Foods That Reduce Inflammation

Organic Health Protocol

This eBook from professional trainer and nutritionist Thomas DeLauer and Dr. Mike Brookins shows you all of the secrets to reducing inflammation all through your body. These body hacks are secrets to the way that your body works that you would never have thought of. You will learn the foods that you will need to avoid in order to have a really healthy life. You will learn to reset your body in 7 days or less just by eating organic, really healthy foods. Food affects they way that your body works so much more than people tend to believe. You will learn how to cut through all the nonsense that you will read on the internet and get right to the part that heals your inflammation and other health problems. Inflammation is only a symptom If you are not healthy and eating well, your whole body will suffer. We give you a way to reverse that! Read more here...

Organic Health Protocol Summary


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Antiinflammatory Activity Of Spirulina

Cyclooxygenase-2 (COX-2) has an important role in catalyzing the conversion of arachidonic acid to prostaglandins and other eicosanoids.37 The overexpression of COX-2 is associated with high levels of prostaglandin E2 (PGE2) that are observed in various malignancies of the colon, breast, lung, prostrate, skin, cervix, pancreas, and bladder.38 Excess prostaglandin levels cause inflammation, influence cell proliferation, and the mediation of immune suppression.39,40 Many investigations have confirmed that nonsteroidal anti-inflammatory drugs and selective COX-2 inhibitors can induce apoptosis in colon cancer cell lines and transformed fibroblasts.41,42 Phycocyanin, present in Spirulina, has been claimed to have a selectively inhibitory effect on COX-2.28 Restated, phycocyanin is a natural COX-2 inhibitor, which controls inflammation that is caused by the presence of the enzyme COX-2. Studies have been conducted to examine the involvement of phycocyanin in inducing apoptosis in tumor...

Nonsteroid Antiinflammatory Drugs And Antifever Analgesics

A huge quantity of drugs belonging to various classes of compounds exhibit analgesic, anti-fever, and anti-inflammatory action. In addition, they are devoid of many undesirable effects that accompany opioid analgesics (respiratory depression, addiction, etc.). They are called nonnarcotic analgesics, aspirin-like substances, anti-fever analgesics, etc., in order to differentiate nonsteroidal, anti-inflammatory, and anti-fever analgesics from opioids and glucocorticoids. The exact mechanism of action of these drugs is not conclusively known. It is supposed that it might be connected with its ability to inhibit synthesis of prostaglandins, which reduces their sensitizing influence on nerve endings, which in turn reduces the effect of neurotransmitter action bradykinin in particular. However, analgesic and anti-inflammatory activity of these drugs is not always correlated with their ability to suppress prostaglandins. There are other assumptions about the mechanism of action of...

Nonsteroidal Antiinflammatory Drugs

NSAIDs are among the most widely used pharmaceutical agents in the world. They are commonly administered for their analgesic and anti-inflammatory effects on a variety of musculoskeletal conditions. Because of basic science data and retrospective reports of delayed healing of fractures in humans, many sports medicine experts 43,44 now caution against the use of NSAIDs in athletes with a fracture. Although animal models may provide a starting point for clinical research, results of such investigations should not be extrapolated to humans. In addition, clinical decisions regarding patient care should not be based on low-level evidence from poorly conducted retrospective reviews, case reports, or expert opinion. The following discussion examines the best available evidence on which to base clinical decisions regarding NSAID use in fracture care.

Combination of Iodine and Anti Inflammatory Agents

The evolution of a chemical burn involves a variety of inflammatory processes including production of inflammatory mediators 4, 13-19 and dermal infiltration of polymorphonuclear cells 4 . This was supported by the beneficial effect of anti-inflammatory agents such as olvanil and indomethacin against SM in the mouse ear edema model 14 . A combination of iodine with steroidal (clobetasol) and nonsteroidal (piroxicam) anti-inflammatory agents led to improved therapeutic activity in the guinea pig skin irritation and mouse ear edema models 20 . This kind of preparation also showed a beneficial effect in HF burns in guinea pigs (data not shown).

Complications of Tracheal Surgery

As tracheal surgery became more common, a pattern of complications inevitably appeared. These were analyzed by Levasseur in 1971, Couraud in 1982, and by Grillo in 1986, along with their colleagues.92,182,183 In 11 patients, Levasseur and colleagues observed 1 restenosis and 4 lethal erosions of brachiocephalic artery.92 This led the authors to recommend cervical muscle or thymic interposition for prophylaxis against hemorrhage. Couraud and colleagues, reporting on 122 cases of resection with only 4 deaths and 1 failure, emphasized anti-infectious and anti-inflammatory precautions.182 Grillo and colleagues reviewed incidence, causes, treatment, and prevention of complications in 416 primary reconstructions, 279 for postintubation lesions.183 Suture line granulations occurred in 28 of 209 cases, when various nonabsorbable sutures were used for anastomosis, but in none of 113 after the adoption of absorbable Vicryl sutures. Brachiocephalic artery injuries were best avoided by avoiding...

Salicylic acid derivatives

Aspirin exhibits analgesic, fever-reducing, and anti-inflammatory action, and it also reduces aggregation of thrombocytes. It is believed that the primary mechanism of action is the irreversible acetylation of cyclooxygenase, which results in the inability to synthesize prostaglandins, prostacyclins, and thromboxane. As a result, the pyrogenic effect of prostaglandins on the centers of thermoregulation and sensitive nerve endings is reduced, which leads to a lessening of sensitivity to painful neurotransmission. The antiaggrega-tory effect of aspirin is explained by the irreversible inability to synthesize thromboxane A2 in the thrombocytes. Today, aspirin is used in larger quantities than any other drug. Aspirin is widely used for head and neuralgic pains, rheumatic conditions, painful symptoms of various etiologies, and eliminating painful feelings during menstruation. It is used in conditions such as fevers, prevention and treatment of thrombosis and embolism, and for prevention of...

Other Defense Factors In Milk Acting In The Infants

LF and LF-cin are also anti-inflammatory, e.g. by inhibiting production of anti-inflammatory cytokines like IL-1, IL-6, IL-8, TNF-a 18-21-22. Furthermore, it can bind to B-cells and inhibit antibody synthesis, affect T cell proliferation, interfere with the complement system, interfere with the cytotoxic effects ofNK cells and block histamin release from mast cells22- Using experimental colitis in mice as another in vivo model we could also show protective effects of LF36 .Thus there were significant effects delaying the appearance ofblood in the stool (p< 0.001) and macroscopic bleedings from the rectum (p 0.008). The length ofthe colon was not reduced in the LF treated group as in the untreated controls (p< 0.05) and there were fewer changes in the histologic picture (p 0.012). Synthetic peptides derived from LF seemed also able to reduce the inflammatory changes including the number ofMHC II positive cells. High levels of LF could be shown in serum and also in urine ofthe...

The influence of external funding and commercial interests

Pharmaceutical industry and those supported by other means.71 The results of 89 of published industry-supported trials favoured the new therapy, as compared to 61 of the other trials. Similar results have been reported for non-steroidal anti-inflammatory drug trials72 and drug studies published in symposium proceedings.73 The implication is that the pharmaceutical industry tends to discourage the publication of negative studies which it has funded. For example, a manuscript reporting on a trial comparing the bioequivalence of generic and brand levothyroxine products, which had failed to produce the results desired by the sponsor of the study, Boots Pharmaceuticals, was withdrawn because Boots took legal action against the university and the investigators. The actions of Boots, recounted in detail by one of the editors of JAMA, Drummond Rennie,74 meant that publication of the paper75 was delayed by about seven years. In a national survey of life-science faculty members in the United...

Medical and Nursing Management

The medical management of non-infectious uveitis includes steroid ophthalmic drops and dilation drops (often Cyclogyl) to reduce inflammation,paralyze the ciliary body for pain control and pull the iris away from the lens. Beta-blocker, alpha-agonist, carbonic anhydrase inhibitors and prostaglandin analog eye

Inflammatory mediators

The inflammatory process is driven in part by cytokines including TNF-a and IL-1b, IL-6, and IL-8. All have been found in BAL fluid and plasma of patients with ARDS.56 62 63 TNF-a and IL-1b can both produce an ARDS-like condition when administered to rodents. They are produced by inflammatory cells and can promote neutrophil-endothelial adhesion, microvascular leakage, and amplify other proin-flammatory responses. Despite their profile in the septic response, the importance of these cytokines in the pathogen-esis of ARDS is unclear. Levels of TNF-a are not uniformly increased in patients with lung injury and anti-TNF-a and IL-1 therapies have been disappointing. The increase in TNF-a levels occurs very early in the clinical course and may be missed by the time of presentation, although anti-TNF-a therapies can still be of benefit in some cases of sepsis.64 The huge redundancy in the proinflammatory mediator systems suggests that the search for a common pathway susceptible to...

Thromboxane Synthase And 5lipoxygenase Inhibitors

Leukotrienes (LT) are derived from arachidonic acid by 5-lipoxygenase. LTB4 is a potent neutrophil chemokine while LTC4 and LTD4 cause pulmonary vasoconstriction, capillary leak, and pulmonary oedema. The role of leukotrienes in ARDS has been less well researched but bronchoalveolar lavage fluid from patients with ARDS contains increased concentrations of LTB4, LTC4 and LTD4, which may be markers for developing ARDS.49 Ketoconazole is an imidazole antifungal agent that inhibits thromboxane synthase and 5-lipoxygenase without inhibiting CoX. Ketoconazole may therefore have a dual anti-inflammatory action in ARDS by inhibiting inflammatory eicosanoid synthesis and directing COX products down other less inflammatory metabolic paths such as those synthesising prostacyclin or PGE2.50 Four trials have used enteral ketoconazole in patients at risk of or with ARDS. The incidence of acute respiratory failure was reduced in high risk surgical patients and other critically ill patients.51-53...

Therapeutic Implications

Cholesterol as well as triglycerides through the use of HMG-CoA reductase inhibitors, better known as statins. However, it has been noted that statins likely have vasoprotective properties outside of control of serum lipids and have immunomodulating effects that also lead to regression prevention of atherosclerotic disease. Statins inhibit HMG-CoA reductase preventing the synthesis of cholesterol from mevalonic acid, and this has long been believed to be the main mechanism of cardioprotection. There are now data suggesting that statins also have anti-inflammatory effects that include inhibition of leukocyte recruitment and adhesion (143-147), reduction in chemokine production, upregulation of peroxisome proliferator-activated receptor (PPAR)-a and -y (144-149), down-regulation of MMPs with concomitant upregulation of TIMP-1 (145,146), subversion of Th response toward a Th2 response through inhibition of proin-flammatory cytokine production (e.g., TNF-a and IL-1P) (144-147), and...

Recent Advances since the Edmonton Protocol

Recent attention has been focused on the loss of viable islets not only during the isolation and purification process,40 but also when embolized into the portal vein of the recipient liver. Based on metabolic tests in post-transplant recipients, it is estimated that only 25 to 50 of the implanted islet mass actually engrafts in the patient.33 Recently, Dr Olle Korsgren and colleagues in Sweden have shown that human islets exposed to ABO-compatible blood triggers an instant blood mediated inflammatory reaction (IBMIR), characterized by activation of platelets and the coagulation and complement systems, leading to islet damage by clot formation and leukocyte infiltration.41 Further investigation into the mechanisms of this phenomenon revealed that tissue factor and thrombin play critical roles in mediating IBMIR, indicating that strategies to block binding of these factors may have considerable therapeutic potential in islet transplantation. Furthermore, in recent years, several...

Other Potential Roles As A Neuropeptidase

Substance P, Neurotensin, endorphins93 and Bradykinin32 (all degraded by 24.15 as discussed) are primary mediators of the inflammatory response. Substance P induces cytokine release and activates mast cells93a. Neurotensin has been seen to bind to peritioneal macrophages and modulate phagocytic activation93. Enkephalins and endorphins stimulate interferon release, chemotaxis, superoxide production, antibody-dependent cytotoxicity and a variety of other functions93. Bradykinin is markedly increased in human skin during severe inflammation. It induces vasodilation, prostacyclin synthesis, and leads to intracellular calcium influx32. Also at least one paper reported that PGE2 upregulates 24.1594. It is known that chronic users of non-steroidal anti-inflammatory drugs (NSAIDS) are consistently seen to have a reduced incidence of AD, and a consequent diminished rate of progression to dementia. Therefore, the effect of PGE2 on 24.15 (which is in turn inhibited by NSAIDS) is another possible...

Comparative Mediatorlipidomic Profiling Of Engineered Experimental Animals

The powerful approach of transgenics (TG), namely, deletion and overexpression of a gene product coupled with lipidomics, can give valuable insights into the role of select pathways in disease processes. We recently used the mediator lipidomics approach to evaluate transgenic rabbits overexpressing human 15-lipoxygenase (LOX) type 1 in their leukocytes.11 We can take a lipidomic snapshot of cell activation and examine the difference between the transgenic and the nontransgenic rabbits, where the key enzyme is not overproduced, but rather is in its normal state, to evaluate the impact of overexpression of a key enzyme in a pathway. In this case, 15-LOX overexpression leads to enhanced LXA4, as well as enhanced 5,15-diHETE formation with reduced leukotriene B4 (LTB4) formation (Figure 12.4). Because LTB4 is a potent chemoattractant and LXA4 is a counter-regulatory anti-inflammatory within the eicosanoid family, the relationship between these mediators and the overproduction of LXA4 is a...

Specific asthma drug treatment

On admission to the ICU there should be a rapid review of earlier asthma treatment to identify elements that can be intensified or deficiencies remedied. Drugs contraindicated in asthma include b blockers, aspirin, non-steroidal anti-inflammatory drugs, and adenosine. The addition of aminophylline does not add to the bronchodi-lating effect of optimal doses of b agonists.48 Other reported benefits of aminophylline such as improving diaphragmatic endurance, stimulating ventilatory drive, and anti-inflammatory effect do not seem to improve outcome in acute severe asthma.49-53 Currently, aminophylline is not recommended as a first line drug in acute asthma management and its inclusion as a second line agent is still debated.46 However, when other agents fail to achieve bronchodilation, aminophyl-line can be used providing dosing regimens are adhered to. Typically, a loading dose of 5 mg kg by slow intravenous infusion over 20 minutes is followed by an infusion of 500 mg kg h. If...

Cytokine and Chemokine Production by DCs

Both TLR-dependent and -independent DC activation results in the production of cytokines and chemokines, although some cytokines, such as pDC-derived type I IFN, show a strict TLR dependency (Asselin-Paturel and Trinchieri, 2005 Colonna et al, 2002 Liu, 2005 Reis e Sousa, 2004). MDCs have the ability to produce a variety of proinflammatory (TNF-a, IL-1, IL-6) and anti-inflammatory (IL-10) cytokines. They are the main source of the Th1-polarizing cytokine IL-12, together with macrophages that produce much lower levels. Although MDCs can produce IL-12 in vitro after CD40-ligand stimulation (Cella et al., 1996), TLR triggering was shown to be required for IL-12 production in vivo (Sporri and Reis e Sousa, 2005). Autocrine type-I IFN could play a key role in this process as it was shown to be required in vitro for the production of IL-12 by DCs (Gautier et al., 2005). Another important TLR-induced cytokine is IL-6, which inhibits regulatory T cellmediated immune suppression (Pasare and...

Surgical Technique

The midline implant is placed first, followed by two more implants that are placed approximately 2 mm to either side of the midline implant. Each palatal implant comes preloaded in the needle of a disposable delivery tool that inserts the implant into the soft palate. Ideally, the insertion site is set as close to the hard-palate and soft-palate junction as possible (Figs. 33.2, 33.3). After theprocedure, a flexible nasoendos-copy is preformed to ensure that the implant has not breached the nasal mucosal surface of the soft palate (Fig. 33.4). Hemostasis, if required, is achieved with electrocautery. All patients are prescribed anesthetic gargles and lozenges, nonsteroidal anti-inflammatory agents, narcotics or nonnarcotic analgesics.

Postoperative Care

Intraoperatively an intravenous single-shot antibiotic with 2 g cefazolin is administered otherwise, antibiotics are only used in cases of relevant inflammatory complications. In patients with a history of oral aphthous ulcers, a virostatic is applied. The severe pain occurring in almost all of the patients in the first postoperative days is treated with diclofenac suppositories, and later with tablets. Apart from aspirin, there is no significant increased risk of postoperative bleeding for nonsteroidal anti-inflammatory drugs, as recently published in a meta-analysis 23 . In most cases, postoperatively, there is a remarkable edema of the uvula stump which can even enhance postoperative snoring. The patient should know this. During the first postoperative day, the patients are fed via infusion, and take in tea and ice cream, as in the case of a tonsillectomy. Most patients are also able to swallow liquids, albeit under pain. From the second day, they receive a special tonsillectomy...

Impaired Wound Healing

The inhibitory effects of corticosteroids on wound healing were first described in 1950, but the cellular events were not known until the 1960s. The anti-inflammatory steroids have two major effects on wound repair (1) inhibition of initial inflammation and (2) diminution of collagen synthesis. These effects are seen clinically as increased rates of postoperative complications in patients who receive 7 8

Role of Wolbachia in Filarial Pathogenesis Inflammatory Activity of Wolbachia

Soluble extracts of B. malayi have been demonstrated to induce the production of proinflamma-tory cytokines by macrophages in vitro. In contrast, soluble extracts of the aposymbiotic species Acanthocheilonema viteae did not stimulate macrophages, and furthermore, only Wolbachia-containing extracts from insect cell lines induced an inflammatory response, strongly suggesting a role for Wolbachia in this response (49). Similarly, another study demonstrated that soluble extracts of O. volvulus and O. ochengi induced the production of pro- and antiinflammatory cytokines from isolated monocytes in vitro (50).

External validity of reviews

The most commonly used and statistically most robust metric used to summarise effectiveness within systematic reviews is the odds ratio. However, the odds ratio alone is insufficient to summarise the evidence from trials. Used alone it is not readily interpretable and it needs to be considered alongside a summary statistic of absolute risk reduction.26 Therefore a systematic review that presents the odds ratio alone is difficult, if not impossible, to use. The only option would be to assume that the odds ratio could be applied to the level of baseline risk in the population within which the guideline would subsequently be used.27 For conditions where this information might be available this strategy involves having to make a number of assumptions. However, for many conditions for which one might want to develop guidelines (depression, non-steroidal anti-inflammatory drug use) levels of baseline risk are not available.

ASecretases K6L17 Cleavage

The deduced sequence of ADAMs show existence of the Zn-binding motif HEXXH (see Fig 4), providing a potential target for design of anti-inflammatory agents notably hydroxamates (Table 1), and the creation of the DN mutant. Comparison of the hydroxamate inhibitor batimastat shows 100-700 fold higher potency towards TACE and collagenase compared to ACE secretase and a-secretase. The analog marimastat is 4 fold more potent towards APP than ACE but still retains considerable potency towards

Effects of Carbon Monoxide on Brain Functions

CO has also been reported to have specific anti-inflammatory and antiapoptotic effects (Brouard et al., 2002 Otterbein et al., 2003). The mechanism of protection against apoptotic-like cell death by which CO would act has been suggested to be mediated through the activation of a transduction pathway involving the p38 kinase (Otterbein et al., 2000). This cascade has been previously demonstrated in endothelial cells. When these cells are exposed to inflammatory stimuli, they become activated through the expression of inflammatory proteins. Through the generation of protective genes (heme oxygenase would be among them), these cells are protected against the effects of triggering the apoptotic cascade (Otterbein et al., 2003). Through this process, CO would be generated and would act as a cytopro-tective molecule that would limit the deleterious effects of the triggered inflammatory process (Otterbein et al., 2000, 2003).

Sbp And Sbprelated Complications As Possible Risk Factors Attending Liver Transplantation

SBP still die during hospitalization because of the initial infectious process, the underlying liver disease, or both (12-15,18,32-38). The impact of the development of SBP in patients on the liver transplant waiting list has recently been analyzed. In a preliminary study published in abstract form (39), 6 of patients with chronic liver disease developed SBP while awaiting transplantation, which averaged five months. More important, 62 of these patients died before receiving a liver transplant, whereas the mortality rate of patients who did not develop SBP while awaiting transplantation was only 16 . On the other hand, renal and liver function can deteriorate significantly as a consequence of SBP, and such derangements may persist after the resolution of SBP (8,14,40). Renal impairment may be related to the administration of nephrotoxic antimicrobial agents, such as aminoglycoside antibiotic agents, or to the deletereous effects of the inflammatory response itself (41-44). The...

Howard S Kaufman Mary L Harris

Crohn's disease is an inflammatory disease of unknown etiology that may affect the entire gastrointestinal tract from the mouth to the anus. Epidemiologic studies suggest that both genetic predisposition and environmental factors contribute to the development of this chronic relapsing disorder that is manifested by an unrestrained inflammatory response in the intestines. Effective medical therapy for Crohn's disease is based on anti-inflammatory, immunosuppressant, and immunomodulating strategies. Although it is not curative, most patients with Crohn's disease will require surgery for palliation of the complications of this disorder. This chapter highlights the epidemiology, pathogenesis, evaluation, and medical management of Crohn's disease of the small intestine.

Immunopharmacological Drugs

Undoubtedly, inflammation is also an immune response. Drugs described in other chapters, such as antihistamine agents, nonsteroid anti-inflammatory agents, antiserotonin drugs, and many others can also be formally grouped with immunopharmacological agents. However, only the drugs having a direct effect on cells that have immune functions, such as lymphocytes, plasma cells, and subtypes of these cells will be examined in this chapter. It should be noted that the vital functional products of these cells themselves, such as lymphokines, interferons, and interleukins, are very important immunopharmacological drugs. The immune system has an enormous number of antigens that differentiate between 'own' and 'alien' molecules. It plays a huge role in autoimmune diseases, hypersensitivity reactions in the body to certain irritants, and in transplant rejections.

Other Effects of Cortisol

The basic allergic reaction between antigen and antibody is not affected by cortisol, and even some of the secondary effects of the allergic reaction still occur. However, because the inflammatory response is responsible for many of the serious and sometimes lethal effects of allergic reactions, administration of cortisol, followed by its effect in reducing inflammation and the release of inflammatory products, can be lifesaving. For instance, cortisol effectively prevents shock or death in anaphylaxis, which otherwise kills many people, as explained in Chapter 34.

Spirulina And The Innate Immune System

Although Spirulina can stimulate the production of some of the major proinflammatory cytokines, TNF-a and IL-1, there have been several investigations of its ability to inhibit inflammatory reactions. Even more data are available on the anti-inflammatory activities of phycocyanin. A high-molecular-weight polysaccharide fraction of Spirulina induced COX-2 mRNA expression in a monocyte cell line.15 In contrast, phycocyanin was shown to selectively inhibit COX-2 activity in vitro 1 and to reduce the LPS-induced production of prostaglandin E2 in a mouse macrophage cell line, without affecting LPS-induced COX-2 protein expression.12 In addition, oral administration of phycocyanin dose dependently decreased the concentrations of leukotriene B4 and prostaglandin E2 in inflamed tissue in mouse models of inflammation.18,19 Furthermore, phycocyanin administered orally 1 h before induction of inflammation inhibited several types of acute and subchronic inflammatory responses.20 Consistent with...

Intralesional Therapies Steroids

Mechanisms of action Anti-inflammatory and reduction in collagen synthesis. Proposed in 1954 by Teasley 32 in 29 patients, with results that were at best equivocal. Subsequently in 1954, Boedner et al. 33 reported successful outcomes in 17 patients who were treated with intra-lesional hydrocortisone and cortisone injections. A study by Winter and Khanna 34 in 1975 demonstrated no statistical difference between patients treated with intra-lesional dexamethasone injections, when compared with the natural history of the disease in their general patient population. A prospective study by Williams and Green 35 in 1980 using intra-lesional triamci-

Exogenous Antigenotoxins

Aflatoxin Biosynthesis Pathway

Most antigenotoxins are taken up via consumption of food, and more especially from fruit and vegetables as part of the diet. Recently however, synthetic antigenotoxins such as nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, indomethacin, sulindac and oltipraz have been recognized. Also food supplements in the form of tablets containing vitamins, minerals, trace elements and other additives can be included in this group. NSAIDs have been shown to prevent the growth and formation of colon adenomas or carcinomas in several epidemiological and intervention studies. The mechanism of this protective effect may be very complex and multifactorial but enhancement of detoxification enzymes by NSAIDs was evident. Oltipraz, which is both an inhibitor of activating systems and an enhancer of detoxification enzymes, was shown to have strong antigenotoxic potential by preventing aflatoxin Brinduced DNA damage (Figure 1). Aflatoxin B1 is a fungal toxin, thought to be the cause of many...

Spirulina In Adaptive Immune Responses

It also remains to be established how phycocyanin exerts biological activities in vivo since proteins are generally broken down into individual amino acids or small oligopeptides before absorption. The phycocyanobilin chromophore, however, structurally resembles the bile pigment bilirubin, which can be absorbed from any part of the small or large intestine as long as it remains unconjugated. This would suggest that the phycocyanobilin part of phycocyanin is mainly responsible for the antioxidant and anti-inflammatory effects seen after oral administration of phycocyanin. This is supported by the observation that this chromophore accounts for much of the radical scavenging and antioxidant properties of phycocyanin and Spirulina.41

Hsp Function In Muscular Diseases

Finally, the overexpression of hsp 90 may modulate the cellular responses to steroids. The anti-inflammatory effects of steroids are well established both in DMD and in the inflammatory myopathies, with possible targets belonging to either the immune system or the muscle itself. Indeed, glucocorticoids enhance myoblast proliferation and promote muscle regeneration. Hsp 90, by forming a complex with the steroid receptors, may mediate these effects. Furthermore, hsp 90 may also activate MyoDI, a major protein involved in myo-genesis (41).

Orthostatic Hypotension

Recombinant erythropoietin alpha (25 to 75 U kg sc two or three times weekly) corrects the mild anemia frequently seen in patients with severe autonomic failure and may increase blood pressure and orthostatic tolerance. y Other agents that may be of benefit in the treatment of orthostatic hypotension include ergotamine tartrate, dihydroergotamine, monoamine oxidase inhibitors, yohimbine, and nonsteroidal anti-inflammatory agents. It is unclear whether any of these agents is effective.

Dietary Supplement Health and Education Act DSHEA and Spirulina

Spirulina is sold in health food stores and similar outlets as a dietary supplement. There appears to be a lack of understanding about their regulatory status. Until 1994 dietary supplements were regulated as foods by FDA. However, with passage of the Dietary Supplement Health and Education Act of 1994 (DSHEA), Congress amended the food regulations to include several provisions that apply only to dietary supplements and dietary ingredients of dietary supplements. As a result of these provisions, dietary ingredients used in dietary supplements are no longer subject to the pre-market safety evaluations required of other new food ingredients or for new uses of old food ingredients. They must, however, meet the requirements of other safety provisions. FDA defines a dietary supplement as a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients a vitamin, a mineral, an herb or other botanical, an amino...

Spirulina As A Natural Therapeutic Intervention For Inflammation And Oxidative Stress In Aging

Spirulina, is a very interesting and promising source of phytochemicals that has also shown hopeful results in dealing with age-related changes. With both antioxidant and anti-inflammatory actions, Spirulina has the ability to supplement our internal anti-oxidant defense systems as well as control any excessive inflammation. The first known use of Spirulina as a dietary supplement came from the Aztecs more than 400 years ago. The Spanish conquistadors found the Aztecs drying the green growth, called tecuitlatl, from Lake Texcoco located near Mexico city. Today, Lake Texcoco is still plentiful in Spirulina. It has also been speculated that the Mayans specifically farmed Spirulina as a crop. Likewise, the Kanembu who live along lake Chad were found to be taking the growth form the lake and drying it for food (Ciferri and Tiboni, 1985). Classified as a cynobacteria (blue-green algae) Spirulina is abundant in phycocy-anin, which gives it a blue pigmentation. The large amount of...

Anastomotic Complications and Their Management Summary

A third factor impacting on the transplant airway anastomosis is the use of high dose steroids. The potential adverse effects of steroids on the healing of airway anastomoses are numerous. The anti-inflammatory and lympholytic effects of steroids impair the process of wound healing in general. The use of steroids has been associated with anastomotic complications in other types of airway surgery.5 In lung transplants, steroids have been shown to explicitly impair the healing of bronchial anastomoses and are associated with an increased incidence of bacterial sepsis.6 Despite these findings, the routine use of steroids following lung transplantation

Formation of Reactive Metabolites

Enzymes catalyzing phase 2 of drug metabolism may also form reactive metabolites. For instance, UGT may promote the formation of protein ad-ducts when it is conjugating carboxylic acids like nonsteroidal antiinflammatory drugs (NSAIDs) (86). But to our knowledge, even if there is evidence that some NSAIDs cross the blood-brain barrier and enter the CNS, the possible formation of reactive metabolites in the brain has never been reported. Formation of reactive metabolites has been also described during hepatic conjugation of arylamines or polycyclic arylmethanol with sulfate and glutathi-one but once again, no evidence of such activities in the brain has been presented.

Carcinogenblocking Activities Antimutagenicity

Abbreviations AA, arachidonic acid COX, cyciooxygenase CpG, cytosine-guanosine DFMO, 2-difiuoromethylornithine DHEA, dehydroepiandrosterone GSH, glutathione GST, glutathione-S-transferase FGF, fibroblast growth factor IGF, insulin-like growth factor iNOS, inducible nitric oxide synthase LOX, lipoxygenase NAC, N-acetyl-L-cysteine NK, natural killer NSAID, nonsteroidal anti-inflammatory drug ODC, ornithine decarboxylase PEITC, phenylethyl-isothiocyanate PG, prostaglandin PPAR, peroxisome proliferator-activated receptor SERM, selective oestrogen receptor modulator TGF, transforming growth factor. See also Kelloff, G. J. (2000). Advances in Cancer Research, 278, 199-334. Abbreviations AA, arachidonic acid COX, cyciooxygenase CpG, cytosine-guanosine DFMO, 2-difiuoromethylornithine DHEA, dehydroepiandrosterone GSH, glutathione GST, glutathione-S-transferase FGF, fibroblast growth factor IGF, insulin-like growth factor iNOS, inducible nitric oxide synthase LOX, lipoxygenase NAC,...

Pharmacology 11 The Biologicalpharmacological Activity Of The Salvia Genus

The traditional Chinese herbal drug Dan-Shen (Tan-shen, S. miltiorrkiza Bge.) is described to have sedative, antimicrobial, antispasmodic, anti-inflammatory and antioxidant properties. Tan-shen is mentioned in Chinese Pharmacopoeia as a drug that treats problems associated with heart and circulatory system (oral preparations decoction or tablet with Panax notoginseng) insomnia (dry, oral preparation decoction with Polygala tenuifolia and Zizyphus spinosa) and as a drug used in the S. haematodes Wall., known as red sage, was found to posses significant CNS depressant (anticonvulsant) properties (Akbar et al., 1985). Further pharmacological screening revealed a broad variety of pharmacological effects. When tested in animal models, the ethanolic extract of red sage showed anti-inflammatory and analgesic effects, hypothermic response in non-pyretic rats and enhancement of the wound healing process (Akbar, 1989). The ethanolic extract of S. haematodes had significant inotropic and...

Fibrosis Is It Linked to Inflammation

Recently, the notion that the chronicity of inflammation may not actually drive the fibrogenic process has been widely appreciated (Tables 1, 2, and 3). Some propose that it is indeed the alteration of the mesenchymal cell pheno-types that disrupts the balance between collagen synthesis and degradation in the wound-healing process, highlighted by clinical evidence that shows unsuccessful treatment of fibrosis with anti-inflammatory or immunosuppressive drugs (18,19). One scenario is that mesenchymal cells (myofibroblasts and fibroblasts) are phenotypically altered and thus do not undergo apoptosis after resolution. Whereas the study by Moore et al. implicates the fibrocyte as having a central, profibrotic (profibrogenic) role in the fibrotic disease, other studies suggest otherwise. Ortiz et al. show that not all bone marrow-derived cells are damaging during tissue repair (19). They demonstrate that murine mesenchymal stem cells migrate to the fibrotic lung, adopt epithelial-like...

Foreword to the Fourth Edition

Recombinant cytokines provide useful laboratory probes for studying the cell biology of innate and adaptive immunity and inflammation. Cytokines are the major orchestrators of host defense processes and, as such, are involved in responses to exogenous and endogenous insults, repair and restoration of homeostasis. Microbial pathogens have operated on these principles far longer than immunologists and have been shown to produce variants of proinflammatory cytokines, their receptors and chemokine antagonists that subvert and suppress the host immune and inflammatory defenses. Deletion of these products reduces the pathogenicity of these viruses. In addition to their role in host defense, cytokines appear to play a major role in development and some of them may account for as yet unidentified embryonic inductive factors. The study of cytokines is also elucidating the mechanisms underlying pathophysiological processes. Cytokines mediate not only host responses to invading organisms, tumors...

Downregulation of the Immune Response

Interleukin-10 (IL-10) plays an antiinflammatory role in controlling the strongly activated immune response following clearance of rickettsial infection. The serum concentration of IL-10 in C3H HeN mice is elevated on day 10 after inoculation of R. typhi, but not at the peak of the bacterial load on day five or in convalescence on day 15 (34). On day 10, the rickettsial load is below the limit of detection, having been controlled by the immune response. Continued activation of antirickettsial, cell-mediated immunity after bacterial clearance could be more harmful than beneficial. The observed effects of immune regulation by high IL-10 levels include decreased IL-12 concentration and transient immunosuppression of T-cell responses between days 10 and 15. Stimulation of spleen cells collected from R. typhi-infected mice with con-canavalin A during this period yields lower production of IL-2 and IL-12 than those of na ve mice (34). Similarly, serum IL-10 concentrations are increased in...

Interactions Between Cytokines

The effect of a cytokine in vivo will depend on the immediate cytokine environment. This is best illustrated in the context of inflammation at an inflamed site, many different cytokines and their inhibitors can be detected. Apparent redundancy in the actions of cytokines would imply that blocking a given cytokine would have only a marginal effect. This is not the case, however, as is best illustrated by the profound anti-inflammatory effect of anti-TNF strategies, which currently comprise neutralizing antibodies or soluble receptors9. At the same time, anticytokine measures will be induced, such as increased production of the IL-1 receptor antagonist (IL-1 Ra) and the inhibitory cytokine IL-10. It is the balance of activating and inhibitory cytokines that will determine outcome6. Recently, it has been suggested that certain polymorphisms in the promoter regions of cytokine genes might lead to imbalances in cytokine networks. For example, individuals with a polymorphism in the gene for...

Propionic acid derivatives

This series of anti-inflammatory, analgesic, and fever-reducing compounds (ibuprofen, naproxene, ketoprofen, fenprofen) can be equally identified as both propionic acid derivatives as well as phenylpropionic acid derivatives. The mechanism of their action is not conclusively known however, it has been suggested that it is also connected with the suppression of prostaglandin synthetase activity.

Michael C Koester Md Atc Kurt P Spindler MD

This article discusses the current understanding of the potential role for bisphosphonates, parathyroid hormone (PTH), and vitamin D supplementation in the treatment of sports-related fractures. The available evidence regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and their effects on fracture healing are also reviewed. Discussion focuses on the applicability of these findings to the sports medicine population the potential role of pharmacologic agents for implant fixation and osteoporosis treatment are not discussed.

Anthranylic acid derivatives

Anthranylic acid derivatives are direct structural analogs of salicylic acid derivatives. They possess analgesic, anti-inflammatory, and fever-reducing activity. They are similar to pyrazolones in terms of analgesic and fever-reducing activity, yet they exceed the antiinflammatory activity of salicylates. The mechanism of action of this series of nonsteroid, anti-inflammatory analgesics is not conclusively known.

Targeting Downstream Effectors of PCatenin

Cyclooxygenase-2 is overexpressed in many tumors and its direct or indirect regulation by Wnt p-catenin signaling has been demonstrated (82,194-196,208). Its activity can be inhibited by selective cyclooxygenase (COX)-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs (197). Epidemiological and experimental studies have demonstrated that COX-2 inhibitors and nonselective nonsteroidal antiinflammatory drugs can inhibit the development of colorectal cancer (198-201). The COX-2 inhibitor celecoxib has been approved for reduction and regression of col-orectal polyps in FAP patients. However, to effectively downregulate Wnt p-catenin signaling by inhibiting downstream effectors of the pathway more than one P-catenin Tcf-regulated gene needs to be targeted. This kind of an approach is appealing but specific studies are pending.

Management Of Neuropathy Associated With Nucleoside Reverse Transcriptase Inhibitor Therapy

Neuropathic pain may be intermittent and tolerable for some patients and require only nonsteroidal anti-inflammatory agents for relief. For many individuals, the pain is both continuous and severe enough to limit function. The World Health Organization has published a three-step analgesic ladder to provide a systematic and rational approach to pain management. Although developed to treat cancer-related pain, the same approach is useful for addressing neuropathic pain associated with HIV and dideoxynucleoside therapy. Initially, adjuvants such as tricyclic agents (amitriptyline and others) or anticonvulsants (gabapentin, lamotrigine, carbamazepine, and others) are used in combination with nonopioid analgesics. In the second step, a second adjuvant with a differing mechanism of action is added. Many patients with moderate neuropathic

Drug Induced Hepatotoxicity

Patients with nonacetaminophen drug-induced FHF have a poorer prognosis.68 Severe liver failure has been reported in patients taking isoniazid.85 Increased risk of toxicity occurs in those who chronically ingest alcohol.86 Patients who ingest isoniazid with the enzyme inducer rifampin, have an increased risk of developing FHF. The interval between drug administration and onset of liver disease is shorter with rifampin.87,88 Psychotropic drugs such as the monoamine oxidase inhibitors and tricyclic antidepressants have been reported to cause FHF, particularly when used in conjunction with hepatic enzyme inducers.89,90 Nonsteroidal anti-inflammatory drugs (NSAIDs) can be hepatotoxic and several cases of FHF have been reported in patients using piroxicam, pirprofen, ibuprofen and indometha-cin.91-94 The mechanism of hepatocellular injury induced by these drugs is thought to be idiosyncratic rather than intrinsic toxicity.95 Halothane-induced FHF occurs within 2 weeks of general anesthesia...

Specific Effects of Topical Formulations

In addition, vehicles can exert an emollient (re-lipidizing or re-greasing effect), which is of great importance in the postexposure treatment of skin conditions, where a cracked, rigid or rough skin surface is the main problem to be considered. Furthermore, some moisturizers, in their capacity of postexposure skin care products, release anti-inflammatory and epithelial growth-promoting substances.

Management of Achilles Paratendinopathy

In the early phase of Achilles paratendinopa-thy, conservative, nonoperative management is pursued.2,55 Identification and correction of the predisposing factors mentioned earlier are addressed initially.55 Correction of malalignment is addressed with orthotics, and if problems are identified with the training program, it is modified to place less strain on the Achilles tendon. In patients with severe symptoms, the lower extremity (or just the ankle joint) is completely rested for a short time.2 The use of nonsteroidal antiinflammatory drugs (NSAIDs) did not positively affect the outcome of Achilles tendinopathy in a randomized clinical trial 56 however, they are often used for early management of pain from Achilles paratendinopathy.55 The corticosteroid injections around the Achilles tendon should be used with extreme caution,55,57 and should be administered only by experienced physicians.57 Failure to adequately respond after 3 to 6 months of conservative management is the...

Does the Use of NSAIDs Affect Achilles Tendon Healing

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in soft-tissue disorders. Many different drugs exist within this category and their use is not without potential side-effects, such as gastrointestinal disturbances and renal damage. What is the evidence that they are helpful in the management of Achilles disorders, and is there any evidence that their use might be potentially harmful Physicians have frequently used nonsteroidal anti-inflammatory drugs (NSAIDs) in Achilles tendinopathy, especially in the clinically acute phases.49-51

Conservative Management

Training errors, muscle weakness, decreased flexibility, biomechanical abnormalities, and poor equipment have all been suggested as important etiological factors.14,15,18-22 Again, these suggestions are resting on poor scientific grounds, and are to be considered as unsubstantiated hypotheses. Despite the absence of scientific evidence for an ongoing chemical inflammation inside the tendon,23 nonsteroidal anti-inflammatory drugs (NSAIDs) are most often being used as part of the initial management.17,18 Consequently, the use of NSAIDs to decrease existing chemical inflammation in the chronic painful Achilles tendon can be questioned. Indeed, in a randomized double-blind placebo-controlled study of 70 patients with chronic painful Achilles tendinopathy, oral piroxi-cam gave similar results as placebo.24

Therapeutic Uses Of Spirulina

Spirulina and its active constituents have specific therapeutic uses beyond general nutritional values. In vitro and in vivo studies have shown that either Spirulina or its active constituent, C-phycocyanin is promising in chemoprevention and cancer protection,98 neuroprotection,99 antiviral action,100 cardiovascular protection,87 immunomodulation,101 hepatoprotection,102 anti-inflammatory action,103 antioxidant action,104 and protection against chemical- and drug-induced toxicities.87,105-107

The Role Of Inflammation In Aging

In aging, a series of unchecked inflammatory events can lead to exaggerated proin-flammatory cytokine levels such as, increases in interleukin 1 (IL-1), IL-1 receptor agonists, tumor necrosis factor (TNF), and transforming growth factor- .1> 2 When functioning correctly, cytokines send the appropriate amount of the correct signal to assist in resolving the immune stimulus such as, IL-4, IL-10, and IL-13, which act to suppress inflammation, or IL-1, IL-6, IL-8, IL-11, and IL-12, which act to stimulate inflammation. In a healthily immune system both pro- and anti-inflammatory cytokine are used to acutely handle the immune stimulus. In the aged system, the profile of cytokine activation does not resemble acute activation instead a chronic inflammation state is seen. This chronic pattern of activation can change the microenvironment within the CNS leading to detrimental outcomes. A growing body of evidence has linked age-dependent alterations in cognitive ability with an altered...

Method of Treatment

Used as a contact medium between cylinder and skin (Fig. 4b). Three thousand impulses of 0.60mJ mm2 were administered under regi-nal anesthesia. Only one therapy session was undertaken with each patient. No cold therapy or nonsteroidal antiinflammatory drugs (NSAIDs) were allowed after the procedure. Active exercises began as an outpatient treatment the day after SWT for 4-6 weeks.


Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective for short-term symptomatic relief in patients with acute low back pain.44 There does not seem to be a specific type of NSAID that is clearly more effective than others.44 Therapy is titrated to provide pain relief at a minimal dose, and is continued for four to six weeks. NSAIDs should not be continued indefinitely, but rather prescribed for a specific period.3


Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly beneficial in relieving acute neck pain. However, side effects are common, and usually two or three medications must be tried before a beneficial result without unacceptable side effects is achieved. Muscle relaxants help relieve muscle spasm in some patients alternatives include carisoprodol (Soma), methocarbamol (Robaxin), and diazepam (Valium). Narcotics may be useful in the acute setting, but should be prescribed in a strictly time-limited man-ner.76 The physician should be alert to the possibility of addiction or abuse.

Problems with use

There are no known drug interactions with exogenous melatonin, but its effect also depends on the endogenous secretion which can be increased by selective serotonin re-uptake inhibitor antidepressants and antipsychotic drugs and reduced by beta blockers, benzodiazepines, sodium valproate, gabapentin and nonsteroidal anti-inflammatory drugs.

General Principles

Many of these misadventures can be avoided by careful evaluation before the first gastric operation and by adherence to the important technical principles outlined elsewhere in this volume. It should not be discovered after an unsuccessful laparoscopic fundoplication that the patient has disordered esophageal motility and or idiopathic gastroparesis. Surgeons who perform bariatric surgery should know that staple line disruption can be eliminated by proper technique. Those operating for peptic ulcer disease need to understand the role of Helicobacter pylori in the pathogenesis of this disease. It may no longer make sense to perform more extensive surgery to lower the risk of recurrent ulcer, because ulcer recurrence can be minimized by the treatment of H. pylori infection. It should be recognized that ulcer patients referred for surgery due to intractability or nonhealing may represent a group at high risk for a poor surgical result. The large majority of peptic ulcers can be healed...

Salvia sclarea

Cold extract of clary will help draw out thorns and splinters and reduce inflammation. The dried roots, crushed and powdered, can be used like snuff to clear the head and ease a headache. An ointment made with clary leaves will help draw out inflammation and bring boils and spots to a head Back, 1987 .


The pathophysiology of ARDS is driven by an aggressive inflammatory reaction. Indirect injury occurs as part of a systemic inflammatory response syndrome (SIRS), which can be due to infective or non-infective causes such as pancreatitis or trauma when SIRS is caused by infection it is called sepsis. SIRS with organ dysfunction is called severe sepsis and, in the presence of significant hypotension, septic shock.12 ARDS can thus occur in conjunction with failure of other organs, the multiorgan dysfunction syndrome (MODS). A number of endogenous anti-inflammatory mechanisms are also initiated to counterbalance the effects of such an aggressive inflammatory response and this is termed the compensatory anti-inflammatory response syndrome (CARS), although these responses too may be excessive and contribute to a state of immunoparesis.1314


Lung injury is initiated by a specific insult but can be exacerbated by inappropriate mechanical ventilatory strategies (reviewed in chapter 8). Briefly, alveolar overdistension can generate a proinflammatory response which is exacerbated by repetitive opening and closing of alveoli as occurs through the use of inappropriately low levels of positive end expiratory pressure (PEEP).8 Indeed, overdistension or recurrent opening closing of alveoli can also induce structural damage to the lung.35 36 The effect of high inspired concentrations of oxygen on the disease process is uncertain, particularly in humans. However, prolonged exposure to 100 oxygen is fatal in most animal models, producing neutrophil influx and alveolar oedema that can be blocked in rodents using anti-inflammatory strategies such as inhaled low dose carbon


With initiation of inflammation there is increased leucocyte production and rapid recruitment to the inflamed site. There is also activation of mediator cascades including the production of cytokines, chemokines, acute phase proteins, free radicals, complement, coagulation pathway components, and focal upregulation of adhesion molecule expression. The antiinflammatory response includes the glucocorticoids, cytokines (interleukin (IL)-4, IL-10 and IL-1 receptor antagonist (IL-1ra)) and other mechanisms such as shedding of adhesion molecules.39-41


Over half of patients require no treatment for acute pericarditis and another 40 respond to bed rest, nonsteroidal anti-inflammatory medications and mild diuretics. Asymptomatic effusions can be followed while awaiting spontaneous resolution, which may take up to two years. Chronic effusions that cause symptoms and or hemodynamic abnormalities of cardiac compression should be treated with


Type II alveolar cells synthesise and recycle surfactant phospholipids and proteins. Surfactant lowers alveolar surface tension and prevents collapse at low lung volumes. The same effects reduce the hydrostatic pressure gradient favouring fluid movement into the alveolar space. Surfactant also has anti-inflammatory and antimicrobial properties. During ARDS, surfactant activity may be deficient because of reduced production, increased removal with recurrent alveolar collapse during ventilation, abnormal composition and, importantly, dysfunction caused by plasma proteins,30 ROS, and proteases in the flooded alveolar space.31


Unlike glucocorticoids, mineralocorticoids have an insignificant effect on carbohydrate volume. They do not exhibit any anti-inflammatory or anti-allergy properties. They are used for chronic adrenal insufficiency, as well as for raising tonicity and work capacity of muscles.


A history of mechanical ventilation or ICU admission is a well documented indicator of subsequent near fatal asthma.2 3 Women and smokers are also over-represented in both life threatening attacks and asthma deaths.3-5 It is believed that patients who have had a life threatening attack and those who die are from a similar demographic group. In a large study of patients admitted with a near fatal episode, two thirds of subsequent severe attacks or deaths had occurred within a year.2 5 Interestingly, the association between asthma deaths and b agonist use is still debated and there has been concern that the use of long acting b agonists may increase asthma mortality.6 This has not been confirmed in studies monitoring their use.7 8 In contrast, there is a consensus that underuse of anti-inflammatory treatment in the period leading up to the acute severe attack worsens prognosis.9

Il6 Ascitic Fluid

Correction of shock when present and of patient hydration by both parenteral fluid replacement and discontinuation of diuretic drugs are mandatory. Administration of potentially nephrotoxic drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aminoglycoside antibiotic agents must be avoided or limited as much as possible. The same measures should be applied in the case of the development of renal impairment. Although not proven in patients with SBP, plasma expansion with human albumin, alone or combined with systemic vasconstrictors, which have reversed a number of cases of hepatorenal syndrome in cirrhotic patients (38), may be useful in preventing and or treating renal impairment during episodes of SBP.


Corticosteroids have many anti-inflammatory effects that make them potent immunosuppressants. These anti-inflammatory effects are also the mechanisms through which the complications of steroid therapy occur. Much of their activity is initiated at the molecular level via binding to cytoplasmic hormone receptors. The steroid receptor complex migrates to the nucleus, where it acts by affecting gene transcription. The net effects are inhibition of cytokine gene transcription and secretion, particularly IL-1, IL-6, and tumor necrosis factor by macrophages and IL-2 by T cells. Furthermore, macrophage activation and mobilization are inhibited, as is endothelial adhesion molecule expression.


With development of microarray technologies, the expression level of practically the entire mammalian genome can be measured. Expression changes in transcripts may serve as biomarkers for exposure and also serve to aid in understanding the mechanism of action of the stimuli as well as the cellular pathways involved in response. Within the pharmaceutical discovery and development process, an illustrative application of transcript profiling is the use of microarrays (employing cDNA or oligonucleotide probes) to predict or investigate toxicity, an approach that has become known as toxicogenomics. Several recent publications on toxicogenomics have been published and can be reviewed for a more detailed discussion of its general principles.4-6 Treatment of test systems with known reference toxicants (with similar toxic end point, mechanism, chemical structure, target organ, etc.) permits the identification of diagnostic gene expression patterns for particular toxic outcomes. The ability of...


Cohort and case-control studies have demonstrated the protective role of aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS) (Potter, 1999). These are believed to act through the inhibition of cyclo-oxygenase (COX) which is involved in the synthesis of prostaglandin (converts arachidonic acid to prostaglandin G2). The more specific COX antagonists (sulindac) have been shown to cause adenomas to regress in FAP and to restore the altered apoptotic index in the normal-appearing mucosa of FAP subjects to normal. The molecular mechanisms underlying these interesting observational data are unknown. A drawback of NSAIDs is their gastrointestinal side-effects. COX-2 is not expressed by normal colonic epithelial cells but is upregu-lated in cancer cells. The latest generation of selective COX-2 antagonists was developed in order to achieve therapeutic or preventive effects without accompanying gastrointestinal disturbance. At this stage it is not known if the more selective...

H3c ch3

Some strong natural antioxidants like carnosol were proved to exhibit anti-inflammatory and inhibitory effects with regard to tumor-initiation activities in mice test systems (Huang et al., 1994). Also some sage compounds (ursolic and or oleanolic acid) that show no antioxidant activity (Wu et al., 1982) may turn promising in future research of inflammation and of cancer prevention. A squalene derived triterpenoid ursolic acid (structure 29) and its isomer oleanolic acid (structure 30) (up to 4 in sage leaves, dry weight basis) (Brieskorn and Kapadia, 1980), act anti-inflammatory and inhibit tumorigenesis in mouse skin (Tokuda et al., 1986 Huang et al., 1994 Ho et al., 1994). Recent data on the anti-inflammatory activity of sage (S. officinalis L.) extracts when applied topically (IDJ0 2040 pg cm2) and evaluated as oedema inhibition after Croton oil induced dermatitis in mouse ear, confirm suggest ursolic acid to be the main active ingredient, responsible for sage anti-inflammatory...


The electrodiagnostic abnormalities also show a distal to proximal gradient. The most sensitive NCS are the plantar mixed NCS, followed by the superficial peroneal and sural sensory NCS, followed by the upper extremity sensory NCS. The motor NCS abnormalities and needle electrode examination abnormalities follow this same pattern. When one considers that a nerve is made of sensory, motor, and autonomic axons ranging in size from small to large, it is easy to envision the range of clinical symptoms this disorder produces. Small fiber sensory disruption causes loss of pain and temperature perception, as well as more prevalent features of dysautonomia. Large fiber sensory involvement impairs proprioception, vibratory perception, gait (sensory ataxia), and reflexes. Motor axon dysfunction produces weakness, and autonomic axon involvement produces various dysautonomic features. Occasionally, patients present with disproportionate small fiber or large fiber sensory involvement or autonomic...

Apophyseal Injuries

It is important to advise the patient and family that it is a self-limited condition that improves with rest and attainment of skeletal maturity. Activity modification, use of a knee sleeve, ice, massage, and antiinflammatory medication are usually helpful for reducing discomfort. NSAIDs nonsteroidal antiinflammatory drugs PFD patellofemoral dysfunction OCD osteochondritis dissecans RICE rest, ice, compression, and elevation ASIS anterosuperior iliac spine AIIS anteroinferior iliac spine. NSAIDs nonsteroidal antiinflammatory drugs PFD patellofemoral dysfunction OCD osteochondritis dissecans RICE rest, ice, compression, and elevation ASIS anterosuperior iliac spine AIIS anteroinferior iliac spine. The patient and family must understand that 12 to 18 months may be required to allow spontaneous resolution by physiologic epiphysiodesis. Treatment with ice, antiinflammatory medication, and an appropriately contoured knee pad relieves symptoms. The level of sporting activity is balanced...

Basic immunology

Table For Basic Immunology

Most inflammatory skin disease responds to topical or systemic corticosteroids. However, long-term use of corticosteroids has significant toxicity and there are multiple nonsteroidal immunosuppressive agents used in dermatology. Steroid sparing agents used in the treatment of autoimmune bullous diseases include azathioprine, cyclophosphamide, dapsone, gold, and methotrexate. Immunosuppressive agents useful for psoriasis include cyclosporine A, hydroxyurea, mycophenolate mofetil, and methotrexate. Phototherapy with UVB, or psoralen plus UVA, has immunosuppressive effects. Antimalarials (e.g., hydroxychloroquine) are useful for connective tissue disease. Additional immunomodulatory therapies used in dermatology include extracoporeal photophoresis, interferons, interferon inducers, and topical nitrogen mustard. Nonsteroidal antiinflammatory agents under investigation for skin conditions include FK506 and related compounds that can have topical activity. With the use of molecular biology...

Mechanisms of action

DHEA has also been shown to increase endothelial proliferation and improve endothelial function in vitro using endothelial cells, as well as in vivo measured by flow-mediated dilatation of the brachial artery, by a mechanism independent of either androgen or estrogen receptor activity 281 . Iwasaki etal. demonstrated that DHEA and DHEA-S both had possible anti-inflammatory and immunomodulatory effects by inhibiting proinflammatory cytokine-induced transcription, an effect that neither estradi-ol nor T could duplicate 282 .


There are no clinical studies that have evaluated the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) on stress fracture healing. Animal studies suggest that NSAIDs may decrease healing in complete fractures therefore, cautious use of NSAIDs for stress fractures is warranted 21 .

Iron Losses

Feeding to infants, aspirin, nonsteroidal anti-inflammatory drugs or corticosteroid administration, and hereditary hemorrhagic telangiectasia see (4) for review . In addition to these conditions, a significant amount of iron (210-240 mg unit) can be lost with regular blood donation.


Necrotizing enterocolitis almost exclusively occurs in bottle-fed infants. The beneficial effect of maternal milk could be due to interference with direct contact between bacteria and mucosa, in combination with the antiinflammatory properties ofhuman milk. For example, human colostrum has been shown to protectcell monolayers from injury by activated polymorphonuclear leukocytes ' . IgA antibodies are not only non-inflammatogenic,


In medicine, pyrazolonee derivatives play a significant role as analgesics, anti-inflammatory, and fever-reducing agents. Among these are antipyrin, butadion, amidopyrin, phenylpyrazon, sulfinpyrazone, sodium methamizol sodium (analgin), and a few others. In terms of analgesic and anti-inflammatory action, they are similar to salicylic acid derivatives. Although the mechanism of their action is not completely known, it is supposed that pyrazolone derivatives, like aspirin, inhibit biosynthesis of prostaglandins and reduce permeability of capillaries, thus preventing the development of inflammatory reactions. A serious limitation to the wide use of pyrazolonee in medicine is the cases of onset of agran-ulocytosis upon use of methamizol sodium.


Infants are reported to eat less than normal amounts during infections 12. Some have reported that breast-fed infants are less prone to anorexia during infectious illnesses 1,2. In animals, illness-induced anorexia (IIA) is associated with the release ofinterleukin-1 and tumor necrosis factor whose main mediators are the prostaglandins . Prostaglandins, cytokines, anti-inflammatory factors and the PUFAs docosahexaenoic (DHA) and arachidonic (AA) are among the substances present in human milk that likely modulate an infant's immune system and may account for the putative dampening of anorectic responses during illnesses of breastfed infants. It also is noteworthy that DHA and AA are prostaglandin precursors. AA derived prostaglandins are more potent than those derived from DHA. This study's aims were to assess energy intakes ofbreast- and formula-fed infants during and after an infectious episode and to assess possible relationships between circulating concentrations of IL-1 and TNF,...


Bed rest is not recommended for the treatment of low back pain or sciatica rather, a rapid return to normal activities is usually the best course.14 Nonsteroidal anti-inflammatory drugs can be used in a time-limited way for symptomatic relief.44 Back exercises are not useful for acute low back pain, but can help prevent recurrence of back pain and can be used to treat patients with chronic low back pain.14 Work activities may be modified at first, but avoiding iatrogenic disability is key to successful management of acute low back pain.5,41 Surgery should be reserved for patients with progressive neurological deficit or those who have sciatica or pseudoclaudication that persists after nonoperative therapy has failed.14

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