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By Z. Jens. University of Montana, Missoula. 2019.

We recommend a dosage of at least 15 billion to 20 billion organisms during antibiotic therapy; leave as much time as possible between the dose of antibiotic and the probiotic supplement cheap nasonex nasal spray 18 gm on-line. If pseudomembranous enterocolitis develops discount 18gm nasonex nasal spray with visa, in addition to Lactobacillus and Bifidobacter species we also recommend supplementing with Saccharomyces boulardi (also known as S discount 18gm nasonex nasal spray fast delivery. Botanical Medicines Berberine Plants that contain the alkaloid berberine such as goldenseal (Hydrastis canadensis), barberry (Berberis vulgaris), Oregon grape (Berberis aquifolium), and goldthread (Coptis chinensis) have a long history of use in infectious diarrhea. Clinical studies with pure berberine have shown significant success in the treatment of acute diarrhea. Clinical studies have shown berberine comparable to standard antibiotics in most cases; in fact, results were better in several studies. For example, one study focused on 65 children under five years of age who had acute diarrhea caused by E. The children who were given berberine tannate (25 mg every six hours) responded better than those who received standard antibiotic therapy. The children received daily divided doses of either berberine (5 mg/kg per day), the drug metronidazole (10 mg/kg per day), or a placebo of vitamin B syrup. In the metronidazole group, 33% of the children were without symptoms and, upon stool analysis, all were found to be giardia-free. In comparison, 15% of the children who took the placebo were without symptoms and, upon stool analysis, 25% were found to be giardia-free. These results indicate that berberine was actually more effective than metronidazole in relieving symptoms at half the dose, but less effective than the drug in clearing the organism from the intestines. Finally, in a study of 200 adult patients with acute diarrhea, the subjects were given standard antibiotic treatment with or without berberine hydrochloride (150 mg per day). Results of the study indicated that the patients who received berberine recovered more quickly. Despite these results, owing to the serious consequences of an ineffectively treated infectious diarrhea, the best approach may be to use berberine-containing plants along with standard antibiotic therapy. Much of berberine’s effectiveness is undoubtedly due to its direct antimicrobial activity. However, it also has an effect in blocking the action of toxins produced by certain bacteria. Good results have been obtained using berberine in the treatment of traveler’s diarrhea. In one study, patients with traveler’s diarrhea randomly served as controls or received 400 mg berberine sulfate in a single dose. Twenty-four hours after treatment, significantly more treated patients than controls stopped having diarrhea (42% vs. If you are planning to travel to an underdeveloped country or an area where there is poor water quality or poor sanitation, the prophylactic use of berberine-containing herbs (and probiotic preparations) may be appropriate. Take them one week prior to your trip, during your stay, and one week after visiting. Tormentil Root An extract of tormentil root (Potentilla tormentilla) has been shown to be useful to treat infectious diarrhea, shorten the duration of rotavirus diarrhea, and decrease the requirement for rehydration solutions. In this study, 40 children ranging in age from three months to seven years with rotavirus diarrhea were divided into two groups: a treatment group that consisted of 20 children given 3 drops of tormentil root extract per year of life three times per day until discontinuation of diarrhea or a maximum of five days, and a control group of 20 children who received a placebo. The duration of diarrhea was 60% less in the tormentil root extract treatment group than in the placebo group (three days compared with five days in the control group). In the treatment group 8 of 20 children (40%) were diarrhea free 48 hours after admission to the hospital, compared with 1 of 20 (5%) in the control group. Children in the treatment group also needed smaller volumes of parenteral fluids than subjects in the control group. If any of the following apply, a physician should be consulted: • Diarrhea in a child under six years of age • Severe or bloody diarrhea • Diarrhea that lasts more than three days • Significant signs of dehydration (sunken eyes, severe dry mouth, strong body odor, etc. Dried root or as infusion (tea), 2 to 4 g three times per day Tincture (1:5), 6 to 12 ml (1. The organisms most commonly cultured from middle ear fluid during acute otitis media include Streptococcus pneumoniae (40–50%), Haemophilus influenzae (30–40%), and Moraxella catarrhalis (10–15%). Chronic ear infection—also known as serous, secretory, or nonsuppurative otitis media; chronic otitis media with effusion; and “glue ear”—is a constant swelling and fluid accumulation in the middle ear. Nearly two-thirds of American children have a bout of acute otitis media by two years of age, and chronic otitis media affects two-thirds of children younger than the age of six. Otitis media is the most common diagnosis in children and is the leading cause of all visits to pediatricians. Children diagnosed with otitis media during infancy are also at greater risk for developing allergic eczema and asthma during school age. Standard Medical Treatment The standard medical approach to an ear infection in children is antibiotics, pain relievers (acetaminophen or ibuprofen), and/or antihistamines. If the ear infection is long-standing and unresponsive to the drugs, surgery is performed. The surgery involves the placement of a tiny plastic myringotomy tube through the eardrum to assist the normal drainage of fluid into the throat via the eustachian tube. It is not a curative procedure, as children with myringotomy tubes in their ears are in fact more likely to have further problems with otitis media. Myringotomies are currently performed on nearly 1 million American children each year. It appears that the unnecessary surgery of the past, the tonsillectomy, has been replaced by this new procedure. In fact, there is a direct correlation between the decline of the tonsillectomy and the rise of the myringotomy. More than 2 million myringotomy tubes are inserted into children’s ears each year, and 600,000 tonsillectomies and adenoidectomies are done. A 1994 evaluation of the appropriateness of myringotomy tubes for children younger than 16 years of age in the United States found that only 42% were judged as being appropriate. A number of well-designed studies have demonstrated that there were no significant differences in the clinical course of acute otitis media when conventional treatments were compared with a placebo. Specifically, no differences were found between treatment other than antibiotics, ear tubes, ear tubes with antibiotics, and antibiotics alone. This reduced recurrence rate is undoubtedly a reflection of the suppressive effects antibiotics have on the immune system, and of the fact that they disturb the normal flora of the upper respiratory tract. Instead of antibiotics, the recommendation from this group of experts was to use pain relievers and have the parent observe the child closely.

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In some cases the joint appears essentially normal discount nasonex nasal spray on line, with little if any joint space narrowing order nasonex nasal spray 18gm line, yet the pain can be excruciating purchase nasonex nasal spray online. On the other hand, there are cases where there is tremendous deformity, yet little if any pain. In fact, about 40% of individuals with the worst X-ray classification for osteoarthritis are pain free. Therapeutic Considerations Normally the body deals with damage to cartilage by attempting to repair itself. The major therapeutic goal should be to decrease the rate of damage and enhance the repair and regeneration of the collagen matrix. All subjects had X-ray changes suggestive of advanced osteoarthritis, yet the researchers reported marked clinical improvement and X-ray evidence of repair in 14 of 31 hips over time. Although these drugs provide short-term symptomatic relief, they do not address the cause of the problem and may actually increase the rate of degeneration of the joint cartilage. Diet and Exercise The key dietary focus in the prevention and treatment of osteoarthritis is the achievement of normal body weight and improvement in insulin sensitivity. Excess weight means increased stress on weight- bearing joints, and there is also considerable evidence linking osteoarthritis to insulin resistance (see the chapter “Obesity and Weight Management”). Insulin resistance not only increases inflammation but also impairs cartilage regeneration. Weight reduction, possibly due to a combination of mechanical and physiological factors, reduces the risk for osteoarthritis and has also been shown to reduce pain and improve cartilage function in existing osteoarthritis, especially when combined with exercise. When arthritis pain develops, sufferers often tend to reduce activity, and inactivity in turn decreases muscle strength. Muscle weakness increases joint wear, and the inactivity can lead to weight gain, which can worsen osteoarthritis, causing this cycle to repeat itself. In addition, patients with diabetes and cardiovascular concerns who limit their exercise may also increase their risk related to these illnesses. Weight loss and exercise independently decrease the causative factors of osteoarthritis and produce clinical improvement, but the best results are achieved by a combined approach. One study involved 252 obese elderly patients with a body mass index greater than 28 and X-ray-confirmed osteoarthritis who were randomized into healthful-lifestyle (control), diet-only, exercise-only, and diet-plus- exercise groups. The dietary interventions were intended to produce an average weight loss of 5% during the 18-month period. Compared with control patients and the diet-only group, subjects in the diet-plus-exercise group gained a significant improvement in self-reported physical function, six- minute walking distance, stair-climb times, and knee pain scores. Improvements in the exercise-only group were limited to the six-minute walking distance. In general, the principles detailed in the chapter “A Health-Promoting Diet” are appropriate for osteoarthritis. As with other degenerative health conditions, the Mediterranean diet may show positive effects in arthritis. The Mediterranean diet includes abundant plant foods (fruits, vegetables, whole grains, beans, nuts and seeds); minimally processed, seasonal, locally grown foods; fish and poultry; olive oil as the main source of fat; and dairy products, red meat, and wine in low to moderate amounts. Thus the diet is rich in monounsaturated fatty acids, long-chain polyunsaturated fatty acids, antioxidants, and unrefined carbohydrates. The Mediterranean diet has shown significant effects in rheumatoid arthritis in two recent studies and may show similar benefit in osteoarthritis. A horticulturist, Norman Childers, arrived at this method after finding that this simple dietary elimination cured his own arthritis. Presumably these alkaloids inhibit normal collagen repair in the joints or promote inflammatory degeneration of the joint. Nutritional Supplements Glucosamine Glucosamine sulfate has emerged as the most popular nutritional approach to osteoarthritis. It appears that as some people age, they lose the ability to manufacture sufficient levels of glucosamine. The result is that cartilage loses its gel-like nature and consequently its ability to act as a shock absorber. Extensive preclinical and clinical research, including long-term double-blind studies, supports a potential role for glucosamine as a primary treatment for arthritis. Typically the advantages of glucosamine over these other treatments are seen after two to four weeks of use, but there is some evidence that the longer glucosamine is used, the greater the therapeutic benefit. The results from the two longest placebo-controlled trials show quite convincingly that glucosamine slows down the progression of osteoarthritis and in many cases produces regression of the disease, as noted by X-ray improvements, and significantly reduces the incidence of total joint replacement even as much as five years after glucosamine treatment is discontinued. X-rays were taken of weight-bearing joints at enrollment and after one and three years. Average joint-space width was assessed along with symptoms of pain, stiffness, and functionality. Symptoms improved more significantly in the glucosamine group, but the most telling result was the fact that joint space narrowed 0. After three years, postmenopausal participants in the glucosamine group showed no joint space narrowing, whereas participants in the placebo group experienced a narrowing of 0. These results may indicate that postmenopausal women may be especially responsive to glucosamine. The clinical effect is impressive, especially when glucosamine’s safety and lack of side effects are considered. In one of the earlier comparative studies in which glucosamine (1,500 mg per day) was compared with ibuprofen (1,200 mg per day), pain scores decreased faster in the first two weeks in the ibuprofen group. However, by week four the group receiving glucosamine experienced a significantly better improvement than the ibuprofen group. However, by the end of the second week, the group taking glucosamine experienced results as good as those of the ibuprofen group. In addition, although the side effects of glucosamine were mild and affected only 6% of the group, ibuprofen produced more significant side effects much more frequently, with 35% of the group experiencing them. Glucosamine was shown to offer significant benefit in an open trial involving 1,506 patients in Portugal. Symptoms of pain at rest, on standing, and during exercise, as well as in limited active and passive movements, all improved steadily throughout the treatment period. Objective therapeutic efficacy was rated by doctors as “good” in 59% of the patients and “sufficient” in a further 36%. Glucosamine produced good benefit in a significant portion of patients who had not responded to any other medical treatment. The improvement with glucosamine lasted for 6 to 12 weeks after the end of treatment.

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Of 121 laboratories that had applied to take part in the survey buy discount nasonex nasal spray 18 gm on-line, 75 from the Federal Republic of Germany and 19 from other European countries sent in their results for evaluation buy 18gm nasonex nasal spray fast delivery. Percentile 1500- 1000; T 3500Г Sample В 3000- -I 2500 2000 1500- 100Cfe 4 8 20 36 52 72 76 Kit No cheap nasonex nasal spray 18gm on line. In part this might be traceable to the not unequivocal data of the producers of the kits. These units of values were taken over by the evaluation that had been used by the majority of participants. Since the values do not follow a normal distribution, preference is given in the further considerations to the median and to the 16 and 84% percentiles as criteria of precision. Insofar as a sub-collective consisted of less than six values, in Figs 2—4 simply the median is indicated; collectives with less than three values are not considered. Further, one can deduce that the antibodies of the individual kits have differing characteristics. Given these prerequisites, discrepancies necessarily arise between the medians for these individual kits (Fig. The good inter­ laboratory precision that had been attained with the radio- and enzyme- immunoassays by the firm of Abbott (No. Errors by the participants in converting to ng/mL have probably led to the high values of the medians for kit No. But this com­ parison is not possible since the working standards are based on two different international reference materials. All working standards should refer only to one specific international reference preparation, and its unit should also be employed for routine analyses. Referring to efforts to set up a national quality surveillance scheme in India, a speaker enquired whether or not it was desirable to found such schemes in developing countries on the use of matched reagents. Such reagents, if locally prepared, would not be identical with those used in international schemes; standards might constitute a particular problem in this respect. Should standards be distributed in relatively large amounts or in individual sub-ampoules each containing enough for a single assay? The ideal arrangement would be for the co-ordinating labora­ tory regularly to distribute sub-ampoules of the international standards or reference preparations. As many as 10 000 such sub-ampoules might be obtained from one ampoule of the original material. He saw no need for matched reagents beyond this, though there could be advantages in standardizing assay design, as far as this was feasible. Kit assays went one step further than did matched- reagent assays, in that all necessary items were included in the package, but the onus was then on the manufacturer to market a good product. The target values for analyte concentrations in the serum pools from which samples for analysis were derived constituted an important aspect of quality surveillance schemes. Voigt saw no possibility of establishing true target values for peptide hormones, for which no independent reference methods of measurement existed. Hunter replied that, in his view, this was perfectly possible through recovery experi­ ments, though he agreed as to the need to confirm parallelism in their results. Röhle indicated that in the Federal Republic of Germany, where kit assays were in general use, quality surveillance had demonstrated a marked improvement in assay performance in recent years. The improvement could be attributed to the introduction of more reliable kits with more rugged protocols. Indeed, the overall imprecision for kit assays might have fallen below that for matched-reagent assays. Hunter agreed that kits had shown continuing improvement over the years, especially in respect of results on supposedly analyte-free samples. A speaker pointed out that the requirement to carry out clinical trials hindered manufacturers from introducing new and improved products. Sufi conceded that matched-reagent schemes did not always lead to improvements in assay performance. Such schemes could have a second objective, however, namely the distribution of scarce materials. Laboratories in advanced countries generally had the means to set up their own in-house assays rather than depend on kits. Many laboratories in developing countries would prefer to do the same, especially in view of the high cost of kits, but lacked the necessary high-quality reagents. The programme was continuing, but with an increasing emphasis on regional devolution. How­ ever, different methods of automatic data-processing had been observed to give differing results. In the particular case of receptor assays, a European co-ordinating committee had been set up and the possibility of organizing work on a regional basis existed. However, their limitations were well recognized and other forms of analysis were being investigated. On the subject of licensing of assay laboratories, a speaker referred to the situation in Ontario, Canada, where licensing was obligatory and laboratories had to participate in quality surveillance schemes for assays of all types. In his experience, considerations other than scientific often diminished the utility of such schemes when they were compulsory. There was a danger, however, in taking a kit designed for one purpose and using it for another. For the detection of neonatal hypothyroidism, for example, he would prefer a specially designed kit. The problems are initially of an organizational nature concerned with obtaining necessary local support from administrators with limited funds available from socialized health budgets. Stressing the relevance of proposed techniques to national priorities in many fields would be required. Centres should be located so as to serve as wide an area as possible, and administrative obstacles in communication, clearance, transport etc. It is suggested that emphasis be placed on training of personnel, particularly at technician level, in selected centres within a region, and by regional training courses, so that expertise gained may be better applied to local situations. The degree of sophistication of equipment selected is seen to depend on the factors of work load and possibility for repair and maintenance.

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This free radical goes on to form 2+ hydrogen peroxide (H2O2) effective nasonex nasal spray 18 gm, another oxygen radical species purchase 18 gm nasonex nasal spray with amex. These free radical species result in cellular injury via lipid peroxidation of the plasma membrane purchase nasonex nasal spray australia, oxidation of sulfhydryl groups of intracellu- lar and membrane proteins, nucleic acid injury, and breakdown of components of the extracellular matrix such as collagen and hyaluronic acid. The level of oxygen radical formation after ischemia–reperfusion injury in the heart can overwhelm the natural scavenger systems. These findings suggest a role for gene transfer of natural scavengers as a means to protect the myocardium in the event of an ischemia–reperfusion event. However, no studies have investigated the direct antioxidant effect and ensuing improvement in myocardial function of this treatment after ischernia and reperfusion injury. This application of gene therapy technology may offer a novel and exciting approach for prophylaxis against myocardial ischemic injury when incorporated into a system of long-term, regulated transgene expression. In addition to the overexpression of antioxidant genes, some researchers have proposed intervening in the program of gene expression within the myocardium that lead to the downstream deleterious effects of ischemia reperfusion. Genetic manipulation of donor tissues offers the opportunity to design organ- specific immunosuppression during cardiac transplantation. Although transgenic animals are being explored as potential sources for immunologically protected xenografts, the delivery of genes for immunosuppressive proteins, or the blockade of certain genes in human donor grafts, may allow site-specific, localized immuno- suppression. Alternatively, these approaches could result in a reduction or elimina- tion of the need for toxic systemic immunosuppressive regimens. The current state of this technology has pro- vided us with an exciting glimpse of its therapeutic potential. Routine application, however, will require improvement of existing techniques along with the develop- ment of novel methods for gene transfer. More importantly, no one method of gene transfer will serve as the defining approach. Rather, it will be the use of all avail- able techniques, either individually or in combination, that will shape the applica- tion of this therapy. Over the past two decades, as scientists have begun to unlock the genetic code, more insight into the pathogenesis of disease has been gained. With the use of gene manipulation technology, this new information can be used to further improve the understanding and treatment of complex acquired and con- genital diseases previously unresponsive to traditional surgical and pharmacologic therapy. This ideal vector would also have the flexibility to accommodate genes of all sizes, incorporate control of the temporal pattern and degree of gene expression, and to recognize specific cell types for tailored delivery or expression. Recombinant adenoviruses have become the most widely used viral vectors for experimental in vivo cardiovascular gene transfer. Adenoassociated virus has successfully transduced myocardial cells after direct injection of viral suspensions into heart tissue; and these infections have yielded relatively stable expression for greater than 60 days. For nonviral gene delivery, the controlled application of a pressurized en- vironment to vascular tissue in a nondistended manner has recently been found to enhance oligonucleotide uptake and nuclear localization. This method may be particularly useful for ex vivo applications, such as vein graft- ing or transplantation, and may represent a means of enhancing plasmid gene delivery. For myocardial infarction, gene therapy offers the ability to genetically convert cardiac fibroblasts into functional cardiomyocytes. Genetic manipula- tion may be used to limit the degree of injury sustained by the myocardium after ischemia and reperfusion through the transfer of natural scavengers of oxidative tissue injury. Adenovirus-mediated over-expression of the cyclin/cyclin dependent kinase inhibitor, p2l inhibits vascular smooth muscle cell proliferation and neointima formation in the rat carotid artery model of balloon angioplasty. Cytostatic gene therapy for vascular proliferative disorders with a constitutively active form of the retinoblastoma gene product. Gene transfer of tissue inhibitor of metalloproteinase- 2 inhibits metalloproteinase activity and neointima formation in human saphenous veins. Delivery and expression of fluid shear stress-inducible promoters to the vessel wall:Applications for cardiovascular gene therapy. Cell cycle inhibition preserves endothelial function in genetically engineered rabbit vein grafts. Preliminary clinical experience with genetic engi- neering of human vein grafts: Evidence for target gene inhibition. A novel molecular strategy using cis element “decoy” of E2F binding site inhibits smooth muscle proliferation in vivo. Gene therapy for vascular smooth muscle cell pro- liferation after arterial injury. Inhibition of neointimal cell bcl-x expression induces apop- tosis and regression of vascular disease. Antisense c-myb oligonucleotides inhibit intimal arte- rial smooth muscle cell accumulation in vivo. Restoration of beta-adrenergic signaling in failing cardiac ventricular myocytes via adenoviral-mediated gene transfer. Efficient catheter-mediated gene transfer into the heart using replication-defective adenovirus. Intracoronary gene transfer of fibroblast growth factor- 5 increases blood flow and contractile function in an ischaemic region of the heart. Long-term gene transfer in porcine myocardium after coro- nary infusion of an adeno-associated virus vector. Gene therapy with extracellular superoxide dismutase attenuates myocardial stunning in conscious rabbits. Biologic bypass with the use of adenovirus-mediated gene transfer of the complementary deoxyribonucleic acid for vascular endothelial growth factor 121 improves myocardial perfusion and function in the ischernic porcine heart. In vivo transfection of cis element “decoy” against nuclear factor-kappab binding site prevents myocardial infarction. Muscle differentiation during repair of myocardial necro- sis in rats via gene transfer with MyoD. Complete reversal of ischemic wall motion abnormali- ties by combined use of gene therapy with transmyocardial laser revascularization. Induction of neoangiogenesis in ischemic myocardium by human growth factors: First clinical results of a new treatment of coro- nary heart disease.

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It is believed that with effective neuromonitoring buy 18 gm nasonex nasal spray overnight delivery, secondary brain injury can be rec- ognised early and better managed before irreversible injury occurs purchase discount nasonex nasal spray line, thereby improving pa- tient outcome safe 18 gm nasonex nasal spray. There are several different, but related, factors that have to be taken into consideration when a mass lesion within the cranial cavity starts to expand. These are the displacement of brain tissue from one intracranial compartment to another or the spinal canal. These herniae, in turn, lead to the de- 26 Clinical Assessment and Diagnostic Procedures in Neurotrauma 309 velopment of pressure gradients because of obliteration of subarachnoid space and cisterns and secondary vascular complications, such as haemorrhage and ischaemic brain damage. There is circumstantial evidence that this information can be used to modify and optimise patient treatment. Pressure autoregulation mechanisms protect against cerebral ischaemia due to hypotension and against excessive Àow (malignant hyperaemia) during hypertension, when capillary damage, oedema, diffuse haemorrhage, and intracra- nial hypertension might otherwise result. At present, no single method can be regarded as a gold-standard measure of cerebral autoregulation. Although a publication earlier this decade found that SjvO2 monitoring does not substantially inÀuence the management of head-injured patients, other studies indicate a clear and practical bene¿t [35, 36]. There are dif¿cul- ties in establishing the relationship between Àow and metabolism in injured brain regions from the global venous drainage of the brain. More clinical studies need to be conducted to unequivocally prove the utility of this interesting noninvasive technology [37]. BtO2 differs from SjvO2 in that it monitors oxygen metabolism in a small, focal volume of brain. Several studies demonstrate that BtO2 is inÀuenced by a wide range of parameters [38]. In conclusion, BtO2 may be a predictor of patient outcome, and speci¿cally, BtO2 <10 mmHg is associated with a greater risk of poor outcome. Biomarkers should be traceable in blood and should be proportional to the mechanical impact and extent of the injury, and their speci¿city is as important as their sensitivity. S-100 proteins are brain-speci¿c calcium-binding pro- teins with small molecular weight (20 kDa) and can be found in the cytoplasm of astroglia and Schwann cells. Although an association between several biomarkers and outcome has been established, the prognostic value of biomarkers is unclear owing to relatively small numbers analysed in univariate analyses [52]. The prognostic value of routinely measured laboratory variables has been more widely investigated. High glucose concentrations, low haemoglobin, low platelets, and coagula- tion disturbances are the strongest predictors of outcome and are independently related to poorer outcome [53–56]. On the basis of the observed association between higher glucose concentration and poorer outcome, two randomised trials were recently done to assess the effect of intensive insulin therapy to reduce glucose concentrations. Hence, large numbers of obser- vations are required before signi¿cant data convergence is achieved providing a consistent picture. The injury usually triggers a variety of pathophysiological mechanisms that in turn create a highly heterogeneous pattern of changes within the brain. The monitoring of comatose head-injured patients in neurointensive care provides information regarding the Àuctuations in cerebral haemodynamic and metabolic function. Following brain trauma, the system of cerebrovascular circulation usually works without feedback information. Moreover, physiologically negative feedback loops are converted to positive vicious cy- cles. The aim of clinical assessment and diagnostic monitoring is to provide missing data, closing the disrupted control loop by an appropriate therapy managed by doctors’ deci- sions. Tagliaferri F, Compagnone C, Korsic M et al (2006) A systematic review of brain injury epidemiology in Europe. Brain Trauma Foundation (2007) Guidelines for the management of severe trau- matic brain injury (3rd edn). Zuercher M, Ummenhofer W, Baltussen A et al (2009) The use of Glasgow Coma Scale in injury assessment: a critical review. Stocchetti N, Pagan F, Calappi E et al (2004) Inaccurate early assessment of neu- rological severity in head injury. Marshall l, Marshall S, Klauber M et al (1991) New classi¿cation of head injury based on computerized tomography. Association for the Advancement of Automotive Medicine (1990) The abbreviated injury scale, 1990 revision. Botteri M, Bandera E, Minelli C et al (2008) Cerebral blood Àow thresholds for 314 M. Czosnyka M, Smielewski P, Timofeev I et al (2007) Intracranial Pressure: more than a number. Marino R, Gasparotti R, Pinelli L et al (2006) Post-traumatic cerebral infarction in patients with moderate or severe head trauma. Maloney-Wilensky E, Gracias V, Itkin A et al (2009) Brain tissue oxygen and outcome after severe traumatic brain injury: A systematic review. Am J Phys Med Rehabil 82:53–64 26 Clinical Assessment and Diagnostic Procedures in Neurotrauma 315 43. Sawauchi S, Taya K, Murakami S et al (2005) Serum S-100B protein and neu- ron-speci¿c enolase after traumatic brain injury [in Japanese]. Rainey T, Lesko M, Sacho R et al (2009) Predicting outcome after severe trau- matic brain injury using the serum S100B biomarker: results using a single (24h) time-point. Kövesdi E, Lückl J, Bukovics P et al (2010) Update on protein biomarkers in traumatic brain injury with emphasis on clinical use in adults and paediatrics. Lannoo E, Van Rietvelde F, Colardyn F et al (2000) Early predictors of mortality and morbidity after severe closed head injury. Rovlias A, Kotsou S (2001) The blood leukocyte count and its prognostic signi¿- cance in severe head injury. Historically, they have been considered as punishments by the god(s) or were associated with the movement of celestial bodies, the stars, inÀuencing human affairs and determining the course of events. The word disaster in fact stems from the Latin dis as- tro, and implies an unfavourable position of the planets (stars), thus linking them to fate. From its summit, a huge cloud of lapillus and lava obscured the sun and fell to the areas surrounding the volcano, destroying towns such as Pompeii, Ercolano, Stabia and Naples. The pottery of classi- cal Greece depicts hunters helping dress each others’ wounds.

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