acid reflux.
Because the use of a nasogastric catheter is awkward and distressing to the patient, a newer catheter-free approach has been developed the Bravo pH Monitoring System, Medtronic, Minneapolis, MN that uses a tiny disposable capsule pH monitor that is pinned to the lower esophagus via an endoscopic approach.
The capsule transmits pH data to a data logger that is worn on the body. After several days, the disposable capsule is sloughed off the esophagus and passes out of the digestive tract. The assessment also noted that catheterless pH monitoring may be unsuitable for some patients, for example patients with pacemakers. Dickman and Fass stated that "pH testing remains a commonly used evaluative tool in clinical practice.
However, the original tool that included a nasally placed pH catheter was plagued with a variety of shortcomings, primarily the effect of the procedure on patients' lifestyle and thus on reflux-provoking activities.
The miniaturization of evaluative techniques in gastroenterology was the impetus for the development of the wireless pH capsule and the SmartPill. These modalities improve patients' tolerability of the required test and provide a unique opportunity for expansion of indications and data collection.
The introduction of the multi-channel intraluminal impedance with a pH sensor allowed the detection of gastroesophageal reflux GER that is non-acidic. However, the value of the technique beyond the realm of academic gastroenterology remains to be elucidated.
Recently, there was a renewal of interest in Bilitec The technique, which has never found a clear clinical role, has been recommended as an important tool in evaluating patients who failed PPI therapy.
However, data to support its clinical value in this situation have remained scant". Wenner et al evaluated and compared the subjective experience of patients undergoing esophageal pH monitoring by means of the wireless pH capsule method or the conventional catheter-based method. Using a randomized study design, patients referred for esophageal pH testing underwent both wireless and traditional catheter-based hr pH recording with a 7-day interval.
The wireless pH capsule was placed during endoscopy and followed by hr pH recording. All patients answered a questionnaire, including a cm visual analog scale VASwhich described the perceived severity of symptoms and the degree of interference with normal daily activities during the pH tests. A total of 31 patients 16 women and 15 men were included in the analysis. The severity of all adverse symptoms associated with the wireless technique was significantly lower compared with the catheter-based technique median VAS 2.
Wireless pH recording was associated with less interference with off-work activities and normal daily life, median VAS 0. Patients actively working during both tests reported less interference with normal work during the capsule-based test than during the catheter-based pH test median VAS 0.
The authors concluded that these findings showed that a significant majority of patients undergoing esophageal pH monitoring preferred the wireless pH capsule over the traditional catheter-based technique because of less adverse symptoms and less interference with normal daily life. Despite consensus guidelines, the presentation, diagnosis, and treatment remain controversial. Web-based questionnaires were e-mailed to otolaryngologists. Data were analyzed to determine differences in proportions between groups.
The response rate was 48 of otolaryngologists. Symptoms considered to be strongly or moderately associated with LPR included globus sensation, excessive throat clearing, sore or burning throat, hoarseness, chronic cough, and dysphonia.Customer reviews. Write a review. How does Amazon calculate star ratings?
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Filter by. All reviewers Verified purchase only All reviewers.Aetna considers oxaliplatin injection Eloxatin medically necessary for the following indications:. Aetna considers pressurized intra-peritoneal aerosol chemotherapy PIPAC with oxaliplatin for peritoneal metastasis experimental and investigational because the effectiveness of this approach has not been established.
Colorectal cancer is the second-leading causes of cancer death in the United States. For many years, standard treatment of colorectal cancer was 5-fluorouracil 5-FU -based therapy. Recent availability of newer agents, including capecitabine, irinotecan and oxaliplatin, has significantly expanded the options available for the management of patients with advanced colorectal cancer, with consequent improvements in survival.
On February 12,the U. Food and Drug Administration FDA approved cetuximab Erbituxa monoclonal antibody, as a combination treatment with irinotecan for the treatment of patients with advanced colorectal cancer that has spread to other parts of the body; or alone if patients can not tolerate irinotecan.
Although cetuximab has been demonstrated to shrink tumors in some patients and delay tumor growth, especially when used as a combination treatment, it has not been shown to extend patients' lives. It is believed to work via the formation of reactive platinum complexes, which inhibit DNA synthesis by forming inter-strand and intra-strand cross-linking of DNA molecules, thus disrupting DNA replication and transcription.
Oxaliplatin has been reported to exhibit cytotoxic efficacy as well as a well-tolerated safety profile. The main side effect of oxaliplatin is a sensory neuropathy exacerbated by cold exposure. Pre-clinical studies have demonstrated that oxaliplatin is synergistic with FU and SN, the active metabolite of irinotecan.
Furthermore, oxaliplatin has been shown to be effective when used in combination with 5-FU and leucovorin LV for the treatment of advanced colorectal cancer. In addition to treatment of colorectal carcinoma, oxaliplatin has been approved by the FDA for use as adjuvant treatment of stage III colon cancer patients who have undergone complete resection of the primary tumor.
The U. Prior adjuvant or palliative 5-FU-based chemotherapy and radiation therapy are permitted. The indication is based on an improvement in disease-free survival, with no demonstrated benefit in overall survival after a median follow-up of 4 years. The FDA-approved labeling of Eloxatin has the following recommendations regarding dosing and administration for colorectal cancer:.
Other adverse reactions, including serious adverse reactions, have been reported.
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Eloxatin is contraindicated in persons with a known allergy to oxaliplatin or other platinum-based compounds. Anaphylactic reactions to Eloxatin have been reported, and may occur within minutes of Eloxatin administration.
Epinephrine, corticosteroids, and antihistamines have been employed to alleviate symptoms. Larsen and colleagues stated that in case of response to chemotherapy, unresectable liver metastases from colorectal cancer CRC can be converted to resectable and thereby obtain a chance of cure. Secondary aims were to evaluate the conversion rate from unresectable to resectable liver metastases, median PFS, median OS, and toxicity. Calcium folinate and 5-FU were delivered systemically while oxaliplatin was delivered alternating between systemic and intra-hepatic administration.
When oxaliplatin was delivered via the intra-hepatic route, infusion time was reduced to 10 mins followed by embolic material. In patients with KRAS wild-type tumors, cetuximab was added. The treatment was well-tolerated and only pain in the liver and a mild increase in liver enzymes were observed following intra-hepatic oxaliplatin. A high response rate and long median OS were obtained.
These preliminary findings need to be validated by well-designed studies. Treatments for esophageal cancer and gastroesophageal junction cancer have centered on combined-modality therapy: combinations of 5-FU, cisplatin, and radiation. More recently, oxaliplatin has been studied for the treatment of esophageal cancer. At completion of cycle 1, eligible patients could undergo an operation or begin cycle 2 without XRT. Post-operative patients were eligible for cycle 2.
Stage IV patients were allowed 3 cycles in the absence of disease progression. Thirty-six patients completed cycle 1, 29 patients started cycle 2, and 24 patients completed cycle 2. No grade 4 hematologic toxicity was noted. Eleven grade 3 and two grade 4 clinical toxicities were noted in eight patients. Oxaliplatin appears to be as effective as cisplatin for esophageal cancer, with better tolerability.Generic Name: amoxicillin and clavulanate potassium Dosage Form: powder, for oral suspension.
Medically reviewed by Drugs. Last updated on Nov 21, To reduce the development of drug-resistant bacteria and maintain the effectiveness of Augmentin ES Powder for Oral Suspension and other antibacterial drugs, Augmentin ES Powder for Oral Suspension should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
The Augmentin ES brand name has been discontinued in the U. If generic versions of this product have been approved by the FDA, there may be generic equivalents available. Amoxicillin is an analog of ampicillin, derived from the basic penicillin nucleus, 6-aminopenicillanic acid. Chemically, amoxicillin is 2 S ,5 R ,6 R [ R - - Amino p -hydroxyphenyl acetamido]-3,3-dimethyloxothiaazabicyclo[3. Clavulanic acid is produced by the fermentation of Streptomyces clavuligerus.
Chemically, clavulanate potassium is potassium Z - 2 R ,5 R 2-hydroxyethylidene oxooxaazabicyclo[3. Powder for Oral Suspension- Colloidal silicon dioxide, strawberry cream flavor, xanthan gum, aspartame asodium carboxymethylcellulose, and silicon dioxide. The mean plasma amoxicillin and clavulanate pharmacokinetic parameter values are listed in the following table. Concurrent administration of probenecid delays amoxicillin excretion but does not delay renal excretion of clavulanic acid.
Amoxicillin diffuses readily into most body tissues and fluids with the exception of the brain and spinal fluid. The results of experiments involving the administration of clavulanic acid to animals suggest that this compound, like amoxicillin, is well distributed in body tissues. Amoxicillin is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microorganisms. The following in vitro data are available, but their clinical significance is unknown.
NOTE: S. Adequate and well-controlled clinical trials have established the effectiveness of amoxicillin alone in treating certain clinical infections due to S. When available, the clinical microbiology laboratory should provide cumulative results of in vitro susceptibility test results for antimicrobial drugs used in local hospitals and practice areas to the physician as periodic reports that describe the susceptibility profile of nosocomial and community-acquired pathogens.
These reports should aid the physician in selecting the most effective antimicrobial. Quantitative methods are used to determine antimicrobial minimum inhibitory concentrations MICs.
These MICs provide estimates of the susceptibility of bacteria to antimicrobial compounds. The MICs should be determined using a standardized procedure. MICs are expressed in terms of the amoxicillin concentration in the presence of clavulanic acid at a constant 2 parts amoxicillin to 1 part clavulanic acid. The MIC values should be interpreted according to criteria provided in Table 3.
Quantitative methods that require measurement of zone diameters also provides reproducible estimates of the susceptibility of bacteria to antimicrobials. One such standardized technique requires the use of a standardized inoculum concentration.
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