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Integrative Medicine Clinic of Arizona | Integrative …

June 26th, 2018 8:44 am

Rising healthcare costs and decreased reimbursement payments have created an environment where most primary care physicians are forced to see 30 to 50 patients per day. This makes it virtually impossible to establish strong relationships and serve the needs of patients. You have most likely felt the end effects of these changes with rushed medical appointments, lack of focus on your concerns and overuse of pharmaceuticals to treat the symptoms, but not actually fix the cause of your condition.

We have a better solution.

The Integrative Medicine Clinic of Arizona is committed to focusing on you and thoroughly addressing your health.

Our physician, Cheri Dersam, M.D., is trained in both Traditional and Integrative Medicine. This allows her to fully address your health concerns today and reduce your risks for health problems in the future.

She takes the time to listen to your concerns and turn the focus back to you. By fully exploring your past and present health, nutrition, activity and lifestyle and utilizing conventional and innovative lab testing, she will explore the root cause of your health concerns. She will also investigate genetic risk factors that can predict the likelihood you may develop conditions such as cardiovascular disease, stroke, Alzheimers Disease and certain cancers. Dr. Dersam will then recommend a health promotion plan personalized to you. This will include balancing your nutrition, digestion, activity, stress, sleep, hormones, and adjusting medications as needed.

Because we do not participate with any insurance company contracts, this frees us from all of the time-consuming administrative hassles and we can spend more time with you. This translates into more time with the physician and allows us to offer you a team approach to your healthcare. This team includes a physician, nutritionist, health coach and acupuncturist with the addition of a chiropractor, psychologist and/or other alternative therapists as needed at discounted prices.

Choose a primary care physician who has time to listen to your concerns, is highly trained and offers an effective treatment plan that is personalized to you.

If you are ready to take charge of your health, join our membership practice today or book a free 20-minute consultation appointment by calling us at (480)766-3586.

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Where Do We Get Adult Stem Cells? | Boston Children’s Hospital

June 26th, 2018 8:42 am

There are several ways adult stem cells can be isolated, most of which are being actively explored by our researchers.

1) From the body itself:Scientists are discovering that many tissues and organs contain a small number of adult stem cells that help maintain them. Adult stem cells have been found in the brain, bone marrow, blood vessels, skeletal muscle, skin, teeth, heart, gut, liver, and other (although not all) organs and tissues. They are thought to live in a specific area of each tissue, where they may remain dormant for years, dividing and creating new cells only when they are activated by tissue injury, disease or anything else that makes the body need more cells.

Adult stem cells can be isolated from the body in different ways, depending on the tissue. Blood stem cells, for example, can be taken from a donors bone marrow, from blood in the umbilical cord when a baby is born, or from a persons circulating blood. Mesenchymal stem cells, which can make bone, cartilage, fat, fibrous connective tissue, and cells that support the formation of blood can also be isolated from bone marrow. Neural stem cells (which form the brains three major cell types) have been isolated from the brain and spinal cord. Research teams at Childrens, headed by leading scientists Stuart Orkin, MD and William Pu, MD, both affiliate members of the Stem Cell Program, recently isolated cardiac stem cells from the heart.

Isolating adult stem cells, however, is just the first step. The cells then need to be grown to large enough numbers to be useful for treatment purposes. The laboratory of Leonard Zon, MD, director of the Stem Cell Program, has developed a technique for boosting numbers of blood stem cells thats now in Phase I clinical testing.

2) From amniotic fluid:Amniotic fluid, which bathes the fetus in the womb, contains fetal cells including mesenchymal stem cells, which are able to make a variety of tissues. Many pregnant women elect to have amniotic fluid drawn to test for chromosome defects, the procedure known as amniocentesis. This fluid is normally discarded after testing, but Childrens Hospital Boston surgeon Dario Fauza, MD, a Principal Investigator at Childrens and an affiliate member of the Stem Cell Program, has been investigating the idea of isolating mesenchymal stem cells and using them to grow new tissues for babies who have birth defects detected while they are still in the womb, such as congenital diaphragmatic hernia. These tissues would match the baby genetically, so would not be rejected by the immune system, and could be implanted either in utero or after the baby is born.

3) From pluripotent stem cells:Because embryonic stem cells and induced pluripotent cells (iPS cells), which are functionally similar, are able to create all types of cells and tissues, scientists at Childrens and elsewhere hope to use them to produce many different kinds of adult stem cells. Laboratories around the world are testing different chemical and mechanical factors that might prod embryonic stem cells or iPS cells into forming a particular kind of adult stem cell. Adult stem cells made in this fashion would potentially match the patient genetically, eliminating both the problem of tissue rejection and the need for toxic therapies to suppress the immune system.

4) From other adult stem cells:A number of research groups have reported that certain kinds of adult stem cells can transform, or differentiate, into apparently unrelated cell types (such as brain stem cells that differentiate into blood cells or blood-forming cells that differentiate into cardiac muscle cells). This phenomenon, called transdifferentiation, has been reported in some animals. However, its still far from clear how versatile adult stem cells really are, whether transdifferentiation can occur in human cells, or whether it could be made to happen reliably in the lab.

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Journal of Fertilization: In Vitro – IVF-Worldwide …

June 25th, 2018 9:48 am

IVF Treatment

Unlike artificial insemination wherein the sperm is introduced into uterus, in IVF, the sperm and egg are fertilized outside the uterus in laboratory conditions. The fertilized egg is then introduced into womans uterus. Most often, IVF is not the first treatment suggested for infertility because of its complex nature and costs involved in it.

Related Journals of IVF Treatment

Gynecology & Obstetrics; Andrology & Gynecology: Current Research; Andrology-Open Access; Reproductive Biomedicine Online; Human Reproduction; Fertility and Sterility; Molecular Human Reproduction, Journal of Assisted Reproduction and Genetics; Acta Obstetricia Et Gynecologica Scandinavica; European Journal of Obstetrics & Gynecology and Reproductive Biology

Recent advances and latest techniques in IVF treatment are enabling to achieve high success rates and minimizing the chances of multiple pregnancies and birth defects. The refinements are being done in every step of IVF i.e., ovarian stimulation, collection of sperm, fertilization, embryo development in lab conditions and introduction of embryo into uterus.

Related Journals of Advances in In-vitro Fertilization

International Journal of Andrology, Gynecology & Obstetrics; Andrology-Open Acce; Andrology & Gynecology: Current Research; Journal of Assisted Reproduction and Genetics; Fertility and Sterility; American Journal of Obstetrics and Gynecology; Reproductive Biology and Endocrinology; Archives of Gynecology and Obstetrics; Reproductive Medicine and Biology

Infertility is when not being able to achieve pregnancy even after regular intercourse. It is the most common problem which suffers the couples from having children. Many treatments have been available with different success rates. They include fertility drugs, intrauterine insemination (IUI), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), donor insemination (DI), egg (or embryo) donation and surrogacy.

Related Journals of Infertility Treatment

Gynecology & Obstetrics; Critical Care Obstetrics & Gynecology; Andrology & Gynecology: Current Research; Infertility and Reproductive Medicine Clinics of North America; Journal of Reproduction and Infertility; International Journal of Infertility and Fetal Medicine; Iranian Journal of Obstetrics, Gynecology and Infertility;Reproductive Biomedicine Online; Human Reproduction

Artificial Insemination (AI) is one of the infertility treatments available for both men and women. In this technique, the sperm is directly introduced into womans uterus, fallopian tube or cervix. The most common form of artificial insemination is intra Uterine Insemination (IUI). Although the success rate of this technique is less, it is the first infertility treatment doctor would suggest as it involves less cost and the treatment method is simple.

Related Journals of Artificial Insemination

Critical Care Obstetrics & Gynecology; Gynecology & Obstetrics; Andrology & Gynecology: Current Research; Theriogenology;Journal of Dairy Science; Animal Reproduction Science; Reproduction; Reproduction Fertility and Development; Reproduction in Domestic Animals

Reproductive genetics is a sub-filed of medical genetics that primarily involve conducting different tests for predicting possible outcomes of future pregnancies. The tests involve analyzing genetic material like chromosomes, genes, DNA, RNA and gene products for accessing genetic changes that have likelihood of causing some disease after pregnancy in either mother or child.

Related Journals of Reproductive Genetics

Human Reproduction and Genetic Ethics, Reproductive System & Sexual Disorders; Current Trends in Gynecologic Oncology; Andrology & Gynecology: Current Research; Journal of Assisted Reproduction and Genetics; Conservation Genetics; Animal Reproduction Science; Reproductive Biomedicine Online; Human Reproduction Update; PLoS Genetics

Semen analysis is the most common way of accessing infertility in men. It basically evaluates the quality and environment of sperm. The analysis involves testing various sperm parameters such as sperm morphology, sperm count, sperm motility etc. It helps to test sperm donors for quality sperm to be used in assisted reproductive techniques.

Related Journals of Semen Analysis and Sperm Characteristics

Andrology & Gynecology: Current Research; Andrology-Open Access; Reproductive System & Sexual Disorders; Fertility and Sterility; Asian Journal of Andrology; Theriogenology; Human Reproduction; Journal of Assisted Reproduction and Genetics; Reproductive Biomedicine Online

Endometriosis is disease condition in woman in which the tissue which normally grows inside the uterus will grow outside the uterus. The side effects of the condition are pelvic pain and infertility. In 70% of the cases, the pelvic pain would be severe during menstruation. The cause for such condition is not clearly understood yet.

Related Journals of Endometriosis Treatment

Gynecology & Obstetrics; Critical Care Obstetrics & Gynecology; Andrology & Gynecology: Current Research; Journal of Endometriosis; Journal of Minimally Invasive Gynecology; Human Reproduction; Fertility and Sterility; International Journal of Gynecology & Obstetrics; Obstetrical & Gynecological Survey

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2018 Personalized Medicine Conference GRC

June 25th, 2018 9:44 am

Sunday2:00 pm - 8:00 pm

Arrival and Check-in

Dinner

Introductory Comments by GRC Site Staff / Welcome from the GRC Chair

Discussion Leader: Chih-Ming Ho (University of California, Los Angeles, USA)

Introduction by Discussion Leader

Dean Ho (BIGHEART, National University of Singapore, Singapore)

Discussion

Edward Kai-Hua Chow (Cancer Science Institute of Singapore, National University of Singapore, Singapore)

Discussion

Bin Tean Teh (National Cancer Centre Singapore, Singapore)

Discussion

General Discussion

Breakfast

Discussion Leader: Mien-Chie Hung (University of Texas MD Anderson Cancer Center, USA)

Introduction by Discussion Leader

Wei Zhang (Comprehensive Cancer Center, Wake Forest University, USA)

Discussion

Group Photo / Coffee Break

Chuan He (University of Chicago, USA)

Discussion

Jindan Yu (Northwestern University, USA)

Discussion

General Discussion

Lunch

Free Time

Poster Session

Dinner

Discussion Leader: Rita Yen-Hua Huang (Taipei Medical University, Taiwan)

Introduction by Discussion Leader

Ye-Guang Chen (Tsinghua University, China)

Discussion

Bradley Cairns (University of Utah, USA)

Discussion

General Discussion

Breakfast

Discussion Leader: Wei Jia (University of Hawaii Cancer Center, USA)

Introduction by Discussion Leader

Neal Rosen (Memorial Sloan Kettering Cancer Center, USA)

Discussion

Coffee Break

Van-Dang Chi (Ludwig Cancer Research, USA)

Discussion

Shengfang Jin (Agios Pharmaceuticals Inc, USA)

Discussion

General Discussion

Lunch

Poster Session

Discussion Leader: Tony S.K. Mok (Chinese University of Hong Kong, Hong Kong SAR China)

Introduction by Discussion Leader

Patrycja Nowak-Sliwinska (University of Geneva, Switzerland)

Discussion

Hong Wu (School of Life Sciences, Peking University, China)

Discussion

Jonathan Keats (Translational Genomics Research Institute (TGen) / City of Hope, USA)

Discussion

General Discussion

Dinner

Breakfast

Discussion Leader: Priscilla Kelly (Science, AAAS, USA)

Introduction by Discussion Leader

Pui-Yan Kwok (Institute of Biomedical Sciences, Academia Sinica, Taiwan)

Discussion

Sridhar Mani (Albert Einstein College of Medicine, USA)

Discussion

Coffee Break

Christiane Querfeld (Cutaneous Lymphoma Program, City of Hope, USA)

Discussion

Irene O.L. Ng (The University of Hong Kong, Hong Kong SAR China)

Discussion

General Discussion

Lunch

Free Time

Poster Session

Dinner

Business MeetingNominations for the Next Vice Chair; Fill in Conference Evaluation Forms; Discuss Future Site and Scheduling Preferences; Election of the Next Vice Chair

Discussion Leader: Richard Weinshilboum (Mayo Clinic, USA)

Introduction by Discussion Leader

James Lee (University of Pittsburgh School of Medicine, USA)

Discussion

Steven Offer (Mayo Clinic, USA)

Discussion

Liewei Wang (Mayo Clinic, USA)

Discussion

General Discussion

Breakfast

Discussion Leader: Chien-Tsun Kuan (Development Center for Biotechnology, Taiwan)

Introduction by Discussion Leader

Arjan Griffioen (VU University Medical Center, The Netherlands)

Discussion

John Williams (Beckman Research Institute, City of Hope, USA)

Discussion

Coffee Break

Xianting Ding (Institute for Personalized Medicine, Shanghai Jiao Tong University, China)

Discussion

Ali Zarrinpar (Division of Transplantation and Hepatobiliary Surgery, University of Florida College of Medicine, USA)

Discussion

General Discussion

Lunch

Free Time

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About the Fred A. Litwin Family Centre in Genetic Medicine

June 24th, 2018 7:45 am

');$.get(url, function(data){$('.rightNav-wp-' + idx).html(data);});}var rightPanel = $('#rightpanel');if (rightPanel.length == 0) rightPanel = $('#rightpanel-placeholder');$.each(webparts, function(i,e){addWp(i,e);});}if (!window.location.origin) {window.location.origin = window.location.protocol + '//' + window.location.host;}var pn = _spPageContextInfo.serverRequestPath.replace(/^//ig,''),pNames = [], curSite,webparts = UHNPageData.siteWebParts ? UHNPageData.siteWebParts.rows : []; // from XSLTDataViewWebpartwhile (pn.indexOf('/') > 0) {pNames.push(pn);pn = pn.substr(0, pn.lastIndexOf('/'));}pNames.push(pn);for (var i = 0; i 0) {continue;}curSite = webparts[j];j = webparts.length;i = pNames.length;}}}if (curSite === undefined) {curSite = webparts.filter(function(e){return e.Title == 'Global';})[0];if (curSite === undefined) return reloadSiteWebParts();}if (!curSite.HideRightNav) {generateHTML(curSite.Webparts);$('#rightpanel').show();} else {HideRightNav = curSite.HideRightNav;$('#rightpanel').hide();}$('#MSO_ContentTable').toggleClass('col-sm-9', !curSite.HideRightNav);}window.HideRightNav = false;window.safetyAttempts = 0;initRightNav();$(function(){var userGroup = [2164];if (_spPageContextInfo.userId) {$().SPServices({operation: 'GetUserCollectionFromGroup',groupName: 'Designers',completefunc: function (xDataUser, Status) {$(xDataUser.responseXML).find("User").each(function() {userGroup.push(parseInt($(this).attr("ID").trim()));});if ($.inArray(_spPageContextInfo.userId, userGroup) > -1) {$('#title-links ul').prepend('

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Biotechnology Career | Jobs, Salary, Courses & Colleges in …

June 24th, 2018 7:43 am

Biotechnology is one of the most progressive and beneficial scientific advances of the last quarter century. An interdisciplinary field that includes mathematics, physics, chemistry, engineering and others, it combines various- technologies to either create a new product or modify an existing one to suit our needs.

Its widespread application across multiple industries like food, pharmaceutical, chemical, bio-products, textiles, medicine, nutrition, environmental conservation and animal sciences makes a career in biotechnology one of the fastest growing fields with ample opportunities for qualified professionals.

Biotechnology combines the theoretical (genetics, molecular biology, biochemistry, embryology and cell biology), and the practical (chemical engineering, information technology and robotics)scientific aptitude, a keen interest in the biological sciences, problem solving skills. An analytical mind is essential for successful career in biotechnology.

The candidate should be methodical and patient by nature, able to work neatly and accurately and have a flair for laboratory work. The ability to work independently is another important aspect. The knowledge of computers is a must.

10 + 2 science stream graduates can opt for a B.Tech (Biotechnology) or an integrated M. Tech (Biotechnology); science stream graduates from any field (engineering, medicine etc.) can opt for a M. Tech (Biotechnology).

IIT Delhi and Kharagpur offer admission into a five year integrated M.Tech through a Joint Entrance Examination.

The Jawaharlal Nehru University, New Delhi conducts an all-India entrance examination for their Msc Biotechnology program.

Any candidate with an undergraduate degree from a 10+2+3 system with at least 55% marks in:

Is eligible to apply for the JNU Msc(Biotechnology) as well as others.

The Department of Biotechnology (DBT) also offers postgraduate courses in selected institutions, and through four prominent research institutes, further provides a two-year support for post doctoral programs; the objective is to prepare long term biotech professionals and scientists for frontier research and advance research methodologies.

Two other institutes, backed by the DBT, provide a one-year MD/MS training in medical biotech. The cover fields such as:

SRM University offers B.Tech in Biotechnology, Genetic Engineering, and Bioinformatics. They also offer an M.Tech in Biotechnology and Biomedical Engineering.

Applications Forms Now Available

Affordable and intelligent R&D partnering with Chinese and American corporate bodies has great scope in mining Indias biotech potential and co-developing tech; India has a global market worth a $91 billion. Thats why so many global pharma companies are flocking to India for their own R&D initiatives.

A bio-technologist may find jobs in various quarters. Biotechnology jobs in India can be found in the following fields:

While government institutes and organizations, such as Department of Biotechnology (DBT), several agriculture, dairy and horticulture institutes may offer job opportunities to Biotechnology professionals, one can expect the best salary in private sector.

Drug companies in biotechnology like Dabur, Ranbaxy, Hindustan Lever and Dr Reddy's Labs that have their R & D units offer Biotechnology professionals with handsome pay-packages. There are also ample opportunities available to bio-technologists in the food processing industry, chemical industry and the textile industry.

Some industries employ bio-technologists in their marketing divisions to develop business in sectors where their products would be required.

The major companies, hiring bio-technologists, include Hindustan Lever, Thapar Group, Indo American Hybrid Seeds, Bincon India Ltd., IDPL and Hindustan Antibiotics.

The Government of India provides large-scale employment to most bio-technologists in its research laboratories. Those employed as researchers in government sector can have a starting salary of Rs. 9000 per month along with government perks/allowances.

Private sector pharmaceutical companies generally offer salary between Rs. 12,000- Rs. 20,000 per month to an entry-level postgraduate. A skilled and experienced bio-technologist can get salaries far beyond his expectations.

Indian Institute Of Technology

Indian Institute Of Technology

Vellore Institute Of Technology

Indian Institute Of Technology, Guwahati

National Institute Of Technology, Warangal

PSG College Of Technology

National Institute Of Technology, Durgapur

Manipal Institute Of Technology

BMS College of Engineering

Chaitanya Bharathi Institute of Technology

PES Institute of Technology

SASTRA University

National Institute of Technology, Raipur

GITAM University

Karunya University

Note: Selection through All India Combined Entrance Test

Courses Offered : B.Tech in Biotechnology, Genetic Engineering, and Bioinformatics. M.Tech in Biotechnology and Biomedical Engineering

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Centenarian – Wikipedia

June 24th, 2018 7:42 am

A centenarian is a person who lives to or beyond the age of 100 years. Because life expectancies worldwide are far below 100, and it is extremely rare to live to see one's 100th birthday, the term is invariably associated with extreme longevity. In 2012, the United Nations estimated that there were 316,600 living centenarians worldwide.[1]

As life expectancy is increasing across the world, and the world population has also increased rapidly, the number of centenarians is expected to increase quickly in the future.[2] According to the UK ONS, one-third of babies born in 2013 in the UK are expected to live to 100.[3]

A supercentenarian, sometimes hyphenated as super-centenarian, is a human (or individual species) who has lived to the age of 110 or more, something only achieved by about one in 1,000 centenarians.

Even rarer is a person who has lived to age 115 there are only 46 people in recorded history who have indisputably reached this age, of whom only Chiyo Miyako, Giuseppina Projetto, Kane Tanaka, Maria Giuseppa Robucci and Shimoe Akiyama are living as of 2018.[4][5][6]

There has only been one known case of a person of 120 years of age or older whose birth was independently verified by historical documents: Jeanne Calment, who lived to the age of 122 years, 164 days.

Japan currently has the greatest number of known centenarians of any nation with 67,824 according to their 2017 census, along with the highest proportion of centenarians at 34.85 per 100,000 people. Japan started recording its centenarians in 1963. The number of Japanese centenarians in that year was 153, but surpassed the 10,000 mark in 1998; 20,000 in 2003; and 40,000 in 2009.

According to a 1998 United Nations demographic survey, Japan is expected to have 272,000 centenarians by 2050;[7] other sources suggest that the number could be closer to 1 million.[8] The incidence of centenarians in Japan was one per 3,522 people in 2008.[9]

In Japan, the number of centenarians is highly skewed towards females. Japan in fiscal year 2016 had 57,525 female centenarians, while males were 8,167, a ratio of 7:1. The increase of centenarians was even more skewed at 11.6:1.[10]

The total number of living centenarians in the world remains uncertain. It was estimated by the Population Division of the United Nations as 23,000 in 1950, 110,000 in 1990, 150,000 in 1995, 209,000 in 2000, 324,000 in 2005[11] and 455,000 in 2009.[12] However, these older estimates did not take into account the contemporary downward adjustments of national estimates made by several countries such as the United States; thus, in 2012, the UN estimated there to be only 316,600 centenarians worldwide.[1] The following table gives estimated centenarian populations by country, including both the latest and the earliest known estimates, where available.

In many countries, people receive a gift or congratulations from state institutions on their 100th birthday.

Swedish centenarians receive a telegram from the King and Queen of Sweden.[62]

Centenarians born in Italy receive a letter from the President of Italy.

In the United Kingdom and the other Commonwealth realms, the British (and Commonwealth) monarch sends greetings (formerly as a telegram) on the 100th birthday and on every birthday beginning with the 105th. The tradition of Royal congratulations dates from 1908, when the Secretary for King Edward VII sent a congratulatory letter to Reverend Thomas Lord of Horncastle in a newspaper clipping, declaring, "I am commanded by the King to congratulate you on the attainment of your hundredth year, after a most useful life." The practice was formalised from 1917, under the reign of King George V, who also sent congratulations on the attainment of a 60th Wedding anniversary. Queen Elizabeth II sends a greeting card style with the notation: "I am so pleased to know that you are celebrating your one-hundredth birthday, I send my congratulations and best wishes to you on such a special occasion", thereafter each few years the card is updated with a current picture of the Queen to ensure people do not receive the same card more than once. The Queen further sends her congratulations on one's 105th birthday and every year thereafter as well as on special wedding anniversaries; people must apply for greetings three weeks before the event, on the official British Monarch's website.[63]

Centenarians born in Ireland receive a 2,540 "Centenarians' Bounty" and a letter from the President of Ireland, even if they are resident abroad.[64]

In the United States, centenarians traditionally receive a letter from the President, congratulating them for their longevity.

Japanese centenarians receive a silver cup and a certificate from the Prime Minister of Japan upon the Respect for the Aged Day following their 100th birthday, honouring them for their longevity and prosperity in their lives.[65][66][67]

An aspect of blessing in many cultures is to offer a wish that the recipient lives to 100 years old. Among Hindus, people who touch the feet of elders are often blessed with "May you live a hundred years". In Sweden, the traditional birthday song states, May he/she live for one hundred years. In Judaism, the term May you live to be 120 years old is a common blessing. In Poland, Sto lat, a wish to live a hundred years, is a traditional form of praise and good wishes, and the song "sto lat, sto lat" is sung on the occasion of the birthday celebrationsarguably, it is the most popular song in Poland and among Poles around the globe.

Chinese emperors were hailed to live ten thousand years, while empresses were hailed to live a thousand years. In Italy, "A hundred of these days!" (cento di questi giorni) is an augury for birthdays, to live to celebrate 100 more birthdays.[68] Some Italians say "Cent'anni!", which means "a hundred years", in that they wish that they could all live happily for a hundred years. In Greece, wishing someone Happy Birthday ends with the expression (na ta ekatostisis), which can be loosely translated as "may you make it one hundred birthdays".

While the number of centenarians per capita was much lower in ancient times than today, the data suggest that they were not unheard of. However, ancient demographics and chronicles are biased in favor of wealthy or powerful individuals rather than the ordinary person. A rare glimpse of an ordinary person is the legionary veteran Julius Valens whose tombstone states he lived 100 years - "VIXIT ANNIS C".[69] Grmek and Gourevitch speculate that during the Classical Greek period, anyone who lived past the age of five years surviving all the common childhood illnesses of that era had a reasonable chance of living to a relatively old age. Life expectancy in 400 BC was estimated to be around 30 years.[where?] One demographer of ancient civilizations reported that Greek men lived to 45 years on average (based on a sample size of 91), while women lived to 36.2 years (based on a sample size of 55). Notably, the gender statistics are inverted compared to today childbirth at the time had a far higher mortality rate than in modern times, skewing female statistics downward. It was common for average citizens to take great care in their hygiene, Mediterranean diet and exercise, although there was much more male trauma per capita than today, due to military service being virtually universal for citizens of Ancient Greece. This also biased the statistics for men downward.[70]

Diogenes Laertius (c. AD 250) gives one of the earliest references regarding the plausible centenarian longevity given by a scientist, the astronomer Hipparchus of Nicea (c. 185 c. 120 BC), who, according to the doxographer, assured that the philosopher Democritus of Abdera (c. 470/460 c. 370/360 BC) lived 109 years. All other ancient accounts of Democritus appear to agree that the philosopher lived at least 90 years. However, such longevity would not be dramatically out of line with that of other ancient Greek philosophers thought to have lived beyond the age of 90 (e.g. Xenophanes of Colophon, c. 570/565 c. 475/470 BC; Pyrrho of Ellis, c. 360 - c. 270 BC; Eratosthenes of Cirene c. 285 c. 190 BC). The case of Democritus differs from those of, for example, Epimenides of Crete (7th and 6th centuries BC), who is said to have lived an implausible 154, 157 or 290 years, depending on the source.

Numerous other historical figures were reputed to have lived past 100. The sixth dynasty Egyptian ruler Pepi II is believed by some Egyptologists to have lived to 100 or more (c. 2278 c. 2184 BC), as he is said to have reigned for 94 years.[71] However this is disputed: others say he only reigned 64 years.[72] Hosius of Crdoba, the man who convinced Constantine the Great to call the First Council of Nicaea, reportedly lived to age 102. The Chronicon of Bernold of Constance records the death in 1097 of Azzo marchio de Longobardia, pater Welfonis ducis de Baiowaria, commenting that he was iam maior centenario.[73] Ultimately, there is no reason to believe that centenarians did not exist in antiquity, even if they were not commonplace.[74]

Research in Italy suggests that healthy centenarians have high levels of both vitamin A and vitamin E and that this seems to be important in causing their extreme longevity.[75] Other research contradicts this, however, and has found that this theory does not apply to centenarians from Sardinia, for whom other factors probably play a more important role.[76] A preliminary study carried out in Poland showed that, in comparison with young healthy female adults, centenarians living in Upper Silesia had significantly higher red blood cell glutathione reductase and catalase activities, although serum levels of vitamin E were not significantly higher.[77] Researchers in Denmark have also found that centenarians exhibit a high activity of glutathione reductase in red blood cells. In this study, the centenarians having the best cognitive and physical functional capacity tended to have the highest activity of this enzyme.[78]

Other research has found that people whose parents became centenarians have an increased number of nave B cells. It is well known that the children of parents who have a long life are also likely to reach a healthy age, but it is not known why, although the inherited genes are probably important.[79] A variation in the gene FOXO3A is known to have a positive effect on the life expectancy of humans, and is found much more often in people living to 100 and beyond - moreover, this appears to be true worldwide.[80]

Men and women who are 100 or older tend to have extroverted personalities, according to Thomas T. Perls, the director of the New England Centenarian Study at Boston University. Centenarians will often have many friends, strong ties to relatives and high self-esteem. In addition, some research suggests that the offspring of centenarians are more likely to age in better cardiovascular health than their peers.[81]

Lymphoblastoid cell lines established from blood samples of centenarians have significantly higher activity of the DNA repair protein PARP (Poly ADP ribose polymerase) than cell lines from younger (20 to 70 years old) individuals.[82] The lymphocytic cells of centenarians have characteristics typical of cells from young people, both in their capability of priming the mechanism of repair after H2O2 sublethal oxidative DNA damage and in their PARP capacity.[83] PARP activity measured in the permeabilized mononuclear leukocyte blood cells of thirteen mammalian species correlated with maximum lifespan of the species.[84] These findings suggest that PARP mediated DNA repair activity contributes to the longevity of centenarians, consistent with the DNA damage theory of aging.[85]

Many experts attribute Japan's high life expectancy to the typical Japanese diet, which is particularly low in refined simple carbohydrates, and to hygienic practices. The number of centenarians in relation to the total population was, in September 2010, 114% higher in Shimane Prefecture than the national average. This ratio was also 92% higher in Okinawa Prefecture.[86][87][88] In Okinawa, studies have shown five factors that have contributed to the large number of centenarians in that region:[86]

Although these factors vary from those mentioned in the previous study, the culture of Okinawa has proven these factors to be important in its large population of centenarians.[86]

A historical study from Korea found that male eunuchs in the royal court had a centenarian rate of over 3%, and that eunuchs lived on average 14 to 19 years longer than uncastrated men.[89]

The number of Japanese centenarians was called into question in 2010, following a series of reports showing that hundreds of thousands of elderly people had gone "missing" in the country. The deaths of many centenarians had not been reported, casting doubt on the country's reputation for having a large population of centenarians.[90][91][92][93]

In July 2010, Sogen Kato, a centenarian listed as the oldest living male in Tokyo, registered to be aged 111, was found to have died some 30 years before; his body was found mummified in his bed,[94] resulting in a police investigation into centenarians listed over the age of 105. Soon after the discovery, the Japanese police found that at least 200 other Japanese centenarians were "missing", and began a nationwide search in early August 2010.[95]

By measuring the biological age of various tissues from centenarians, researchers may be able to identify tissues that are protected from aging effects. According to a study of 30 different body parts from centenarians and younger controls, the cerebellum is the youngest brain region (and probably body part) in centenarians (about 15 years younger than expected [96]) according to an epigenetic biomarker of tissue age known as epigenetic clock.[97]

These findings could explain why the cerebellum exhibits fewer neuropathological hallmarks of age related dementias compared to other brain regions. Further, the offspring of semi-supercentenarians (subjects who reached an age of 105109 years) have a lower epigenetic age than age-matched controls (age difference=5.1 years in peripheral blood mononuclear cells) and centenarians are younger (8.6 years) than expected based on their chronological age.[98]

Centenarians are often the subject of news stories, which often focus on the fact that they are over 100 years old. Along with the typical birthday celebrations, these reports provide researchers and cultural historians with evidence as to how the rest of society views this elderly population. Some examples:

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Beluga whale – Wikipedia

June 24th, 2018 7:42 am

The beluga whale or white whale (Delphinapterus leucas) is an Arctic and sub-Arctic cetacean. It is one of two members of the family Monodontidae, along with the narwhal, and the only member of the genus Delphinapterus. This marine mammal is commonly referred to as the beluga, melonhead, or sea canary due to its high-pitched twitter.

It is adapted to life in the Arctic, so has anatomical and physiological characteristics that differentiate it from other cetaceans. Amongst these are its all-white colour and the absence of a dorsal fin. It possesses a distinctive protuberance at the front of its head which houses an echolocation organ called the melon, which in this species is large and deformable. The beluga's body size is between that of a dolphin's and a true whale's, with males growing up to 5.5m (18ft) long and weighing up to 1,600kg (3,530lb). This whale has a stocky body. A large percentage of its weight is blubber, as is true of many cetaceans. Its sense of hearing is highly developed and its echolocation allows it to move about and find blowholes under sheet ice.

Belugas are gregarious and form groups of up to 10 animals on average, although during the summer, they can gather in the hundreds or even thousands in estuaries and shallow coastal areas. They are slow swimmers, but can dive to 700m (2,300ft) below the surface. They are opportunistic feeders and their diets vary according to their locations and the season. The majority of belugas live in the Arctic Ocean and the seas and coasts around North America, Russia and Greenland; their worldwide population is thought to number around 150,000. They are migratory and the majority of groups spend the winter around the Arctic ice cap; when the sea ice melts in summer, they move to warmer river estuaries and coastal areas. Some populations are sedentary and do not migrate over great distances during the year.

The native peoples of North America and Russia have hunted belugas for many centuries. They were also hunted commercially during the 19th century and part of the 20th century. Whale hunting has been under international control since 1973. Currently, only certain Inuit and Alaska Native groups are allowed to carry out subsistence hunting of belugas. Other threats include natural predators (polar bears and killer whales), contamination of rivers (as with PCBs which bioaccumulate up the food chain), and infectious diseases. From a conservation perspective, the beluga was placed on the International Union for Conservation of Nature's Red List in 2008 as being "near threatened"; the subpopulation from the Cook Inlet in Alaska, however, is considered critically endangered and is under the protection of the United States' Endangered Species Act. Of seven Canadian beluga populations, the two inhabiting eastern Hudson Bay and Ungava Bay are listed as endangered.

Belugas are one of the most commonly kept cetaceans in captivity and are housed in aquariums, dolphinariums, and wildlife parks in North America, Europe, and Asia. They are popular with the public due to their colour and expression.

The beluga was first described in 1776 by Peter Simon Pallas.[1] It is a member of the Monodontidae family, which is in turn part of the parvorder Odontoceti (toothed whales).[1] The Irrawaddy dolphin was once placed in the same family; recent genetic evidence suggests these dolphins belong to the family Delphinidae.[3][4] The narwhal is the only other species within the Monodontidae besides the beluga.[5] A skull has been discovered with intermediate characteristics supporting the hypothesis that hybridization is possible between these two families.[6]

The name of the genus, Delphinapterus, means "dolphin without fin" (from the Greek (delphin), dolphin and (apteros), without fin) and the species name leucas means "white" (from the Greek (leukas), white).[7] The Red List of Threatened Species gives both beluga and white whale as common names, though the former is now more popular. The English name comes from the Russian (belukha), which derives from the word (blyj), meaning "white".[7] The name beluga in Russian refers to an unrelated species, a fish, beluga sturgeon.

The whale is also colloquially known as the sea canary on account of its high-pitched squeaks, squeals, clucks, and whistles. A Japanese researcher says he taught a beluga to "talk" by using these sounds to identify three different objects, offering hope that humans may one day be able to communicate effectively with sea mammals.[8] A similar observation has been made by Canadian researchers, where a beluga which died in 2007 "talked" when he was still a subadult. Another example is NOC, a beluga whale that could mimic the rhythm and tone of human language. Beluga whales in the wild have been reported to imitate human voices.[9]

Mitochondrial DNA studies have shown modern cetaceans last shared a common ancestor between 30 and 34 million years ago.[10] The family Monodontidae separated relatively early from the other odontoceti; it split from the Delphinoidea between 11 and 15 million years ago, and from the Phocoenidae, its closest relatives in evolutionary terms, more recently still.[11] In 2017 the genome of a beluga whale was sequenced, comprising 2.327 Gbp of assembled genomic sequence that encoded 29,581 predicted genes.[12] The authors estimated that the genome-wide sequence similarity between beluga whales and killer whales to be 97.87% 2.4 107% (mean standard deviation).

The beluga's earliest known ancestor is the prehistoric Denebola brachycephala from the late Miocene period (910 million years ago).[13][14] A single fossil from the Baja California Peninsula indicates the family once inhabited warmer waters.[15] The fossil record also indicates, in comparatively recent times, the beluga's range varied with that of the polar ice packs expanding during ice ages and contracting when the ice retreated. Counter-evidence to this theory comes from the finding in 1849 of fossilised beluga bones in Vermont in the United States, 240km (150mi) from the Atlantic Ocean. The bones were discovered during construction of the first railroad between Rutland and Burlington in Vermont, when workers unearthed the bones of a mysterious animal in Charlotte. Buried nearly 10ft (3.0m) below the surface in a thick blue clay, these bones were unlike those of any animal previously discovered in Vermont. Experts identified the bones as those of a beluga. Because Charlotte is over 150mi (240km) from the nearest ocean, early naturalists were at a loss to explain the presence of the bones of a marine mammal buried beneath the fields of rural Vermont. The remains were found to be preserved in the sediments of the Champlain Sea, an extension of the Atlantic Ocean within the continent resulting from the rise in sea level at the end of the ice ages some 12,000 years ago.[17] Today, the Charlotte whale is the official Vermont State Fossil (making Vermont the only state whose official fossil is that of a still extant animal).[18]

Its body is round, particularly when well fed, and tapers less smoothly to the head than the tail. The sudden tapering to the base of its neck gives it the appearance of shoulders, unique among cetaceans. The tailfin grows and becomes increasingly and ornately curved as the animal ages. The flippers are broad and shortmaking them almost square-shaped.

Preliminary investigations suggested a beluga's life expectancy was rarely more than 30 years.[19] The method used to calculate the age of a beluga is based on counting the layers of dentin and dental cement in a specimen's teeth, which were originally thought to be deposited once or twice a year. The layers can be readily identified as one layer consists of opaque dense material and the other is transparent and less dense. It is therefore possible to estimate the age of the individual by extrapolating the number of layers identified and the estimated frequency with which the deposits are laid down.[20] A 2006 study using radiocarbon dating of the dentine layers showed the deposit of this material occurs with a lesser frequency (once per year) than was previously thought. The study therefore estimated belugas can live for 70 or 80 years.[21]

The species presents a moderate degree of sexual dimorphism, as the males are 25% longer than the females and are sturdier.[22] Adult male belugas can range from 3.5 to 5.5m (11 to 18ft), while the females measure 3 to 4.1m (9.8 to 13.5ft).[23] Males weigh between 1,100 and 1,600kg (2,430 and 3,530lb), occasionally up to 1,900kg (4,190lb) while females weigh between 700 and 1,200kg (1,540 and 2,650lb).[24][25] They rank as mid-sized species among toothed whales.[26]

Individuals of both sexes reach their maximum size by the time they are 10 years old.[27] The beluga's body shape is stocky and fusiform (cone-shaped with the point facing backwards), and they frequently have folds of fat, particularly along the ventral surface.[28] Between 40% and 50% of their body weight is fat, which is a higher proportion than for cetaceans that do not inhabit the Arctic, where fat only represents 30% of body weight.[29][30] The fat forms a layer that covers all of the body except the head, and it can be up to 15cm (5.9in) thick. It acts as insulation in waters with temperatures between 0 and 18C, as well as being an important reserve during periods without food.[31]

The adult beluga is rarely mistaken for any other species, because it is completely white or whitish-grey in colour.[32] Calves are usually born grey,[23] and by the time they are a month old, have turned dark grey or blue grey. They then start to progressively lose their pigmentation until they attain their distinctive white colouration, at the age of seven years in females and 9 in males.[32] The white colouration of the skin is an adaptation to life in the Arctic that allows belugas to camouflage themselves in the polar ice caps as protection against their main predators, polar bears and killer whales.[33] Unlike other cetaceans, the belugas seasonally shed their skin.[34] During the winter, the epidermis thickens and the skin can become yellowish, mainly on the back and fins. When they migrate to the estuaries during the summer, they rub themselves on the gravel of the riverbeds to remove the cutaneous covering.[34]

Like most toothed whales, it has a compartment found at the centre of the forehead that contains an organ used for echolocation called a melon, which contains fatty tissue.[35] The shape of the beluga's head is unlike that of any other cetacean, as the melon is extremely bulbous, lobed, and visible as a large frontal prominence.[35] Another distinctive characteristic it possesses is the melon is malleable; its shape is changed during the emission of sounds.[5] The beluga is able to change the shape of its head by blowing air around its sinuses to focus the emitted sounds.[36][37] This organ contains fatty acids, mainly isovaleric acid (60.1%) and long-chain branched acids (16.9%), a very different composition from its body fat, and which could play a role in its echolocation system.[38]

Unlike many dolphins and whales, the seven vertebrae in the neck are not fused together, allowing the animal to turn its head laterally without needing to rotate its body.[39] This gives the head a lateral manoeuvrability that allows an improved field of view and movement and helps in catching prey and evading predators in deep water.[33] The rostrum has about eight to 10 small, blunt, and slightly curved teeth on each side of the jaw and a total of 36 to 40 teeth.[40] Belugas do not use their teeth to chew, but for catching hold of their prey; they then tear them up and swallow them nearly whole.[41] Belugas only have a single spiracle, which is located on the top of the head behind the melon, and has a muscular covering, allowing it to be completely sealed. Under normal conditions, the spiracle is closed and an animal must contract the muscular covering to open the spiracle.[42] A beluga's thyroid gland is larger than that of terrestrial mammals weighing three times more than that of a horse which helps it to maintain a greater metabolism during the summer when it lives in river estuaries.[43] It is the marine cetacean that most frequently develops hyperplastic and neoplastic lesions of the thyroid.[44]

The fins retain the bony vestiges of the beluga's mammalian ancestors, and are firmly bound together by connective tissue.[28] The fins are small in relation to the size of the body, rounded and oar-shaped, and slightly curled at the tips.[7] These versatile extremities are mainly used as a rudder to control direction, to work in synchrony with the tailfin and for agile movement in shallow waters up to 3m (9.8ft) deep.[27] The fins also contain a mechanism for regulating body temperature, as the arteries feeding the fin's muscles are surrounded by veins that dilate or contract to gain or lose heat.[28][45] The tailfin is flat with two oar-like lobes, it does not have any bones, and is made up of hard, dense, fibrous connective tissue. The tailfin has a distinctive curvature along the lower edge.[28] The longitudinal muscles of the back provide the ascending and descending movement of the tailfin, which has a similar thermoregulation mechanism to the pectoral fins.[28]

Belugas have a dorsal ridge, rather than a dorsal fin.[23] The absence of the dorsal fin is reflected in the genus name of the speciesapterus the Greek word for "wingless". The evolutionary preference for a dorsal ridge rather than a fin is believed to be an adaptation to under-ice conditions, or possibly as a way of preserving heat.[5] The crest is hard and, along with the head, can be used to open holes in ice up to 8cm (3.1in) thick.[46]

The beluga has a very specialized sense of hearing and its auditory cortex is highly developed. It can hear sounds within the range of 1.2 to 120kHz, with the greatest sensitivity between 10 and 75kHz,[47] where the average hearing range for humans is 0.02 to 20kHz.[48] The majority of sounds are most probably received by the lower jaw and transmitted towards the middle ear. In the toothed whales, the lower jawbone is broad with a cavity at its base, which projects towards the place where it joins the cranium. A fatty deposit inside this small cavity connects to the middle ear.[49] Toothed whales also possess a small external auditory hole a few centimetres behind their eyes; each hole communicates with an external auditory conduit and an eardrum. It is not known if these organs are functional or simply vestigial.[49]

Belugas are able to see within and outside of water, but their vision is relatively poor when compared to dolphins.[50] Their eyes are especially adapted to seeing under water, although when they come into contact with the air, the crystalline lens and the cornea adjust to overcome the associated myopia (the range of vision under water is short).[50] A beluga's retina has cones and rods, which also suggests they can see in low light. The presence of cone cells indicates they can see colours, although this suggestion has not been confirmed.[50] Glands located in the medial corner of their eyes secrete an oily, gelatinous substance that lubricates the eye and helps flush out foreign bodies. This substance forms a film that protects the cornea and the conjunctiva from pathogenic organisms.[50]

Studies on captive animals show they seek frequent physical contact with other belugas.[33] Areas in the mouth have been found that could act as chemoreceptors for different tastes, and they can detect the presence of blood in water, which causes them to react immediately by displaying typical alarm behaviour.[33] Like the other toothed whales, their brains lack olfactory bulbs and olfactory nerves, which suggests they do not have a sense of smell.[35]

These cetaceans are highly sociable and they regularly form small groups, or pods, that may contain between two and 25 individuals, with an average of 10 members.[51] Pods tend to be unstable, meaning individuals tend to move from pod to pod. Radio tracking has even shown belugas can start out in one pod and within a few days be hundreds of miles away from that pod.[52] These pods contain animals of both sexes,[53] and are led by a dominant male.[40] Many hundreds and even thousands of individuals can be present when the pods join together in river estuaries during the summer. This can represent a significant proportion of the total population and is when they are most vulnerable to being hunted.[54]

They are cooperative animals and frequently hunt in coordinated groups.[55] The animals in a pod are very sociable and often chase each other as if they are playing or fighting, and they often rub against each other.[56]

In captivity, they can be seen to be constantly playing, vocalizing, and swimming around each other.[57] They show a great deal of curiosity towards humans and frequently approach the windows in the tanks to observe them.[58] Belugas may also playfully spit at humans or other whales. It is not unusual for an aquarium handler to be drenched by one of his charges. Some researchers believe spitting originated with blowing sand away from crustaceans at the sea bottom.

Belugas also show a great degree of curiosity towards humans in the wild, and frequently swim alongside boats.[59] They also play with objects they find in the water; in the wild, they do this with wood, plants, dead fish, and bubbles they have created.[29] During the breeding season, adults have been observed carrying objects such as plants, nets, and even the skeleton of a dead reindeer on their heads and backs.[57] Captive females have also been observed displaying this behaviour, carrying items such as floats and buoys, after they have lost a calf; experts consider this interaction with the objects could be acting as a substitute behaviour.[60]

Belugas are slower swimmers than the other toothed whales, such as the killer whale and the common bottlenose dolphin, because they are less hydrodynamic and have limited movement of their tailfins, which produce the greatest thrust.[61] They frequently swim at between 3 and 9km/h (1.9 and 5.6mph), although they are able to maintain a speed of 22km/h for up to 15 min.[40] Unlike most cetaceans, they are capable of swimming backwards.[27][62] Belugas swim on the surface between 5% and 10% of the time, while for the rest of the time they swim at a depth sufficient to cover their bodies.[27] They do not jump out of the water like dolphins or killer whales.[7]

These animals usually only dive to depths to 20m (66ft),[63] although they are capable of diving to greater depths. Individual captive animals have been recorded at depths between 400 and 647 m below sea level,[64] while animals in the wild have been recorded as diving to a depth of more than 700 m, with the greatest recorded depth being 872 m.[65] A dive normally lasts 3 to 5 min, but can last up to 18 min.[40][65][66] In the shallower water of the estuaries, a diving session may last around two minutes; the sequence consists of five or six rapid, shallow dives followed by a deeper dive lasting up to one minute.[27] The average number of dives per day varies between 31 and 51.[65]

All cetaceans, including belugas, have physiological adaptations designed to conserve oxygen while they are under water.[67] During a dive, these animals will reduce their heart rate from 100 beats a minute to between 12 and 20.[67] Blood flow is diverted away from certain tissues and organs and towards the brain, heart and lungs, which require a constant oxygen supply.[67] The amount of oxygen dissolved in the blood is 5.5%, which is greater than that found in land-based mammals and is similar to that of Weddell seals (a diving marine mammal). One study found a female beluga had 16.5 l of oxygen dissolved in her blood.[68] Lastly, the beluga's muscles contain high levels of the protein myoglobin, which stores oxygen in muscle. Myoglobin concentrations are several times greater than for terrestrial mammals, which help prevent oxygen deficiency during dives.[69]

Beluga whales often accompany bowhead whales, for curiosity and to secure polynya feasible to breathe as bowheads are capable of breaking through ice from underwater by headbutting.[70]

Belugas play an important role in the structure and function of marine resources in the Arctic Ocean, as they are the most abundant toothed whales in the region.[71] They are opportunistic feeders; their feeding habits depend on their locations and the season.[22] For example, when they are in the Beaufort Sea, they mainly eat Arctic cod (Boreogadus saida) and the stomachs of belugas caught near Greenland were found to contain rose fish (Sebastes marinus), Greenland halibut (Reinhardtius hippoglossoides), and northern shrimp (Pandalus borealis),[72] while in Alaska their staple diet is Pacific salmon (Oncorhynchus kisutch).[73] In general, the diets of these cetaceans consist mainly of fish; apart from those previously mentioned, other fish they feed on include capelin (Mallotus villosus), smelt, sole, flounder, herring, sculpin, and other types of salmon.[74] They also consume a great quantity of invertebrates, apart from shrimp, such as squid, crabs, clams, octopus, sea snails, bristle worms, and other deep-sea species.[74][75] Animals in captivity eat 2.5% to 3.0% of their body weight per day, which equates to 18.2 to 27.2kg.[76]

Foraging on the seabed typically takes place at depths between 20 and 40 m,[77] although they can dive to depths of 700 m in search of food.[65] Their flexible necks provide a wide range of movement while they are searching for food on the ocean floor. Some animals have been observed to suck up water and then forcefully expel it to uncover their prey hidden in the silt on the seabed.[55] As their teeth are neither large nor sharp, belugas must use suction to bring their prey into their mouths; it also means their prey has to be consumed whole, which in turn means it cannot be too large or the belugas run the risk of it getting stuck in their throats.[78] They also join together into coordinated groups of five or more to feed on shoals of fish by steering the fish into shallow water, where the belugas then attack them.[55] For example, in the estuary of the Amur River, where they mainly feed on salmon, groups of six or eight individuals join together to surround a shoal of fish and prevent their escape. Individuals then take turns feeding on the fish.[46]

Estimations of the age of sexual maturity for beluga whales vary considerably; the majority of authors estimate males reach sexual maturity when they are between four and seven years old, and females reach maturity when they are between four and nine years old.[79] The average age at which females first give birth is 8.5 years and fertility begins to decrease when they are 25, with no births recorded for females older than 41.[79]

Female belugas typically give birth to one calf every three years.[23] Most mating occurs usually February through May, but some mating occurs at other times of year.[5] The beluga may have delayed implantation.[5] Gestation has been estimated to last 12.0 to 14.5 months,[23] but information derived from captive females suggests a longer gestation period up to 475 days (15.8 months).[80]

Calves are born over a protracted period that varies by location. In the Canadian Arctic, calves are born between March and September, while in Hudson Bay, the peak calving period is in late June, and in Cumberland Sound, most calves are born from late July to early August.[81] Births usually take place in bays or estuaries where the water is warm with a temperature of 10 to 15C.[51] Newborns are about 1.5m (4.9ft) long, weigh about 80kg (180lb), and are grey in colour.[40] They are able to swim alongside their mothers immediately after birth.[82] The newborn calves nurse under water and initiate lactation a few hours after birth; thereafter, they feed at intervals around an hour.[55] Studies of captive females have indicated their milk composition varies between individuals and with the stage of lactation; it has an average content of 28% fat, 11% protein, 60.3% water, and less than 1% residual solids.[83] The milk contains about 92 cal per ounce.[84]

The calves remain dependent on their mothers for nursing for the first year, when their teeth appear.[51] After this, they start to supplement their diets with shrimp and small fish.[35] The majority of the calves continue nursing until they are 20 months old, although occasionally lactation can continue for more than two years,[40] and lactational anoestrus may not occur. Alloparenting (care by females different from the mother) has been observed in captive belugas, including spontaneous and long-term milk production. This suggests this behaviour, which is also seen in other mammals, may be present in belugas in the wild.[85]

Belugas use sounds and echolocation for movement, communication, to find breathing holes in the ice, and to hunt in dark or turbid waters.[36] They produce a rapid sequence of clicks that pass through the melon, which acts as an acoustic lens to focus the sounds into a beam that is projected forward through the surrounding water.[84] These sounds spread through the water at a speed of nearly 1.6km per second, some four times faster than the speed of sound in air. The sound waves reflect from objects and return as echoes that are heard and interpreted by the animal.[36] This enables them to determine the distance, speed, size, shape and the object's internal structure within the beam of sound. They use this ability when moving around thick Arctic ice sheets, to find areas of unfrozen water for breathing, or air pockets trapped under the ice.[51]

Some evidence indicates that belugas are highly sensitive to noise produced by humans. In one study, the maximum frequencies produced by an individual located in San Diego Bay, California, were between 40 and 60kHz. The same individual produced sounds with a maximum frequency of 100 to 120kHz when transferred to Kaneohe Bay in Hawaii. The difference in frequencies is thought to be a response to the difference in environmental noise in the two areas.[86]

These animals communicate using sounds of high frequency; their calls can sound like bird songs, so belugas were nicknamed "canaries of the sea".[87] Like the other toothed whales, belugas do not possess vocal cords and the sounds are probably produced by the movement of air between the nasal sacks, which are located near to the blowhole.[36]

Belugas are among the most vocal cetaceans.[88] They use their vocalisations for echolocation, during mating and for communication. They possess a large repertoire, emitting up to 11 different sounds, such as cackles, whistles, trills and squawks.[36] They make sounds by grinding their teeth or splashing, but they rarely use body language to make visual displays with their pectoral fins or tailfins, nor do they perform somersaults or jumps in the way other species do, such as dolphins.[36]

The beluga inhabits a discontinuous circumpolar distribution in Arctic and sub-Arctic waters.[89] During the summer, they can mainly be found in the deep waters ranging from 76N to 80N, particularly along the coasts of Alaska, northern Canada, western Greenland, and northern Russia.[89] The southernmost extent of their range includes isolated populations in the St. Lawrence River in the Atlantic,[90] and the Amur River delta, the Shantar Islands, and the waters surrounding Sakhalin Island in the Sea of Okhotsk.[91]

Belugas have a seasonal migratory pattern.[92] Migration patterns are passed from parents to offspring. Some travel as far as 6,000 kilometers per year.[93] When the summer sites become blocked with ice during the autumn, they move to spend the winter in the open sea alongside the pack ice or in areas covered with ice, surviving by using polynyas to surface and breathe.[94] In summer after the sheet ice has melted, they move to coastal areas with shallower water (13 m deep), although sometimes they migrate towards deeper waters (>800 m).[92] In the summer, they occupy estuaries and the waters of the continental shelf, and on occasion, they even swim up the rivers.[92] A number of incidents have been reported where groups or individuals have been found hundreds or even thousands of kilometres from the ocean.[95][96] One such example comes from 9 June 2006, when a young beluga carcass was found in the Tanana River near Fairbanks in central Alaska, nearly 1,700 kilometers (1,100mi) from the nearest ocean habitat. Belugas sometimes follow migrating fish, leading Alaska state biologist Tom Seaton to speculate it had followed migrating salmon up the river at some point in the previous autumn.[97] The rivers they most often travel up include: the Northern Dvina, the Mezen, the Pechora, the Ob and the Yenisei in Asia; the Yukon and the Kuskokwim in Alaska, and the Saint Lawrence in Canada.[89] Spending time in a river has been shown to stimulate an animal's metabolism and facilitates the seasonal renewal of the epidermal layer.[43] In addition, the rivers represent a safe haven for newborn calves where they will not be preyed upon by killer whales.[5] Calves often return to the same estuary as their mother in the summer, meeting her sometimes even after becoming fully mature.[98]

The migration season is relatively predictable, as it is basically determined by the amount of daylight and not by other variable physical or biological factors, such as the condition of the sea ice.[99] Vagrants may travel further south to areas such as Irish[100] and Scottish waters,[101] islands of Orkney[102] and Hebrides,[103] and to Japanese waters.[104] There had been several vagrant individuals [105] demonstrated seasonal residencies at Volcano Bay,[106][107][108] and a unique whale were used to return annually to areas adjacent to Shibetsu in Nemuro Strait in the 2000s.[109] On rarer occasions, individuals of vagrancy can reach the Korean Peninsula.[110] A few other individuals have been confirmed to return to the coasts of Hokkaido, and one particular individual became a resident in brackish waters of Lake Notoro since in 2014.[111][112]

Some populations are not migratory and certain resident groups will stay in well-defined areas, for example in Cook Inlet, the estuary of the Saint Lawrence River and Cumberland Sound.[113] The population in Cook Inlet stays in the waters furthest inside the inlet during the summer and until the end of autumn, then during the winter, they disperse to the deeper water in the centre of the inlet, but without completely leaving it.[114][115]

In April, the animals that spend the winter in the centre and southwest of the Bering Sea move to the north coast of Alaska and the east coast of Russia.[113] The populations living in the Ungava Bay and the eastern and western sides of Hudson Bay overwinter together beneath the sea ice in Hudson Strait. Whales in James Bay spend winter months within the basin could be a distinct group from these in Hudson Bay.[116] The populations of the White Sea, the Kara Sea and the Laptev Sea overwinter in the Barents Sea.[113] In the spring, the groups separate and migrate to their respective summer sites.[113]

Belugas exploit a varied range of habitats; they are most commonly seen in shallow waters close to the coast, but they have also been reported to live for extended periods in deeper water, where they feed and give birth to their young.[113]

In coastal areas, they can be found in coves, fjords, canals, bays, and shallow waters in the Arctic Ocean that are continuously lit by sunlight.[29] They are also often seen during the summer in river estuaries, where they feed, socialize, and give birth to young. These waters usually have a temperature between 8 and 10C.[29] The mudflats of Cook Inlet in Alaska are a popular location for these animals to spend the first few months of summer.[117] In the eastern Beaufort Sea, female belugas with their young and immature males prefer the open waters close to land; the adult males live in waters covered by ice near to the Canadian Arctic Archipelago, while the younger males and females with slightly older young can be found nearer to the ice shelf.[118] Generally, the use of different habitats in summer reflects differences in feeding habits, risk from predators, and reproductive factors for each of the subpopulations.[22]

The global beluga population is made up of a number of subpopulations. The scientific committee of the International Whaling Commission recognizes these 29 subpopulations:[2][22]

The estimate of population sizes is complicated because the boundaries for some of these groups overlap geographically or seasonally. The IUCN estimated the world beluga population in 2008 to be well in excess of 150,000.[2]

The native populations of the Canadian, Alaskan, and Russian Arctic regions hunt belugas for their meat, blubber, and skin. The cured skin is the only cetacean skin that is sufficiently thick to be used as leather.[119] Belugas were easy prey for hunters due to their predictable migration patterns and the high population density in estuaries and surrounding coastal areas during the summer.[119]

Commercial whaling by European and American whalers during the 18th and 19th centuries decreased beluga populations in the Canadian Arctic.[119] The animals were hunted for their meat and blubber, while the Europeans used the oil from the melon as a lubricant for clocks, machinery, and lighting in lighthouses.[119] Mineral oil replaced whale oil in the 1860s, but the hunting of these animals continued unabated. In 1863, the cured skin could be used to make horse harnesses, machine belts for saw mills, and shoelaces. These manufactured items ensured the hunting of belugas continued for the rest of the 19th century and the beginning of the 20th century.[120] Between 1868 and 1911, Scottish and American whalers killed more than 20,000 belugas in Lancaster Sound and Davis Strait.[119]

During the 1920s, fishermen in the Saint Lawrence River estuary considered belugas to be a threat to the fishing industry, as they eat large quantities of cod, salmon, tuna, and other fish caught by the local fishermen.[120] The presence of belugas in the estuary was, therefore, considered to be undesirable; in 1928, the Government of Quebec offered a reward of 15 dollars for each dead beluga.[121] The Quebec Department of Fisheries launched a study into the influence of these cetaceans on local fish populations in 1938. The unrestricted killing of belugas continued into the 1950s, when the supposed voracity of the belugas was found to be overestimated and did not adversely affect fish populations.[120] L'Isle-aux-Coudres is the setting for the classic 1963 National Film Board of Canada documentary Pour la suite du monde, which depicts a one-off resurrection of the beluga hunt.

The Arctic's native peoples still carry out subsistence hunting of belugas to obtain food and raw materials. This practice is a part of their culture, but doubts still remain whether the number of whales killed may be sustainable.[122] The number of animals killed is about 200 to 550 in Alaska and around 1,000 in Canada.[123] However, in areas such as Cook Inlet, Ungava Bay, and western Greenland, previous levels of commercial whaling have put the species in danger of extinction, and continued hunting by the native peoples may mean some populations will continue to decline.[122] The Canadian sites are the focus of discussions between the local communities and the Canadian government, with the objective of permitting sustainable hunting that does not put the species at risk of extinction.[124]

1970-99[126] 2013-15[127] 2000-2012[128]

2003-16[131]

1987-90 Cook Inlet[134] 1990-2011[135] 2012-2015 +Cook Inlet[136] [137]

During the winter, belugas commonly become trapped in the ice without being able to escape to open water, which may be several kilometres away.[138] Polar bears take particular advantage of these situations and are able to locate the belugas using their sense of smell. The bears swipe at the belugas and drag them onto the ice to eat them.[24] They are able to capture large individuals in this way; in one documented incident, a bear weighing between 150 and 180kg was able to capture an animal that weighed 935kg.[139]

Killer whales are able to capture both young and adult belugas.[24] They live in all the seas of the world and share the same habitat as belugas in the sub-Arctic region. Attacks on belugas by killer whales have been reported in the waters of Greenland, Russia, Canada, and Alaska.[140][141] A number of killings have been recorded in Cook Inlet, and experts are concerned the predation by killer whales will impede the recovery of this subpopulation, which has already been badly depleted by hunting.[140] The killer whales arrive at the beginning of August, but the belugas are occasionally able to hear their presence and evade them. The groups near to or under the sea ice have a degree of protection, as the killer whale's large dorsal fin, up to 2 m in length, impedes their movement under the ice and does not allow them to get sufficiently close to the breathing holes in the ice.[29]

The beluga is considered an excellent sentinel species (indicator of environment health and changes), because it is long-lived, at the top of the food web, bears large amounts of fat and blubber, relatively well-studied for a cetacean, and still somewhat common.

Human pollution can be a threat to belugas' health when they congregate in river estuaries. Chemical substances such as DDT and heavy metals such as lead, mercury and cadmium have been found in individuals of the Saint Lawrence River population.[142] Local beluga carcasses contain so many contaminants, they are treated as toxic waste.[143] Levels of polychlorinated biphenyls between 240 and 800 ppm have been found in belugas' brains, liver and muscles, with the highest levels found in males.[144] These levels are significantly greater than those found in Arctic populations.[145] These substances have a proven adverse effect on these cetaceans, as they cause cancers, reproductive diseases, and the deterioration of the immune system, making individuals more susceptible to pneumonias, ulcers, cysts, tumours, and bacterial infections.[145] Although the populations that inhabit the river estuaries run the greatest risk of contamination, high levels of zinc, cadmium, mercury, and selenium have also been found in the muscles, livers, and kidneys of animals that live in the open sea.[146]

From a sample of 129 beluga adults from the Saint Lawrence River examined between 1983 and 1999, a total of 27% had suffered cancer.[147] This is a higher percentage than that documented for other populations of this species and is much higher than for other cetaceans and for the majority of terrestrial mammals; in fact, the rate is only comparable to the levels found in humans and some domesticated animals.[147] For example, the rate of intestinal cancer in the sample is much higher than for humans. This condition is thought to be directly related to environmental contamination, in this case by polycyclic aromatic hydrocarbons, and coincides with the high incidence of this disease in humans residing in the area.[147] The prevalence of tumours suggests the contaminants identified in the animals that inhabit the estuary are having a direct carcinogenic effect or they are at least causing an immunological deterioration that is reducing the inhabitants' resistance to the disease.[148]

Indirect human disturbance may also be a threat. While some populations tolerate small boats, most actively try to avoid ships. Whale-watching has become a booming activity in the St. Lawrence and Churchill River areas, and acoustic contamination from this activity appears to have an effect on belugas. For example, a correlation appears to exist between the passage of belugas across the mouth of the Saguenay River, which has decreased by 60%, and the increase in the use of recreational motorboats in the area.[149] A dramatic decrease has also been recorded in the number of calls between animals (decreasing from 3.4 to 10.5 calls/min to 0 or <1) after exposure to the noise produced by ships, the effect being most persistent and pronounced with larger ships such as ferries than with smaller boats.[150] Belugas can detect the presence of large ships (for example icebreakers) up to 50km away, and they move rapidly in the opposite direction or perpendicular to the ship following the edge of the sea ice for distances of up to 80km to avoid them. The presence of shipping produces avoidance behaviour, causing deeper dives for feeding, the break-up of groups, and asynchrony in dives.[151]

As with any animal population, a number of pathogens cause death and disease in belugas, including viruses, bacteria, protozoans, and fungi, which mainly cause skin, intestinal, and respiratory infections.[152]

Papillomaviruses have been found in the stomachs of belugas in the Saint Lawrence River. Animals in this location have also been recorded as suffering infections caused by herpesviruses and in certain cases to be suffering from encephalitis caused by the protozoan Sarcocystis. Cases have been recorded of ciliate protozoa colonising the spiracle of certain individuals, but they are not thought to be pathogens or are not very harmful.[153]:26, 303, 359

The bacterium Erysipelothrix rhusiopathiae, which probably comes from eating infected fish, poses a threat to belugas kept in captivity, causing anorexia and dermal plaques and lesions that can lead to septicemia.[153]:26, 303, 359 This condition can cause death if it is not diagnosed and treated in time with antibiotics such as ciprofloxacin.[154][153][153]:3167

A study of infections caused by parasitic worms in a number of individuals of both sexes found the presence of larvae from a species from the genus Contracaecum in their stomachs and intestines, Anisakis simplex in their stomachs, Pharurus pallasii in their ear canals, Hadwenius seymouri in their intestines, and Leucasiella arctica in their rectums.[155]

Belugas were among the first whale species to be kept in captivity. The first beluga was shown at Barnum's Museum in New York City in 1861.[156] For most of the 20th century, Canada was the predominant source for belugas destined for exhibition. Until the early 1960s, they were taken from the St. Lawrence River estuary (famously captured in the film documentary Pour la suite du monde) and from 1967 from the Churchill River estuary. This continued until 1992, when the practice was banned.[157] Since Canada ceased to be the supplier of these animals, Russia has become the largest provider.[157] Individuals are caught in the Amur River delta and the far eastern seas of the country, and then are either transported domestically to aquaria in Moscow, St. Petersburg, and Sochi, or exported to foreign nations, including Canada.[157]

Today, it remains one of the few whale species kept at aquaria and marine parks across North America, Europe, and Asia.[157] As of 2006, 30 belugas were in Canada and 28 in the United States, and 42 deaths in captivity had been reported up to that time.[157] A single specimen can reportedly fetch up to US$100,000 on the market. The beluga's popularity with visitors reflects its attractive colour and its range of facial expressions. The latter is possible because while most cetacean "smiles" are fixed, the extra movement afforded by the beluga's unfused cervical vertebrae allows a greater range of apparent expression.[39]

To provide some enrichment while in captivity, aquaria train belugas to perform behaviours for the public[158] and for medical exams, such as blood draws[159] and ultrasound,[160] provide toys,[158] and allow the public to play recorded or live music.[161]

Most belugas found in aquaria are caught in the wild, as captive-breeding programs have not had much success so far.[162] For example, despite best efforts, as of 2010, only two male whales had been successfully used as stud animals in the Association of Zoos and Aquariums beluga population, Nanuq at SeaWorld San Diego and Naluark at the Shedd Aquarium in Chicago, USA. Nanuq has fathered 10 calves, five of which survived birth.[163] Naluark at Shedd Aquarium has fathered four living offspring.[164] Naluark has been relocated to the Mystic Aquarium in the hope that he will breed with two of their females.[165] The first beluga calf born in captivity in Europe was born in L'Oceanogrfic marine park in Valencia, Spain, in November 2006.[166] However, the calf died 25 days later after suffering metabolic complications, infections, and not being able to feed properly.[167] A second calf was born in November, 16th 2016, and was successfully maintained by artificial feeding based on enriched milk.[168]

Between 1960 and 1992, the United States Navy carried out a program that included the study of marine mammals' abilities with echolocation, with the objective of improving the detection of underwater objects. The program started with dolphins, but a large number of belugas were also used from 1975 on.[169] The program included training these mammals to carry equipment and material to divers working under water, the location of lost objects, surveillance of ships and submarines, and underwater monitoring using cameras held in their mouths.[169] A similar program was implemented by the Russian Navy during the Cold War, in which belugas were also trained for antimining operations in Arctic waters.[142]

In 2009 during a free-diving competition in a tank of icy water in Harbin, China, a captive beluga brought a cramp-paralyzed diver from the bottom of the pool up to the surface by holding her foot in its mouth, saving the diver's life.[170][171]

Films which have publicized issues of beluga welfare include Born to Be Free,[172] Sonic Sea,[173] and Vancouver Aquarium Uncovered.[174]

Whale watching has become an important activity in the recovery of the economies of towns in Hudson Bay near to the Saint Lawrence and Churchill Rivers. The best time to see belugas is during the summer, when they meet in large numbers in the estuaries of the rivers and in their summer habitats.[175] The animals are easily seen due to their high numbers and their curiosity regarding the presence of humans.[175]

However, the boats' presence poses a threat to the animals, as it distracts them from important activities such as feeding, social interaction and reproduction. In addition, the noise produced by the motors has an adverse effect on their auditory function and reduces their ability to detect their prey, communicate, and navigate.[176] To protect these marine animals during whale-watching activities, the US National Oceanic and Atmospheric Administration has published a Guide for observing marine life. The guide recommends boats carrying the whale watchers keep their distance from the cetaceans and it expressly prohibits chasing, harassing, obstructing, touching, or feeding them.[177]

Some regular migrations do occur into Russian EEZ of Sea of Japan such as to Rudnaya Bay, where diving with wild belugas became a less-known but popular attraction.[178]

Male belugas in captivity can mimic the pattern of human speech, several octaves lower than typical whale calls. It is not the first time a beluga has been known to sound human, and they often shout like children, in the wild.[179] One captive beluga, after overhearing divers using an underwater communication system, caused one of the divers to surface by imitating their order to get out of the water. Subsequent recordings confirmed that the beluga had become skilled at imitating the patterns and frequency of human speech. After several years, this beluga ceased making these sounds.[180]

Prior to 2008, the beluga was listed as "vulnerable" by the International Union for Conservation of Nature (IUCN), a higher level of concern. The IUCN cited the stability of the largest subpopulations and improved census methods that indicate a larger population than previously estimated. In 2008, the beluga was reclassified as "near threatened" by the IUCN due to uncertainty about threats to their numbers and the number of belugas over parts of its range (especially the Russian Arctic), and the expectation that if current conservation efforts cease, especially hunting management, the beluga population is likely to qualify for "threatened" status within five years.[181] In June 2017, its status was reassessed to "least concern".[2]

Subpopulations are subject to differing levels of threat and warrant individual assessment. The nonmigratory Cook Inlet subpopulation is listed as "Critically Endangered" by the IUCN as of 2006[2] and is listed as Endangered under the Endangered Species Act as of October 2008.[182][183][184] This was due to overharvesting of belugas prior to 1998. The population has failed to recover, though the reported harvest has been small. The most recently published estimate as of May 2008 was 302 (CV=0.16) in 2006.[2] In addition, the National Marine Fisheries Service indicated the 2007 aerial survey's point estimate was 375.

The US Congress passed the Marine Mammal Protection Act of 1972 outlawing the persecution and hunting of all marine mammals within US coastal waters. The act has been amended a number of times to permit subsistence hunting by native peoples, temporary capture of restricted numbers for research, education and public display, and to decriminalise the accidental capture of individuals during fishing operations.[185] The act also states that all whales in US territorial waters are under the jurisdiction of the National Marine Fisheries Service, a division of NOAA.[185]

To prevent hunting, belugas are protected under the 1986 International Moratorium on Commercial Whaling; however, hunting of small numbers of belugas is still allowed. Since it is very difficult to know the exact population of belugas because their habitats include inland waters away from the ocean, they easily come in contact with oil and gas development centres. To prevent whales from coming in contact with industrial waste, the Alaskan and Canadian governments are relocating sites where whales and waste come in contact.

The beluga whale is listed on appendix II[186] of the Convention on the Conservation of Migratory Species of Wild Animals (CMS). It is listed on Appendix II[186] as it has an unfavourable conservation status or would benefit significantly from international co-operation organised by tailored agreements. All toothed whales are protected under the CITES that was signed in 1973 to regulate the commercial exploitation of certain species.[187]

The isolated beluga population in the Saint Lawrence River has been legally protected since 1983.[188] In 1988 Canadian Department of Fisheries and Oceans and Environment Canada, a governmental agency that supervises national parks, implemented the Saint Lawrence Action Plan[189] with the aim of reducing industrial contamination by 90% by 1993; as of 1992, the emissions had been reduced by 59%.[122] The population of the St. Lawrence belugas decreased from 10,000 in 1885 to around 1,000 in the 1980 and around 900 in 2012.[190]

Pour la suite du monde, is a Canadian documentary film released in 1963 about traditional beluga hunting carried out by the inhabitants of L'Isle-aux-Coudres on the Saint Lawrence River.[191]

White Whale Records was an American record company that operated between 1965 and 1971 in Los Angeles, California, it was the record company of The Turtles. The company's logo was the silhouette of a beluga with the words "White Whale" above it.[192]

The children's singer Raffi released an album called Baby Beluga in 1980. The album starts with the sound of whales communicating, and includes songs representing the ocean and whales playing. The song "Baby Beluga" was composed after Raffi saw a recently born beluga calf in Vancouver Aquarium.[193]

Yamaha's Beluga motorcycle (Riva 80/CV80) which had an 80-cc engine was produced from 1981 until 1987 and sold throughout the world, particularly in Canada, the USA, the Netherlands, Belgium, Sweden, and Japan.[194]

The Beluga class submarine (project 1710 Mackerel) was an experimental Russian submarine whose prototype operated until 1997, with the whole project being discontinued in the mid-2000s.[195]

The fuselage design of the Airbus Beluga, one of the world's biggest cargo planes, is very similar to that of a beluga; it was originally called the Super Transporter, but the nickname Beluga became more popular and was then officially adopted.[196]

The German company SkySails GmbH & Co. KG, a subsidiary of the Beluga Shipping group based in Hamburg, tested a new propulsion system for ships that involved a large wing similar to that used in paragliding and which has demonstrated a reduction in fuel use between 10% and 35%. The programme to prove the efficiency of the system was called Project Beluga, as it involved the ship MS Beluga Skysails. The company's insignia, a beluga's tailfin, was printed on the giant wing, which had a surface area of 160m2.[197]

A 2002 episode of science fiction series Dark Angel titled "Dawg Day Afternoon" claims that beluga whales are the result of a hybridisation between a humpback whale and a dolphin.

In the Disney/Pixar film Finding Dory, (a sequel to Finding Nemo) the character Bailey is a beluga whale.[198]

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NewVisionClinics – Specialist Eye Surgeons For Melbourne

June 24th, 2018 7:40 am

NewVision Clinics provide expert ophthalmologist services in Melbourne, making it convenient for everyone to consult an eye specialist. We pride ourselves on using the latest technology, combined with the most modern procedures, ensuring the highest standards of vision correction for all of our clients.

NewVision Cllinics is a full service ophthalmological provider. We specialise in laser eye surgery and support both LASIK and Advanced PRK techniques using the process of Lasersight. Our principal Professor Noel Alpins is recognised around the globe as a leading authority in corrective laser eye surgery with a special interest in astigmatism, you can rest assured you have chosen a professional clinic that is leading the way in Australia.

Throughout our website you will find many useful resources, each designed to help you understand the process. We make sure our patients fully understand what is involved with the procedure required by providing professional advice in a relaxed environment.

If you feel your vision is deteriorating, you want to reduce the need for glasses or contact lenses, or have any concerns regarding your eyesight, contact us today. We provide a no-cost, no-obligation assessment, tailoring the best solution to your individual requirements

Talk to one of our helpful and friendly staff today and discover more about our full range of services. We can book you in for assessment with our team and put you on the road to better eye sight. Call us on1800 20 20 20and we will be happy to discuss your situation and book a consultation that suits your schedule.

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Health and Wellness : Personalized Medicine

June 23rd, 2018 5:46 pm

Personalized medicine relies on tests to help determine an individuals response to certain medications.

Personalized medicine takes into account your unique genetic makeup. Unlike "genetic medicine," which is directed at such inherited diseases as sickle cell anemia, personalized medicine can help your doctor tailor treatment for conditions such as heart disease and deep vein thrombosis. This enables him/her to focus on prevention, detection and early intervention.

Your genetic makeup also affects which medicines work best for youand how you respond to them. Your doctor can prescribe targeted treatment based on both:

We offer two such tests, which represent the forefront of personalized medicine. They can determine your response to two of the most widely prescribed drugs.

Marketed as Coumadin and Jantoven, warfarin thins the blood to help prevent and treat deep vein thrombosis, stroke, heart attack, atrial fibrillation and other diseases of the arteries and veins. The right dosage is crucial. Too low a dose could increase the risk of a life-threatening blood clot. Too high a dose could increase bleeding risk. Plus, your response to a specific dose can vary widely. We offer the AccuType Warfarin test to help your physician determine the appropriate dosage based on your genetic information.

Marketed as Plavix, clopidogrel is another blood thinner. The AccuType CP test identifies if youre unlikely to respond well to the drug and therefore at increased risk for stroke or heart attack. It also identifies if youre likely to be overly sensitive to the drug and therefore at increased risk for bleeding episodes.

Personalized medicine, including these two laboratory tests, can help make possible:

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Genetic Engineering Will Change Everything Forever …

June 23rd, 2018 5:46 pm

Designer babies, the end of diseases, genetically modified humans that never age. Outrageous things that used to be science fiction are suddenly becoming reality. The only thing we know for sure is that things will change irreversibly.

Support us on Patreon so we can make more videos (and get cool stuff in return): https://www.patreon.com/Kurzgesagt?ty=h

Kurzgesagt merch here: http://bit.ly/1P1hQIH

Get the music of the video here:

soundcloud: http://bit.ly/2aRxNZdbandcamp: http://bit.ly/2berrSWhttp://www.epic-mountain.com

Thanks to Volker Henn, James Gurney and (prefers anonymity) for help with this video!

THANKS A LOT TO OUR LOVELY PATRONS FOR SUPPORTING US:

Jeffrey Schneider, Konstantin Kaganovich, Tom Leiser, Archie Castillo, Russell Eishard, Ben Kershaw, Marius Stollen, Henry Bowman, Ben Johns, Bogdan Radu, Sam Toland, Pierre Thalamy, Christopher Morgan, Rocks Arent People, Ross Devereux, Pascal Michaud, Derek DuBreuil, Sofia Quintero, Robert Swiniarski, Merkt Kzlrmak, Michelle Rowley, Andy Dong, Saphir Patel, Harris Rotto, Thomas Huzij, Ryan James Burke, NTRX, Chaz Lewis, Amir Resali, The War on Stupid, John Pestana, Lucien Delbert, iaDRM, Jacob Edwards, Lauritz Klaus, Jason Hunt, Marcus : ), Taylor Lau, Rhett H Eisenberg, Mr.Z, Jeremy Dumet, Fatman13, Kasturi Raghavan, Kousora, Rich Sekmistrz, Mozart Peter, Gaby Germanos, Andreas Hertle, Alena Vlachova, Zdravko aek

SOURCES AND FURTHER READING:

The best book we read about the topic: GMO Sapiens

https://goo.gl/NxFmk8

(affiliate link, we get a cut if buy the book!)

Good Overview by Wired:http://bit.ly/1DuM4zq

timeline of computer development:http://bit.ly/1VtiJ0N

Selective breeding: http://bit.ly/29GaPVS

DNA:http://bit.ly/1rQs8Yk

Radiation research:http://bit.ly/2ad6wT1

inserting DNA snippets into organisms:http://bit.ly/2apyqbj

First genetically modified animal:http://bit.ly/2abkfYO

First GM patent:http://bit.ly/2a5cCox

chemicals produced by GMOs:http://bit.ly/29UvTbhhttp://bit.ly/2abeHwUhttp://bit.ly/2a86sBy

Flavr Savr Tomato:http://bit.ly/29YPVwN

First Human Engineering:http://bit.ly/29ZTfsf

glowing fish:http://bit.ly/29UwuJU

CRISPR:http://go.nature.com/24Nhykm

HIV cut from cells and rats with CRISPR:http://go.nature.com/1RwR1xIhttp://ti.me/1TlADSi

first human CRISPR trials fighting cancer:http://go.nature.com/28PW40r

first human CRISPR trial approved by Chinese for August 2016:http://go.nature.com/29RYNnK

genetic diseases:http://go.nature.com/2a8f7ny

pregnancies with Down Syndrome terminated:http://bit.ly/2acVyvg( 1999 European study)

CRISPR and aging:http://bit.ly/2a3NYAVhttp://bit.ly/SuomTyhttp://go.nature.com/29WpDj1http://ti.me/1R7Vus9

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Stem Cell Therapy For Orthopedic Injuries and Arthritis …

June 23rd, 2018 5:44 pm

Stems cell therapy is a cutting-edge technology that is now widely being used in orthopedic and sports medicine. The procedure involves using a patients own stem cells, which have the unique property of being able to develop into many different cell types, to treat injuries and arthritis.

Stem cells can be found in our bone marrow, fat cells and other tissues. These cells are frequently taken from the bone marrow or from a small amount of fat tissue, where a high concentration of stem cells can be extracted. This concentration is known as bone marrow aspirate or lipoaspirate respectively.

The aspirate is then injected into the site of injury so the cells can help repair the injured or degenerative tissue. Stem cell therapy is also commonly used to treat arthritis, meniscal tears and a variety of orthopedic and medical conditions. Patients can experience significant pain relief within one to two months after the procedure.

Although stem cell therapy has been used for decades, it is still considered experimental in orthopedic and sports medicine. Stem cell therapy should not be used as the first step in treating an orthopedic injury.

In addition, the risk of bone marrow aspiration for stem cell therapy includes infection, prolonged bleeding, pain at the aspiration or injection site, bruising and nerve injury.

The best way to determine if you are a candidate for stem cell therapy is to have a thorough evaluation by a physician experienced with stem cell therapies. Stem cell therapy is usually not covered by insurance. However, depending on the type of treatment that is needed, partial reimbursement may be possible.

Dr. Alicia Carter is respected in her field for her experience, personal care, and non-operative approach to orthopedic and sports injuries. As a clinical instructor at Columbia University College of Physicians and Surgeons, she is tasked with staying on the forefront of new technologies that are impacting and improving peoples lives. Dr. Carter has almost a decade of experience in the field of regenerative medicine and she is an active member of the International Society of Regenerative Medicine. Patients prefer her patience, her gentle hand and her anesthetizing techniques, which allow her to perform procedures with minimal or no discomfort. She has successfully treated patients with stem cell therapy and will work with you to determine if its right for you.

Dr. Carter offers complimentary monthly group stem cell therapy information sessions. These sessions do fill quickly so contact our office to reserve your spot today.

Book Now!

Q: Does Dr. Carter perform stem cell treatments for the spine (cervical, thoracic and lumbar) and joints? A: Yes. Dr. Carter treats virtually all orthopedic and sports conditions and can use stem cell treatments for most, including disorders and injuries of the cervical spine.

Q: Where does Dr. Carter get the stem cells from?A: Stem cells can be obtained from the bone marrow/pelvic bone or from a small amount of abdominal fat tissue.

Q: Is stem cell therapy covered by insurance? A: Stem cell therapy is typically not covered by insurances. However, depending on your condition, partial reimbursement may be possible. Reimbursement questions can be answered in more detail after your consult and once we know more about your insurance coverage.

Q: How much does stem cell therapy cost?A: The price can vary depending on the type of condition being treated and whether bone marrow aspirate or fat tissue is utilized to acquire the stem cells.

Q: Do I have to pay for the initial consult? A: It depends on your insurance plan. If you have to pay upfront for initial consult, then it will be deducted from the total cost of the stem cell procedure if you are a candidate. If youre not a candidate, then the consultation feet is nonrefundable however, alternative treatments will be thoroughly discussed. We will gladly submit the consult visit claim to your insurance company on your behalf, which may or may not be reimbursable.

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Stem Cell Therapy – Stem Cells Heal Me

June 23rd, 2018 5:43 pm

Palliative management has consisted of lifestyle changes (diet, exercise, activity restrictions, and others), physical therapy, injections and medication. When severe, surgery has been an option for both joint and spine degenerative disease. Joint replacement, disc replacement and fusion were available to those with severe limitations in function related to the degenerative process.

These surgeries hold both great promise and great risk. Surgery results in irreversible structural change. It is a bridge burner in the respect that surgery forever changes the anatomy. In many cases surgical outcome is good and justifies this change in anatomy. In some, however, the change results in worsening of the original pain and overall worsening of function. Statistics show poorer outcomes with each successive surgery. Unfortunately, it is difficult, if not impossible to predict a successful surgical intervention in any individual patient.

Successful treatment is usually temporary and measured over years since surgical joint prosthetics wear out and require revision and replacement. Spine fusion speeds the degenerative process at adjacent vertebral levels.

Stem cell therapy, available now, is a means to stimulate healing in patients suffering both joint and disc related pain. Although we do not know how long lasting this treatment will be, we do know that the structure of the joint or spine is not changed with regenerative treatment.When patients are properly selected, outcomes are quite good. Best of all, stem cell treatment does not change anatomy and surgical options continue to be open and available if necessary.

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The Future Of Nano Medicine

June 22nd, 2018 7:50 pm

Nanomedicine, refers to highly specific medical intervention at the molecular level for curing disease or repairing damaged tissues. Though in its infancy, could we be looking at the future of medicine? Early clinical trials certainly look promising.How Nanomedicine Works

Nanomedicine works by injecting nanoparticles into the body Can be used to: Deliver medicine Find and treat disease Repair damaged cells

One human hair is approximately 80,000 nanometers wideApplications of Nanomedicine

Drug Delivery Using nanotechnology to deliver medicine, diabetic rats kept stable blood sugar levels for 10 days after injection Cancer Diagnosis and Treatment Using microRNA from a patients blood plasma and nanotechnology: Medical professionals can determine if lung cancer is present Begin treatment the same day Using Nano-Therm therapy to overheat brain cancer cells helps to destroy them In clinical trials, those with recurrent glioblastoma survived a median of 13 months More than double the survival rate of those not receiving Nano-Therm therapyNanotechnology is already commonly used in sunscreen and to make tennis balls more bouncy

Flu Testing Todays flu tests are: Time consuming Inaccurate Nanomedicine gold flu testing provides: Instant results Immediate treatment cycle to avoid spreading to others commercial nanotech testing no more than 5 years away Cell Feedback Nanomedicine can be used to test cells response to drugs offering new drug testing methods Provides instant feedback to how cells respond to medicine Can save years and millions of dollars on testing and clinical trials Can improve current medications

In a 1956, Arthur C. Clarke first envisioned the concept of nanotechnology in a short story, The Next TenantsAdvantages of Nanomedicine

Faster diagnosis of many ailments More precise treatments of conditions such as cancer Repair tissue deep within the body Target only diseased organs, lessening the need for drugsSources

https://commonfund.nih.gov/nanomedicine/overview.aspx http://www.understandingnano.com/medicine.html http://pubs.acs.org/doi/abs/10.1021/nn400630x http://www.nature.com/nnano/journal/v6/n10/full/nnano.2011.147.html http://www.dana.org/news/features/detail_bw.aspx?id=35592 http://pubs.rsc.org/en/Content/ArticleLanding/2011/AN/C1AN15303J http://onlinelibrary.wiley.com/doi/10.1002/smll.201001642/abstract http://www.clinam.org/benefits.html

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Long-Term Effects of Bone Marrow Transplantation: Overview …

June 22nd, 2018 7:47 pm

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Patey-Mariaud de Serre N, Reijasse D, Verkarre V, Canioni D, Colomb V, Haddad E. Chronic intestinal graft-versus-host disease: clinical, histological and immunohistochemical analysis of 17 children. Bone Marrow Transplant. 2002 Feb. 29(3):223-30. [Medline].

Browning B, Thormann K, Seshadri R, Duerst R, Kletzel M, Jacobsohn DA. Weight loss and reduced body mass index: a critical issue in children with multiorgan chronic graft-versus-host disease. Bone Marrow Transplant. 2006 Mar. 37(5):527-33. [Medline].

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Lee SJ, Vogelsang G, Gilman A, Weisdorf DJ, Pavletic S, Antin JH. A survey of diagnosis, management, and grading of chronic GVHD. Biol Blood Marrow Transplant. 2002. 8(1):32-9. [Medline].

Jacobsohn DA, Chen AR, Zahurak M, Piantadosi S, Anders V, Bolanos-Meade J. Phase II study of pentostatin in patients with corticosteroid-refractory chronic graft-versus-host disease. J Clin Oncol. 2007 Sep 20. 25(27):4255-61. [Medline].

Ringden O, Uzunel M, Rasmusson I, Remberger M, Sundberg B, Lonnies H. Mesenchymal stem cells for treatment of therapy-resistant graft-versus-host disease. Transplantation. 2006 May 27. 81(10):1390-7. [Medline].

Gao L, Zhang Y, Hu B, Liu J, Kong P, Lou S, et al. Phase II Multicenter, Randomized, Double-Blind Controlled Study of Efficacy and Safety of Umbilical Cord-Derived Mesenchymal Stromal Cells in the Prophylaxis of Chronic Graft-Versus-Host Disease After HLA-Haploidentical Stem-Cell Transplantation. J Clin Oncol. 2016 Aug 20. 34 (24):2843-50. [Medline].

Kanold J, Paillard C, Halle P, D'Incan M, Bordigoni P, Demeocq F. Extracorporeal photochemotherapy for graft versus host disease in pediatric patients. Transfus Apher Sci. 2003 Feb. 28(1):71-80. [Medline].

Calzavara Pinton P, Porta F, Izzi T, et al. Prospects for ultraviolet A1 phototherapy as a treatment for chronic cutaneous graft-versus-host disease. Haematologica. 2003. 88:1169-1175.

Elad S, Or R, Resnick I, Shapira MY. Topical tacrolimus--a novel treatment alternative for cutaneous chronic graft-versus-host disease. Transpl Int. 2003. 16:665-670.

Socie G, Curtis RE, Deeg HJ, Sobocinski KA, Filipovich AH, Travis LB. New malignant diseases after allogeneic marrow transplantation for childhood acute leukemia. J Clin Oncol. 2000 Jan. 18(2):348-57. [Medline].

Leisenring W, Friedman DL, Flowers ME, Schwartz JL, Deeg HJ. Nonmelanoma skin and mucosal cancers after hematopoietic cell transplantation. J Clin Oncol. 2006 Mar 1. 24(7):1119-26. [Medline].

Danner-Koptik KE, Majhail NS, Brazauskas R, Wang Z, Buchbinder D, Cahn JY. Second malignancies after autologous hematopoietic cell transplantation in children. Bone Marrow Transplant. 2013 Mar. 48(3):363-8. [Medline].

Kolb HJ, Guenther W, Duell T, et al. Cancer after bone marrow transplantation. IBMTR and EBMT/EULEP Study Group on Late Effects. Bone Marrow Transplant. 1992. 10 Suppl 1:135-138.

Deeg HJ, Socie G. Malignancies after hematopoietic stem cell transplantation: many questions, some answers. Blood. 1998 Mar 15. 91(6):1833-44. [Medline].

aya CV, Fung JJ, Nalesnik MA, et al. Epstein-Barr virus-induced posttransplant lymphoproliferative disorders. ASTS/ASTP EBV-PTLD Task Force and The Mayo Clinic Organized International Consensus Development Meeting. Transplantation. 1999. 68:1517-1525.

Penn I, Hammond W, Brettschneider L, Starzl TE. Malignant lymphomas in transplantation patients. Transplant Proc. 1969. 1:106-112.

Yufu Y, Kimura M, Kawano R, Noguchi Y, Takatsuki H, Uike N. Epstein-Barr virus-associated T cell lymphoproliferative disorder following autologous blood stem cell transplantation for relapsed Hodgkin's disease. Bone Marrow Transplant. 2000 Dec. 26(12):1339-41. [Medline].

Cohen JI. Epstein-Barr virus lymphoproliferative disease associated with acquired immunodeficiency. Medicine (Baltimore). 1991. 70:137-160.

Sklar CA. Growth and neuroendocrine dysfunction following therapy for childhood cancer. Pediatr Clin North Am. 1997 Apr. 44(2):489-503. [Medline].

Bakker B, Oostdijk W, Geskus RB, Stokvis-Brantsma WH, Vossen JM, Wit JM. Patterns of growth and body proportions after total-body irradiation and hematopoietic stem cell transplantation during childhood. Pediatr Res. 2006 Feb. 59(2):259-64. [Medline].

Cohen A, Rovelli A, Bakker B, Uderzo C, van Lint MT, Esperou H. Final height of patients who underwent bone marrow transplantation for hematological disorders during childhood: a study by the Working Party for Late Effects-EBMT. Blood. 1999 Jun 15. 93(12):4109-15. [Medline].

Afify Z, Shaw PJ, Clavano-Harding A, Cowell CT. Growth and endocrine function in children with acute myeloid leukaemia after bone marrow transplantation using busulfan/cyclophosphamide. Bone Marrow Transplant. 2000. 25:1087-1092.

Chemaitilly W, Boulad F, Heller G, Kernan NA, Small TN, O'Reilly RJ. Final height in pediatric patients after hyperfractionated total body irradiation and stem cell transplantation. Bone Marrow Transplant. 2007 Jul. 40(1):29-35. [Medline].

Shalet SM. Irradiation-induced growth failure. Clin Endocrinol Metab. 1986 Aug. 15(3):591-606. [Medline].

Shalet SM, Clayton PE, Price DA. Growth and pituitary function in children treated for brain tumours or acute lymphoblastic leukaemia. Horm Res. 1988. 30(2-3):53-61. [Medline].

Sanders JE, Guthrie KA, Hoffmeister PA, Woolfrey AE, Carpenter PA, Appelbaum FR. Final adult height of patients who received hematopoietic cell transplantation in childhood. Blood. 2005 Feb 1. 105(3):1348-54. [Medline].

Sklar CA, Mertens AC, Mitby P, Occhiogrosso G, Qin J, Heller G. Risk of disease recurrence and second neoplasms in survivors of childhood cancer treated with growth hormone: a report from the Childhood Cancer Survivor Study. J Clin Endocrinol Metab. 2002 Jul. 87(7):3136-41. [Medline].

Ergun-Longmire B, Mertens AC, Mitby P, Qin J, Heller G, Shi W. Growth hormone treatment and risk of second neoplasms in the childhood cancer survivor. J Clin Endocrinol Metab. 2006 Sep. 91(9):3494-8. [Medline].

Woodmansee WW, Zimmermann AG, Child CJ, Rong Q, Erfurth EM, Beck-Peccoz P. Incidence of second neoplasm in childhood cancer survivors treated with GH: an analysis of GeNeSIS and HypoCCS. Eur J Endocrinol. 2013 Apr. 168(4):565-73. [Medline].

Mackenzie S, Craven T, Gattamaneni HR, Swindell R, Shalet SM, Brabant G. Long-term safety of growth hormone replacement after CNS irradiation. J Clin Endocrinol Metab. 2011 Sep. 96(9):2756-61. [Medline].

Johnston RJ, Wallace WH. Normal ovarian function and assessment of ovarian reserve in the survivor of childhood cancer. Pediatr Blood Cancer. 2009 Aug. 53(2):296-302. [Medline].

Richardson SJ, Senikas V, Nelson JF. Follicular depletion during the menopausal transition: evidence for accelerated loss and ultimate exhaustion. J Clin Endocrinol Metab. 1987 Dec. 65(6):1231-7. [Medline].

Treloar AE. Menstrual cyclicity and the pre-menopause. Maturitas. 1981 Dec. 3(3-4):249-64. [Medline].

Wallace WH, Thomson AB, Saran F, Kelsey TW. Predicting age of ovarian failure after radiation to a field that includes the ovaries. Int J Radiat Oncol Biol Phys. 2005 Jul 1. 62(3):738-44. [Medline].

Sarafoglou K, Boulad F, Gillio A, Sklar C. Gonadal function after bone marrow transplantation for acute leukemia during childhood. J Pediatr. 1997 Feb. 130(2):210-6. [Medline].

Liu J, Malhotra R, Voltarelli J, Stracieri AB, Oliveira L, Simoes BP. Ovarian recovery after stem cell transplantation. Bone Marrow Transplant. 2008 Feb. 41(3):275-8. [Medline].

Brachet C, Heinrichs C, Tenoutasse S, Devalck C, Azzi N, Ferster A. Children with sickle cell disease: growth and gonadal function after hematopoietic stem cell transplantation. J Pediatr Hematol Oncol. 2007 Jul. 29(7):445-50. [Medline].

Lie Fong S, Laven JS, Hakvoort-Cammel FG, Schipper I, Visser JA, Themmen AP. Assessment of ovarian reserve in adult childhood cancer survivors using anti-Mllerian hormone. Hum Reprod. 2009 Apr. 24(4):982-90. [Medline].

Petryk A, Bergemann TL, Polga KM, Ulrich KJ, Raatz SK, Brown DM. Prospective study of changes in bone mineral density and turnover in children after hematopoietic cell transplantation. J Clin Endocrinol Metab. 2006 Mar. 91(3):899-905. [Medline].

Gallagher JC. Effect of early menopause on bone mineral density and fractures. Menopause. 2007 May-Jun. 14(3 Pt 2):567-71. [Medline].

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de Kleijn MJ, van der Schouw YT, Verbeek AL, Peeters PH, Banga JD, van der Graaf Y. Endogenous estrogen exposure and cardiovascular mortality risk in postmenopausal women. Am J Epidemiol. 2002 Feb 15. 155(4):339-45. [Medline].

Mondul AM, Rodriguez C, Jacobs EJ, Calle EE. Age at natural menopause and cause-specific mortality. Am J Epidemiol. 2005 Dec 1. 162(11):1089-97. [Medline].

Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 2009 Feb 5. 360(6):573-87. [Medline].

Yao S, McCarthy PL, Dunford LM, Roy DM, Brown K, Paplham P. High prevalence of early-onset osteopenia/osteoporosis after allogeneic stem cell transplantation and improvement after bisphosphonate therapy. Bone Marrow Transplant. 2008 Feb. 41(4):393-8. [Medline].

Salooja N, Szydlo RM, Socie G, Rio B, Chatterjee R, Ljungman P. Pregnancy outcomes after peripheral blood or bone marrow transplantation: a retrospective survey. Lancet. 2001 Jul 28. 358(9278):271-6. [Medline].

Winther JF, Boice JD Jr, Frederiksen K, Bautz A, Mulvihill JJ, Stovall M. Radiotherapy for childhood cancer and risk for congenital malformations in offspring: a population-based cohort study. Clin Genet. 2009 Jan. 75(1):50-6. [Medline]. [Full Text].

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Bakker B, Massa GG, Oostdijk W, Van Weel-Sipman MH, Vossen JM, Wit JM. Pubertal development and growth after total-body irradiation and bone marrow transplantation for haematological malignancies. Eur J Pediatr. 2000 Jan-Feb. 159(1-2):31-7. [Medline].

Somali M, Mpatakoias V, Avramides A, Sakellari I, Kaloyannidis P, Smias C. Function of the hypothalamic-pituitary-gonadal axis in long-term survivors of hematopoietic stem cell transplantation for hematological diseases. Gynecol Endocrinol. 2005 Jul. 21(1):18-26. [Medline].

Anserini P, Chiodi S, Spinelli S, Costa M, Conte N, Copello F. Semen analysis following allogeneic bone marrow transplantation. Additional data for evidence-based counselling. Bone Marrow Transplant. 2002 Oct. 30(7):447-51. [Medline].

Sanders JE, Hawley J, Levy W, Gooley T, Buckner CD, Deeg HJ. Pregnancies following high-dose cyclophosphamide with or without high-dose busulfan or total-body irradiation and bone marrow transplantation. Blood. 1996 Apr 1. 87(7):3045-52. [Medline].

Sanders JE, Hoffmeister PA, Woolfrey AE, Carpenter PA, Storer BE, Storb RF. Thyroid function following hematopoietic cell transplantation in children: 30 years'' experience. Blood. 2009 Jan 8. 113(2):306-8. [Medline]. [Full Text].

Cohen A, Rovelli A, Merlo DF, van Lint MT, Lanino E, Bresters D. Risk for secondary thyroid carcinoma after hematopoietic stem-cell transplantation: an EBMT Late Effects Working Party Study. J Clin Oncol. 2007 Jun 10. 25(17):2449-54. [Medline].

Hoffmeister PA, Madtes DK, Storer BE, Sanders JE. Pulmonary function in long-term survivors of pediatric hematopoietic cell transplantation. Pediatr Blood Cancer. 2006 Oct 15. 47(5):594-606. [Medline].

Cerveri I, Zoia MC, Fulgoni P, Corsico A, Casali L, Tinelli C. Late pulmonary sequelae after childhood bone marrow transplantation. Thorax. 1999 Feb. 54(2):131-5. [Medline].

Uderzo C, Pillon M, Corti P, Tridello G, Tana F, Zintl F. Impact of cumulative anthracycline dose, preparative regimen and chronic graft-versus-host disease on pulmonary and cardiac function in children 5 years after allogeneic hematopoietic stem cell transplantation: a prospective evaluation on behalf of the EBMT Pediatric Diseases and Late Effects Working Parties. Bone Marrow Transplant. 2007 Jun. 39(11):667-75. [Medline].

Faraci M, Barra S, Cohen A, Lanino E, Grisolia F, Miano M. Very late nonfatal consequences of fractionated TBI in children undergoing bone marrow transplant. Int J Radiat Oncol Biol Phys. 2005 Dec 1. 63(5):1568-75. [Medline].

Rieger CT, Rieger H, Kolb HJ, Peterson L, Huppmann S, Fiegl M. Infectious complications after allogeneic stem cell transplantation: incidence in matched-related and matched-unrelated transplant settings. Transpl Infect Dis. 2009 Jun. 11(3):220-6. [Medline].

de Medeiros CR, Moreira VA, Pasquini R. Cytomegalovirus as a cause of very late interstitial pneumonia after bone marrow transplantation. Bone Marrow Transplant. 2000. 26:443-444.

Afessa B, Litzow MR, Tefferi A. Bronchiolitis obliterans and other late onset non-infectious pulmonary complications in hematopoietic stem cell transplantation. Bone Marrow Transplant. 2001 Sep. 28(5):425-34. [Medline].

Palmas A, Tefferi A, Myers JL, Scott JP, Swensen SJ, Chen MG. Late-onset noninfectious pulmonary complications after allogeneic bone marrow transplantation. Br J Haematol. 1998 Mar. 100(4):680-7. [Medline].

Patriarca F, Skert C, Bonifazi F, Sperotto A, Fili C, Stanzani M. Effect on survival of the development of late-onset non-infectious pulmonary complications after stem cell transplantation. Haematologica. 2006 Sep. 91(9):1268-72. [Medline].

Faraci M, Bekassy AN, De Fazio V, Tichelli A, Dini G. Non-endocrine late complications in children after allogeneic haematopoietic SCT. Bone Marrow Transplant. 2008. 41 Suppl 2:S49-57.

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Long-Term Effects of Bone Marrow Transplantation: Overview ...

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Gene Therapy | Pfizer: One of the world’s premier …

June 22nd, 2018 7:46 pm

Gene therapy is a technology aimed at correcting or fixing a gene that may be defective. This exciting and potentially transformative area of research is focused on the development of potential treatments for monogenic diseases, or diseases that are caused by a defect in one gene.

The technology involves the introduction of genetic material (DNA or RNA) into the body, often through delivering a corrected copy of a gene to a patients cells to compensate for a defective one, using a viral vector.

The technology involves the introduction of genetic material (DNA or RNA) into the body, often through delivering a corrected copy of a gene to a patients cells to compensate for a defective one, using a viral vector.

Viral vectors can be developed using adeno-associated virus (AAV), a naturally occurring virus which has been adapted for gene therapy use. Its ability to deliver genetic material to a wide range of tissues makes AAV vectors useful for transferring therapeutic genes into target cells. Gene therapy research holds tremendous promise in leading to the possible development of highly-specialized, potentially one-time delivery treatments for patients suffering from rare, monogenic diseases.

Pfizer aims to build an industry-leading gene therapy platform with a strategy focused on establishing a transformational portfolio through in-house capabilities, and enhancing those capabilities through strategic collaborations, as well as potential licensing and M&A activities.

We're working to access the most effective vector designs available to build a robust clinical stage portfolio, and employing a scalable manufacturing approach, proprietary cell lines and sophisticated analytics to support clinical development.

In addition, we're collaborating with some of the foremost experts in this field, through collaborations with Spark Therapeutics, Inc., on a potentially transformative gene therapy treatment for hemophilia B, which received Breakthrough Therapy designation from the US Food and Drug Administration, and 4D Molecular Therapeutics to discover and develop targeted next-generation AAV vectors for cardiac disease.

Gene therapy holds the promise of bringing true disease modification for patients suffering from devastating diseases, a promise were working to seeing become a reality in the years to come.

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Blood type – Wikipedia

June 22nd, 2018 6:45 am

"Type O" redirects here. It is not to be confused with type 0.

A blood type (also called a blood group) is a classification of blood based on the presence and absence of antibodies and also based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs). These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system. Some of these antigens are also present on the surface of other types of cells of various tissues. Several of these red blood cell surface antigens can stem from one allele (or an alternative version of a gene) and collectively form a blood group system.[1] Blood types are inherited and represent contributions from both parents. A total of 36 human blood group systems are now recognized by the International Society of Blood Transfusion (ISBT).[2] The two most important ones are ABO and the Rh blood group systems; they determine someone's blood type (A, B, AB and O, with +, or null denoting RhD status) for suitability in blood transfusion.

A complete blood type would describe a full set of 30 substances on the surface of red blood cells, and an individual's blood type is one of many possible combinations of blood-group antigens.[3] Across the 36 blood groups, over 340 different blood-group antigens have been found.[2] Almost always, an individual has the same blood group for life, but very rarely an individual's blood type changes through addition or suppression of an antigen in infection, malignancy, or autoimmune disease.[4][5][6][7] Another more common cause in blood type change is a bone marrow transplant. Bone-marrow transplants are performed for many leukemias and lymphomas, among other diseases. If a person receives bone marrow from someone who is a different ABO type (e.g., a type A patient receives a type O bone marrow), the patient's blood type will eventually convert to the donor's type.

Some blood types are associated with inheritance of other diseases; for example, the Kell antigen is sometimes associated with McLeod syndrome.[8] Certain blood types may affect susceptibility to infections, an example being the resistance to specific malaria species seen in individuals lacking the Duffy antigen.[9] The Duffy antigen, presumably as a result of natural selection, is less common in ethnic groups from areas with a high incidence of malaria.[10]

The ABO blood group system involves two antigens and two antibodies found in human blood. The two antigens are antigen A and antigen B. The two antibodies are antibody A and antibody B. The antigens are present on the red blood cells and the antibodies in the serum. Regarding the antigen property of the blood all human beings can be classified into 4 groups, those with antigen A (group A), those with antigen B (group B), those with both antigen A and B (group AB) and those with neither antigen (group O). The antibodies present together with the antigens are found as follows:

1. Antigen A with antibody B2. Antigen B with antibody A3. Antigen AB has no antibodies4. Antigen nil (group O) with antibody A and B.

There is an agglutination reaction between similar antigen and antibody (for example, antigen A agglutinates the antibody A and antigen B agglutinates the antibody B). Thus, transfusion can be considered safe as long as the serum of the recipient does not contain antibodies for the blood cell antigens of the donor.

The ABO system is the most important blood-group system in human-blood transfusion. The associated anti-A and anti-B antibodies are usually immunoglobulin M, abbreviated IgM, antibodies. ABO IgM antibodies are produced in the first years of life by sensitization to environmental substances such as food, bacteria, and viruses.[citation needed] The original terminology used by Karl Landsteiner in 1901 for the classification was A/B/C; in later publications "C" became "O".[11] "O" is often called 0 (zero, or null) in other languages.[11][12]

The Rh system (Rh meaning Rhesus) is the second most significant blood-group system in human-blood transfusion with currently 50 antigens. The most significant Rh antigen is the D antigen, because it is the most likely to provoke an immune system response of the five main Rh antigens. It is common for D-negative individuals not to have any anti-D IgG or IgM antibodies, because anti-D antibodies are not usually produced by sensitization against environmental substances. However, D-negative individuals can produce IgG anti-D antibodies following a sensitizing event: possibly a fetomaternal transfusion of blood from a fetus in pregnancy or occasionally a blood transfusion with D positive RBCs.[13] Rh disease can develop in these cases.[14] Rh negative blood types are much less common in Asian populations (0.3%) than they are in European populations (15%).[15] The presence or absence of the Rh(D) antigen is signified by the + or sign, so that, for example, the A group is ABO type A and does not have the Rh (D) antigen.

As with many other genetic traits, the distribution of ABO and Rh blood groups varies significantly between populations.

Thirty-three blood-group systems have been identified by the International Society for Blood Transfusion in addition to the common ABO and Rh systems.[16] Thus, in addition to the ABO antigens and Rh antigens, many other antigens are expressed on the RBC surface membrane. For example, an individual can be AB, D positive, and at the same time M and N positive (MNS system), K positive (Kell system), Lea or Leb negative (Lewis system), and so on, being positive or negative for each blood group system antigen. Many of the blood group systems were named after the patients in whom the corresponding antibodies were initially encountered.

Transfusion medicine is a specialized branch of hematology that is concerned with the study of blood groups, along with the work of a blood bank to provide a transfusion service for blood and other blood products. Across the world, blood products must be prescribed by a medical doctor (licensed physician or surgeon) in a similar way as medicines.

Much of the routine work of a blood bank involves testing blood from both donors and recipients to ensure that every individual recipient is given blood that is compatible and is as safe as possible. If a unit of incompatible blood is transfused between a donor and recipient, a severe acute hemolytic reaction with hemolysis (RBC destruction), renal failure and shock is likely to occur, and death is a possibility. Antibodies can be highly active and can attack RBCs and bind components of the complement system to cause massive hemolysis of the transfused blood.

Patients should ideally receive their own blood or type-specific blood products to minimize the chance of a transfusion reaction. Risks can be further reduced by cross-matching blood, but this may be skipped when blood is required for an emergency. Cross-matching involves mixing a sample of the recipient's serum with a sample of the donor's red blood cells and checking if the mixture agglutinates, or forms clumps. If agglutination is not obvious by direct vision, blood bank technicians usually check for agglutination with a microscope. If agglutination occurs, that particular donor's blood cannot be transfused to that particular recipient. In a blood bank it is vital that all blood specimens are correctly identified, so labelling has been standardized using a barcode system known as ISBT 128.

The blood group may be included on identification tags or on tattoos worn by military personnel, in case they should need an emergency blood transfusion. Frontline German Waffen-SS had blood group tattoos during World War II.

Rare blood types can cause supply problems for blood banks and hospitals. For example, Duffy-negative blood occurs much more frequently in people of African origin,[19] and the rarity of this blood type in the rest of the population can result in a shortage of Duffy-negative blood for these patients. Similarly for RhD negative people, there is a risk associated with travelling to parts of the world where supplies of RhD negative blood are rare, particularly East Asia, where blood services may endeavor to encourage Westerners to donate blood.[20]

Pregnant women may carry a fetus with a blood type which is different from their own. In those cases, the mother can make IgG blood group antibodies. This can happen if some of the fetus' blood cells pass into the mother's blood circulation (e.g. a small fetomaternal hemorrhage at the time of childbirth or obstetric intervention), or sometimes after a therapeutic blood transfusion. This can cause Rh disease or other forms of hemolytic disease of the newborn (HDN) in the current pregnancy and/or subsequent pregnancies. Sometimes this is lethal for the fetus; in these cases it is called hydrops fetalis.[21] If a pregnant woman is known to have anti-D antibodies, the Rh blood type of a fetus can be tested by analysis of fetal DNA in maternal plasma to assess the risk to the fetus of Rh disease.[22] One of the major advances of twentieth century medicine was to prevent this disease by stopping the formation of Anti-D antibodies by D negative mothers with an injectable medication called Rho(D) immune globulin.[23][24] Antibodies associated with some blood groups can cause severe HDN, others can only cause mild HDN and others are not known to cause HDN.[21]

To provide maximum benefit from each blood donation and to extend shelf-life, blood banks fractionate some whole blood into several products. The most common of these products are packed RBCs, plasma, platelets, cryoprecipitate, and fresh frozen plasma (FFP). FFP is quick-frozen to retain the labile clotting factors V and VIII, which are usually administered to patients who have a potentially fatal clotting problem caused by a condition such as advanced liver disease, overdose of anticoagulant, or disseminated intravascular coagulation (DIC).

Units of packed red cells are made by removing as much of the plasma as possible from whole blood units.

Clotting factors synthesized by modern recombinant methods are now in routine clinical use for hemophilia, as the risks of infection transmission that occur with pooled blood products are avoided.

Table note1. Assumes absence of atypical antibodies that would cause an incompatibility between donor and recipient blood, as is usual for blood selected by cross matching.

An Rh D-negative patient who does not have any anti-D antibodies (never being previously sensitized to D-positive RBCs) can receive a transfusion of D-positive blood once, but this would cause sensitization to the D antigen, and a female patient would become at risk for hemolytic disease of the newborn. If a D-negative patient has developed anti-D antibodies, a subsequent exposure to D-positive blood would lead to a potentially dangerous transfusion reaction. Rh D-positive blood should never be given to D-negative women of child bearing age or to patients with D antibodies, so blood banks must conserve Rh-negative blood for these patients. In extreme circumstances, such as for a major bleed when stocks of D-negative blood units are very low at the blood bank, D-positive blood might be given to D-negative females above child-bearing age or to Rh-negative males, providing that they did not have anti-D antibodies, to conserve D-negative blood stock in the blood bank. The converse is not true; Rh D-positive patients do not react to D negative blood.

This same matching is done for other antigens of the Rh system as C, c, E and e and for other blood group systems with a known risk for immunization such as the Kell system in particular for females of child-bearing age or patients with known need for many transfusions.

Blood plasma compatibility is the inverse of red blood cell compatibility.[28] Type AB plasma carries neither anti-A nor anti-B antibodies and can be transfused to individuals of any blood group; but type AB patients can only receive type AB plasma. Type O carries both antibodies, so individuals of blood group O can receive plasma from any blood group, but type O plasma can be used only by type O recipients.

Table note1. Assumes absence of strong atypical antibodies in donor plasma

Rh D antibodies are uncommon, so generally neither D negative nor D positive blood contain anti-D antibodies. If a potential donor is found to have anti-D antibodies or any strong atypical blood group antibody by antibody screening in the blood bank, they would not be accepted as a donor (or in some blood banks the blood would be drawn but the product would need to be appropriately labeled); therefore, donor blood plasma issued by a blood bank can be selected to be free of D antibodies and free of other atypical antibodies, and such donor plasma issued from a blood bank would be suitable for a recipient who may be D positive or D negative, as long as blood plasma and the recipient are ABO compatible.[citation needed]

In transfusions of packed red blood cells, individuals with type O Rh D negative blood are often called universal donors. Those with type AB Rh D positive blood are called universal recipients. However, these terms are only generally true with respect to possible reactions of the recipient's anti-A and anti-B antibodies to transfused red blood cells, and also possible sensitization to Rh D antigens. One exception is individuals with hh antigen system (also known as the Bombay phenotype) who can only receive blood safely from other hh donors, because they form antibodies against the H antigen present on all red blood cells.[29][30]

Blood donors with exceptionally strong anti-A, anti-B or any atypical blood group antibody may be excluded from blood donation. In general, while the plasma fraction of a blood transfusion may carry donor antibodies not found in the recipient, a significant reaction is unlikely because of dilution.

Additionally, red blood cell surface antigens other than A, B and Rh D, might cause adverse reactions and sensitization, if they can bind to the corresponding antibodies to generate an immune response. Transfusions are further complicated because platelets and white blood cells (WBCs) have their own systems of surface antigens, and sensitization to platelet or WBC antigens can occur as a result of transfusion.

For transfusions of plasma, this situation is reversed. Type O plasma, containing both anti-A and anti-B antibodies, can only be given to O recipients. The antibodies will attack the antigens on any other blood type. Conversely, AB plasma can be given to patients of any ABO blood group, because it does not contain any anti-A or anti-B antibodies.

Typically, blood type tests are performed through addition of a blood sample to a solution containing antibodies corresponding to each antigen. The presence of an antigen on the surface of the blood cells is indicated by agglutination. An alternative system for blood type determination involving no antibodies was developed in 2017 at Imperial College London which makes use of paramagnetic molecularly imprinted polymer nanoparticles with affinity for specific blood antigens.[31] In these tests, rather than agglutination, a positive result is indicated by decolorization as red blood cells which bind to the nanoparticles are pulled toward a magnet and removed from solution.

In addition to the current practice of serologic testing of blood types, the progress in molecular diagnostics allows the increasing use of blood group genotyping. In contrast to serologic tests reporting a direct blood type phenotype, genotyping allows the prediction of a phenotype based on the knowledge of the molecular basis of the currently known antigens. This allows a more detailed determination of the blood type and therefore a better match for transfusion, which can be crucial in particular for patients with needs for many transfusions to prevent allo-immunization.[32][33]

Blood types were first discovered by an Austrian Physician Karl Landsteiner working at the Pathological-Anatomical Institute of the University of Vienna (now Medical University of Vienna). In 1900, he found that blood sera from different persons would clump together (agglutinate) when mixed in test tubes, and not only that some human blood also agglutinated with animal blood.[34] He wrote a two-sentence footnote:

The serum of healthy human beings not only agglutinates animal red cells, but also often those of human origin, from other individuals. It remains to be seen whether this appearance is related to inborn differences between individuals or it is the result of some damage of bacterial kind.[35]

This was the first evidence that blood variation exists in humans. The next year, in 1901, he made a definitive observation that blood serum of an individual would agglutinate with only those of certain individuals. Based on this he classified human bloods into three groups, namely group A, group B, and group C. He defined that group A blood agglutinates with group B, but never with its own type. Similarly, group B blood agglutinates with group A. Group C blood is different in that it agglutinates with both A and B.[36] This was the discovery of blood groups for which Landsteiner was awarded the Nobel Prize in Physiology or Medicine in 1930. (C was later renamed to O after the German Ohne, meaning without, or zero, or null.[37]) The group AB was discovered a year later by Landsteiner's students Adriano Sturli, and Alfred von Decastello.[38][39]

In 1927, Landsteiner, with Philip Levine, discovered the MN blood group system,[40] and the P system.[41] Development of the Coombs test in 1945,[42] the advent of transfusion medicine, and the understanding of ABO hemolytic disease of the newborn led to discovery of more blood groups. As of 2018, the International Society of Blood Transfusion (ISBT) recognizes 346 blood group antigens which are assigned to 36 blood groups.[2]

A popular belief in Japan is that a person's ABO blood type is predictive of their personality, character, and compatibility with others. This belief is also widespread in South Korea[43] and Taiwan. The theory reached Japan in a 1927 psychologist's report, and the government of the time commissioned a study aimed at breeding better soldiers.[43] Interest in the theory faded in the 1930s. Ultimately, the discovery of DNA in the following decades indicated that DNA instead had an important role in both heredity generally and personality specifically. Interest in the theory was revived in the 1970s by Masahiko Nomi, a broadcaster with a background in law rather than science.[43] The theory is widely accepted in Japanese and South Korean popular culture.[44]

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Blood type - Wikipedia

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Stem Cell Transplant Reviews, Comments, Testimonials …

June 22nd, 2018 6:44 am

I survived that accident with all my organs intact . I was hospitalized for 19 days at CIMA hospital.I got burnt on my hands and legs, left and right side. The most dangerous was my left side,There was a hole in my instep, where the power exited it was 3 inches wide and 5 inches kind of oblong shape, The bones going to my toes were exposed as well as tendons the depth ouch. Lest say to the bones.I commenced treatment with the hospital , doing Vac and then Honey patch. Finally discharged and resumed treatment with Beachside clinic under Doctor,s guidance. This treatment was done twice weekly and this lasted till December, the healing process was very good , but in a slow progression.On December 4 2017 I met Dr Leslie and he gave me a quick review on what he can do to make this wound close up in 6 weeksI was very impressed with his presentation, I went on his web site and looked up his work also googled.I finally discussed this with a RN from USA who is knowledgeable on STEM CELLS . I was now convinced that Dr Leslies stems cells is the best thing to do, I made an appointment and got the stem cells done on the 14 of Dec 2017 in his clinic in San JoseAt the time of the procedure the wound was huge, but after the stem transplant on my first visit after the stem cells, I have seen very positive signs of rapid healing of my wound, I did two PRP injection Jan 4 and Jan 13 , both PRP did have very positive resultsThe wound is now One inch in diameterMo

December, 2017

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The 3rd Asia Pacific Tele-Ophthalmology Society Symposium

June 22nd, 2018 6:43 am

Michael F. Chiang, MD, is Knowles Professor of Ophthalmology & Medical Informatics and Clinical Epidemiology at the Oregon Health & Science University (OHSU) Casey Eye Institute, and is Vice-Chair (Research) in the ophthalmology department. His clinical practice focuses on pediatric ophthalmology and strabismus. He is board-certified in clinical informatics, and is an elected Fellow of the American College of Medical Informatics. His research has been NIH-funded since 2003, and involves applications of telemedicine, clinical information systems, computer-based image analysis, and genotype-phenotype correlation to improve delivery of health care. His group has published over 140 peer-reviewed journal papers. He directs an NIH-funded T32 training program in visual science for graduate students & postdoctoral fellows at OHSU, directs an NIH-funded K12 mentored clinician-scientist program in ophthalmology, and teaches in both the ophthalmology & biomedical informatics departments. Before coming to OHSU in 2010, he spent 9 years at Columbia University, where he was Anne S. Cohen Associate Professor of Ophthalmology & Biomedical Informatics, director of medical student education in ophthalmology, and director of the introductory graduate student course in biomedical informatics.Dr. Chiang received a B.S. in Electrical Engineering & Biology from Stanford University, and an M.D. from Harvard Medical School & the Harvard-MIT Division of Health Sciences and Technology. He received an M.A. in Biomedical Informatics from Columbia University, where he was an NLM fellow in biomedical informatics. He completed residency and pediatric ophthalmology fellowship training at the Johns Hopkins Wilmer Eye Institute. He is past Chair of the American Academy of Ophthalmology (AAO) Medical Information Technology Committee, Chair of the AAO IRIS Registry Data Analytics Committee, member of the AAO IRIS Registry Executive Committee, and member of the AAO Board of Trustees. He is Associate Editor for the Journal of the American Medical Informatics Association (JAMIA), Associate Editor for the Journal of the American Association for Pediatric Ophthalmology & Strabismus, and serves on the Editorial Boards for Ophthalmology, Ophthalmology Retina, Asia-Pacific Journal of Ophthalmology, and EyeNet. He has received Top Doctor awards from Castle Connolly, Best Doctors in America, and Portland Monthly magazine, and has received numerous research and teaching awards.

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The 3rd Asia Pacific Tele-Ophthalmology Society Symposium

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Early complications of hematopoietic cell transplant

June 22nd, 2018 6:42 am

Following hematopoietic cell transplantation (HCT), recipients will be immunocompromised and may also have treatment-related organ and tissue damage. Transplant recipients therefore require careful monitoring in the early post-transplant period to ensure that complications are recognized early, while there are more therapeutic options and while treatments can be more effective.

Better clinical care and management of early post-transplant complications have led to significantly lower rates of transplant-related mortality (TRM) over time. Figure 1 shows that one-year TRM has become significantly lower over time for unrelated donor transplants in adults with leukemia, lymphoma, myeloproliferative neoplasms, and myelodysplastic syndromes (pointwise p-value at all time points <0.001). [1]

Download slide: Transplant-Related Mortality after Adult Bone Marrow or PBSC Transplantation for Malignant Diseases

The most common complications that may occur in the early post-transplant period from transplant infusion to one year post-transplant are listed below. Recognizing marrow transplant complications early is critical to the health of transplant recipients, and a timely collaboration with the transplant center to develop a treatment plan is recommended.

Because it is a complex disease with many manifestations, chronic graft-versus-host disease (GVHD) is discussed separately.

Oral Mucositis

Oral mucositis is inflammation of oral mucosa that typically manifests as erythema or ulcerations. It can result from the cytotoxic effects of chemotherapy- and radiation-based pre-transplant conditioning regimens. [2,3]

Mouth sores associated with acute graft-versus-host disease (GVHD) may also develop 2-4 weeks post-transplant. The severity and the patient's hematologic status govern appropriate oral management. Meticulous oral hygiene and palliation of symptoms are essential.

Acute Graft-Versus-Host Disease (GVHD)

Acute GVHD is a common complication of allogeneic transplantation in which activated donor T cells attack the tissues of the transplant recipient after recognizing host tissues as antigenically foreign. The resulting inflammatory cytokines can cause tissue damage, and the commonly involved organs include the liver, skin, mucosa, and the gastrointestinal tract.

By classical definition, GVHD appearing before day 100 post-transplant is acute GVHD, and GVHD appearing after day 100 is chronic GVHD. However, acute GVHD may still occur later than 100 days post transplant (e.g., during tapering of immunosupressive drugs, or following a donor lymphocyte infusion). Some patients may also develop an overlap syndrome, where features of both acute and chronic GVHD are present. [4,5]

Stem Cell Graft Failure

Graft failure is a rare, but life-threatening complication following allogeneic HCT. The most common cause of graft failure is an immunological rejection of the graft mediated by recipient T cells, natural killer cells, and/or antibodies. Other causes are infection, recurrent disease, or an insufficient number of stem cells in the donated graft. Graft failure occurs in approximately 5% of allogeneic transplants. [6]

The rate of failure can vary by graft source, and is increased in HLA-mismatched grafts, unrelated-donor grafts, T cell-depleted grafts, and umbilical cord blood grafts. Patients allo-sensitized through prior blood transfusions or pregnancy, and those receiving reduced-intensity conditioning are also at a higher risk of experiencing graft failure.

If graft failure occurs, treatment is a second HCT, using cells from the same donor or from a different donor. Patients experiencing graft failure after a cord blood transplant cannot get backup cells from the same cord blood unit. However, it may be possible to use a different cord blood unit or a backup adult donor instead.

Early Infections

All transplant recipients are susceptible to infections and require careful monitoring, which allows for timely administration of antibacterial, antiviral, and/or antifungal agents. [7]

Average times of full immune recovery are:

Common infections in early and later post-transplant time periods are shown below.

> 0-3 Months:

> 3 Months:

Organ Injury/Toxicity

Organ injury and toxicity following transplant can include hepatic veno-occlusive disease (VOD) also known as sinusoidal obstruction syndrome, renal failure, pulmonary toxicity, thrombotic microangiopathy (TMA), and cardiovascular complications.

In the early post-transplant neutropenic period, there is an increased risk of various bacterial, fungal, and viral infections of the lung, and pneumonia develops in 40% to 60% of transplant recipients. [8] The pneumonias that can occur include herpes simplex pneumonitis, cytomegalovirus pneumonitis, and Pneumocystis carinii pneumonia.

Bronchiolitis obliterans syndrome and bronchiolitis obliterans organizing pneumonia can appear later (post day 100) in the transplant recovery period. Bronchiolitis obliterans is closely associated with chronic GVHD and may result from alloimmunologic injury to host bronchiolar epithelial cells. [8,9]

Chronic kidney disease (CKD) is associated with the use of TBI in the transplant conditioning regimen, although many cases are idiopathic. TBI-associated CKD has a typical latency of 3-6 months from irradiation to injury. CKD after transplantation may not be recognized early due to competing clinical priorities such as the treatment of GVHD, and monitoring for infections and disease recurrence. [10]

Sinusoidal obstructive syndrome (SOS) also known as veno-occlusive disease (VOD) of the liver (SOS/VOD) is the result of damage to the hepatic sinusoids, resulting in biliary obstruction. Risk factors include the use of busulfan, TBI, infection, acute GVHD, and pre-existing liver dysfunction due to iron overload or hepatitis. [11]

Transplant-associated TMA is a rare complication after allogeneic transplantation, and can occur after autologous transplantation. Risk factors for TMA include pre-transplant conditioning with busulfan, fludarabine, platinum-based chemotherapy, and total body irradiation (TBI). TMA is also associated with the use of the calcineurin inhibitors, tacrolimus and cyclosporine. Transplant-associated TMA syndromes present as hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP). [12]

Cardiovascular complications may manifest as subclinical abnormalities or present as overt congestive heart failure or angina. The cardiac complications include any cardiac dysfunction due to cardiomyopathy, valvular anomaly, or conduction anomaly. [13]

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Early complications of hematopoietic cell transplant

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