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By A. Chenor. Loyola University, New Orleans. 2018.

It is equally beneficial in those cases of cynanche maligna purchase 100 mg voveran sr otc muscle relaxer kidney, with dark redness of mucous membranes voveran sr 100 mg visa muscle relaxant general anesthesia. Whilst in ordinary sore throat from cold, with dusky discoloration, it offers one of the best local applications in the materia medica. The Bittersweet has the reputation of being a good alterative, in cutaneous diseases, syphilis, scrofula, and inflammatory deposits, and we conclude that it increases waste and excretion. It exerts a marked influence upon the cerebro-spinal centers, when used in large doses, but this has not been studied. I would advise the employment of the remedy in small doses in those cases of chronic disease in which the circulation is feeble, the hands and feet cold and purplish, with fullness of tissues and tendency to œdema. I do not know that it will prove better than other remedies, but it deserves investigation. Its action is very similar to Belladonna, being a stimulant to the capillary circulation. It may be employed in congestion of the nerve centers, of the abdominal viscera, and of the kidneys. It relieves irritation of stomach and bowels, colic, and is said to promote the menstrual flow. It may be employed as a stimulant to the cerebro-spinal centers, when there is a defect of reflex action, imperfect respiration, and threatened paralysis. It also relieves the excited innervation from atony, and thus gives rest and sleep. It may be used in inflammation of the mouth and throat, and in disease in which this is a continuous complaint, or where there is profuse secretion of saliva (not mercurial. It relieves irritation of the urinary passages, influences the prostate gland, checks gleet and prostatorrhœa, and may be employed in chronic inflammation of the cervix uteri, and in chronic vaginitis with leucorrhœa. I give the formula for the preparation of a tincture of burnt sponge, not because I think it possesses all the properties attributed to it by Homœopaths, but that it may be tested. I have used it in some cases with seeming advantage, and have seen results following its prescription by others, that in the ordinary use of medicine we would call remarkable cures. A quotation from Jahr’s Repertory will show the Homœopathic uses: “Diseases of the lymphatic vessels and glands; heat, with dry, hot skin, thirst, headache and delirium; redness of the eyes, with burning and lachrymation; frequent eructations, with cutting and tearing in the stomach; relaxed feeling in the stomach, as if the stomach were open; orchitis; induration of testes; pain in the larynx on touching it and turning the head; burning in the larynx and trachea; dryness, husky and hoarse voice; inflammation of the larynx, trachea and bronchi; croup; laryngeal and tracheal phthisis; cough, deep from the chest, with soreness and burning, or chronic cough with yellowish expectoration and hoarseness; wheezing inspirations, asthma with amenorrhœa; goitre; hard goitre. The Staphylea has been confounded with the Ptelea, until we hardly know whether a writer in the olden times was describing one or the other. Jones, and valued so highly by him as a tonic, was the article under consideration. At least it would be well for some of our friends who know the article, to procure specimens and thoroughly test it. Jones claimed that it was a pure unirritating tonic, having a soothing influence upon mucous membranes. He employed it in the convalescence from fevers and inflammations, and whenever the stomach was feeble and irritable. The marsh rosemary is an excellent astringent, and at the same time relieves irritation of mucous membranes. It may be used in atonic dyspepsia, in diarrhœa, chronic dysentery, hemorrhage from the lungs, bronchorrhœa, sore throat, chronic laryngitis, and in any catarrhal disease with profuse secretion. Stillingia increases waste and excretion, but its principal action probably is upon the lymphatic system, favoring the formation of good lymph, hence good blood and nutrition. Experience shows that it favorably influences the system in secondary syphilis, in some forms of scrofula, and in cases of chronic disease where the tissues are feeble and not readily removed and renewed. I believe it to be more especially useful in those cases where there is predominant affection of mucous membranes, and secondly, where the skin is involved. In these cases I have used the simple tincture as above, largely diluted with water, with much better results than I have obtained from any of the compounds of Stillingia or alterative syrups. Evidently in the ordinary manufacture of “Compound Syrup of Stillingia,” the virtues of Stillingia, if it has any, are wholly lost, simply because water or dilute alcohol is not a proper menstruum.

He and his therapist agree to work on a replacement thought for his most malicious thought (see the sec- tion “After the Verdict: Replacing and Rehabilitating Your Thoughts” later in this chapter) generic 100 mg voveran sr spasms just below sternum. After he creates the first replacement though order voveran sr 100 mg visa spasms pain rib cage, he continues putting his other malicious thoughts on trial and replacing them, one at a time. Putting your thoughts on trial You guessed it; it’s your turn to visit Thought Court. Don’t be concerned if you struggle in your initial attempts; this important exercise takes practice. Pay attention to your body’s signals and write them down whenever you feel some- thing unpleasant. Refer to the Daily Unpleasant Emotions Checklist in Chapter 4 for help finding the right feeling words. Rate your feeling on a scale of intensity from 1 (almost undetectable) to 100 (maximal). Ask yourself what was going on when you started noticing your emotions and your body’s signals. The corresponding event can be something happening in your world, but an event can also be in the form of a thought or image that runs through your mind. Be concrete and specific; don’t write something overly general such as “I hate my work. Refer to The Thought Query Quiz in Chapter 4 if you experience any difficulty figuring out your thoughts about the event. Review your thoughts and write down the thought or thoughts that evoke the great- est amount of emotion — your most malicious thoughts. Worksheet 6-6 My Thought Tracker Feelings & Sensations Corresponding Events Thoughts/Interpretations (Rated 1–100) Chapter 6: Indicting and Rehabilitating Thoughts 83 My most malicious thoughts: 1. In time, you’re likely to start changing the way you think and, therefore, the way you feel. Take a malicious thought and consider the Prosecutor’s Investigative Questions in Worksheet 6-3. After you put one thought on trial using the instructions that follow, proceed to put other malicious thoughts through the same process. In Worksheet 6-8, designate one of your most malicious thoughts as the accused thought and write it down. In the left-hand column, write all the reasons, evidence, and logic that support the truth of your accused thought. In the right-hand column, write refutations of all the reasons, evidence, and logic presented by the defense. After all, you need to use the Thought Court method numerous times to feel the full benefit. After you complete the Thought Court process, decide for yourself whether or not your thought is guilty of causing you unneeded emotional distress such as anxiety, depression, or other difficult feelings. Even if you conclude that your thought has some grain of truth, you’re likely to discover that it’s highly suspect of causing you more harm than good. In Thought Court, you don’t judge your thought guilty only on the basis of “beyond a reason- able doubt. Reviewing more Thought Court cases To help you understand Thought Court better, this section contains a few more examples. Because the Thought Tracker also appears in Chapters 4 and 5, we start with the accused thought here, which comes from the most malicious thoughts at the end of a Thought Tracker (see “Putting your thoughts on trial”). Connor: Doomed to unhappiness Over the years, Connor, a 58-year-old high school teacher, became an avid outdoorsman, spending his summer vacations camping, fishing, and hiking. Although his arthritis has been getting progressively worse, Connor has tried to ignore the pain. His doctor refers him to an orthopedic specialist who tells Connor he needs a hip replacement. He fills out some Thought Trackers and zeroes in on a malicious thought: “I’ll never be happy again. Chapter 6: Indicting and Rehabilitating Thoughts 85 Worksheet 6-9 Connor’s Thought on Trial Worksheet Accused thought: I’ll never be happy again — life will just be a downhill slide from here. Defending the Thought Prosecuting the Thought This hip replacement is just Many people get hip replacements without the beginning of the end.

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The individual has been living in the of sepsis (often with gram-negative bacteria carried United States for 20 years but grew up in with the larvae as they penetrate the intestinal Central America discount 100mg voveran sr mastercard spasms after hemorrhoidectomy. Patients who become immunosuppressed causing these symptoms is: may see the life cycle of Strongyloides reactivated A order 100mg voveran sr visa muscle relaxant injections. Trypanosoma brucei rhodesiense with serious illness resulting; this can occur many B. Schistosoma japonicum Microbiology/Apply knowledge of fundamental life cycles, pathogenesis, and immunosuppressives/ Parasitology/3 7. An oligonucleotide with a large number of done by breaking the hydrogen bonds between base repeating C-G-C codons pairs. D Restriction endonucleases are enzymes that cut a binding site for a restriction endonuclease? The point mutation changes an A to a T within the restriction site, causing loss of the normal-sized fragment. Cloning a human gene into a bacterium in order Answers to Questions 3–5 to make a large molecular probe requires which vector? The recombinant plasmid is added to a culture produce a fluorescent or chemiluminescent signal? Commercially available plasmids have terminal ends of the probe promoter and reporter genes such as lac and lacZ B. These can be used to nucleotides into the probe identify colonies with successful recombinants. Splicing the gene for β-galactosidase into the also carry antibiotic resistance genes that allow the probe recombinants to be purified. Heat denaturation of the probe followed by acid recombinant bacteria results in large amounts of the treatment gene, which can be harvested using the restriction Molecular/Apply principles of special procedures/ enzyme, denatured, and labeled to make the probe. After washing to remove unbound streptavidin, a colorimetric, fluorescent, or chemiluminescent substrate is added. D Mosaicism occurs when cells within the same individual contain different numbers of chromosomes and results from nondisjunction during early embryonic development. Chimeras are molecules created when translocation occurs between genes (exons) on different chromosomes. A Each phosphoric acid subunit within a phosphodiester separated by agarose gel electrophoresis. Since the charge is distributed evenly, smaller fragments move more rapidly through the gel. If the distance traveled is plotted against the log of molecular weight, the plot will be a straight line with a negative slope because the larger the molecule, the more slowly it moves through the pores of the gel. It is frequently added to molten agarose or capillary electrophoresis buffer at a A. Ethidium bromide is the binding of the complementary base sequence Molecular/Apply principles of basic laboratory of the probe to the target sequence. Which of the following types of mutation causes Answers to Questions 9–11 the premature termination of protein synthesis? D The human genome contains approximately 3 billion base pairs and approximately 25,000 genes. They are subject to selection pressures that cause genes to drift in the population. Over 350,000 such differences are present in the human genome, but very few are associated with human disease. Which of the following is the most common type Answers to Questions 12–13 of polymorphism? The sequence can repeat 3 to Molecular/Apply principles of special procedures/ 14 times, resulting in 12 different alleles. Unlike conventional electrophoresis, a stationary support such as agarose is not used. Instead, a small-bore open tubular column is immersed in buffer solution at its ends and subjected to an electric field. The negative nature of the glass capillary attracts cations that are pulled to the cathode when the voltage is applied.

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It can give quantitative results 100mg voveran sr with amex muscle relaxant without drowsiness, and valuable in establishing a diagnosis and in evaluating effect of treatment 2 buy discount voveran sr 100mg online muscle relaxant pregnancy category. Complement fixation test: Wasserman test; Kolmer test Principle: Reagin-containing sera (mixture of IgM and IgA) fix complement in the presence of “cardiolipin-cholestrol-lecithin complex” antigen. Add diluted serum containing antibody to the sensitized gelatin particle in a microdilution tray. Positive result when agglutination occurs Treatment: Penicillin Tetracycline Erythromycin Control measures: Treatment of cases and screen contacts Practice safe sex with condoms Health education 278 2. Tightly coiled, thin, flexible spiraled spirochetes forming one polared hooked ends. Grow best in semisolid (Fletcher’s or Stuart’s) media under O aerobic condition at 28-30 c. Fatty acid oxidation is major source of energy Antigenic structure: Lipopolysaccharide: Determine the specificity of human immune response to the organism and serologic classification of leptospirae Pathogenesis and clinical features: Essentially zoonotic infection and humans are accidental host Source of infection is contaminated foood and water with leprospia spp. Obligate intracellular pleomorphic gram-negative coccobacilli occurring in single, pairs, short rods and filaments. Antigenic structure: Group-specific antigens Species-specific antigens Clinical Features: Clinical illness is due to the invasion and multiplication of rickettsiae in the endothelial cells of small blood vessels. It manifests with fever, headache, malaise, skin rash and enlargement of liver and spleen. Hosts and vectors of the medically important rickettsiae Organism Disease Hosts Vectors 1. It causes epidemic or louse-borne typhus and the milder recrudescence form, Brill-Zinser disease. Clinical Features: It is transmitted by self-inoculation of the organism by scratching after bite by infected louse(Pediculous humanus corporis and pediculous humanus capitis). The illness manifests with sudden onset of fever, headache, malaise, prostration and skin rash. Epidemics of the disease are associated with overcrowding, cold weather, lack of washing facilities and fuel, famine and war. The disease is milder than louse-borne typhus and occurs in those individuals living or working in highly rat-infested area. Laboratory diagnosis: Specimen: Serum for serological tests The serological tests to diagnose typhus are: 1. The smallest living micro-organism capable of free living in nature self-replicating on laboratory media. Highly pleomorphic due to absence of rigid cell wall, instead bounded by a triple-layered “unit membrane”. Have enzyme systems and make their own proteins, lipids, nucleic acids and vitamins. The elementary body is reorganized into reticulate body in the host cell which is specifically adapted for intracellular growth. The reticulate body grows and divides many times to form inclusions in the host cell cytoplasm. With in 24-48 hours of developmental cycle, the reticulate bodies rearrange them selves into infective elementary bodies and released after host cell rupture. Antigenic structure: Group-specific antigen Species-specific antigen Chlamydia trachomatis. Appearance in giemsa’s stain Elementary body -------- Purple Reticulate body---------- Blue Host cell cytoplasm----- Blue. Appearance in iodine stain Brown inclusions in host cell cytoplasm because of glycogen matrix surrounding the particle. Incubation period is 3-10 days Route of transmission is through indirect contact like eye-to- eye by infected fingers or sharing towels. It manifests as a chronic keratoconjunctivitis producing scarring and deformity of the eyelids, corneal vascularization and opacities which may lead to blindness. Laboratory diagnosis: Specimen: Conjunctival scraping from upper tarsal conjunctivae.

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If allowed to progress without treatment purchase 100 mg voveran sr with amex spasms 1983, the swelling can become more difficult to manage purchase 100 mg voveran sr with visa spasms when urinating. Hematoma or Seroma Formation Hematoma formation (collection of blood inside the cavity) may occur after either mastectomy or breast conservation and usually develops within the first 12 hours after surgery. The nurse assesses for signs and symptoms of a hematoma at the surgical site, which may include swelling, tightness, pain, and bruising of the skin. The surgeon should be notified immediately for gross swelling or increased bloody output from the drain. The patient may take warm showers or apply warm compresses to help increase the absorption. A seroma, a collection of serous fluid, may accumulate under the breast incision after mastectomy or breast conservation or in the axilla. Signs and symptoms may include swelling, heaviness, discomfort, and a sloshing of fluid. Seromas may develop temporarily after the drain is removed or if the drain is in place and becomes obstructed. Seromas rarely pose a threat and may be treated by unclogging the drain or manually aspirating the fluid with a needle and syringe. Large, long-standing seromas that have not been aspirated could lead to infection. Small seromas that are not bothersome to the patient usually resolve on their own. Hand and Arm Care After Axillary Lymph Node Dissection Avoid blood pressures, injections, and blood draws in affected extremity. This risk may be higher in patients with accompanying conditions such as diabetes, immune disorders, and advanced age, as well as in those with poor hygiene. Patients are taught to monitor for signs and symptoms of infection (redness, warmth around incision, tenderness, foul- smelling drainage, temperature greater than 100. Promoting Home and Community-Based Care Teaching Patients Self-Care Patients who undergo breast cancer surgery receive a tremendous amount of information preoperatively and postoperatively. It is often difficult for the patient to absorb all of the information, partly because of the emotional distress that often accompanies the diagnosis and treatment. Teaching may need to be reviewed and reinforced to ensure that the patient and family are prepared to manage the necessary home care. The nurse reiterates symptoms the patient should report, such as infection, seroma, hematoma, or arm swelling. Initially, the drainage fluid appears bloody, but it gradually changes to a serosanguineous and then a serous fluid over the next several days. If the patient lives alone and drainage management is difficult for her, a referral for a home care nurse should be made. The drains are usually removed when the output is less than 30 mL in a 24-hour period (approximately 7 to 10 days). Generally, the patient may shower on the second postoperative day and wash the incision and drain site with soap and water to prevent infection. If immediate reconstruction has been performed, showering may be contraindicated until the drain is removed. The patient should know that sensation may be decreased in the operative area because the nerves were disrupted during surgery, and gentle care is needed to avoid injury. After the incision has completely healed (usually after 4 to 6 weeks), lotions or creams may be applied to the area to increase skin elasticity. The patient can begin to use deodorant on the affected side, although many women note that they no longer perspire as much as before the surgery. Range of motion exercises are initiated on the second postoperative day, although instruction often occurs on the first postoperative day. The goals of the exercise regimen are to increase circulation and muscle strength, prevent joint stiffness and contractures, and restore full range of motion. The patient is instructed to perform range of motion exercises at home 3 times a day for 20 minutes at a time until full range of motion is restored (generally 4 to 6 weeks). Most patients find that after the drain is removed, range of motion returns quickly if they have adhered to their exercise program.

In certain rare circumstances such antibodies may also harm the child cheap voveran sr 100mg fast delivery spasms under left rib, for instance when they are directed against epitopes expressed by the child’s own tissues which the mother has reacted against immunologically (the most important clinical example of this is rhesus factor incompatibility) buy voveran sr 100mg with mastercard esophageal spasms xanax. High concentrations of IgA antibodies are found in the intestinal tract and contents, saliva, bronchial and nasal se- cretions, and milk—where they are strategically positioned to intercept infec- tious pathogens (particularly commensals) (Fig. IgE antibodies bind to high-affinity Fce receptors present on basophilic granulocytes and mast cells. Cross-linking of mast cell bound IgE antibodies by antigen results in cellular degranulation and causes the release of highly active biogenic amines (his- tamine, kinines). IgE antibodies are produced in large quantities following parasitic infestations of the intestine, lung or skin, and play a significant role in the local immune response raised against these pathogens. This probably enhances Tcell-dependent activation of IgA-producing B cells, which are preferentially recruited to the mucosal regions (“homing”) via local adhesion molecules and antigen depots, resulting in a type of geographic specificity within the immune response. The diversity of T-cell receptors is also achieved by means of genetic rearrangement of V, D, and J segments (Fig. However, the T-cell receptor is never secreted, and instead remains membrane-bound. Each T-cell receptor consists of two transmembrane chains, of either the a and b forms, or the c and d forms (not to be confused with the heavy Kayser, Medical Microbiology © 2005 Thieme All rights reserved. Usage subject to terms and conditions of license 58 2 Basic Principles of Immunology chains of Ig bearing the same designations). Both chains have two extracel- lular domains, a transmembrane anchor element and a short intracellular ex- tension. Instead the T-cell re- ceptor can only recognize its specific epitope once the antigen has been cleaved into shorter peptide fragments by the presenting cell. The T-Cell System 59 immunological rejection of cell transfusions or tissue and organ transplants. Its true function as a peptide-presenting molecule was not discovered until the seventies, when its role became apparent whilst testing the specificity of virus-specific cytotoxic Tcells. These molecules consist of a heavy a chain with three Ig-like polymorphic domains (these are encoded by 100–1000 alleles, with the a1 and a2 domains being much more polymorphic than the a3 do- main) and a nonmembrane-bound (soluble) single-domain b2 microglobulin (b2M, which is encoded by a relatively small number of alleles). Additional, non- classical, class I antigens which exhibit a low degree of polymorphism are also present on lymphohematopoietic cells and play a role in cellular differ- entiation. These are made up by two different polymorphic transmembrane chains that consist of two domains each (a1 is highly poly- morphic, whilst b1 is moderately polymorphic, and b2 is fairly constant). Usage subject to terms and conditions of license The T-Cell System 61 Presentation of Endogenous and Exogenous Antigens 2 Fig. Antigens taken up from exogenous sources (right) are cleaved into peptides within phagosomes. Usage subject to terms and conditions of license 62 2 Basic Principles of Immunology length. The complex mechanisms involved in this process have not yet been fully delineated. The term “trans- plantation antigens” is therefore a misnomer, and is only used because their real function was not discovered until a later time. T-Cell Maturation: Positive and Negative Selection Maturation of Tcells occurs largely within the thymus. The random processes governing the genetic generation of an array of T-cell receptors results ab or cd receptor chain combinations which are in the majority of cases are non-functional. However, recent experiments have shown that this is 2 probable an experimental artefact and that it is not (or not solely) the thymic epithelial cells that determine the selection process, but that this process is driven by cells formed in the bone marrow. Thus, only Tcells with moderate binding affinities are allowed to mature and exit the thymus. The enormous proliferation of immature thymocytes is paralleled by continuous cell death of large numbers of thymocytes (apop- tosis, see summary in Fig. In general, the maturation and survival of lymphocytes is considered to be dependent on a continuous, repetitive, signaling via transmembrane molecules, and cessation of these signals is usually taken as a reliable indicator of cell death. They are also called T helper cells due to their important role in T-B cell col- laboration (Fig. Although these cells sometimes demonstrate an ability to cause cytotoxic destruction in vitro, this does not hold true in vivo. These cells are also known as cytotoxic T cells due to their ability to destroy histocompatible virus-infected, or otherwise altered, target cells as well as allogeneic cells. Costimulatory molecules are not required for this lytic Kayser, Medical Microbiology © 2005 Thieme All rights reserved.

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The degradation processes possibly occurring after this time are not taken into account cheap voveran sr 100 mg mastercard spasms with fever. Accurate mass determination and calculated elemental composition data can be used for structure elucidation purchase voveran sr 100mg otc spasms while pregnant. The new identified products indicate that currently applied methods are likely to underestimate the residue levels of ceftiofur and cefapirin found in kidney samples. Furthermore, this research resulted in a new approach for the quantitative analysis of ceftiofur, cefapirin and other cephalosporins in tissue. Preparation of kidney extract A blank bovine kidney sample was defrosted and homogenised at room temperature, after which 5 g was transferred to a 50 mL test tube. The gradient (mobile phase A, 0,05 % ammonia in water, pH adjusted to 8 with acetic acid; mobile phase B, 0. The instrument was operated in the positive W-mode (resolution ≥ 10,000) and was calibrated spanning a range of 90 to 1050 using a solution of sodium formate in 2- propanol to obtain a mass error below 5 ppm. A solution of 1 µg mL leucine-enkephalin in -1 water/acetonitrile (1:2), infused at a flow rate of 10 µL min was used as a reference, resulting in a lock mass of m/z = 557. The reference scan frequency was set at 10 scans, the reference cone voltage at 20 V and the reference aperture 1 voltage at 8. Stock solutions were diluted to 200 ng mL in water of which 20 mL was transferred to a test tube and placed into a Julabo 25 water bath (Julabo, Seelbach, Germany) set at a temperature of 37 °C. Stock solutions were diluted in each of the phosphate buffer -1 solutions to obtain 10 µg mL solutions at different pHs in the range of 2. After 0, 30, 60, 120 and 180 minutes at room temperature, 100 µL of these solutions was combined with 4. The compounds were considered unstable when the peak intensity decreased over 10 %. A separation was established using an X-Bridge C18 analytical column, 150 x 3 mm, 5 µm (Waters). Both solutions and pure methanol were diluted tenfold in water to obtain solutions containing 10 % methanol after which 2 mL was transferred to different test tubes in duplicate, resulting in two identical sets, each set consisting of one blank tube, one containing 100 µg cefapirin, and one containing 200 µg ceftiofur. The different fractions of each of the 20 injections were combined in test tubes resulting in 4 mL fractions. This software aligned chromatograms of the blank solution with the chromatograms of the ceftiofur and cefapirin spiked solutions, after which the differences between the two sets of chromatograms were determined. This procedure resulted in chromatograms containing accurate mass full scan data showing mainly degradation products. For each degradation product, the most likely molecular formulas was selected, using the elemental composition option in MassLynx 4. The molecular formula of the degradation products was determined with a high certainty because ceftiofur and cefapirin contain sulfur atoms having a very specific isotope [M+2] and several nitrogen atoms. Before Fourier transformation and phasing, a 1/3 shifted sine squared window multiplication was applied and a zero-filling to 128 K data points were applied. Antimicrobial activity becomes visible as a zone of growth inhibition around the paper disk. Kinetics The kinetic experiment was carried out for ceftiofur and cefapirin separately. Nothing further was added to the first test tube, 5 mL kidney extract was added to the second test tube, 125 µL 25 % ammonia was added to the third test tube and 5 mL kidney extract and 125 µL 25 % ammonia were added to the fourth test tube. From the data obtained, the formation of the degradation products was studied in a qualitative way using the MetAlign Software. In the figures displaying kinetic results the highest signal obtained is set at 100 % and all other signals are related to this without suggesting a quantitative relation exists. The corresponding retention times and molecular formulas are presented in table 5. Because of the lack of reference standards for the proposed degradation products, none of these structures can be considered as 100 % identified.

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