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Drugs that act primarily as CNS stimulants have a relatively limited therapeutic use but assume clinical importance for other reasons. Some members of this group, e.g., the amphetamines, are much abused, and others are not infrequent causes of poisoning. Amphetamines (Benzedrine, Adderall) These drugs and dextroamphetamine, its D-isomer, are powerful analeptics (CNS stimulants) and in addition have signi cant hypertensive, respiratorystimulant, and appetite-depressant effects. They are effective in the management of narcolepsy but have been much more widely and sometimes indiscriminately used for the control of obesity, the abolition of fatigue, and the treatment of hyperactivity in children. Undoubtedly, they are able to reverse fatigue, postpone the need for sleep, and elevate mood, but these effects are not entirely predictable, and the user must pay for the period of wakefulness with even greater fatigue and often with depression that may follow. The intravenous use of a high dose of amphetamine produces an immediate feeling of ecstasy, the ash. Because of the popularity of the amphetamines and the ease with which they can be procured, instances of acute and chronic intoxication are observed frequently. The toxic signs are essentially an exaggeration of the analeptic effects restlessness, excessive speech and motor activity, tremor, and insomnia. Severe intoxication may give rise to hallucinations, delusions, and changes in affect and thought processes a state that may be indistinguishable from paranoid schizophrenia. An amphetamine associated vasculitis and intracerebral and subarachnoid hemorrhage are well-recognized but rare complications of chronic intoxication (Harrington et al), and they may occur after acute use as well. Similar cerebrovascular complications may appear with sympathomimetic agents contained in over-the-counter cold medications and in dieting aids. Phenylpropanolamine has been implicated most often, but ephedrine and similar agents rarely have the same effects and induce a vasculopathy. The pathogenesis of the vascular lesion is unknown (both vasospasm and arteritis have been reported), and the same state occurs with cocaine, as described below. Chronic use of amphetamines can lead to a high degree of tolerance and psychologic dependence. Withdrawal of the drug after sustained oral or intravenous use is regularly followed by a period of prolonged sleep (a disproportionate amount of which is REM sleep), from which the patient awakens with a ravenous appetite, muscle pains, and feelings of profound fatigue and depres-
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6. Type a different name in the text entry field, and then click the OK button to close the
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CHAPTER 2 Introduction to Variables
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The discovery of several types of seizure disorder based on inherited defects of the potassium channel has elicited considerable
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Suppose we move from (0, b) to some point (x, y) on the line by going x units to the right and y units upward. The x coordinate of the point (x, y) will be 0 + x, because we have moved x units horizontally from a point where x = 0. The y coordinate of the point (x, y) will be b + y, because we have moved y units vertically from a point where y = b. If we can get an equation that allows us to calculate y in terms of x for the arbitrary point (x, y), then we will have demonstrated how y is a function of x. As things turn out, we ll also get the SI form of the equation for the line. We can express y in terms of the slope m and the increment x by morphing the formula that defines slope. That formula, once again, is m = y / x Multiplying through by x, we get m x = y Now remember that y = b + y We can substitute m x for y in this equation, getting y = b + m x
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to pages or data to which she is not entitled. Each application or page item now has an attribute called Session State Protection. Setting this attribute to Restricted - May Not Be Set From Browser will prevent end users from tampering with the value of the attribute. The only way to change a Restricted... item s value is through constructs inside the application, such as computations or processes at the application or page level. This technique enables the developer to store values in items with the confidence that an end user cannot change their values.
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6. Repeat Step 5 for the Button and ListBox objects as shown in Figure 4-2. 7. In addition to the page load event, your C# code should include three more event
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The cause of this disease is the anaerobic, spore-forming rod Clostridium tetani. The organisms are found in the feces of some humans and many animals, particularly horses, from which they readily contaminate the soil. The spores may remain dormant for many months or years, but when they are introduced into a wound, especially if a foreign body or suppurative bacteria are present, they are converted into their vegetative forms, which produce the exotoxin tetanospasmin. In developing countries, tetanus is still a common disease, particularly in newborns, in whom the spores are introduced via the umbilical cord (tetanus neonatorum). In the United States, the incidence rate of tetanus is about one per million per year. Injection of contaminated heroin is a signi cant cause. About two-thirds of all injuries leading to tetanus occur from deep scratches and puncture wounds in the home and about 20 percent in gardens and on farms. Since 1903, when Morax and Marie proposed their theory of centripetal migration of the tetanus toxin, it has been taught that spread to the nervous system occurs via the peripheral nerves, the toxin ascending in the axis cylinders or the perineural sheaths. Modern studies, utilizing uorescein-labeled tetanus antitoxin, have disclosed that the toxin is also widely disseminated via blood or lymphatics, probably accounting for the generalized form of the disease. However, in local tetanus, the likely mode of spread to the CNS is indeed by retrograde axonal transport. Mode of Action of Tetanus Toxin Like botulinum toxin, the tetanus toxin is a zinc-dependent protease. It blocks neurotransmitter release by cleaving surface proteins of the synaptic vesicles, thus preventing the normal exocytosis of neurotransmitter. The toxin interferes with the function of the re ex arc by the blockade of inhibitory transmitters, mainly GABA, at presynaptic sites in the spinal cord and brainstem. Elicitation of the jaw jerk, for example, is normally followed by the abrupt suppression of motor neuron activity, manifested in the electromyogram (EMG) as a silent period (see further on). In the patient with tetanus, there is a failure of this inhibitory mechanism, with a resulting increase in activation of the neurons that innervate the masseter muscles (trismus or lockjaw). Of all neuromuscular systems, the masseter innervation seems to be the most sensitive to the toxin. Not only do afferent stimuli produce an exaggerated effect, but they also abolish reciprocal innervation; both agonists and antagonists contract, giving rise to the characteristic muscular spasm as discussed on page 40. In addition to its generalized effects on the motor neurons of the spinal cord and brainstem, there is evidence that the toxin acts directly on skeletal muscle at the point where the axon forms the end plate (accounting perhaps for localized tetanus) and also upon the cerebral cortex and the sympathetic nervous system, in the hypothalamus.
This assumption is quite plausible. How might Eve try to guess x She could experiment with all possible values of x, each time checking whether x e y mod N , but this would take exponential time. Or she could try to factor N to retrieve p and q, and then gure out d by inverting e modulo (p 1)(q 1), but we believe factoring to be hard. Intractability is normally a source of dismay; the insight of RSA lies in using it to advantage.
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