text
stringlengths
0
868k
Angiostrongyliasis caused by infection with angiostrongylus cantonensis is primarily characterized by eosinophilic meningitis, meningoencephalitis, or myelitis . Ingestion of raw or half - cooked apple snails containing third stage larvae (l3) of a. cantonensis is the commonest route of infection . After ingestion by h...
Annual epidemics of seasonal influenza result in about 35 million cases of severe illness and 250 000500 000 deaths worldwide . Healthcare workers (hcws) can be a key source for influenza transmission in communities and hospitals as they are exposed to both infected patients and high - risk groups [2, 3]. Vaccination i...
In denmark, mebendazole and pyrvinium are used in the treatment of enterobiasis caused by enterobius vermicularis (threadworm, seatworm, or pinworm). Treatment of the whole family is therefore recommended, if a child has been infected . Pinworms are commonly resided in the colon, but can in rare cases migrate to the va...
Peripheral nerve injury is a common disease, the proliferation of glia and extraneural connective tissue in peripheral nerve defect may hinder the growth of anagenetic axon or misguide the growth cone of axon; thus, the anagenetic axon cannot reach the target organ or even results in the formation of neuroma at the ner...
Natural product phosphonates are in wide use in medicine and agriculture. (1) one member of this class of natural products, phosphinothricin (pt), is an unusual amino acid with a phosphinate side chain (scheme 1). Synthetic pt (glufosinate) is the active component of the commercially important herbicides liberty, ignit...
Malaria is a life - threatening disease, which is responsible for roughly 1 million deaths each year . Approximately 40% of the world's population is exposed to the risk of malaria, particularly those in tropical and subtropical countries . Malaria also poses a huge economic burden in countries where the disease is end...
Progeria is a genetic disorder rarely encountered and is characterized by features of premature aging . It is also known as " hutchinson - gilford progeria syndrome " (1). Although signs and symptoms vary in age of onset and severity, they are remarkably consistent overall . Children with hgps usually appear normal at ...
Henoch - schonlein purpura is one of the most common types of vasculitis in children . Henoch - schonlein purpura (hsp) is one of the most common types of vasculitis in children . It is a multisystem disorder that involves various joints and organs, and results from a leukocytoclastic vasculitis of small vessels . The ...
Increasing daily physical activity (pa) is a key strategy for preventing or minimizing numerous chronic diseases [1, 2]. Daily pa consists of all occupational, domestic, and leisure - time activities . While participation in leisure - time activities has remained relatively stable over the years, technological advancem...
Total daily energy expenditure consists of three factors: resting metabolic rate (rmr), thermic effect of food intake (tef), and physical activity1 . In general, rmr is the most important component accounting for 6075% of total daily energy expenditure . Tef is defined as the increase in energy expenditure in response ...
Pediatric obesity is a serious health condition, conferring both immediate and long - term health risks [13]. Multidisciplinary approaches in diverse sectors, including pediatric primary care, have been proposed to reduce the high prevalence of childhood obesity . Multi - disciplinary clinical programs require a consid...
Agranulocytosis, diabetic ketoacidosis, gastrointestinal hypomotility, and myocarditis are well - known adverse effects of clozapine, which are sometimes life threatening . Here a male patient, 36 years, with elevated creatinine kinase levels (9899 u / l), developed rhabdomyolysis afterafter admission to the emergency ...
Graphene, a single layer of sp - bonded carbon, has fabulous electronic, mechanical, and optical properties . Owing to its industrial adaptability, epitaxial graphene (eg) formed by annealing of sic bulk crystal is attracting recent attentions [2 - 4]. Eg, however, face two challenges: the limited diameter of the subst...
Comparative analysis of genomes from distant species provides new insights into gene functions, genome evolution and phylogeny . In particular, the comparative genomics of prokaryotes has revealed previously underappreciated major trends in genome evolution, namely, extensive lineage - specific gene loss and horizontal...
The term macrolide encompasses a diverse family of unrelated compounds with large macrolactam rings . Macrolide rings are comprised of a large macrocycle lactone ring to which one or more deoxy sugars, usually cladinose and desosamine, may be attached . In addition to their antibacterial activity, macrolides have diver...
Colorectal cancer (crc) develops either sporadically (85% of the cases), as part of a hereditary cancer syndrome (10%), or as a background of inflammatory bowel disease . The incidence of crc in iran has been significantly increased since 1970 [2, 3]. According to iran national cancer registry (incr) report, approximat...
Prostate cancer is one of the most commonly diagnosed malignancies in men [1, 2]. In the usa and several western european countries, the incidence rates of pca have exceeded the remaining malignant neoplasms in males [3, 4]. There were 9,273 new pca diagnoses recorded nationwide, according to the national polish cancer...
Vitiligo is a generalized autoimmune disease manifesting acquired white patches due to loss of melanocytes . It is the most prevalent pigmentary disorder with an incidence rate between 0.1 and 2% showing multifactorial etiology and polygenic inheritance . Autoimmune disorders, genetic factors, autotoxic metabolites of ...
Nowadays, society emphasizes the importance of an attractive physical appearance and especially facial beauty . Patients are requiring more frequently dental treatments, orthodontic and orthognatic surgical treatments and of course, plastic - surgical treatments for enhancing and optimizing their facial appearance . So...
A large amount of scientific research is directed towards anterior cruciate ligament (acl) injuries . However, recent epidemiological studies have demonstrated a continued high incidence of acl injuries despite the implementation of intervention programs . As these injuries remain a significant problem, research direct...
Mu - opioid receptor (mor) agonists, such as morphine, are the gold standard in the treatment of moderate to severe pain, however, their therapeutic use is often limited due to serious side effects including tolerance, dependence, respiratory depression, and constipation . Numerous studies have shown promise for amelio...
It is characterized by acute and mostly intense abdominal pain accompanied by peritonism and potentially meteorism, nausea, vomiting and in severe and advanced cases shock . In most cases abdominal pathologies cause this acute condition including but not limited to appendicitis, cholecystitis, pancreatitis, mesenteric ...
Deposited data can be found in the gene expression omnibus (geo) database: http://www.ncbi.nlm.nih.gov/geo/query/acc.cgi?acc=gse57560 . Gse57560 correlation of gene expression with bladder capacity in interstitial cystitis / bladder pain syndrome . A flow diagram outlining of the experimental design for this study can ...
Epidemiological studies have documented a high impact and the profound effect that the disorder can have on an individual s quality of life . Although migraine is a highly prevalent and disabling condition, it is underdiagnosed and undertreated [3, 4]. Recent advances have been made in the management of migraine, but p...
Jadb: assigned (as a medical student) to patient during hospitalization and participated in review of the literature, drafting, and editing of case report . Jan: attending assigned to patient during hospitalization and performed editing of case report and final approval . Sjs: provided nephrology consult during hospita...
It is reported that about 11000 patients are admitted to hospitals due to cervical spinal injury annually15) and around 75% of them require intubation and mechanical ventilation due to respiratory problems21). Tracheostomy is required in 11 - 35% of patients with cervical spinal cord injury to maintain airway and to ma...
Hepatocyte nuclear factor 4a (hnf4a) is an orphan member of the nuclear receptor family of transcription factors (1). It is expressed primarily in the liver, gut, kidney and pancreas and has important role during embryonic life in pancreatic development and maintaining of cell function (2). Indeed, knockout studies fou...
The field of assisted reproductive technology (art) is advancing day by day with newer laboratory techniques being discovered . The area of cryopreservation is one of them . Till date, it has been possible to freeze sperms and embryos for many years, but successful pregnancies from oocytes have been elusive with only f...
Their mean age was 21.20 years (standard deviation [sd] = 1.46; range 1824 years of age). The study followed the tenets of the declaration of helsinki and informed consent was obtained from all subjects after an explanation of the nature and possible consequences of the study . All subjects had best - corrected visual ...
Individuals affected by multimorbidity report multiple barriers to self - care, including the compound effects of medications, difficulties in coordinating multiple medications, the total burden of medications, and financial challenges . 15) to treatment, further reducing the benefits of therapies, which are only parti...
Peritonitis is one of the most common factors responsible for morbidity and mortality in patients on continuous ambulatory peritoneal dialysis (capd). Approximately 48% of peritonitis episodes have a fungal etiology, candida species accounting for 75% . The reported incidence of mortality in bacterial peritonitis is ap...
Intussusception is a relatively common disease in children, but it is a relatively rare disease in adults, and leading points in adults are different from those in children . In patients showing bowel obstruction, the cause has been reported to be intussusception in 1% of the patients, and cases with sigmoidorectal int...
In the eukaryotic genome, protein kinases comprise one of the largest families of proteins (manning et al ., 2002a) and together with their counteracting protein phosphatases, they regulate a common post - translational modification observed in intracellular signaling . Activation of protein kinases and phosphatases ty...
Freshwater eels, genus anguilla, consist of 19 species and subspecies, and inhabit from tropical to temperate areas all over the world, except for the coastal lines of the south atlantic and eastern pacific oceans (ege 1939; watanabe et al . All anguillid species have catadromous life histories, in which spawning occur...
People with intellectual disabilities (i d) have a wide range of needs and most exhibit behavioral problems . Around 7 - 15% of people with i d have severely challenging behavioral problems . The nature and severity of these behavioral problems vary with the degree of i d . In children with i d, the social environment ...
Endometrial cancer is the most common gynaecologic malignancy in developed countries with an estimated incidence of 49,560 new cases for 2013 and an estimated mortality of 8190 deaths for the same year in the u.s . . European cancer observatory (eco) a project developed by the international agency for research on cance...
Fragaria vesca l. is a well - known and valuable plant species; however, its cultivation is still much poorly spread . Currently grown cultivars of fragaria vesca are derived from a wild species, which can be found in woods and grasslands in europe, western asia, north america, and temperate areas in chile . Their wide...
The administration of bolus insulin before each meal is important to maintain postprandial blood glucose levels as close to normal as possible . Rapidacting insulin analogs have a more rapid onset of action than regular insulin, providing improved postprandial glycemic control in multiple daily insulin injection (mdi) ...
Many lines of evidence suggest that serotonin transporter (sert) plays an important role in the pathophysiology of major depressive disorder (mdd) and the therapeutic actions of sert - targeted antidepressants (owens and nemeroff, 1994; mann, 2013) that exert their function by blocking the sert, thereby increasing sero...
Angiokeratoma is a rare cutaneous vascular disorder of the papillary dermis that is characterized by one or more dilated vessels in the upper part of the dermis . In the majority of cases, it is also associated with epidermal reactions such as acanthosis and/or hyperkeratosis1 . This disorder can be classified into fiv...
This was considered an incidental radiographic finding and is known as chilaiditi's sign . However, this rare radiographic finding may be symptomatic and is then more correctly known as chilaiditi's syndrome . It is exceptionally rare for this condition to cause bowel obstruction or require surgical correction . Furthe...
There is a tendency to claim that our imaginations are limited in addressing the age - old question, are we alone in the universe? That life - forms elsewhere, if indeed they exist at all, would have characteristics outside our own limited biochemical repertoire is a popular trope of science fiction . A good example of...
From 1984 to 2006, 105 patients received operations for congenital hyperinsulinism at hpital necker enfants malades and were followed over the long term (table 1). The first symptoms occurred in 87 neonates (<1 week), and after 1 month (to 1 year) of age in 18 cases . The patients presented with severe (<0.3 mmol / l) ...
The malaria parasites are maintained as a source of reservoir in these conditions and help in transmission in the community . It is not only helpful in decreasing the morbidity and mortality but also prevents the transmission . Microscopy of peripheral blood smear and rapid diagnostic tests (rdt) detecting malarial ant...
It is estimated the global health expenditure on diabetes is approximately $673billion; indeed in the usa alone the cost is approximately $320 billion . Of this cost, however, only 12% is spent on directly managing the diabetes itself, with the majority of the expenditure being on the complications of the disease . Car...
During the last 50 years nearly 1000 drugs have been identified as possible causes of hepatic injury, termed drug - induced hepatotoxicity, especially adriamycin (adr). Cancer is one of the most of common causes of death in the world, and the prevalence of adr - induced hepatotoxicity, therefore, is increasing . While ...
Lewandowsky and lutz dysplasia or epidermodysplasia verruciformis (ev) is an extremely rare genetic disorder first documented by felix lewandowsky and william lutz in 1922 . It begins in childhood and is characterized by generalized infections with human papilloma virus (hpv), frequent association with cutaneous carcin...
Jainism is one of the oldest religions of india, dating back to the 6 century bce . Maharashtra has the maximum number of jains (1.3%), followed by rajasthan (1.2%), delhi (1.1%), and gujarat (1%). In south india, karnataka has 0.72% jains and tamil nadu has 0.12% . In spite of the small numbers, their present - day co...
The concept of the fetal genome is no longer that of a static framework inherited from paternal and maternal sources but a malleable scaffold constantly adapting to stimuli . This is most evident in studies involving fetal programming due to the effects of nutritional variation and glucocorticoid exposure . Here, we ex...
The creation of a comprehensive collection of non - essential open reading frame (orf) deletions in the yeast saccharomyces cerevisiae has made this organism a primary model for genomics and high - throughput biology (1). The genomics data generated using the gene deletion collection has been central in driving the dev...
Endometriosis is characterized by the presence of active endometrial tissue outside of the uterine cavity . Endometriosis can involve the genitourinary tract, with the bladder being the most commonly affected site . Symptomatic urinary tract involvement is rare, occurring in 1% to 2% of women, and it typically presents...
The rising level of morbidity and mortality is a sign of social as well as individual malaise . In most parts of the world, mental health and mental illness are largely ignored or neglected, resulting in increasing burden of mental disorders in the community and a widening of treatment gap . Meta - analysis of epidemio...
Intravenous thrombolytic therapy when given within 4.5 h from symptom onset remains the mainstay of treatment for ischemic stroke patients . While intravenous tissue plasminogen activator (iv tpa) has been shown to be effective in improving outcome, the most feared complication is symptomatic intracerebral hemorrhage (...
Drug delivery to the brain remains a hotly debated and hugely studied area in biomedicine . The transport of a vast majority of therapeutic molecules to the brain is restricted by the presence of a natural obstacle called the blood brain barrier (bbb) (bicker et al ., 2014). This limitation highlights the need to creat...
Compression therapy is used for the treatment of venous pathologies such as deep vein thrombosis and chronic - venous insufficiency . The application of the external pressure on the lower limbs acts to compress the veins thus reducing their diameter . In consequence the velocity increases, which in turn encourages the ...
Atherosclerosis has a complex etiology that leads to arterial obstruction and often results in inadequate perfusion of the distal limbs . Patients with atherosclerosis can have severe complications of this condition, with widespread systemic manifestations, and the operations undertaken are often challenging for anesth...
A number of endocrine alterations have been described in patients with lipodystrophy, and this has been attributed to adipocyte malfunction and rare coding mutations in the genes responsible for adipogenesis. [13] hyperinsulinemia, metabolic syndrome, fatty liver, and dyslipidemia are frequently described in patients w...
As the leading cause of gastroenteritis in young children under the age of five, rotavirus (rv) infections annually are responsible for approximately 600,000 deaths worldwide [1, 2]. During infection, the rv nonstructural protein 4 (nsp4) functions as a viral enterotoxin by binding an extracellular receptor and activat...
Micrornas (mirnas) are short (2024 nucleotide) noncoding rnas involved in posttranscriptional regulation of gene expression . Mirna genes can be epigenetically regulated and mirnas can themselves repress key enzymes that drive epigenetic remodeling and directly modulate gene transcription in the nucleus through recogni...
The prevalence of childhood obesity has been rising during the past decades in many parts of the world . In portugal this picture is particularly alarming owing to the increasing risk of developing cardiovascular diseases in overweight and obese individuals [4, 5]. Over the long term, childhood / adolescence overweight...
Glandular odontogenic cyst (goc) is a rare lesion that arises in the tooth bearing areas of the jaws . Padayachee and van wyk initially reported it as a sialodontogenic cyst in 1987 based on the possibility of salivary gland origin but its odontogenic origin was first described in 1988 by gardner et al ., who proposed ...
The shortened dental arch concept seems to be a relevant approach from a cost - effective point of view . The shortened dental arch concept is a potentially cost - effective approach in the management of reduced dentitions . A body of mainly circumstantial evidence shows that shortened dental arches, comprising all ant...
Endotracheal suctioning (ets) is one of the most common supportive measures in intensive care units (icu). Closed system suctioning (css) decreases the rate of cardiorespiratory complication mainly due to continuation of ventilatory support and oxygenation during procedure . Css has questionable efficacy, therefore hig...
Prostate cancer is the most common malignancy among men in the united states and is the second leading cause of male cancer death . The incidence of prostate cancer varies widely among ethnic populations, and african american men in the united states have the highest incidence of prostate cancer . The prostate - specif...
Meningitis is common and is among the most serious infections occurring in individuals with hiv infection [1, 2]. The etiology of meningitis in hiv - endemic areas has been significantly altered in favor of cryptococcal meningitis and tb meningitis [1, 3, 4]. Evidence shows that cryptococcal meningitis is the most comm...
During a 12-month period (10/20019/2002), 199 consecutive environmental specimens were submitted for possible detection of b. anthracis . Hemolysis types were determined by subculturing them on 5% horse, sheep, and human blood agar plates: -, -, and -hemolysis were defined, according to standard criteria (13). Strong -...
The ph - sensing ion - sensitive field - effect transistor (isfet), first proposed by bergveld in 1970, has become the basis for many contemporary semiconductors and their respective biosensors.1 in an isfet, the ions within the sample media undergo multiple environment - influenced reactions . The resulting molecules ...
Thimerosal is a preservative that is widely used in medical products, including as a preservative in vaccines, immunoglobulin preparations, skin test antigens, antivenins, ophthalmic and nasal products, and tattoo inks, and is composed of 49.6 percent ethylmercury by weight . The widespread use of thimerosal exposes ma...
Keratoconus is an ectatic corneal disease characterized by corneal protrusion, irregular astigmatism, and decreased visual acuity due to progressive corneal thinning . Keratoconus leads to biomechanical changes in the cornea, and its definite cause is unknown . The biomechanical features of the cornea are determined by...
Albopictus mosquito was designated as permanently established in 6 southeast departments (administrative districts) in metropolitan france as follows: alpes - maritimes (2004), the 2 departments that comprise corsica, haute - corse (2006) and corse - du - sud (2007), var (2007), bouches - du - rhne (2009), and alpes - ...
The use of imaging to assess the choroidal layer is valuable in the diagnosis and monitoring of several ocular conditions such as central serous retinopathy [1, 2], polypoidal choroid vasculopathy, and high myopia [4, 5]; abnormal choroidal thickness has been implicated in the pathophysiology of those conditions . Amon...
The purpose of dentistry is to respond to the patients needs and desires, in other words to restore function, comfort, esthetics, speech, health and enhance the quality of life . Dental implants are alloplastic materials which are surgically inserted into residual alveolar bone primarily as a prosthetic foundation . Im...
Wada test scores were 5/5 using the left hemisphere (right carotid injection) and 3/5 using the right hemisphere . At the age of 21, she underwent invasive eeg monitoring, which captured 10 seizures arising from the right hippocampus and 1 from the left . Convulsive seizures resolved with surgery, but both complex part...
In january 2012, a previously unknown severe disease was observed in pigs on several farms in northern and eastern china . In shandong province,> 80,000 pigs were infected . The affected pigs had high fever (> 40.5c), anorexia, coughing, respiratory distress, conjunctival serous and mucinous secretion, and posterior pa...
A 26-year - old female was referred to our department of oral and maxillofacial surgery with a chief complaint of deviated nose and smaller nostril on the right side . Past surgical history revealed that she had undergone cleft lip repair at the age of 3 years . Extra oral examination findings were nasal pyramid was ti...
Primary breast sarcomas are rare and comprise <1% of all malignant breast neoplasm . In a study, at mayo clinic of america primary sarcomas of breast accounted for 0.0006% (18 out of 27,881 malignancies). These malignancies arise from the connective tissue of the mammary gland, however, cases of cystosarcoma phyllodes ...
Approximately 150,000 patients are diagnosed with colorectal cancer (crc) in the us each year and one third of patients die annually from this disease 1 . Nearly 8,000 patients are diagnosed with synchronous peritoneal surface malignancy (psm) each year 2 . Hence, psm is a frequent manifestation in the natural history ...
An ongoing reliable and comparative analysis of causes of death in different age groups, particularly in neonates and young children is the basis for national and international decision - making and planning process in the health system . These data are very useful in health policies for disease prevention and control ...
The nose is a part of the airway system which is most easily accessible for morphological and pathophysiological evaluation of changes occurring as a response to various stimuli . After total laryngectomy in advanced laryngeal cancer patients, upper airway cannot do its physiological functions because upper and lower a...
The atomic level description of these interactions, the so - called interactome (1), gives access to the molecular bases of biological activity and the eventual rational intervention for medical purposes . At present, only a tiny fraction of complexes from the estimated number of all possible protein protein interactio...
Participants performed aerobic and resistance exercise at least three times per week and had been doing so for at least 6 months (table 1). Participant characteristics the research took place in the human and environmental physiology research unit at the university of ottawa . After being informed of the purpose, proto...
The cilium is a microtubule - rich organelle that protrudes from the apical membrane of most vertebrate cells (figure 1). Observed initially via a light microscope over 300 years ago, and largely thought of as vestigial or rudimentary organelles, cilia garnered attention in 1976 because of their association with pcd (a...
In recent studies, drug - eluting stents (des) were more widely used than bare - metal stents (bms) in patients who underwent percutaneous coronary intervention (pci).1 recently, several significant complications after implantation of des have been reported, and stent thrombosis (st) is a rare but fatal complication am...
Twelve women (median age, 56 y; range, 46 - 69 y; 9 white and 3 african american) were enrolled in an ongoing, open - label, single - site feasibility study of hirrem for individuals with diverse psychophysiological conditions . Procedures were approved by the wake forest university health sciences institutional review...
Remote magnetic navigation (mn) for atrial fibrillation (af) catheter ablation is efficient and provides increased comfort for the operators . Despite the lack of randomized trials, mn seems to be associated with less peri - procedural complications compared with manual technique . The latest generation of mn system (n...
Loss of control, is a chronic relapsing disorder similar to diabetes or hypertension.1 it has a considerable component of genetic susceptibility and is also influenced by environmental factors.2 therefore, long - term maintenance therapy is very important . We should recognize redrinking by alcoholics as a symptom such...
The interpretation of a raised amylase in the acute surgical patient is crucial yet complicated as it is raised in a large number of conditions but with a low specificity . This report argues that a transient rise in serum amylase not caused by sepsis or pancreatitis can be caused by a splenic infarction . Therefore an...
The last couple of years have seen a marked growth of interest in the topic of crossmodal correspondences (see marks, 2004; spence, 2011, for reviews). Crossmodal correspondences have been defined as a tendency for a sensory feature, or attribute, in one modality, either physically present or merely imagined, to be mat...
It ovary stops to produce estrogen and progesterone hormones and cancels the women's power of reproducing . The age range of 45 to 55 years is known as natural menopausal time of worldwide women.1 but in bangladesh the maximum range is up to 55 years.2 if any woman's period stops before 45 years old is called early men...
Chemotherapy - induced nausea and vomiting (cinv) negatively impacts the quality of life in cancer patients and may lead to nonadherence to or dose reductions in chemotherapy . Potential cardiac effects of antiemetics warrant special attention, given an estimated 1360% burden of cardiovascular - related diseases that i...
Complex sleep behaviors (csbs) are complex activities, normally associated with wakefulness, that occur when the subject is in a sleep - like state after taking a hypnosedative drug; when the subject awakens the next morning, the subject has little or no memory of the activity . Csbs include sleepwalking with object ma...
Nanoporous silica particles were synthesized and characterized as described previously and as detailed in supplementary figure 1 and the supplementary methods section . Particles larger than 150-nm in diameter were removed via differential centrifugation or size - exclusion chromatography (see supplementary figs . 1a a...
Current ophthalmic simulators demonstrate the equipment setup and 3-dimensional (3d) image perception in a 2d environment . However they do not simulate the 3d nature of the eye so that the trainee does not appreciate the structures within the eye in true 3d, and therefore depth perception and spatial awareness are a p...
The implication of gene environment interactions in the etiology of psychiatric diseases, such as depression and drug addiction is well established in humans (caspi et al . 2002; nilsson et al . 2007) and non - human primates (barr et al . Is widely used to assess long - term consequences of different early experiences...
The study consisted of randomly selected 24 subjects of three groups of age 9, 16, and 27 years (four subjects of both genders in each) who reported to the department of orthodontics and dentofacial orthopaedics, tamil nadu government dental college and hospital . The subjects had no potential health influence on cervi...
Polycystic ovary syndrome (pcos) is one of the most common endocrine disorders, affecting around 47% of the population in women of the reproductive age . However, the etiology and pathophysiology of pcos remain unclear, and the multiple risk factors such as genetics, environment, nutrition, lifestyle, and much more are...