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13,700 | Prior to 1917, Turkey used the lunar Islamic calendar with the Hijri era for general purposes and the Julian calendar for fiscal purposes. The start of the fiscal year was eventually fixed at 1 March and the year number was roughly equivalent to the Hijri year (see Rumi calendar). As the solar year is longer than the lunar year this originally entailed the use of "escape years" every so often when the number of the fiscal year would jump. From 1 March 1917 the fiscal year became Gregorian, rather than Julian. On 1 January 1926 the use of the Gregorian calendar was extended to include use for general purposes and the number of the year became the same as in most other countries. | https://en.wikipedia.org/wiki?curid=23306251 |
13,701 | This section always places the intercalary day on even though it was always obtained by doubling (the (twice sixth) or bissextile day) until the late Middle Ages. The Gregorian calendar is proleptic before 1582 (calculated backwards on the same basis, for years before 1582), and the difference between Gregorian and Julian calendar dates increases by three days every four centuries (all date ranges are inclusive). | https://en.wikipedia.org/wiki?curid=23306251 |
13,702 | The following equation gives the number of days (actually, dates) that the Gregorian calendar is ahead of the Julian calendar, called the "secular difference" between the two calendars. A negative difference means the Julian calendar is ahead of the Gregorian calendar. | https://en.wikipedia.org/wiki?curid=23306251 |
13,703 | where formula_2 is the secular difference and formula_3 is the year using astronomical year numbering, that is, use for BC years. formula_4 means that if the result of the division is not an integer it is rounded down to the nearest integer. Thus during the 1900s, 1900/400 = 4, while during the −500s, −500/400 = −2. | https://en.wikipedia.org/wiki?curid=23306251 |
13,704 | Up to 28 February in the calendar being converted , add one day less or subtract one day more than the calculated value. Give February the appropriate number of days for the calendar being converted . When subtracting days to calculate the Gregorian equivalent of 29 February (Julian), 29 February is discounted. Thus if the calculated value is −4 the Gregorian equivalent of this date is 24 February. | https://en.wikipedia.org/wiki?curid=23306251 |
13,705 | The year used in dates during the Roman Republic and the Roman Empire was the consular year, which began on the day when consuls first entered office—probably 1 May before 222 BC, 15 March from 222 BC and 1 January from 153 BC. The Julian calendar, which began in 45|BC}}, continued to use 1 January as the first day of the new year. Even though the year used for dates changed, the civil year always displayed its months in the order January to December from the Roman Republican period until the present. | https://en.wikipedia.org/wiki?curid=23306251 |
13,706 | During the Middle Ages, under the influence of the Catholic Church, many Western European countries moved the start of the year to one of several important Christian festivals—25 December (Christmas), 25 March (Annunciation), or Easter (France), while the Byzantine Empire began its year on 1 September and Russia did so on 1 March until 1492 when the new year was moved to 1 September. | https://en.wikipedia.org/wiki?curid=23306251 |
13,707 | In common usage, 1 January was regarded as New Year's Day and celebrated as such, but from the 12th century until 1751 the legal year in England began on 25 March (Lady Day). So, for example, the Parliamentary record lists the execution of Charles I on 30 January as occurring in 1648 (as the year did not end until 24 March), although later histories adjust the start of the year to 1 January and record the execution as occurring in 1649. | https://en.wikipedia.org/wiki?curid=23306251 |
13,708 | Most Western European countries changed the start of the year to 1 January before they adopted the Gregorian calendar. For example, Scotland changed the start of the Scottish New Year to 1 January in 1600 (this means that 1599 was a short year). England, Ireland and the British colonies changed the start of the year to 1 January in 1752 (so 1751 was a short year with only 282 days). Later in 1752 in September the Gregorian calendar was introduced throughout Britain and the British colonies (see the section Adoption). These two reforms were implemented by the Calendar (New Style) Act 1750. | https://en.wikipedia.org/wiki?curid=23306251 |
13,709 | In some countries, an official decree or law specified that the start of the year should be 1 January. For such countries, a specific year when a 1 January-year became the norm can be identified. In other countries, the customs varied, and the start of the year moved back and forth as fashion and influence from other countries dictated various customs. | https://en.wikipedia.org/wiki?curid=23306251 |
13,710 | Neither the papal bull nor its attached canons explicitly fix such a date, though it is implied by two tables of saint's days, one labelled 1582 which ends on 31 December, and another for any full year that begins on 1 January. It also specifies its epact relative to 1 January, in contrast with the Julian calendar, which specified it relative to 22 March. The old date was derived from the Greek system: the earlier specified it relative to 1 January. | https://en.wikipedia.org/wiki?curid=23306251 |
13,711 | During the period between 1582, when the first countries adopted the Gregorian calendar, and 1923, when the last European country adopted it, it was often necessary to indicate the date of some event in both the Julian calendar and in the Gregorian calendar, for example, "10/21 February 1750/51", where the dual year accounts for some countries already beginning their numbered year on 1 January while others were still using some other date. Even before 1582, the year sometimes had to be double-dated because of the different beginnings of the year in various countries. Woolley, writing in his biography of John Dee (1527–1608/9), notes that immediately after 1582 English letter writers "customarily" used "two dates" on their letters, one OS and one NS. | https://en.wikipedia.org/wiki?curid=23306251 |
13,712 | "Old Style" (O.S.) and "New Style" (N.S.) indicate dating systems before and after a calendar change, respectively. Usually, this is the change from the Julian calendar to the Gregorian calendar as enacted in various European countries between 1582 and the early 20th century. | https://en.wikipedia.org/wiki?curid=23306251 |
13,713 | In England, Wales, Ireland and Britain's American colonies, there were two calendar changes, both in 1752. The first adjusted the start of a new year from Lady Day (25 March) to 1 January (which Scotland had done from 1600), while the second discarded the Julian calendar in favour of the Gregorian calendar, removing 11 days from the September 1752 calendar to do so. To accommodate the two calendar changes, writers used dual dating to identify a given day by giving its date according to both styles of dating. | https://en.wikipedia.org/wiki?curid=23306251 |
13,714 | For countries such as Russia where no start of year adjustment took place, O.S. and N.S. simply indicate the Julian and Gregorian dating systems. Many Eastern Orthodox countries continue to use the older Julian calendar for religious purposes. | https://en.wikipedia.org/wiki?curid=23306251 |
13,715 | Extending the Gregorian calendar backwards to dates preceding its official introduction produces a proleptic calendar, which should be used with some caution. For ordinary purposes, the dates of events occurring prior to 15 October 1582 are generally shown as they appeared in the Julian calendar, with the year starting on 1 January, and no conversion to their Gregorian equivalents. For example, the Battle of Agincourt is universally considered to have been fought on 25 October 1415 which is Saint Crispin's Day. | https://en.wikipedia.org/wiki?curid=23306251 |
13,716 | Usually, the mapping of new dates onto old dates with a start of year adjustment works well with little confusion for events that happened before the introduction of the Gregorian calendar. But for the period between the first introduction of the Gregorian calendar on 15 October 1582 and its introduction in Britain on 14 September 1752, there can be considerable confusion between events in continental western Europe and in British domains in English language histories. | https://en.wikipedia.org/wiki?curid=23306251 |
13,717 | Events in continental western Europe are usually reported in English language histories as happening under the Gregorian calendar. For example, the Battle of Blenheim is always given as 13 August 1704. Confusion occurs when an event affects both. For example, William III of England set sail from the Netherlands on 11 November 1688 (Gregorian calendar) and arrived at Brixham in England on 5 November 1688 (Julian calendar). | https://en.wikipedia.org/wiki?curid=23306251 |
13,718 | Shakespeare and Cervantes seemingly died on exactly the same date (23 April 1616), but Cervantes predeceased Shakespeare by ten days in real time (as Spain used the Gregorian calendar, but Britain used the Julian calendar). This coincidence encouraged UNESCO to make 23 April the World Book and Copyright Day. | https://en.wikipedia.org/wiki?curid=23306251 |
13,719 | For dates before the year 1, unlike the proleptic Gregorian calendar used in the international standard ISO 8601, the traditional proleptic Gregorian calendar (like the Julian calendar) does not have a year 0 and instead uses the ordinal numbers 1, 2, ... both for years AD and BC. Thus the traditional time line is 2 BC, 1 BC, AD 1, and AD 2. ISO 8601 uses astronomical year numbering which includes a year 0 and negative numbers before it. Thus the ISO 8601 time line is , 0000, 0001, and 0002. | https://en.wikipedia.org/wiki?curid=23306251 |
13,720 | The Gregorian calendar continued to employ the Julian months, which have Latinate names and irregular numbers of days: | https://en.wikipedia.org/wiki?curid=23306251 |
13,721 | Europeans sometimes attempt to remember the number of days in each month by memorizing some form of the traditional verse "Thirty Days Hath September". It appears in Latin, Italian, French and Portuguese, and belongs to a broad oral tradition but the earliest currently attested form of the poem is the English marginalia inserted into a calendar of saints : | https://en.wikipedia.org/wiki?curid=23306251 |
13,722 | Variations appeared in "Mother Goose" and continue to be taught at schools. The unhelpfulness of such involved mnemonics has been parodied as "Thirty days hath September/ But all the rest I can't remember" but it has also been called "probably the only sixteenth-century poem most ordinary citizens know by heart". A common nonverbal alternative is the knuckle mnemonic, considering the knuckles of one's hands as months with 31 days and the lower spaces between them as the months with fewer days. Using two hands, one may start from either pinkie knuckle as January and count across, omitting the space between the index knuckles (July and August). The same procedure can be done using the knuckles of a single hand, returning from the last (July) to the first (August) and continuing through. A similar mnemonic is to move up a piano keyboard in semitones from an F key, taking the white keys as the longer months and the black keys as the shorter ones. | https://en.wikipedia.org/wiki?curid=23306251 |
13,723 | In conjunction with the system of months, there is a system of weeks. A physical or electronic calendar provides conversion from a given date to the weekday and shows multiple dates for a given weekday and month. Calculating the day of the week is not very simple, because of the irregularities in the Gregorian system. When the Gregorian calendar was adopted by each country, the weekly cycle continued uninterrupted. For example, in the case of the few countries that adopted the reformed calendar on the date proposed by Gregory XIII for the calendar's adoption, Friday, 15 October 1582, the preceding date was Thursday, 4 October 1582 (Julian calendar). | https://en.wikipedia.org/wiki?curid=23306251 |
13,724 | Opinions vary about the numbering of the days of the week. ISO 8601, in common use worldwide, starts with Monday=1; printed monthly calendar grids often list Mondays in the first (left) column of dates and Sundays in the last. In North America, the week typically begins on Sunday and ends on Saturday. | https://en.wikipedia.org/wiki?curid=23306251 |
13,725 | The Gregorian calendar improves the approximation made by the Julian calendar by skipping three Julian leap days in every 400 years, giving an average year of 365.2425 mean solar days long. This approximation has an error of about one day per 3,030 years with respect to the current value of the mean tropical year. However, because of the precession of the equinoxes, which is not constant, and the movement of the perihelion (which affects the Earth's orbital speed) the error with respect to the "astronomical" vernal equinox is variable; using the average interval between vernal equinoxes near 2000 of 365.24237 days implies an error closer to 1 day every 7,700 years. By any criterion, the Gregorian calendar is substantially more accurate than the 1 day in 128 years error of the Julian calendar (average year 365.25 days). | https://en.wikipedia.org/wiki?curid=23306251 |
13,726 | In the 19th century, Sir John Herschel proposed a modification to the Gregorian calendar with 969 leap days every 4000 years, instead of 970 leap days that the Gregorian calendar would insert over the same period. This would reduce the average year to 365.24225 days. Herschel's proposal would make the year 4000, and multiples thereof, common instead of leap. While this modification has often been proposed since, it has never been officially adopted. | https://en.wikipedia.org/wiki?curid=23306251 |
13,727 | On time scales of thousands of years, the Gregorian calendar falls behind the astronomical seasons. This is because the Earth's speed of rotation is gradually slowing down, which makes each day slightly longer over time (see tidal acceleration and leap second) while the year maintains a more uniform duration. | https://en.wikipedia.org/wiki?curid=23306251 |
13,728 | Each point is the date and time of the June solstice in that particular year. The error shifts by about a quarter of a day per year. Centurial years are ordinary years, unless they are divisible by 400, in which case they are leap years. This causes a correction in the years 1700, 1800, 1900, 2100, 2200, and 2300. | https://en.wikipedia.org/wiki?curid=23306251 |
13,729 | For instance, these corrections cause 23 December 1903 to be the latest December solstice, and 20 December 2096 to be the earliest solstice—about 2.35 days of variation compared with the astronomical event. | https://en.wikipedia.org/wiki?curid=23306251 |
13,730 | Marfan syndrome (MFS) is a multi-systemic genetic disorder that affects the connective tissue. Those with the condition tend to be tall and thin, with long arms, legs, fingers, and toes. They also typically have exceptionally flexible joints and abnormally curved spines. The most serious complications involve the heart and aorta, with an increased risk of mitral valve prolapse and aortic aneurysm. The lungs, eyes, bones, and the covering of the spinal cord are also commonly affected. The severity of the symptoms is variable. | https://en.wikipedia.org/wiki?curid=45475 |
13,731 | MFS is caused by a mutation in "FBN1", one of the genes that makes fibrillin, which results in abnormal connective tissue. It is an autosomal dominant disorder. In about 75% of cases, it is inherited from a parent with the condition, while in about 25% it is a new mutation. Diagnosis is often based on the Ghent criteria. | https://en.wikipedia.org/wiki?curid=45475 |
13,732 | There is no known cure for MFS. Many of those with the disorder have a normal life expectancy with proper treatment. Management often includes the use of beta blockers such as propranolol or atenolol or, if they are not tolerated, calcium channel blockers or ACE inhibitors. Surgery may be required to repair the aorta or replace a heart valve. Avoiding strenuous exercise is recommended for those with the condition. | https://en.wikipedia.org/wiki?curid=45475 |
13,733 | About 1 in 5,000 to 1 in 10,000 people have MFS. Rates of the condition are similar in different regions of the world. It is named after French pediatrician Antoine Marfan, who first described it in 1896. | https://en.wikipedia.org/wiki?curid=45475 |
13,734 | More than 30 signs and symptoms are variably associated with Marfan syndrome. The most prominent of these affect the skeletal, cardiovascular, and ocular systems, but all fibrous connective tissue throughout the body can be affected. | https://en.wikipedia.org/wiki?curid=45475 |
13,735 | Most of the readily visible signs are associated with the skeletal system. Many individuals with Marfan syndrome grow to above-average height, and some have disproportionately long, slender limbs with thin, weak wrists and long fingers and toes. | https://en.wikipedia.org/wiki?curid=45475 |
13,736 | The Steinberg sign, also known as the thumb sign, is one of the clinical examination tests for Marfan disease in the hands. It is a clinical test in which the tip of the thumb extends beyond the palm when the thumb is clasped in the clenched hand. | https://en.wikipedia.org/wiki?curid=45475 |
13,737 | Besides affecting height and limb proportions, people with Marfan syndrome may have abnormal lateral curvature of the spine scoliosis, thoracic lordosis, abnormal indentation ("pectus excavatum") or protrusion ("pectus carinatum") of the sternum, abnormal joint flexibility, a high-arched palate with crowded teeth and an overbite, flat feet, hammer toes, stooped shoulders, and unexplained stretch marks on the skin. It can also cause pain in the joints, bones, and muscles. Some people with Marfan have speech disorders resulting from symptomatic high palates and small jaws. Early osteoarthritis may occur. Other signs include limited range of motion in the hips due to the femoral head protruding into abnormally deep hip sockets. | https://en.wikipedia.org/wiki?curid=45475 |
13,738 | In Marfan syndrome, the health of the eye can be affected in many ways, but the principal change is partial lens dislocation, where the lens is shifted out of its normal position. This occurs because of weakness in the ciliary zonules, the connective tissue strands which suspend the lens within the eye. The mutations responsible for Marfan syndrome weaken the zonules and cause them to stretch. The inferior zonules are most frequently stretched resulting in the lens shifting upwards and outwards, but it can shift in other directions as well. Nearsightedness (myopia), and blurred vision are common due to connective tissue defects in the eye. Farsightedness can also result particularly if the lens is highly subluxated. Subluxation (partial dislocation) of the lens can be detected clinically in about 60% of people with Marfan syndrome by the use of a slit-lamp biomicroscope. If the lens subluxation is subtle, then imaging with high-resolution ultrasound biomicroscopy might be used. | https://en.wikipedia.org/wiki?curid=45475 |
13,739 | Other signs and symptoms affecting the eye include increased length along an axis of the globe, myopia, corneal flatness, strabismus, exotropia, and esotropia. Those with MFS are also at a high risk for early glaucoma and early cataracts. | https://en.wikipedia.org/wiki?curid=45475 |
13,740 | The most serious signs and symptoms associated with Marfan syndrome involve the cardiovascular system: undue fatigue, shortness of breath, heart palpitations, racing heartbeats, or chest pain radiating to the back, shoulder, or arm. Cold arms, hands, and feet can also be linked to MFS because of inadequate circulation. A heart murmur, abnormal reading on an ECG, or symptoms of angina can indicate further investigation. The signs of regurgitation from prolapse of the mitral or aortic valves (which control the flow of blood through the heart) result from cystic medial degeneration of the valves, which is commonly associated with MFS (see mitral valve prolapse, aortic regurgitation). However, the major sign that would lead a doctor to consider an underlying condition is a dilated aorta or an aortic aneurysm. Sometimes, no heart problems are apparent until the weakening of the connective tissue (cystic medial degeneration) in the ascending aorta causes an aortic aneurysm or aortic dissection, a surgical emergency. An aortic dissection is most often fatal and presents with pain radiating down the back, giving a tearing sensation. | https://en.wikipedia.org/wiki?curid=45475 |
13,741 | Because underlying connective tissue abnormalities cause MFS, the incidence of dehiscence of prosthetic mitral valve is increased. Care should be taken to attempt repair of damaged heart valves rather than replacement. | https://en.wikipedia.org/wiki?curid=45475 |
13,742 | Individuals with Marfan Syndrome may be affected by various lung-related problems. One study found that only 37% of the patient sample studied (mean age 32±14 years; M 45%) had normal lung function. Spontaneous pneumothorax is common. In spontaneous unilateral pneumothorax, air escapes from a lung and occupies the pleural space between the chest wall and a lung. The lung becomes partially compressed or collapsed. This can cause pain, shortness of breath, cyanosis, and, if not treated, death. Other possible pulmonary manifestations of MFS include sleep apnea and idiopathic obstructive lung disease. Pathologic changes in the lungs have been described such as cystic changes, emphysema, pneumonia, bronchiectasis, bullae, apical fibrosis and congenital malformations such as middle lobe hypoplasia. | https://en.wikipedia.org/wiki?curid=45475 |
13,743 | Dural ectasia, the weakening of the connective tissue of the dural sac encasing the spinal cord, can result in a loss of quality of life. It can be present for a long time without producing any noticeable symptoms. Symptoms that can occur are lower back pain, leg pain, abdominal pain, other neurological symptoms in the lower extremities, or headachessymptoms which usually diminish when lying flat. On X-ray, however, dural ectasia is not often visible in the early stages. A worsening of symptoms might warrant an MRI of the lower spine. Dural ectasia that has progressed to this stage would appear in an MRI as a dilated pouch wearing away at the lumbar vertebrae. Other spinal issues associated with MFS include degenerative disc disease, spinal cysts, and dysfunction of the autonomic nervous system. | https://en.wikipedia.org/wiki?curid=45475 |
13,744 | Each parent with the condition has a 50% risk of passing the genetic defect on to any child due to its autosomal dominant nature. Most individuals with MFS have another affected family member. About 75% of cases are inherited. On the other hand, about 15–30% of all cases are due to "de novo" genetic mutations; such spontaneous mutations occur in about one in 20,000 births. Marfan syndrome is also an example of dominant negative mutation and haploinsufficiency. It is associated with variable expressivity; complete penetrance has been definitively documented. | https://en.wikipedia.org/wiki?curid=45475 |
13,745 | Marfan syndrome is caused by mutations in the "FBN1" gene on chromosome 15, which encodes fibrillin 1, a glycoprotein component of the extracellular matrix. Fibrillin-1 is essential for the proper formation of the extracellular matrix, including the biogenesis and maintenance of elastic fibers. The extracellular matrix is critical for both the structural integrity of connective tissue, but also serves as a reservoir for growth factors. Elastic fibers are found throughout the body, but are particularly abundant in the aorta, ligaments and the ciliary zonules of the eye; consequently, these areas are among the worst affected. It can also be caused by a range of intravenous crystal treatments in those susceptible to the disorder. | https://en.wikipedia.org/wiki?curid=45475 |
13,746 | A transgenic mouse has been created carrying a single copy of a mutant fibrillin-1, a mutation similar to that found in the human gene known to cause MFS. This mouse strain recapitulates many of the features of the human disease and promises to provide insights into the pathogenesis of the disease. Reducing the level of normal fibrillin 1 causes a Marfan-related disease in mice. | https://en.wikipedia.org/wiki?curid=45475 |
13,747 | Transforming growth factor beta (TGF-β) plays an important role in MFS. Fibrillin-1 directly binds a latent form of TGF-β, keeping it sequestered and unable to exert its biological activity. The simplest model suggests reduced levels of fibrillin-1 allow TGF-β levels to rise due to inadequate sequestration. Although how elevated TGF-β levels are responsible for the specific pathology seen with the disease is not proven, an inflammatory reaction releasing proteases that slowly degrade the elastic fibers and other components of the extracellular matrix is known to occur. The importance of the TGF-β pathway was confirmed with the discovery of the similar Loeys–Dietz syndrome involving the "TGFβR2" gene on chromosome 3, a receptor protein of TGF-β. Marfan syndrome has often been confused with Loeys–Dietz syndrome, because of the considerable clinical overlap between the two pathologies. | https://en.wikipedia.org/wiki?curid=45475 |
13,748 | Marfanoid–progeroid–lipodystrophy syndrome (MPL), also referred to as Marfan lipodystrophy syndrome (MFLS), is a variant of MFS in which Marfan symptoms are accompanied by features usually associated with neonatal progeroid syndrome (also referred to as Wiedemann–Rautenstrauch syndrome) in which the levels of white adipose tissue are reduced. Since 2010, evidence has been accumulating that MPL is caused by mutations near the 3'-terminus of the "FBN1" gene. It has been shown that these people are also deficient in asprosin, a gluco-regulatory protein hormone which is the C-terminal cleavage product of profibrillin. The levels of asprosin seen in these people were lower than expected for a heterozygous genotype, consistent with a dominant negative effect. | https://en.wikipedia.org/wiki?curid=45475 |
13,749 | Diagnostic criteria of MFS were agreed upon internationally in 1996. However, Marfan syndrome is often difficult to diagnose in children, as they typically do not show symptoms until reaching pubescence. A diagnosis is based on family history and a combination of major and minor indicators of the disorder, rare in the general population, that occur in one individualfor example: four skeletal signs with one or more signs in another body system such as ocular and cardiovascular in one individual. The following conditions may result from MFS, but may also occur in people without any known underlying disorder. | https://en.wikipedia.org/wiki?curid=45475 |
13,750 | In 2010, the Ghent nosology was revised, and new diagnostic criteria superseded the previous agreement made in 1996. The seven new criteria can lead to a diagnosis: | https://en.wikipedia.org/wiki?curid=45475 |
13,751 | The thumb sign (Steinberg's sign) is elicited by asking the person to flex the thumb as far as possible and then close the fingers over it. A positive thumb sign is where the entire distal phalanx is visible beyond the ulnar border of the hand, caused by a combination of hypermobility of the thumb as well as a thumb which is longer than usual. | https://en.wikipedia.org/wiki?curid=45475 |
13,752 | The wrist sign (Walker-Murdoch sign) is elicited by asking the person to curl the thumb and fingers of one hand around the other wrist. A positive wrist sign is where the little finger and the thumb overlap, caused by a combination of thin wrists and long fingers. | https://en.wikipedia.org/wiki?curid=45475 |
13,753 | Many other disorders can produce the same type of body characteristics as Marfan syndrome. Genetic testing and evaluating other signs and symptoms can help to differentiate these. The following are some of the disorders that can manifest as "marfanoid": | https://en.wikipedia.org/wiki?curid=45475 |
13,754 | There is no cure for Marfan syndrome, but life expectancy has increased significantly over the last few decades and is now similar to that of the average person. | https://en.wikipedia.org/wiki?curid=45475 |
13,755 | Regular checkups are recommended to monitor the health of the heart valves and the aorta. Marfan syndrome is treated by addressing each issue as it arises and, in particular, preventive medication even for young children to slow progression of aortic dilation. The goal of this treatment strategy is to slow the progression of aortic dilation and prevent any damage to heart valves by eliminating heart arrythmias, minimizing the heart rate, and lowering the person's blood pressure. | https://en.wikipedia.org/wiki?curid=45475 |
13,756 | The American Heart Association made the following recommendations for people with Marfan syndrome with no or mild aortic dilation: | https://en.wikipedia.org/wiki?curid=45475 |
13,757 | Management often includes the use of beta blockers such as propranolol or if not tolerated calcium channel blockers or ACE inhibitors. Beta blockers are used to reduce the stress exerted on the aorta and to decrease aortic dilation. | https://en.wikipedia.org/wiki?curid=45475 |
13,758 | If the dilation of the aorta progresses to a significant-diameter aneurysm, causes a dissection or a rupture, or leads to failure of the aortic or other valve, then surgery (possibly a composite aortic valve graft or valve-sparing aortic root replacement) becomes necessary. Although aortic graft surgery (or any vascular surgery) is a serious undertaking it is generally successful if undertaken on an elective basis. Surgery in the setting of acute aortic dissection or rupture is considerably more problematic. Elective aortic valve/graft surgery is usually considered when aortic root diameter reaches , but each case needs to be specifically evaluated by a qualified cardiologist. New valve-sparing surgical techniques are becoming more common. As people with Marfan syndrome live longer, other vascular repairs are becoming more common, e.g., repairs of descending thoracic aortic aneurysms and aneurysms of vessels other than the aorta. | https://en.wikipedia.org/wiki?curid=45475 |
13,759 | The skeletal and ocular manifestations of Marfan syndrome can also be serious, although not life-threatening. These symptoms are usually treated in an appropriate manner for the condition, such as with pain medications or muscle relaxants. Because Marfan syndrome may cause asymptomatic spinal abnormalities, any spinal surgery contemplated on a person Marfan should only follow detailed imaging and careful surgical planning, regardless of the indication for surgery. The ocular complications of MFS can often be treated with surgery. Ectopia lentis can be treated, as artificial lenses can be surgically implanted. In addition, surgery can address glaucoma and cataracts. | https://en.wikipedia.org/wiki?curid=45475 |
13,760 | Treatment of a spontaneous pneumothorax is dependent on the volume of air in the pleural space and the natural progression of the individual's condition. A small pneumothorax might resolve without active treatment in one to two weeks. Recurrent pneumothoraces might require chest surgery. Moderately sized pneumothoraces might need chest drain management for several days in a hospital. Large pneumothoraces are likely to be medical emergencies requiring emergency decompression. | https://en.wikipedia.org/wiki?curid=45475 |
13,761 | As an alternative approach, custom-built supports for the aortic root are also being used. As of 2020 this procedure has been used in over 300 people with the first case occurring in 2004. | https://en.wikipedia.org/wiki?curid=45475 |
13,762 | During pregnancy, even in the absence of preconception cardiovascular abnormality, women with Marfan syndrome are at significant risk of aortic dissection, which is often fatal even when rapidly treated. Women with Marfan syndrome, then, should receive a thorough assessment prior to conception, and echocardiography should be performed every six to 10 weeks during pregnancy, to assess the aortic root diameter. For most women, safe vaginal delivery is possible. | https://en.wikipedia.org/wiki?curid=45475 |
13,763 | Prenatal testing can be performed in females with Marfan syndrome to determine if the condition has been inherited in their child. At 10 to 12 weeks of pregnancy, examining a piece of placental tissue through a test called chorionic villus sampling can be performed to make a diagnosis. Another prenatal test can be performed called amniocentesis at 16 to 18 weeks of pregnancy. | https://en.wikipedia.org/wiki?curid=45475 |
13,764 | Marfan syndrome is expressed dominantly. This means a child with one parent a bearer of the gene has a 50% probability of getting the syndrome. In 1996, the first preimplantation genetic testing (PGT) therapy for Marfan was conducted; in essence PGT means conducting a genetic test on early-stage IVF embryo cells and discarding those embryos affected by the Marfan mutation. | https://en.wikipedia.org/wiki?curid=45475 |
13,765 | Prior to modern cardiovascular surgical techniques and medications such as losartan, and metoprolol, the prognosis of those with Marfan syndrome was not good: a range of untreatable cardiovascular issues was common. Lifespan was reduced by at least a third, and many died in their teens and twenties due to cardiovascular problems. Today, cardiovascular symptoms of Marfan syndrome are still the most significant issues in diagnosis and management of the disease, but adequate prophylactic monitoring and prophylactic therapy offers something approaching a normal lifespan, and more manifestations of the disease are being discovered as more patients live longer. Women with Marfan syndrome live longer than men. | https://en.wikipedia.org/wiki?curid=45475 |
13,766 | Marfan syndrome affects males and females equally, and the mutation shows no ethnic or geographical bias. Estimates indicate about 1 in 5,000 to 10,000 individuals have Marfan syndrome. | https://en.wikipedia.org/wiki?curid=45475 |
13,767 | Marfan syndrome is named after Antoine Marfan, the French pediatrician who first described the condition in 1896 after noticing striking features in a five-year-old girl. The gene linked to the disease was first identified by Francesco Ramirez at the Mount Sinai Medical Center in New York City in 1991. | https://en.wikipedia.org/wiki?curid=45475 |
13,768 | In addition the following historical figures and celebrities often appear on lists of people with Marfan syndrome, but from case to case the evidence is speculative, questionable, or even refuted. | https://en.wikipedia.org/wiki?curid=45475 |
13,769 | Ethanol (abbr. EtOH; also called ethyl alcohol, grain alcohol, drinking alcohol, or simply alcohol) is an organic compound. It is an alcohol with the chemical formula . Its formula can be also written as or (an ethyl group linked to a hydroxyl group). Ethanol is a volatile, flammable, colorless liquid with a characteristic wine-like odor and pungent taste. It is a psychoactive recreational drug, the active ingredient in alcoholic drinks. | https://en.wikipedia.org/wiki?curid=10048 |
13,770 | Ethanol is naturally produced by the fermentation process of sugars by yeasts or via petrochemical processes such as ethylene hydration. It has medical applications as an antiseptic and disinfectant. It is used as a chemical solvent and in the synthesis of organic compounds, and as a fuel source. Ethanol also can be dehydrated to make ethylene, an important chemical feedstock. As of 2006, world production of ethanol was , coming mostly from Brazil and the U.S. | https://en.wikipedia.org/wiki?curid=10048 |
13,771 | "Ethanol" is the systematic name defined by the International Union of Pure and Applied Chemistry for a compound consisting of an alkyl group with two carbon atoms (prefix "eth-"), having a single bond between them (infix "-an-") and an attached functional group −OH group (suffix "-ol"). | https://en.wikipedia.org/wiki?curid=10048 |
13,772 | The "eth-" prefix and the qualifier "ethyl" in "ethyl alcohol" originally come from the name "ethyl" assigned in 1834 to the group − by Justus Liebig. He coined the word from the German name "Aether" of the compound −O− (commonly called "ether" in English, more specifically called "diethyl ether"). According to the "Oxford English Dictionary", "Ethyl" is a contraction of the Ancient Greek αἰθήρ (', "upper air") and the Greek word ὕλη (', "substance"). | https://en.wikipedia.org/wiki?curid=10048 |
13,773 | The name "ethanol" was coined as a result of a resolution on naming alcohols and phenols that was adopted at the International Conference on Chemical Nomenclature that was held in April 1892 in Geneva, Switzerland. | https://en.wikipedia.org/wiki?curid=10048 |
13,774 | The term "alcohol" now refers to a wider class of substances in chemistry nomenclature, but in common parlance it remains the name of ethanol. It is a medieval loan from Arabic "al-kuḥl", a powdered ore of antimony used since antiquity as a cosmetic, and retained that meaning in Middle Latin. The use of 'alcohol' for ethanol (in full, "alcohol of wine") is modern and was first recorded in 1753. Before the late 18th century the term "alcohol" generally referred to any sublimated substance. | https://en.wikipedia.org/wiki?curid=10048 |
13,775 | Ethanol is used in medical wipes and most commonly in antibacterial hand sanitizer gels as an antiseptic for its bactericidal and anti-fungal effects. Ethanol kills microorganisms by dissolving their membrane lipid bilayer and denaturing their proteins, and is effective against most bacteria, fungi and viruses. However, it is ineffective against bacterial spores, but that can be alleviated by using hydrogen peroxide. A solution of 70% ethanol is more effective than pure ethanol because ethanol relies on water molecules for optimal antimicrobial activity. Absolute ethanol may inactivate microbes without destroying them because the alcohol is unable to fully permeate the microbe's membrane. Ethanol can also be used as a disinfectant and antiseptic because it causes cell dehydration by disrupting the osmotic balance across the cell membrane, so water leaves the cell leading to cell death. | https://en.wikipedia.org/wiki?curid=10048 |
13,776 | Ethanol may be administered as an antidote to ethylene glycol poisoning and methanol poisoning. Ethanol serves this process by acting as a competitive inhibitor against methanol and ethylene glycol for alcohol dehydrogenase. Though it has more side effects, ethanol is less expensive and more readily available than fomepizole, which is also used as an antidote for methanol and ethylene glycol poisoning. | https://en.wikipedia.org/wiki?curid=10048 |
13,777 | Ethanol, often in high concentrations, is used to dissolve many water-insoluble medications and related compounds. Liquid preparations of pain medications, cough and cold medicines, and mouth washes, for example, may contain up to 25% ethanol and may need to be avoided in individuals with adverse reactions to ethanol such as alcohol-induced respiratory reactions. Ethanol is present mainly as an antimicrobial preservative in over 700 liquid preparations of medicine including acetaminophen, iron supplements, ranitidine, furosemide, mannitol, phenobarbital, trimethoprim/sulfamethoxazole and over-the-counter cough medicine. | https://en.wikipedia.org/wiki?curid=10048 |
13,778 | In mammals, ethanol is primarily metabolized in the liver and stomach by alcohol dehydrogenase (ADH) enzymes. These enzymes catalyze the oxidation of ethanol into acetaldehyde (ethanal): | https://en.wikipedia.org/wiki?curid=10048 |
13,779 | When present in significant concentrations, this metabolism of ethanol is additionally aided by the cytochrome P450 enzyme CYP2E1 in humans, while trace amounts are also metabolized by catalase. | https://en.wikipedia.org/wiki?curid=10048 |
13,780 | The resulting intermediate, acetaldehyde, is a known carcinogen, and poses significantly greater toxicity in humans than ethanol itself. Many of the symptoms typically associated with alcohol intoxication—as well as many of the health hazards typically associated with the long-term consumption of ethanol—can be attributed to acetaldehyde toxicity in humans. | https://en.wikipedia.org/wiki?curid=10048 |
13,781 | The subsequent oxidation of acetaldehyde into acetate is performed by aldehyde dehydrogenase (ALDH) enzymes. A mutation in the ALDH2 gene that encodes for an inactive or dysfunctional form of this enzyme affects roughly 50% of east Asian populations, contributing to the characteristic alcohol flush reaction that can cause temporary reddening of the skin as well as a number of related, and often unpleasant, symptoms of acetaldehyde toxicity. This mutation is typically accompanied by another mutation in the alcohol dehydrogenase enzyme ADH1B in roughly 80% of east Asians, which improves the catalytic efficiency of converting ethanol into acetaldehyde. | https://en.wikipedia.org/wiki?curid=10048 |
13,782 | As a central nervous system depressant, ethanol is one of the most commonly consumed psychoactive drugs. | https://en.wikipedia.org/wiki?curid=10048 |
13,783 | Despite alcohol's psychoactive and carcinogenic properties, it is readily available and legal for sale in most countries. However, there are laws regulating the sale, exportation/importation, taxation, manufacturing, consumption, and possession of alcoholic beverages. The most common regulation is prohibition for minors. | https://en.wikipedia.org/wiki?curid=10048 |
13,784 | The largest single use of ethanol is as an engine fuel and fuel additive. Brazil in particular relies heavily upon the use of ethanol as an engine fuel, due in part to its role as one of the world's leading producers of ethanol. Gasoline sold in Brazil contains at least 25% anhydrous ethanol. Hydrous ethanol (about 95% ethanol and 5% water) can be used as fuel in more than 90% of new gasoline-fueled cars sold in the country. | https://en.wikipedia.org/wiki?curid=10048 |
13,785 | The US and many other countries primarily use E10 (10% ethanol, sometimes known as gasohol) and E85 (85% ethanol) ethanol/gasoline mixtures. Over time, it is believed that a material portion of the ≈ per year market for gasoline will begin to be replaced with fuel ethanol. | https://en.wikipedia.org/wiki?curid=10048 |
13,786 | Australian law limits the use of pure ethanol from sugarcane waste to 10% in automobiles. Older cars (and vintage cars designed to use a slower burning fuel) should have the engine valves upgraded or replaced. | https://en.wikipedia.org/wiki?curid=10048 |
13,787 | According to an industry advocacy group, ethanol as a fuel reduces harmful tailpipe emissions of carbon monoxide, particulate matter, oxides of nitrogen, and other ozone-forming pollutants. Argonne National Laboratory analyzed greenhouse gas emissions of many different engine and fuel combinations, and found that biodiesel/petrodiesel blend (B20) showed a reduction of 8%, conventional E85 ethanol blend a reduction of 17% and cellulosic ethanol 64%, compared with pure gasoline. Ethanol has a much greater research octane number (RON) than gasoline, meaning it is less prone to pre-ignition, allowing for better ignition advance which means more torque, and efficiency in addition to the lower carbon emissions. | https://en.wikipedia.org/wiki?curid=10048 |
13,788 | Ethanol combustion in an internal combustion engine yields many of the products of incomplete combustion produced by gasoline and significantly larger amounts of formaldehyde and related species such as acetaldehyde. This leads to a significantly larger photochemical reactivity and more ground level ozone. This data has been assembled into The Clean Fuels Report comparison of fuel emissions and show that ethanol exhaust generates 2.14 times as much ozone as gasoline exhaust. When this is added into the custom "Localized Pollution Index (LPI)" of The Clean Fuels Report, the local pollution of ethanol (pollution that contributes to smog) is rated 1.7, where gasoline is 1.0 and higher numbers signify greater pollution. The California Air Resources Board formalized this issue in 2008 by recognizing control standards for formaldehydes as an emissions control group, much like the conventional NOx and Reactive Organic Gases (ROGs). | https://en.wikipedia.org/wiki?curid=10048 |
13,789 | More than 20% of Brazilian cars are able to use 100% ethanol as fuel, which includes ethanol-only engines and flex-fuel engines. Flex-fuel engines in Brazil are able to work with all ethanol, all gasoline or any mixture of both. In the U.S. flex-fuel vehicles can run on 0% to 85% ethanol (15% gasoline) since higher ethanol blends are not yet allowed or efficient. Brazil supports this fleet of ethanol-burning automobiles with large national infrastructure that produces ethanol from domestically grown sugarcane. | https://en.wikipedia.org/wiki?curid=10048 |
13,790 | Ethanol's high miscibility with water makes it unsuitable for shipping through modern pipelines like liquid hydrocarbons. Mechanics have seen increased cases of damage to small engines (in particular, the carburetor) and attribute the damage to the increased water retention by ethanol in fuel. | https://en.wikipedia.org/wiki?curid=10048 |
13,791 | Ethanol was commonly used as fuel in early bipropellant rocket (liquid-propelled) vehicles, in conjunction with an oxidizer such as liquid oxygen. The German A-4 ballistic rocket of World War II (better known by its propaganda name ), which is credited as having begun the space age, used ethanol as the main constituent of "B-Stoff". Under such nomenclature, the ethanol was mixed with 25% water to reduce the combustion chamber temperature. The design team helped develop U.S. rockets following World War II, including the ethanol-fueled Redstone rocket which launched the first U.S. satellite. Alcohols fell into general disuse as more energy-dense rocket fuels were developed, although ethanol is currently used in lightweight rocket-powered racing aircraft. | https://en.wikipedia.org/wiki?curid=10048 |
13,792 | Commercial fuel cells operate on reformed natural gas, hydrogen or methanol. Ethanol is an attractive alternative due to its wide availability, low cost, high purity and low toxicity. There is a wide range of fuel cell concepts that have entered trials including direct-ethanol fuel cells, auto-thermal reforming systems and thermally integrated systems. The majority of work is being conducted at a research level although there are a number of organizations at the beginning of the commercialization of ethanol fuel cells. | https://en.wikipedia.org/wiki?curid=10048 |
13,793 | Ethanol fireplaces can be used for home heating or for decoration. Ethanol can also be used as stove fuel for cooking. | https://en.wikipedia.org/wiki?curid=10048 |
13,794 | Ethanol is an important industrial ingredient. It has widespread use as a precursor for other organic compounds such as ethyl halides, ethyl esters, diethyl ether, acetic acid, and ethyl amines. | https://en.wikipedia.org/wiki?curid=10048 |
13,795 | Ethanol is considered a universal solvent, as its molecular structure allows for the dissolving of both polar, hydrophilic and nonpolar, hydrophobic compounds. As ethanol also has a low boiling point, it is easy to remove from a solution that has been used to dissolve other compounds, making it a popular extracting agent for botanical oils. Cannabis oil extraction methods often use ethanol as an extraction solvent, and also as a post-processing solvent to remove oils, waxes, and chlorophyll from solution in a process known as winterization. | https://en.wikipedia.org/wiki?curid=10048 |
13,796 | Ethanol is found in paints, tinctures, markers, and personal care products such as mouthwashes, perfumes and deodorants. However, polysaccharides precipitate from aqueous solution in the presence of alcohol, and ethanol precipitation is used for this reason in the purification of DNA and RNA. | https://en.wikipedia.org/wiki?curid=10048 |
13,797 | Because of its low freezing point of and low toxicity, ethanol is sometimes used in laboratories (with dry ice or other coolants) as a cooling bath to keep vessels at temperatures below the freezing point of water. For the same reason, it is also used as the active fluid in alcohol thermometers. | https://en.wikipedia.org/wiki?curid=10048 |
13,798 | Ethanol is a 2-carbon alcohol. Its molecular formula is CHCHOH. An alternative notation is CH−CH−OH, which indicates that the carbon of a methyl group (CH−) is attached to the carbon of a methylene group (−CH–), which is attached to the oxygen of a hydroxyl group (−OH). It is a constitutional isomer of dimethyl ether. Ethanol is sometimes abbreviated as EtOH, using the common organic chemistry notation of representing the ethyl group (CH−) with Et. | https://en.wikipedia.org/wiki?curid=10048 |
13,799 | Ethanol is a volatile, colorless liquid that has a slight odor. It burns with a smokeless blue flame that is not always visible in normal light. The physical properties of ethanol stem primarily from the presence of its hydroxyl group and the shortness of its carbon chain. Ethanol's hydroxyl group is able to participate in hydrogen bonding, rendering it more viscous and less volatile than less polar organic compounds of similar molecular weight, such as propane. | https://en.wikipedia.org/wiki?curid=10048 |
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