The approximately 12 month old cells used in the current experiment were stable as suggested by Greene and Tischler or had the decreased hctional characteristics seen by Roberts. In retrospect, new cells should probably have been cultured at 6-8 months. Differences in DA release values could also be due to variations in sample.
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Heath BJ, Done M, Balog O, Ziccone S, Rosewarne F. 1994. The Effect of Scavenging on Nitrous Oxide Pollution in the Delivery Suite. Aust NZ J Obstet Gynaecol 34: 4: 484. Health Services Advisory Committee, Anaesthetic agents : controllling exposure under COSHH. 1995. HSE Books, Sudbury. Hoerauf KH, Koller C, Taeger K, Hobbhahn J. 1997. Occupational exposure to sevoflurane and nitrous oxide in operating room personnel. Int Arch Occup Environ Health 69: 134-138. Hoerauf K, Lierz M, Wiesner G, Schroegendorfer K, Lierz P, Spacek A, Brunnberg L, Nusse M. 1999. Genetic damage in operating room personnel exposed to isoflurane and nitrous oxide. Occup Environ Med 56: 433-437. Hoefauf KH, Wiesner G, Schroegendorfer KF, Jobst BP, Spacek A, Harth M, SatorKatzenschlager S, Rudiger HW. 1999. Waste anaesthetic gases induce sister chromatid exchanges in lymphocytes of operating room personnel. Br J Anaesth 82: 5: 764-766. Korczynski RE. 1994. Formaldehyde Exposure in the Funeral Industry. Occupational and Environmental Hygiene Vol 9 No. 8: 575-579. Applied.
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SECTOR ISSUES THEMES Western multinational pharma companies are leapfrogging over the Japan leaders. With every passing day, chances that any Japanese pharma company could be positioned for global leadership, or even leadership within the Japanese market, are declining. Pfizer is now the largest pharma company in Japan, and several other Global pharma companies from the west promise to overtake others in the top ten. Takeda is likely to retain its second rank in the foreseeable future. Most other Japanese pharma companies lack the resources to globalize and face eroding value in a low growth domestic environment. In fact, only five companies are attempting to globalize with a gradually growing sales force mostly in the US ; and R&D pipelines that have some promise on the worldwide markets. These are Takeda, Eisai, Yamanouchi, Fujisawa, and Sankyo. Interestingly, Chugai actually still plans to make small expansion efforts overseas despite Roche's majority ownership and its large presence in these markets. Single digit earnings growth is expected to decline as many products grow older and those with global sales begin to face patent expirations. Generics are a modest 5% of value in Japan at present and though many drugs are already off patent, they retain much of their pre-expiration sales. A Western scale generic industry does not seem at hand in Japan, but efforts in this direction are ongoing. Physicians and patients are being incentivized to use generics, as is the case in other tradition-bound countries, such as France. These incentives may well succeed over the next couple of years, and inflict what may prove to be fatal pain on many of the weaker Japanese pharma companies, though no company will be spared significant pain. There will be a significant impact on earnings with so many off-patent, higher margin drugs still contributing to profits. Motivated generic companies, including those from India, are developing plans to enter the Japanese market and should be watched closely. Broader reform efforts are ongoing in Japan, as always, mostly focused on cost containment, but also in accelerating new drug approvals, streamlining and enhancing the quality of clinical studies, as well as providing incentives for innovation. One of the more important developments is creation of an independent new drug review organization by mid-04. This should help to speed new product approval times to less than 12 months over the next 1-3 years. The next bi-annual drug price cuts in April `04 are expected to be moderate compared to prior years as discounting has become less aggressive. Koseisho is more comfortable that the pharma industry has paid its fair share as drugs now account for 20% of healthcare spending vs. 38% in the 1980s. However, healthcare consumes 10% of Japan's GDP today, as compared to 6% a decade ago, and thus cost containment pressures will persist. Managements are somewhat belatedly beginning to deal with such dark clouds on the horizon. Manufacturing and SG&A cost controls are becoming important contributors to growth, or at least help moderate EPS declines ; as thin pipelines make small advances, but most such efforts can be much more aggressive. Several external forces, such as daiko henjo, are culminating that also may help to support shares. The ongoing share buyback efforts are now more aggressively pursued by many major companies as many stock prices are at or near 2-4 year lows and daiko henjo selling pressure is waning and hydrodiuril.
Potassium-sparing agents. Potassium-sparing diuretics, especially spironolactone Aldactone ; , are proving to be important for Stage C and D congestive heart failure. Spironolactone has shown dramatically lower mortality rates from heart events, particularly in combination with an ACE inhibitor. Its benefits for patients with heart failure derive from its ability to block aldosterone, a hormone involved with salt retention and heart muscle growth. Spironolactone has shown evidence of reducing production of collagen--a protein that in excess can cause organ scarring. Other potassium-sparing agents include amiloride Midamor ; , and triamterene Dyrenium ; . Thiazides. Thiazides often serve as the basis for high blood pressure treatment, either taken alone for mild to moderate hypertension or used in combination with other types of drugs. There are many thiazides and thiazide-related drugs. There are many thiazides and thiazide-related drugs; some common ones are chlorothiazide Diuril ; , chlorthalidone Hygroton ; , indapamide Lozol ; , and hydrochlorothiazide Esidrix, HydroDiuril ; . These agents are usually prescribed for patients with mild heart failure and good kidney functioning. Loop diuretics. Loop diuretics block sodium transport in parts of the kidney; they act faster than thiazides and have a great diuretic effect. It is important therefore to control the medication and avoid dehydration and potassium loss. Loop diuretics include bumetanide Bumex ; , furosemide Lasix ; , and ethacrynic acid Edecrin ; . They are generally used for severe heart failure, especially when kidney function is impaired. One 2000 study reported that twice-daily infusions of furosemide over six to 12 days improved symptoms in patients with severe heart failure who had not responded to other treatments. One-year survival rates after the treatment were 80%. Administration. Treatment is usually started at a low dose and increased until urine output rises and the patient loses weight because of fluid loss. If the patient does not respond quickly enough, more than one diuretic may be required, or it may need to be given intravenously. Diuretics are usually taken long term, with the patient monitored periodically for fluid retention. Problems with Diuretics. The loop and thiazide diuretics deplete the body's supply of potassium, which, if left untreated, increases the risk for arrhythmias. Arrhythmias are heart rhythm disturbances that can, in rare instances, lead to cardiac arrest. In such cases, physicians will either prescribe lower doses of the current diuretic, recommend potassium supplements, or use potassium-sparing diuretics either alone or in combination with a thiazide. Potassium-sparing drugs have their own risks, which include dangerously high levels of potassium in people with existing elevated levels of potassium or in those with damaged kidneys. It should be noted, however, that, in general, all diuretics are more beneficial than harmful. Common Side Effects. Common side effects of diuretics are fatigue, depression, irritability, urinary incontinence, loss of sexual drive, breast swelling in men, and allergic reactions. Diuretics can trigger attacks of gout. They may also increase the risk of gastrointestinal GI ; bleeding. Diuretics may raise cholesterol level and, used alone, they have no effect on enlarged heart size hypertrophy ; . Arrhythmias can also occur as an interaction between diuretics and certain drugs, including some antidepressants, anti-arrhythmic drugs themselves, and digitalis.
B. EXPENDITURES FOR DRUGS 2000 Expenditures TOTAL RECEIVING CASH ASSISTANCE TOTAL Aged Blind Disabled Disabled Child Adult MEDICALLY NEEDY, TOTAL Aged Blind Disabled Child Adult MEDICALLY NEEDY, TOTAL Aged Blind Disabled Child Adult TOTAL OTHER EXPENDITURES RECIPIENTS * * Total Other Expenditures Recipients includes foster care children, 1115 demonstration participants, other recipients, and unknown. * 2001 data on expenditures and number of recipients by maintenance assistance status and basis of eligibility are unknown. Source: CMS, MSIS Report, FY 2000 and CMS-64 Report, FY 2001. $57, 502, 713 $32, 602, 025 $6, 860, 767 $24, 878, 408 $249, 345 $613, 505 $0 $0 $0 $0 $0 $1, 388, 162 $108, 303 $177, 285 $974, 363 $128, 211 $23, 512, 526 Recipients 67, 238 32, 0 0 0 18, 561 133 * Expenditures Recipients $57, 995, 801.
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3. Patients with other complications retinopathy, nephropathy, and severe neuropathy or hypertension ; . 4. Pregnant patients, and all women planning a pregnancy. Other patients who should attend the hospital clinic include 5. Any patient who is on insulin therapy. In addition, please refer up: 6. Any patient who you do not feel confident dealing with. 7. Any patient who insists on hospital attendance. These arrangements may change when an intermediate care service is established, for example, drug interactions.
About Novartis Novartis AG NYSE: NVS ; is a world leader in healthcare with core businesses in pharmaceuticals, consumer health, generics, eye-care, and animal health. In 2001, the Group's businesses achieved sales of CHF 32.0 billion USD 19.1 billion ; and a net income of CHF 7.0 billion USD 4.2 billion ; . The Group invested approximately CHF 4.2 billion USD 2.5 billion ; in R&D. Headquartered in Basel, Switzerland, Novartis Group companies employ about 72 600 people and operate in over 140 countries around the world. For further information please consult : novartis.
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