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By J. Sigmor. DeSales University.

Today while receiving dialysis buy prednisone with a mastercard, he felt anxious then became short of breath discount prednisone 20mg visa, and was found to have low blood pressure discount 20mg prednisone with mastercard. He denies fever cheap 40 mg prednisone otc, chills, nausea, vomiting, headache, chest pain, abdominal pain, urinary symptoms, lower extremity edema, or feeling ill. General: A & O × 3, cachectic male, speaking in full sentences, rapid breathing, mild short of breath, + pulsus paradoxus b. Lungs: tachypnea, good air entry, no crackles, wheezes, or rhonchi; trachea midline; right chest subclavian permacath in place with no surrounding ery- thema or drainage j. Heart: diminished heart sounds, tachycardic rate, regular rhythm, no gallops or rubs, + pulsus paradoxus k. This is a case of nontraumatic pericardial tamponade, a life-threatening con- dition caused by fuid accumulation around the heart which compresses the heart and prevents pumping. His initial presentation of hypotension, tachycardic, tachyp- nea, and shortness of breath should alert to the fact that he is an ill patient who may decompensate quickly. On examination, he presented with the classic signs of pericardial tamponade (Beck’s triad): hypotension, + jugular venous distention, and diminished heart sounds. Classic clinical fndings: Beck’s triad (hypotension, jugular venous distension, and distant heart sounds), narrow pulse pressure, dyspnea, tachycardia, pulsus paradoxus. Echocardiography: gold standard for diagnosing perdicardial effusion and should be performed if patient’s condition allows it. Anxious appearing, middle-aged female, A & O × 3, appearing uncomfort- able, tachypneic, and in moderate shortness of breath, speaking in short sentences. Breathing: moderate respiratory distress, no retractions or cyanosis; breath sounds diminished in right upper, middle, and lower chest; + right side jugular venous distention; unable to assess if there is tracheal deviation c. Decompression of pneumothorax using needle or tube thoracostomy (describe procedure to examiner) g. Patient stated that while standing outside of a bar with her boyfriend she was stabbed once to the right anterior chest by an intoxicated male who ran away with her purse. Social: divorced, lives alone, 1 pack per day smoker since age 18, no drugs, not sexually active 392 Case 90: stab to Chest g. Neck: full range of motion, no jugular vein distension (if chest tube in place), no stridor g. Needle decompression: breath sounds slightly diminished on right side, good air entry to left side, no wheezing or crackles, no ecchymosis, no crep- itus, no bony tenderness ii. Chest tube: chest tube in right 4th intercostals space, midaxillary line, good air entry bilaterally, no wheezing or crackles, 2 cm linear wound to right 3 to 4 intercostal space in the mid axillary line above chest tube, no ecchymosis, crepitus, and bony tenderness i. Female: no blood or discharge, cervical os closed, no cervical motion ten- derness, no adnexal tenderness m. This is a case of a tension pneumothorax in a patient who suffered a stab wound to the chest. The condition is caused by a one-way air leak into the chest cavity secondary to a punctured lung which leads to air accumulation of air and com- pression of the heart. The patient presented with unstable vitals (hypotension, tachycardia, mild hypoxia, and tachypnea), moderate respiratory distress, and decreased breath sounds on the right side. Diagnosis of tension pneumothorax often requires a high level of suspicion in the presence of decreased or absent breath sounds on the affected side. The correct treatment is emergent needle decompression followed by thoracostomy tube. If the patient’s pneumo- thorax is still not decompressed, the patient will go into cardiac arrest. Tension pneumothorax is a life-threatening condition that requires prompt management. Tension pneumothorax is primarily a clinical diagnosis based on patient pre- sentation. Do not delay delivery of treatment modalities while waiting for imag- ing or lab studies. After needle decompression, immediately begin preparation to insert a tho-After needle decompression, immediately begin preparation to insert a tho- racostomy tube. Then reassess the patient, as hemothorax is common with pneumothorax, especially in trauma. She describes the pain as sharp, constant, and progressively worsening for the last 36 hours with nausea and subjective fevers and chills. She denies vomiting, back pain, urinary symptoms, and vaginal bleeding/dis- charge. Social: denies alcohol use, smoking, or illicit drug use; lives with husband at home, sexually active and monogamous g. Female: no blood or discharge, cervical os closed, no cervical motion ten- derness, no adnexal tenderness n. Patient still with signifcant discomfort, worsening until pain meds given, then discomfort improves c. If no antibiotics given, patient decompensates with worsening pain, low blood pressure, and high fever (sepsis) d. The patient’s symptoms of abdominal pain that is constant and localizing to the left lower quadrant are consistent with diverticulitis. If fuids are not administered, the patient will become more tachycardic and eventually hypotensive. Her pain will continue to increase until an opioid medication (such as morphine) is administered. When younger patients develop diverticulitis, it tends to be more severe and require earlier surgical intervention e. G1P1A0, 7 days postpartum after an uncomplicated Case 92: seizure 401 normal spontaneous vaginal delivery. Per husband, the patient has been “jerking her arms and legs” for about 2 to 3 minutes while sitting at the table after eating breakfast. He states his wife was in her usual state of health except for complaint of headache and mild blurry vision in the past few days. She normally takes blood pressure medicine for her chronic hypertension but has forgotten to take them since her discharge from the hospital 6 days ago. Social: lives with husband at home, denies alcohol, smoking, drugs, not sexu- ally active in the past 2 months g. Patient: having another generalized tonic-clonic seizure; seizure stopped on its own after 2 minutes H. Extremities: full range of motion, no deformity, normal pulses, 2+ bilateral pedal edema o. Neuro: grossly moving all four extremities, deep tendon refexes 2+, appears postictal q. Patient: resting comfortable in bed, no additional seizures, now more alert and answering questions, husband at bedside K. This is a condition that typically occurs during the last trimester of pregnancy associated with high blood pressure and seizures. The patient has a history of chronic hypertension and has been noncompliant with her medications in the past several days. Eclampsia is the superimposition of generalized seizure on preeclampsia (hypertension, proteinuria, with or without edema). Eclampsia can occur from the 20th week of gestation until up to 10 days post- partum (although it has been reported as late as 1 month postdelivery). Until that occurs or if the female is postpartum, give the following drug therapy: i. Hydralazine and labetolol are also safe antihypertensive medications for eclamptic patients e. All patients with sustained blood pressure of 140/90 mm Hg or greater and any symptoms that may be related to the hypertensions should have stat obstetrics consultation and should be admitted. He reports being awoken from sleep 30 minutes earlier at 5 a m with palpitations, nausea, shortness of breath, and dizziness. Social: lives with wife at home, quit smoking 20 years ago, denies alcohol or illicit drug use g. Chest: well-healed sternotomy scar, nontender 406 Case 93: Palpitations Figure 93. Rhythm strip unchanged from prior with or without amiodarone Case 93: Palpitations 407 Figure 93. If patient cardioverted, chest pain improved, no longer feeling palpitations, nausea, and dizziness b. This is a case of a ventricular tachycardia, likely from myocardial ischemia or infarction.

Anti-inflammatory activity of Kanzaw oil was evaluated on carrageenin-induced paw edema in rats and it was found that the reduction of paw edema with an oral dose (45g/kg) of Kanzaw oil was comparable to that of standard drug aspirin (300mg/kg) buy prednisone with mastercard. The observation of these two compounds (Lupeol and Campesterol) in the seed oil of Kanzaw [Madhuca lobbii (C generic 5 mg prednisone with mastercard. The in vitro model also employed a shorter duration of incubation period of two days with daily renewal of the bathing solution which is suitable for the screening of such indigenous herbal agents purchase prednisone 10mg with amex. A concentration of 40 to 80mg/ml pineapple significantly killed the test worm during the experimental period of two days purchase 40 mg prednisone. As a prerequisite test for its clinical application and in vivo model using pigs had been done and found satisfactory. The anthelmintic action of fresh pineapple consumed was due to its bromelain content. The mechanism of action of bromelain is due to its proteolytic digestion of the worm’s cuticle. At its edible form and amount, the pineapple possesses sufficient anthelmintic activity even though it was partially destroyed on its passage to the stomach. The required anthelmintic effect was suggestive to be achieved by consuming a quarter to the whole fruit of medium size depending on the age of the subjects. Investigation of anthelmintic and bioactivities and some organic constituents of Balanites aegyptiaca Linn. The investigation of anthelmintic activity of two isolated compounds β-sitosterol and diosgenin was also carried out. Therefore, it could be inferred that β-sitosterol and diosgenin have anthelmintic potency and diosgenin possessed slightly better activity. Investigation of antibacterial activity of three traditional medicine formulations. Three traditional medicine formulations which are widely used by local people were investigated for antibacterial activity using 14 species of bacteria. The bacteria include one specie each of Escherichia coli, Klebsiella pneumoniae, Streptococcus pyogenes and Vibrio cholerae; two species each of Proteus, Salmonella and Staphylococcus and 4 species of Shigellae. The formulations were Ah-bein-nyin, Heleikda-sonna and Nandwin-nganzay which contain herbs and chemicals and have been used as antipyretic or in the treatment of urinary disorders, gastrointestinal disorders and cardiovascular disorders. Fifty percent alcoholic extract of these drugs were found to possess some antibacterial activity on certain bacteria. Moreover, extracts from 7 plants namely, Saxifraga ligulata (Wall) (Nat-hsay-gamone), Capparis sepiaria (Sugaut-net), Holoptelea integrifolia (Pyauk-seik), Zizyphus oenoplia (Baung-bet), Hygrophila spinosa (Su-padaung), Mitragyna parviflora (Htain-they) and unidentified sp. It was observed that Saxifraga ligulata, Capparis sepiaria and Zizyphus oenoplia showed antibacterial activity on some bacteria. Investigation of antimicrobial activities of some organic constituents from Cyperus scariasus R. The aim of this study is to screen in vitro and in vivo antimicrobial activity and some bioactive phytoconstituents from activity guided plant extracts of Cyperus scariosus R. These have been studied on preliminarily in vitro screening of antibacterial activity by agar disc diffusion method. Therefore, among four plants tested, the two antibacterial activities guided plants C. In vitro screening of antibacterial activity by agar well diffusion method, all of the extracts of C. Exhibited the most significant antibacterial activity when compred with activities of extracts of both plants. Activity guided extracts of both plants were separated by column chromatographic method. Investigation of antimicrobial, antidiarrhoeal & antioxidant activities of Sabalin (Cymbopogon flexsuosus) Stapf. This versatile herb will grow in almost any tropical or subtropical climate as long as it gets adequate water and nutrition. In this research, the antimicrobial, antidiarrhoeal and antioxidant activities were investigated. According to the phytochemical investigation, chemical constituent’s flavonoids, alkaloids, phenolic compound, tannins, carbohydrate, glycoside, steroids and reducing sugar) were found in the leaves of Sabalin. Then the citral was isolated from essential oil (70% yields) by using column chromatographic technique using silica gel G. Investigation of bioactive phytoconstituents and the biological activities of some Myanmar traditional medicinal plants. These are the whole plants of Phyllanthus niruri (Taung-zee-phyu), the whole plants of Elephantopus scaber (Taw-mon-lar or Sin-chay) leaves of Eclipta alba (Kyeik-hman) and flowers of Butea monosperma (Pauk-pwint). Fifteen compounds were isolated and identified from the whole plants of Phyllanthus niruri. Among these one was a new flavone sulfonic acid named niruri flavone (8) together with hypophyllanthin (1). Ten compounds were isolated and identified from the whole plants of Elephantopus scaber. Among these two new sesquiterpene lactones named 17, 19-dihydrodeoxyelephantopin (18). Seventeen compounds were isolated and identified from the flowers of Butea monosperma. In the biological activities, primary) screening was carried out for the antitumour activity of 21 compounds (compound 1-9 from P. From these tests, as we are getting not only the cellular toxicity but also the selectivity, results will allow us to evaluate the potential medical value of the metabolites. Antiviral activity of four plant extracts and the pure compounds wedelolactone (44) (isolated from E. The antioxident activity of fourteen pure compounds namely isoquercetin (2), gallic acid (3), brevifolin carboxylic acid (4), methyl brevifolin carboxylate (5), niruri flavone (8) and quercetin-3-0-β-D-glucopyranosyl-(1→4)-α- rhamnopyranoside (9) from P. All the compounds were capable of reducing approximately half of the cation radical at only 10μM. Since a radical scavenger turns into a free radical itself after interaction with a radical and since a reducing agent may autooxidize it is important to test for potential prooxidant activity in vivo. For this purpose bioluminescent dinoflagellate Lingulodinium polyedrum was monitored as an indicator of oxidative stress. Gallic acid (3), niruriflavone (8), quercetin-3- 0-β-D-glucopyranosyl (1→4)-α- rhamnopyranoside (9), butin (27) and wedelolactone (44) proved to be prooxidant in the assay. Gallic acid (3), which showed high scavenging capacity (at 2μM) proved to be highly toxic. This showed that gallic acid (3) can scavenge free radicals fonl1ing prooxidant intenl1ediates. Isoquercetin (2), brevifolin carboxylic acid (4), methyl brevifolin carboxylate (5), and isomonospermoside (butin-3-g1ucoside) (32). Which scavenged free radicals without forming prooxidant intenl1ediates were further tested for protection of Lingulodinium polyedrum against. Investigation of biological activity and of some organic chemical constituents from the seeds of Zanthoxylum alatum Roxb. In the present work, two selected Myanmar medicinal plants, namely Zanthoxylum alatum Roxb. Antibacterial screening by agar well diffusion method against Bacillus subtillis, Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus pumalis, Candida albicans and Mycobacterium species of different extracts of Mak-kat seeds and Taw-shauk roots indicated that polar extracts are good candidates for active compounds, especially ethyl acetate extract. Xanthoxylin (L-1) was isolated as major constituent from active ethyl acetate extract of Z alatum Roxb. The isolated compounds were characterized and identified by chemical methods, modern spectroscopic methods and reference to biosynthesis pathways. Finally, the antidiarrheal activity of the aqueous extract of Zanthoxylum alatum Roxb. There were significant reduction in faecal outputs and frequency of droppings when the plant extracts of 3. In addition, the aqueous extract (3g/kg dose) was found to possess significant antidiarrheal activity, with experimental in vivo antidiarrheal index of 71. Investigation of chemical constituents and bioactivities of some organic compounds from rhizomes of Boesenbergia pandurata (Roxb. Besenbergia pandurata (Roxb) (Seik-phoo) red and yellow rhizomes were chosen for the investigation of chemical analysis and biological action. Rhizomes and roots of this plants are used in cases of stomachic, cough, confinement, diarrhea, also for rheumatism and muscular pains and as tonic and skin liniment in traditional medicine. By silica gel column chromatographic separation technique, seven compounds namely, pinostrobin (A-1, 2%, m.

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Would we (societal representatives) have the moral right to deny all 12-year-old individuals such an option buy 40 mg prednisone with visa, no matter how bright or mature they were order cheap prednisone online, much as we deny the right to legally consume alcohol to those below age 21? A second basic principle of health care ethics purchase prednisone discount, probably the oldest of these prin- ciples order prednisone 10mg with amex, is what is referred to as the principle of nonmaleficence. It is often interpreted to mean that at the very least physicians should do nothing that will cause unnec- essary harm to their patients. Surgeons will cause considerable misery to their patients because of what surgery is, but such surgery does not represent a net harm to the patient because it is confidently believed that surgery will restore the patient’s health. Further, the patient has freely agreed to the surgery because he sees this as protecting his best medical interests. So surgery in these circumstances does not rep- resent a violation of this ethical principle. These are not inert substances; they are often modified viruses, which is to suggest that there is some risk of biological modifica- tion of those viruses within an individual that could have serious adverse conse- quences. Again, we have David’s actual story as a reminder of the kind of risks that are associated with clinical medicine. It is expected that they will either be destroyed or that they will function in such a way that they produce the proteins with which they are normally associated. Again, it is not expected that these genes will somehow insert themselves into normal cells and disrupt the normal function- ing of the genetic machinery. We think we know enough about how things work at that level that it is extremely unlikely that something like that would happen. For any sort of major surgery patients are assuming significant enough risk of harm. We know in general the risks of anesthesia; and we know in general the risks of infection after surgery. In cases where that surgery is medically necessary (90% occluded coronary arteries), the risk of harm is ethically justified by the confidently expected medical benefit. In the case of Donald, however, we cannot talk about “confidently expected medical benefit. Further, there is some legitimate concern about unknown risks that could be very serious, again a reason why we describe these interventions as experimental. Facts like that would seem to undermine the ethical warrant for exposing this patient to almost any level of experimental risk. However, that should be taken as nothing more than a tentative conclusion at this point. There is a third ethical principle that needs to be considered at this point, what is usually referred to as the principle of beneficence. One formulation of this prin- ciple would say that physicians always ought to act in such a way as to advance the best medical interests of their patients. We saw in our discussion of the David case how this principle might be violated by allowing third-party interests, or the physi- cian’s own self-interests, to compromise inappropriately the patient’s interests. It is a common practice today to pay physicians a fee for “recruiting” patients for clinical trials. The fee is intended to cover the cost of that physician’s time in discussing with a patient the nature of the trial and why he might wish to consider it. It is reasonable to ask whether there is anything ethically suspect about this practice. If, on the other hand, the fee is very generous, and it is really intended as a strong incentive for that physician to persuade patients to participate in these trials, then it is prima facie ethically suspect. If he were reluctant to do so, that suggests the practice is potentially ethically corruptive. Sound ethical judgments are always capable of standing the light of day, that is, public scrutiny. There are at least two other construals of that principle that need to be considered in relation to the case of Donald. First, we might take the principle to mean that physicians ought always act in such a way as to maximize the best interests of their patient from the point of view of their best medical judgment. For most medical ethicists today that would be much too broad a warrant for medical paternalism; it would effectively eviscerate the principle of autonomy. The second construal of the principle of beneficence better protects patient autonomy. It says that patients should have the right to determine what they judge to be in their own best interests (within the constraints of good medical practice) from the point of view of their own stable values and life goals. This means that patients do not have to make medical decisions for themselves that are consistent with what a majority of reasonable persons in similar medical circumstances would choose. After all, the argument might go, we allow patients to pursue cosmetic surgery, for the sake of nothing more medically urgent than vanity, even though there are some serious medical risks attached to some of those procedures. This question has a rhetorical ring to it, as if the answer were entirely obvious, but there is room for argument and judgment. To follow up further on that, we would have to specify a number of empirical facts, largely related to Donald’s ability to make decisions that were autonomous enough to warrant moral respect. The fourth ethical principle that has a bearing on our case is the principle of justice. As with the prior principle, there are several different construals we need to consider. Con- sider the case of a physician who has two patients with the same degree of coro- nary artery disease. However, the physician only refers the patient whom he really liked for the surgery. He does not refer the other whom he strongly disliked because the other patient had a history of noncompliance. This will mean that individuals who are financially more well off will have greater access to more expensive experimental therapies. The vast majority of goods and services are distributed in our society on the basis of an individual’s ability to pay. These sorts of consequences are generally not associated with access to other consumer goods, which is why health care might be seen as being morally special. Still, as we shall see below, very few would be prepared to argue that every- one in our society has a moral right to any or all of the health care they might want or need that would offer them any health benefits. Consequently, the most common justice arguments related to health care are that all in our society ought to have assured access to some basic package of health services, perhaps a fairly thick package of health services as proposed by the Clinton Administration in 1993. But even that more generous package would not have guaranteed anyone access to experimental medical therapies of the sort we are discussing. In his case, it would be fair to conclude that this would not be a matter of great moral consequence. In that period of time there is a reasonable chance these thera- peutic interventions will be perfected, which is to say they would become part of the standard medical armamentarium covered by health insurance. In the meantime the quality of his life will continue to be compromised; but he will not have been made worse off by this denial, so this would seem to be a morally tolerable outcome. Edward has some sort of cancer that has not been effectively treated by any current therapies. We have another gene therapy trial that is aimed at attacking the sort of cancer that Edward has. Edward will be dead in a year; he will have no opportunity to wait until the therapy is per- fected and disseminated. Still, he might argue that he has a just claim to at least a fair chance of access to such a trial. The argument might take this form: Gene therapy is not a product of the private effort and investment of some small group of individuals, as would be true with other consumer products. Rather, enormous public investments (tax dollars and university research facilities and training of the researchers them- selves) have made these successes possible. All in our society have contributed to the success of that effort; and consequently, all ought to have at least a fair chance to reap the rewards of that effort. It is unfair that only those who have been espe- cially economically fortunate already should have primary access to such tech- nologies, especially when life itself is at stake. For now it is sufficient to note that not all cases of access to experimental gene therapy are morally alike. There are subtle moral considerations that might tilt our judgment one way or another in a given case.

In the rodent fimbria-fornix lesion model of cholinergic neuron degeneration order discount prednisone on line, neuroprotective effects have been demonstrated by the Bcl-xL gene purchase prednisone 10 mg. Expression of Bcl-xL by lentiviral vectors in this model significantly increases cholinergic neuron survival in the septal region subsequent to axotomy of the pathway order prednisone us. Studies of this nature provide evidence that overexpression of antiapototic factors via gene trans- fer in vivo is sufficient to rescue neuronal populations after axotomy cheap 5mg prednisone free shipping. Within a span of approximately 20 years, the transplantation of cells into the brain evolved from the laboratory setting to clinical trials for severe Parkinson’s. Throughout the 1980s and 1990s, tissues were grafted into the brain to study aspects of neural cell development and to identify the function of different brain areas. Now, we are in a new era of establishing the most appropriate cell grafting technologies for application in the clinic. Unfortunately, the dramatic restorative functional changes seen in certain animal models of neurological disease were not seen with the transfer of the grafting techniques to the human situation. Case in point—transplants of fetal substantia nigra neurons stereotaxically injected into the striatum of Parkinson’s patients. The results from the initial clinical trials were partly encouraging in that there were no major side effects from this type of operation. Some of the transplanted cells in the human striatum show extended survival for years, and for some pa- tients there was a therapeutically significant reduction in the motor symptoms (rigidity and bradykinesia). The modest to moderate improvement seen in some patients does, however, gradually disappear. To date we cannot predict with certainty that Parkinson’s patients who are ideal candidates for a transplant will benefit from this grafting procedure. One of the primary problems with transplanting neurons into the lab animal and human brain has been the issue of poor graft survival. In humans only about 5% of the fetal dopamine neurons survive using the current transplantation protocols. This raises the issue of just how representative are the animal models of human neurological disorders. Although fetal neurons have shown the greatest potential in terms of graft survival and clinical efficacy for Parkinson’s, there are serious concerns associated with the use of human fetal neurons, namely tissue availability, quality control, and ethics. To circumvent some aspects of these problems, research has examined neural xenografts for Parkinson’s and the use of stem or neuronal cells grown in culture. It is now possible to isolate subpopulations of stem or neuronal progenitor cells from the developing or adult nervous system, expand the cells in culture, and then use the cells for transplanta- tion or as vehicles for gene delivery to selected sites of the nervous system. These cells survive in vitro in media enriched with growth factors and with passage express a neuronal phenotype. A major advantage of using progenitor cells for transplan- tation is that they have not been transformed or immortalized and exist naturally in the brain. Continued collaborative efforts between the basic and the clinical research sectors using stem or progenitor cells for ex vivo transgene delivery will be critical to the progression of effective therapy for Parkinson’s and other neu- rodegenerative conditions. As previously described, a variety of non-neuronal primary cells and cell lines have been used largely as a way to deliver an active substance that promotes survival or growth of neurons. Research centered on cell replacement strategies now focus predominantly on the use of neural stem cells. Stem Cells in the Adult Brain Until just a few years ago, it was generally assumed and believed that the adult brain was incapable of generating new neurons. Research on a number of fronts has estab- lished that the adult mammalian brain contains stem cells that can give rise to the full spectrum of neurons and glial cells. In particular, the subventricular zone, an important layer that forms during development and persists into adulthood retains the capacity to generate both neurons and glial cells (Fig. Stem cells by strict definition over the lifetime of the animal must be able to proliferate, show self-renewal, produce progeny with multilineage characteristics, and divide when injured. Progenitor cells refer to cells with a more restricted potential than stem cells, and precursor cells refer to cells within a given developmental pathway. The presence of neural stem cells in the adult brain has established the possibility for using the mature brain as a source of precursor cells for transplantation and helps to establish new therapy directions for neurological injury and disease. In fact, as our understanding of stem cell neurobiology grows, it may be possible to control the proliferation and migration of such cells into areas of the nervous system affected by the diseases discussed in this chapter. The notion of self-repair in the brain is now visible at the basic research level. The potential growth factors governing the commitment and differentiation of the neuronal lineage are indicated. More- over, these newly generated neurons had also made connections to their appropri- ate target. Multipotent stem cell proliferation and differentiation can be regulated by neu- rotrophic factors. When growth factors are added in sequence to neural stem cells, they regulate whether the cells will acquire neuronal or glial characteristics. One sector of gene therapy research focuses on a neural-stem-cell-based strat- egy. With the capability of differentiating along multiple cell lineages, stem cells may be very effective for the delivery of therapeutic gene prod- ucts throughout the brain or spinal cord. The enzyme deficiency in this mouse model causes lysosomal accumulations of undegraded glycosominoglycans in the brain and other tissues that results in fatal degenerative changes. Similar therapeutic paradigms are also being evaluated for other inherited neurogenetic diseases that are characterized by an absence of discrete gene products. Engineered cells and progenitors are also being grafted into mouse models of hexosaminadase deficiencies causing Tay-Sachs and Sandhoff disease. Clones of stem cells or prog- enitor cells are used extensively to study aspects of differentiation along neuronal and glial lineages. These types of progenitor cell lines have been useful in the iden- tification of molecules and neurotrophic factors that initiate and modulate differ- entiation at specific developmental time points. The myc family of protooncogenes consist of a number of well-characterized members including c-myc,N-myc, and L-myc. This retrovirus induces a number of carcinomas in addition to the leukemic disorder myelocytomatosis (myc) in birds and can transform primary cells in tissue culture. The transformation of cells from the developing nervous system with a retrovirus expressing v-myc have revealed extraordinary characteristics. In culture, progenitor cells immortalized with the v-myc oncogene divide continuously. However, when removed from the culture environment and transplanted back into the nervous system of laboratory animals, these v-myc-immortalized cells withdraw from the cell cycle and undergo terminal differentiation. In addition, certain neural progenitor cells generated with v-myc not only stop dividing in the animals’ brain, but the cells also undergo site-specific differentiation. Several hundred grafts of neural cells carrying the v-myc gene have been studied in laboratory animals in numerous regions of the central and peripheral nervous system, and not a single graft has shown continued proliferation (tumor growth). Hence, the cells with this oncogene fall into a special category with highly desired characteristics in consideration of cell replacement strategies for therapeutic restoration of nervous system function. At this time, the precise mechanism(s) that override the expression of the v-myc onco- gene product and pull the cells from mitotic cycling are not known. Alzheimer’s represents the single greatest cause of mental dete- rioration in older people, affecting approximately 4 million in the United States and 300,000 in Canada. The German physi- cian Alois Alzheimer first described this condition in 1907 as a case presentation of a 51-year-old woman whose symptoms included depression, hallucinations, demen- tia, and, upon postmortem examination, a “paucity of cells in the cerebral cortex. Although the majority of individuals are in their sixties, Alzheimer’s can develop at a younger age. No matter when a person is affected, the condition is always progressive and degenerative. Formerly self-reliant people even- tually become dependent upon others for routine daily activities. Although there are a number of promising clues, the definitive cause of Alzheimer’s has not been determined. Scientists recognize that there are two forms of Alzheimer’s—familial and sporadic.