By V. Gunock. Air University. 2018.

Both compound stimuli were paired with reward at this stage (AX+ generic 40mg propranolol mastercard, BY+) generic propranolol 40mg overnight delivery, and both stimulus pairs elicited firing cheap propranolol 40mg mastercard. The association between stimulus X and reward was blocked because it was paired with a stimulus (A) that already predicted reward discount propranolol 40 mg visa. In contrast purchase 40mg propranolol fast delivery, the association between stimulus Y and reward was not blocked because it was paired with a stimulus (B) that did not predict reward. During a “pretraining” stage, mon- keys were presented with one of two stimuli on a given trial (Figure 10. Both compound stimuli were now paired with reward (AX+, BY+), and trials of each type were interleaved. Because of the Kamin blocking effect, learning the association of X with reward was pre- vented because A already predicted reward, and thus rendered X redundant, whereas the association of Y with reward was learned because B did not predict reward (and therefore Y was not redundant). In the third stage, stimuli X and Y were presented in occasional unrewarded trials as a probe to test this prediction (Figures 10. Also as predicted, the Kamin blocking effect was faithfully reflected in the activity of dopaminergic neurons in the midbrain. Nearly half of these (39 cells) responded to the nonredundant stimulus Y, but were not activated by the redundant stimulus X (as in Figure 10. As a population, therefore, dopamine neurons responded much more vigorously to stimulus Y than to X (Figure 10. This finding demonstrated that the dopaminergic cells had acquired stronger responses to the nonredundant stimulus Y, compared to the redundant stimulus X, even though both stimuli had been equally paired with reward during the preceding compound stimulus training. These cells apparently predicted reward in the same way that the monkeys predicted reward. For eye-blink conditioning (and for other protective reflexes), cells in the inferior olivary nuclei compare predicted and received neuronal inputs, probably concerning predictions about the US. One answer is that the cerebellum subserves arbitrary stimulus–response mappings for protective responses, whereas the dopamine system plays a similar role for appetitive responses. This issue has been reviewed recently,58,59 so we will only briefly consider this question here. The central nucleus of the amygdala, the nucleus accumbens of the ventral striatum, and the anterior cingulate cortex appear to be important components of the arbitrary mapping system that underlies certain (but not all) types of Pavlovian approach behavior in rats. Initially neutral objects, when mapped to a positive value, trigger ingestive reflexes, such as those involved in procurement of food or water (licking, chewing, salivation, etc. As reviewed by Baxter and Murray,59 these mechanisms involve different parts of the frontal cortex and amygdala than the typical Pavlovian approach behavior described above: the orbital prefrontal cortex (PF) instead of the anterior cingulate cortex and the basolateral nuclei of the amygdala instead of the central nucleus of the amygdala. These structures, very likely in conjunction with the parts of the basal ganglia with which they are interconnected, underlie the arbitrary mapping of stimuli to their value in a special and highly flexible way. This flexibility is required when neutral stimuli map arbitrarily to food items and the value of those food items changes over a short period of time. Stimuli that map arbitrarily to specific food items can change their current value because of several factors, for example, when that food item has been consumed recently in quantity. Normal monkeys can use this information to choose stimuli that map to a higher current value. This mechanism appears to depend on the basolateral nucleus of the amygdala and the orbital PF: when these structures are removed or their interconnections severed, monkeys can no longer use the stimuli to obtain the temporarily more valued food item. Furthermore, monkeys with those lesions remained perfectly capable of choosing the currently preferred food items. The use of updated stimulus–value mappings allows animals to predict the current, biologically relevant outcome of an action produced in the context of that stimulus. This mechanism permits animals to make choices that lead to the best possible outcome when several possible choices with positive outcomes are available, and to choose appropriately in the face of changing values. As summarized by Shadmehr and his colleagues in this volume,11 in their experiments people move a robotic arm from a central location to a visual target. When, during the course of these movements, the robot imposes a complex pattern of forces on the limb, the movement deviates from a straight line to the target. With practice in countering a particular pattern of forces, the motor system learns to produce a reasonably straight trajectory. There is nothing arbitrary about such IMs; they reflect the physics of the limb and the forces imposed upon the limb. In the experiments that first demonstrated this fact, Rao and Shadmehr62 presented participants with two different patterns of imposed force.

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In many cases cheap propranolol 40 mg line, this cycle of chills buy 40 mg propranolol amex, fever cheap propranolol 80 mg on line, son with the above symptoms who has been in a high- and sweating occurs every other day purchase 40mg propranolol visa, or every third day discount propranolol 40 mg online, risk area should insist on a blood test for malaria. Those doctor may believe the symptoms are just the common with the chronic form of malaria may have a relapse as flu virus. Malaria is often misdiagnosed by North Ameri- long as 50 years after the initial infection. De- Falciparum malaria is far more severe than other types laying treatment of falciparum malaria can be fatal. So many red blood cells are The Chinese herb qiinghaosu (the Western name is destroyed that they block the blood vessels in vital organs artemisinin) has been used in China and southeast Asia (especially the brain and kidneys), and the spleen becomes to fight severe malaria, and became available in Europe enlarged. Malaria in pregnancy can lead to premature deliv- It is not available in the United States and other parts of ery, miscarriage, or stillbirth. Protecting the liver with herbs like gold- it is possible to be reinfected with the parasites again and enseal (Hydrastis canadensis), Chinese goldenthread again. It is also possible to develop a chronic infection (Coptis chinensis), and milk thistle (Silybum marianum) without developing an effective immune response. These herbs should only be used as complementary to conventional treat- Diagnosis ment and not to replace it. These blood smears may need to be repeated Traditional African herbal medicine over a 72-hour period in order to make a diagnosis. Anti- As of late 2002, researchers are studying a tradition- body tests are not usually helpful because many people al African herbal remedy against malaria. Extracts from developed antibodies from past infections, and the tests Microglossa pyrifolia, a trailing shrub belonging to the may not be readily available. A new laser test to detect daisy family (Asteraceae), show promise in treating the presence of malaria parasites in the blood was devel- drug-resistent strains of P. Two new techniques to speed the laboratory diagno- Allopathic treatment sis of malaria show promise as of late 2002. The first is acridine orange (AO), a staining agent that works much Falciparum malaria is a medical emergency that faster (3–10 minutes) than the traditional Giemsa stain must be treated in the hospital. The type of drugs, the 1280 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 method of giving them, and the length of the treatment Malaria is an especially difficult disease to prevent depend on where the malaria was contracted and the by vaccination because the parasite goes through several severity of the patientís illness. One recent, promising vaccine appears to have protected up to 60% of people exposed to malaria. For all strains except falciparum, the treatment for This was evident during field trials for the drug that were malaria is usually chloroquine (Aralen) by mouth for conducted in South America and Africa. In countries where The World Health Organization has been trying to quinine resistance is developing, other treatments may eliminate malaria for the past 30 years by controlling include clindamycin (Cleocin), mefloquin (Lariam), or mosquitoes. Their efforts were successful as long as the sulfadoxone/pyrimethamine (Fansidar). Most patients re- pesticide DDT killed mosquitoes and antimalarial drugs ceive an antibiotic for seven days. Today, however, the may need intensive care and intravenous (IV) malaria problem has returned a hundredfold, especially in Africa. Because both the mosquito and parasite are now ex- A patient with falciparum malaria needs to be hospi- tremely resistant to the insecticides designed to kill talized and given antimalarial drugs in different combi- them, governments are now trying to teach people to nations and doses depending on the resistance of the take antimalarial drugs as a preventive medicine and strain. The patient may need IV fluids, red blood cell avoid getting bitten by mosquitoes. Travelers to high-risk areas should use insect repel- A drug called primaquine may prevent relapses after lant containing DEET for exposed skin. These relapses are is toxic in large amounts, children should not use a con- caused by a form of the parasite that remains in the liver centration higher than 35%. While it is licensed in the United States, it is not market- ed in this country and it is not recommended by the Cen- Those who use the following preventive measures ters for Disease Control and Prevention in Atlanta. Those who live in areas where malaria is epidemic, how- • Sleep inside pyrethrin or permethrin repellent-soaked ever, can contract the disease repeatedly, never fully re- mosquito nets. Anyone visiting areas where malaria is endemic Prevention should take antimalarial drugs starting one week before Preventing mosquito bites while in the tropics is one they leave the United States. This treatment is continued currently working on a malarial vaccine, but the complex through at least four weeks after leaving the endemic area. A par- However, even those who take antimalarial drugs and are asite has much more genetic material than a virus or bac- careful to avoid mosquito bites can still contract malaria.

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Virtually 100% of infants with This means that the gene location has been narrowed MGS have enlarged kidneys with cysts buy cheap propranolol 80mg line. Polydactyly down to a small potential area cheap propranolol 40mg visa, but the exact location and (extra fingers and/or toes) is present in about 80% of precise details about the gene are still unknown discount propranolol 80mg overnight delivery. The polydactyly is usually postaxial Finnish families did not show evidence of a causative (the extra fingers/toes are on the same side of the gene linked to chromosome 17 propranolol 40mg on line. There Middle Eastern families resulted in the second MGS gene may also be webbing of the fingers and toes—the skin being mapped to the short arm of chromosome 11 trusted 80 mg propranolol. More between the fingers or toes fails to separate—leaving the research is being performed to learn more about the pre- digits attached to each other. This can include halted development of the bile ducts, GALE ENCYCLOPEDIA OF GENETIC DISORDERS 727 extra bile ducts, enlarged bile ducts, and loss of blood When signs of MGS are seen on prenatal ultrasound vessels. These liver in the absence of a family history, MGS is often sus- changes are now considered by most to be another hall- pected but not confirmed until after birth and autopsy. However, autopsy is usually needed to distinguish MGS Some reported features are eyes that are closer together from other syndromes with similar features. Every organ or farther apart than usual, broad and flat nose, broad system of the baby is carefully examined for abnormal cheeks, and a wide mouth with full lips. These features are sloping forehead, small early ultrasound with either maternal blood AFP or amni- jaw, low-set ears, and short, webbed neck. If early ultrasound prior to birth also frequently causes clubfoot in the new- reveals no signs of MGS, later scans are still recom- born. No routine genetic tests are currently available Other common features of MGS are abnormalities of to these families. The external (visible) geni- talia are often small or ambiguous (not clearly male or Treatment and management female). There have also been reports of babies with MGS having both male and female reproductive parts There is no effective treatment or cure for MGS. Cleft palate is seen in about 45% of Babies with MGS have extensive birth defects that babies with MGS. The with MGS show the same signs and the characteristic abnormalities seen in the kidneys and liver often leave signs range in severity. There is often no way to repair described in some babies with MGS but are not as com- the organs other than transplant. These include heart defects, enlarged spleen, extra lems could be solved, infants with MGS often have spleen, hydrocephaly (extra water in the brain), absence underdeveloped lungs that cannot support life after birth. Due to the extensive birth defects, the extensive surgeries needed to correct them, Diagnosis and the poor prognosis, babies born with MGS are given minimum care for comfort and warmth. Some of the features of MGS can be detected on pre- natal ultrasound early in the second trimester. At that When MGS is suspected in an unborn baby, parents time, an encephalocele can often be seen as well as other should be given information about the range of symp- brain abnormalities. As the pregnancy continues, a low be cautioned that a diagnosis of MGS often cannot be amount of amniotic fluid becomes apparent. Prognosis can vary if the baby kidneys make the abdomen appear and measure larger has atypical signs of MGS or if the baby has a different than usual. Elective termination of affected pregnancies white on an ultrasound instead of the usual gray color. Measurement of the alpha-fetoprotein (AFP) level Prognosis from either maternal blood or amniotic fluid may help to detect an encephalocele (although most encephaloceles The prognosis for MGS is quite poor. Those that are born living usu- measured in amniotic fluid after about 12 weeks of preg- ally die shortly after birth in the first hours, days, or nancy and in maternal blood after about 15 weeks of weeks of life. AFP elevation in either test increases the (underdeveloped lungs), infection (opening in the skull), chance of an encephalocele or other abnormality in the or organ failure (decreased function of kidneys and liver). MGS is variable and there have been a couple reports of 728 GALE ENCYCLOPEDIA OF GENETIC DISORDERS infants with milder symptoms living longer. One infant for normal growth and development, inhibits the work of with MGS lived until four months of age.

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The rhizome contains triterpene glycosides and many other ingredi- While soy is generally considered safe propranolol 80mg lowest price, it may induce ents that appear to have phytoestrogenic effects purchase propranolol 80mg fast delivery. Other nausea propranolol 80mg amex, bloating propranolol 80 mg sale, and allergic reactions (itchy rashes or traditional herbs sometimes promoted as phytoestro- even asthma if inhaled as dust) in some people buy propranolol 80mg on-line. One gens, such as dong quai (Angelica sinensis), have little study suggested that high midlife soy (tofu) consump- medical evidence to support their use. However, educational and social differences be- Mechanism of Action tween the high- and low-tofu groups may also account for some of these findings. Research findings in regard Soy isoflavones appear to act as selective estrogen recep- to the safety of soy in breast cancer patients conflict, tor modulators in that they can occupy and block the - with an in vitro study suggesting possible stimulation of estrogen receptor. It does not appear to con- Cyanogenic nitrates in flax (especially in immature seed tain isoflavones like soy, and there are conflicting find- pods) have produced toxic reactions. Early reports of luteiniz- ing hormone suppression have been contradicted by Dose more recent research showing no change in go- nadotropins or estradiol. There appears to be no stimu- Soy protein doses of 20 to 60 g daily are used to reduce latory effect on estrogen receptor–positive breast can- hot flashes and to lower elevated cholesterol. Indications Black cohosh root doses vary widely, with up to 2000 mg/day of root being taken several times daily. Soy is possibly effective in reducing menopausal symp- Remifemin is the best-studied brand, and tablets con- toms, such as hot flashes, although it is much less effective taining 40 mg of black cohosh extract with 1 mg of than estrogens for this purpose. High isoflavone soy pro- Conclusions tein intake outperformed lower isoflavone supplements in this regard. Ipriflavone, a semisynthetic isoflavone, is Soy appears to have weak estrogenic activity when effective in the treatment and prevention of osteoporosis taken after menopause but may block the effects of and is used for this purpose in Europe and Japan. In the more potent estrogens (thereby reducing breast cancer United States, the FDA has approved the use of soy in risk) when used before menopause. Although long-term high soy diets 796 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM may help prevent osteoporosis, it is likely that most month period. Semisynthetic or concentrated mend red clover and flaxseed, although they remain isoflavone preparations may play a role in the future. Black cohosh may reduce menopausal symptoms, A listing of other popular herbs and their proposed and it appears safe and well tolerated for at least a 6- actions is given in Table 69. Ginseng is commonly used and frequent ringing in his ears (tinnitus) and ver- to boost energy and stamina. Kava is often recommended for anxiety, and it but his examination produced normal findings, and appears significantly more effective than placebo he was told that the problem would probably wax for this condition. An extensive neurological benefits, saw palmetto for prostatic hypertrophy, evaluation and head computed tomography scan and ginkgo as a cerebral vasodilator. Ginseng is used to increase energy levels and in- (B) Peppermint duce a general sense of physical and mental well- (C) Ginkgo being. Bearberry or uva ursi is a natural treatment (D) Ginger for urinary tract infections, whereas golden seal is (E) Valerian taken as a general anti-infective. Evening 5 to take this herb, you forgot to ask about his other primrose oil (linoleic acid) is commonly thought of medications. Ginkgo would be the most likely herbal treat- (A) Coumadin ment to benefit this patient, since it would improve (B) Propranolol cerebrovascular blood flow and cognitive function. Which one of the following statements is true re- blood pressure reduction), but it would be unlikely garding St. Which one of the following statements is true of the antiplatelet effect, which has produced bleeding Chinese herb ma huang (Ephedra sinensis)? The other med- (A) Ephedra has been associated with increased ications listed are not known to have this problem. Acetaminophen, unlike aspirin, does not have an (B) The FDA recommends that it be taken for no antiplatelet effect. However, it is not fects, hawthorn for its use in congestive heart fail- thought necessary to avoid tyramine while taking ure, and ginseng as a tonic to increase energy levels. Saw palmetto reduces the symptoms of prostatic sons, ephedra should be limited to 8 mg or less per obstruction with long-term use and appears to be as single dose and that a total daily dose of 24 mg not effective as finasteride. These are much lower than past dosage as an antioxidant and for its reputed cardiovascular recommendations.

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In Japan discount 80mg propranolol with amex, honokiol is considered a 1274 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 useful anxiolytic; herbal preparations containing honoki- ol are prescribed as mild tranquilizers propranolol 80 mg otc. Preparations Anxiolytic—A medication or preparation given as Magnolia bark is most commonly used in the fol- a tranquilizer buy generic propranolol 40 mg online. Magnolia is thought to contain certain chemicals that cause • Agastache: for treatment of stomach flu and gastroin- the apoptosis of cancer cells generic propranolol 40mg with mastercard. Honokiol—A compound derived from magnolia • Apricot seed and linum: for treatment of chronic con- that is used in some Japanese herbal preparations stipation and hemorrhoids generic propranolol 80 mg. Honokiol may also be use- • Bupleurum, inula and cyperus: for treatment of stress- ful in treating lung cancer. All these formulas can be made into teas or are com- mercially available as pills or capsules. In addition, allergic re- actions to the pollen from magnolia trees are not unusual. Frey, PhD Interactions In Chinese herbalism, both magnolia bark and flow- Maharishi Ayurveda see Ayurvedic ers are often used in conjunction with other herbs with medicine no reported interactions. There are no formal studies of its interactions with Western pharmaceuticals; however, Mai men dong see Ophiopogon there are anecdotal reports of harmful interactions be- tween magnolia bark and prescription weight-loss med- ications. In addition, magnolia should not be taken to- gether with any medications given to lower blood pres- sure, as it increases their effects. Maitake Description Resources BOOKS Maitake, Grifola frondosa, is a mushroom found Chevallier, Andrew. It is also called “hen-in-the- searchers attribute this latter result to the X and ES frac- woods” and can reach the size of a head of lettuce. More recent studies of the use of cause maitake comes from the polypores group, it pro- MD-fraction in treating cancer patients have also found duces a bunch of leaf-like clumps that are intertwined. This culture is used to make what is called a that started the tumor growth and nail them for destruc- spawn, which is then inoculated into production logs tion. During the next 30 days, cells and prevents them from occurring elsewhere in the the spawn settles in and binds to the log. In addition to its antitumor effects, maitake extract are placed in temperature- and humidity-controlled appears to increase cellular immunity to cancer. Cancer research on apoptosis is one of the main They are then moved to a mushroom fruiting house. This process of programmed cell death is entire procedure requires a period of 10–14 weeks. Two other ic) and fraction ES (anti-hypertensive)components of components of maitake, named fraction X and fraction maitake, conducted studies based on the hypothesis that ES, were discovered by Harry Preuss, a medicine and such chronic diseases of aging as diabetes, hyperten- pathology professor at Georgetown University Medical sion and obesity are connected partly to glucose/insulin Center in Washington, DC. From his 1998 study, Preuss concluded that maitake could positively affect the glucose/insulin bal- General use ance and prevent these age-related diseases. A study done at Georgetown University in 2002 found that an ex- Although the Chinese and Japanese have used tract of maitake does indeed improve glucose/insulin maitake in cooking and healing for many centuries, it is metabolism in insulin-resistant mice. Maitake is known as an adaptogen and tonic, and were fed either cholesterol or dried powder containing as such it aids healthy people to keep their levels of 20% maitake mushroom. Results showed that maitake blood sugar, blood pressure, cholesterol, and weight altered the metabolism of fatty acids by stopping fatty normal. The beta glucan in maitake is a cell-surface car- acid from increasing in the liver and fatty acid levels bohydrate. As a polysaccharide, this glucan activates the white blood cells, called Maitake can also decrease high blood pressure. These benefits increased tional Cancer Institute, showed that maitake both im- 1276 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 proves T-cell activity and kills HIV. One study, using a sulfated maitake extract, stopped HIV killing T-cells by KEY TERMS 97%. Food and Drug Administration Spore—The asexual reproductive body of a mush- (FDA) granted Maitake Products approval to conduct a room or other nonflowering plant. The American Cancer Society (ACS) is less sup- given to strengthen and invigorate the body. Pregnant ACS points out that the Japanese studies of maitake have women and nursing women should consult a health care been done on mice, and that further research is necessary provider before taking maitake.

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