Introduction: Biochemical recurrence after radical prostatectomy has been associated with Gleason pattern 5(GP5) and Prostatic
Specifi c Antigen (PSA) is a sensitive marker of relapse. Was analyzed the correlation between the Gleason score 7(group 2 e 3), pattern Gleason 5, biochemical recurrence and its correlation with other adverse histological findings. Material and Methods: Historic cohort comprising 219 patients, subjected to score 7 radical prostatectomy with acinar adenocarcinoma. and GP5 represents 5% or less of tumor size. Recurrence was determined as postoperative PSA less or equal 0.2/ ml in the second postprostatectomy assessment. Were considered as signifi cant value of p < or equal to 0,005. All statistical analysis were conducted using the SPSS (SPSS Inc: released 2009, version 18.0, Chicago, IL, USA).
Describes the changes made over years in the management of advanced renal cell carcinoma with special focus on re-empowering of the concept of immunotherapy
Describes the changes made over years in the management of advanced renal cell carcinoma with special focus on re-empowering of the concept of immunotherapy
Ohio State's ASH Review 2017 - Benign HematologyOSUCCC - James
Spero R. Cataland, MD
Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Adrenocortical carcinoma (ACC) is a relatively rare malignancy with an estimated incidence of 0.7-2.0 per 1 million population per year showing two distinct age peaks in early childhood and in the 4th-5th decade of life. Most cases of ACCs are sporadic but can also occur in association with several hereditary syndromes, including Li-Fraumeni, Beckwith-Wiedemann, multiple endocrine neoplasia (MEN) 1, congenital adrenal hyperplasia, familial polyposis coli, and germline β-catenin or p53 mutations. Patients with ACC present with either symptoms due to hormone hypersecretion or manifestations of tumor mass effect, although an increasing percentage is discovered as incidentalomas during abdominal imaging.
We report a series of 10 patients with thalamic high HGGs with extensive clinical, neuro-radiological, and pathologic analyses. Moreover, we attempted to correlate survival with some of the clinical data and reviewed the literature with regards to the management of thalamic HGGs.
Comparative analysis of primary repair vs resection and anastomosis, with lap...Enrique Moreno Gonzalez
The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
The modified Glasgow prognostic score in prostate cancer: results from a retr...Enrique Moreno Gonzalez
As the incidence of prostate cancer continues to rise steeply, there is an increasing need to identify more accurate prognostic markers for the disease. There is some evidence that a higher modified Glasgow Prognostic Score (mGPS) may be associated with poorer survival in patients with prostate cancer but it is not known whether this is independent of other established prognostic factors. Therefore the aim of this study was to describe the relationship between mGPS and survival in patients with prostate cancer after adjustment for other prognostic factors.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...JohnJulie1
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Ohio State's ASH Review 2017 - Benign HematologyOSUCCC - James
Spero R. Cataland, MD
Professor of Clinical Internal Medicine
The Ohio State University Comprehensive Cancer Center -
Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
Adrenocortical carcinoma (ACC) is a relatively rare malignancy with an estimated incidence of 0.7-2.0 per 1 million population per year showing two distinct age peaks in early childhood and in the 4th-5th decade of life. Most cases of ACCs are sporadic but can also occur in association with several hereditary syndromes, including Li-Fraumeni, Beckwith-Wiedemann, multiple endocrine neoplasia (MEN) 1, congenital adrenal hyperplasia, familial polyposis coli, and germline β-catenin or p53 mutations. Patients with ACC present with either symptoms due to hormone hypersecretion or manifestations of tumor mass effect, although an increasing percentage is discovered as incidentalomas during abdominal imaging.
We report a series of 10 patients with thalamic high HGGs with extensive clinical, neuro-radiological, and pathologic analyses. Moreover, we attempted to correlate survival with some of the clinical data and reviewed the literature with regards to the management of thalamic HGGs.
Comparative analysis of primary repair vs resection and anastomosis, with lap...Enrique Moreno Gonzalez
The objective is to compare primary repair vs intestinal resection in cases of intestinal typhoid perforations. In addition, we hypothesised the usefulness of laparostomy for the early diagnosis and treatment of complications.
The modified Glasgow prognostic score in prostate cancer: results from a retr...Enrique Moreno Gonzalez
As the incidence of prostate cancer continues to rise steeply, there is an increasing need to identify more accurate prognostic markers for the disease. There is some evidence that a higher modified Glasgow Prognostic Score (mGPS) may be associated with poorer survival in patients with prostate cancer but it is not known whether this is independent of other established prognostic factors. Therefore the aim of this study was to describe the relationship between mGPS and survival in patients with prostate cancer after adjustment for other prognostic factors.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...JohnJulie1
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...EditorSara
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...NainaAnon
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...EditorSara
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...eshaasini
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
Benefit of Serum-Thymidine Kinase 1 Concentration for Risk Assessment from Ga...semualkaira
Human Thymidine kinase 1 (hTK1), a key enzyme involved in the DNA synthesis during S-phase of the cell cycle and upregulation of cell proliferation, thus it is reliable tumor proliferating biomarker for assessment of tumor proliferation rate in serum and in tissue in oncology. This meta-analysis is investigation whether the serum TK1 concentration(STK1p)based on hTK1-IgY-polyclonal-antibody can provide a benefit for risk assessment from gastric neoplasm progression to gastric carcinoma (GC) as well as for evaluation of treatment effect in GC.
EAU - Guidelines on Prostate Cancer dr. ali mujtabaDr Ali MUJTABA
EAU - Guidelines on Prostate Cancer Organ Confined by Dr. Ali Mujtaba, Sindh Institute of Urology and Transplantation (SIUT)
https://www.youtube.com/watch?v=kXX9ItF4as4
https://www.youtube.com/watch?v=0m4YUI6Rr5w
Similar to American Journal of Clinical Anatomy & Physiology (20)
A 5-year old boy, with an established diagnosis of a topic
dermatitis, previously treated by topical corticosteroids and emollient cream with a good improvement, developed widespread papules on his legs, hands and forearm that appeared 5 months ago.
Methods: Retrospectively, the file records of the patients who underwent sleeve gastrectomy were examined. Demographic features, Body Mass Index (BMI), the mouth opening, Mallampati score, thyromental distance, sternomental distance, neck circumference measurements and videolaryngoscopic examination results were recorded Results: In a total of 140 consecutive patients (58 male, 82 female) were included in the study. The mean age of the study participants was 35.40 ± 9.78 and the mean BMI of the patients was 44.33 ± 7.52 kg/m2
. The mean mouth opening of the patients was 4.82 ± 0.54 cm
and the mean neck circumference was 43.52 ± 4.66 cm. The mean thyromental distance was 8.02 ± 1.00 cm and the mean sternomental distance was16.58 ± 1.53 cm. Difficult intubation was determined in 8 (5.7%) patients. In logistic regression analysis, age (p : 0.446), gender (p : 0.371), BMI (p : 0.947), snoring (p : 0.567), sleep apnea (p : 0.218), mouth opening (p : 0.687), thyromental distance (p :0.557), sternomental (p : 0.596) and neck circumference (p : 0.838) were not the independent predictors of difficult intubation. However, Mallampati score (p : 0.001) and preoperative direct laryngoscopy findings (p : 0.037) performed in outpatient clinic were the significant
predictors of difficult intubation. Interestingly, all patients with grade 4 laryngoscopy findings had difficult intubation.
Introduction: Laparoscopic surgery has been performed in Mexico since 1989, but no reports about training tendencies exist. We conducted a national survey in 2015, and here we report the results concerning training characteristics during the surgical residence of the respondents. Materials and Methods: A prospective study was conducted through a survey questioning demographic data, laparoscopic training during pre and post surgical residency and other of areas of laparoscopic practice. The sample was calculated and survey piloted before
application. Special interest in this report was placed on type and quality of training received. Data are reported in percentages.
Heterotopic Ossification (HO) is defined as pathological bone formation at locations where bone normally does not exist. The
presence of HO has been found to be a rare complication after stroke in several studies, whereas there are only sporadic references relating HO to Cerebral Palsy (CP) and few for CP and stroke. No effective treatment for HO has yet been found, whereas the cellular and molecular mechanisms have not been completely understood. Therefore, increased awareness among physicians is required, as a challenge for early diagnosis and treatment. A case of a male patient with CP, who developed HO on the paretichip joint following an ischemic stroke is presented.
Objectives: To assess the practice of food hygiene and safety, and its associated factors among street food vendors in urban areas of Shashemane, West Arsi Zone, Oromia Ethiopia, 2019.
Methods: Cross-sectional study design was applied from December 28, 2019 to January 27, 2020. Data was collected from 120 food handlers, which were selected by purposive sampling techniques. Information was gathered from interview and field observation by conducting food safety survey and using questionnaires via face to face interview. The collected data was entered using Epi Data 3.1 and finally, it was analyzed using SPSS VERSION 20.
A Division I football athlete experienced acute posterior leg pain while pushing off on the line of scrimmage. Ultrasound (US) showed a midsubstance plantaris tendon rupture, an injury that, to our knowledge, has only been described once before in the medical literature [1]. US was also used to assist with rehab progression and return to previous level of activity, which was achieved three weeks after the injury. While there currently are no guidelines regarding return to sport after this injury, this case demonstrates that once pain is controlled and ROM restored, progression through rehabilitation and return to elite level sport is simply based on symptoms.
Type 1 Diabetes (T1D), is a severe disease, representing 5-10% of all reported cases of diabetes worldwide. Fulminant Type 1 Diabetes Mellitus (FT1D) is a subtype of type 1 diabetes mellitus that is largely characterized by the abrupt onset of Diabetic Ketoacidosis (DKA) and severe hyperglycemia without insulin defi ciency. Viral infections have been hypothesized to play a major role in the pathogenesis of Fulminant Type 1 Diabetes Mellitus (FT1D) through the complete and rapid destruction of pancreatic beta cells. Coxsackie viral infection has been detected in islets of 50% of the pancreatic tissue recovered from recent-onset Type 1 Diabetes (T1D) patients. In this report we have highlighted a case where the patient developed a Group B Coxsackie virus infection culminating in the development of Fulminant Type 1 Diabetes Mellitus (FT1D).
Methods: Cercariae are released by infected water snails. To determine the occurrence of cercariae-emitting snails in SchleswigHolstein, 155 public bathing places were visited and searched for fresh water snails. Family and genus of the collected snails were determined and the snails were examined for the shedding of cercariae, using a standard method and a newly developed method.
Objective: To generate preliminary information about of enteroviruses and Enterovirus 71 (EV71) in patients with aseptic meningitis in Khartoum State, Sudan.
Method: Cerebrospinal fluid specimens were collected from 89 aseptic meningitis patients from different Khartoum Hospitals
(Mohammed Alamin Hamid Hospital, Soba Teaching Hospital, Omdurman Military Hospital, Alban Gadeed Teaching Hospital and Police Hospital) within February to May 2015. Among these 89 patients, 43 (48%) were males and 46 (52%) were females. The patient’s age ranged between 1 day and 30 years old. The collected specimens were assayed to detect enteroviruses and EV71 RNA using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) technique
Femoral hernias, comprise 2% to 4% of all hernias in the inguinal region, and occur most commonly in women. Th ey present typically with a mass below the level of the inguinal ligament. The sac may contain preperitoneal fat, omentum, small bowel, or other structures and have a high rate of incarceration and strangulation due to the small size of the hernia neck orifice, requiring emergency surgery. We present the case of a 54-year-old female patient with intestinal occlusion due to incarcerated femoral hernia, repaired by laparoscopic approach, that gave the patient the opportunity to attend her daughter’s wedding the same day.
Small Supernumerary Marker Chromosome (sSMC) is a rare genetic condition marked by the presence of an extra chromosome to the 46 human chromosomes. This case report describes a 4 year old child with SSMC on the 46th chromosome. The child presented with delayed speech and language development, seizures and mild developmental delay. Speech and Language evaluation was carried out and management options are discussed.
A catheter is a thin tube made from medical grade materials that serve a broad range of functions, but mainly catheters are medical devices that can be inserted in the body to treat disease or perform surgical procedures. Catheters have been inserted into body cavities, ducts, or vessels to allow for drainage, administration of therapeutic fluids or gases, operational access for surgery. Catheters help perform tasks in various systems such as cardiovascular, urological, gastrointestinal, neurovascular, and ophthalmic systems. A dataset of 12 patients with varying “weights” and “heights” was recorded along with the lengths of their catheter tubes. This data set was found from two revered statistical textbooks on linear regression and the Department of Scientific Computing at Florida State University. This data set was not able to be linked to any particular clinical or experimental research studies, but the data set can be used to help catheter manufacturers and medical professionals better decide on what particular catheter lengths to use for patients knowing only their height & weight. These research insights could be helpful to healthcare professionals that have patients with incomplete or no healthcare records
to decide what catheter length to use. The main investigative inquiry that needed to be answered was how does patient weight & height influence catheter length together and separately? We conducted linear regression and other statistical analysis procedures in R program & Microsoft Excel and discovered that this data exhibited a quality called multi collinearity. With multi collinearity, all predictors (2 or more
independent variables) are not significant in an all encompassing linear aggression, but the predictors might be significant in their own individual linear regressions. Individual linear regression analyses were conducted for both patient height & weight to see how much they both contribute to varying catheter length. Patient weight was found to be more impatful than patient height in relationship to catheter length, even though height and weight are a classical example of multi collinearity predictors.
Bovine mastitis has a negative impact through economic losses in the dairy sector across the globe. A cross sectional study was carried out from September 2015 to July 2016 to determine the prevalence of bovine mastitis, associated risk factors and isolation of major causative bacteria in lactating dairy cows in selected districts of central highland of Ethiopia. A total of 304 lactating cows selected randomly from five districts were screened by California Mastitis Test (CMT) for subclinical mastitis. Based on CMT result and clinical examination, over all prevalence of mastitis at cow level was 70.62% (214/304).
Two hundred fourteen milk samples collected from CMT positive cows were cultured for isolation of major causative bacteria. From 214 milk samples,187 were culture positive and the most prevalent isolates were Staphylococcus aureus 42.25% (79/187) followed by Streptococcus agalactiae 14.43%
(27/187). Other bacterial isolates were included Coagulase Negative Staphylococcus species 12.83% (24/187), Streptococcus dysgalactiae 5.88% (11/187), Escherichia coli 13.38% (25/187) and Entrococcus feacalis 11.23% (21/187) were also isolated. Moreover, age, parity number, visible teat abnormalities,husbandry practice, barn fl oor status and milking hygiene were considered as risk factors for the occurrence of bovine mastitis and they were found significantly associated with the occurrence of mastitis (p < 0.05). The findings of this study warrants the need for strategic approach including dairy extension that focus on enhancing dairy farmers’ awareness and practice of hygienic milking, regular screening for subclinical mastitis, dry cow therapy and culling of chronically infected cows.
Kratom is an herbal product that is derived from Southeast Asian Mitragyna speciose tree leaves [1-10]. This compound is used for many purposes such as stimulation, euphoria, or analgesia [1-10]. It has been recently identified as a drug of abuse by the United States Drug Enforcement Administration [2,8]. Side-effects from this compound have not been well documented. We describe a case of a 36-year-old female who develop nephrotoxicity after taking an herbal supplement. She took kratom as an adjunctive therapy for back pain management. She developed right upper quadrant pain and nausea. Laboratory tests showed elevated liver enzymes without evidence of bile duct obstruction. Liver enzymes normalized several weeks after Kratom discontinuation. We advise clinicians to be vigilant about Kratom’s hepatotoxic potential on patient health.
The assessment, diagnosis and treatment of critically ill patients is extremely challenging. Patients often deteriorate whilst being
reviewed and their rapidly changing pathophysiology barrages healthcare professionals with new data. Furthermore, comprehensive assessments must be postponed until the patient has been stabilised. So, important data and interventions are often missed in the heat of the moment. In emergency situations, suboptimal management decisions may cause signifi cant morbidity and mortality. Fortunately, standardisation and careful design of documentation (i.e. proformas and checklists) can enhance patient safety. So, I have developed a series of checklist proformas to guide the assessment of critically ill patients. These proformas also promote the systematic recording and presentation of information to facilitate the retrieval of the precise data required for the management for critically ill patients. The proformas have been modifi ed extensively over the last twenty years based on my personal experience and extensive consultation with colleagues in several world-renowned centres of excellence. The proformas were originally developed for use in the intensive therapy unit
or high dependency unit. However, they have been adapted for use by outreach teams reviewing patients admitted outside of critical care areas. The use of these tools can direct eff orts to provide appropriate organ support and provides a framework for diagnostic reasoning.
Systemic Hypertension (HTN) accounts for the largest amount of attributable Cardiovascular (CV) mortality worldwide. There are several factors responsible for the development of HTN and its CV complications. Multicenter trials revealed that risk factors responsible for Micro Vascular Disease (MVD) are similar for those attributable to Coronary Artery Disease (CAD) which include tobacco use, unhealthy cholesterol levels, HTN, obesity and overweight, physical inactivity, unhealthy diet, diabetes, insulin resistance, increasing age and genetic predisposition. In addition, the defective release of Nitric Oxide (NO) could be a putative candidate for HTN and MVD. This study reviewed the risk stratification of hypertensive population employing cardiac imaging modalities which are of crucial importance
in diagnosis. It further emphasized the proper used of cardiac imaging to determine patients at increased CV risk and identify the management strategy. It is now known that NO has an important effect on blood pressure, and the basal release of endothelial Nitric Oxide (eNOS) in HTN may be reduced. Although there are different forms of eNOS gene allele, there is no solid data revealing the potential role of the polymorphism of the eNOS in patients with HTN and coronary vascular diseases. In the present article, the prevalence of eNOS G298 allele in hypertensive patients with micro vascular angina will be demonstrated. This review provides an update on appropriate and justified use of non-invasive imaging tests in hypertensive patients and its important role in proper diagnosis of MVD and CAD. Second, eNOS gene allele and its relation to essential hypertension and angina pectoris are also highlighted.
Methods: Two groups were selected by non-probability random sampling technique including case group of 154 patients with
suspected dengue (fever>2days and <10days) and control group of 146 patients with febrile illness other than dengue. Clinical,hematological and serologic markers of cases and control groups were analyzed. The frequency distribution was used to compare categorical serologic markers and paired sample T test was applied for hematologic variables before and after treatment of dengue using SPSS version 21.
Researchers from Utrecht recently published yet another paper on the use of Magnetic Resonance Imaging (MRI)demonstrating an additional failed attempt to understand the importance of qualitative versus quantitative imaging, and anatomic versus physiologic imaging. Th e implications of this failure here cannot be overstated.
Introduction: Stroke is an even more dramatic major public health problem in young people. Goal of the study: Contribute to the knowledge of strokes in young people. Methodology: This was a retrospective study carried out over a period of 02 years (January 2017 to December 2018) including the files of patients aged 18 to 49 years hospitalized for any suspected case of stroke in the Neurology department of the University Hospital
Center of the Sino-Central African Friendship (CHUSCA) of Bangui.
Background: This report describes a unique case of a patient that developed psychotic symptoms believed to be secondary
to a tentorial meningioma with associated hydrocephalus. These psychotic symptoms subsequently abated with placement of a
ventriculoperitoneal shunt. Case description: 60-year-old female was admitted to an inpatient psychiatric facility on a psychiatric involuntary commitment petition due to progressive paranoia, homicidal ideation and psychosis. The work up showed a calcified six cm tentorial meningioma with associated hydrocephalus. The patient initially rejected treatment but later became amenable to placement of Ventriculoperitoneal Shunt
(VPS).
More from SciRes Literature LLC. | Open Access Journals (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 002
American Journal of Clinical Anatomy & Physiology
INTRODUCTION
Prostatic adenocarcinoma is the sixth most common type of
cancer in the world and second most prevalent in men. In Brazil the
number of new cases estimed for 2018 is 68,200 (Instituto Nacional
do Câncer) and the increased use of Prostatic Specific Antigen (PSA)
significantly increases the number of cases detected [1,2].
One of the most clinical application of serum prostatic antigen is
for detecting prostate cancer recurrence after radical prostatectomy.
Studies have demonstrated recurrence of disease in 15-44% of
patients [3].
In radical prostatectomy specimens, Gleason score 7 is among the
most commonly assigned scores for prostate carcinoma accounting
for 30%-50% of cases [4]. Nevertheless, Gleason score 7 tumors are
heterogeneous and the Gleason Pattern 5 (GP5) is associated with
biochemical relapse. The score of Gleason is especially important for
recurrence biochemical and survival, and the GP5 less or equal a 5
represents a small component of a more aggressive grade presenting
which is not included in the score but influence the disease prognoses.
The amount of GP5 increasing the final score by one point more [5-
7].
The International Society of Urological Pathology (ISUP 2016)
recommended that biopsy Gleason score by adding GP5 to the
primary grade [8].
The detection of PSA is a sensitive marks of biochemical relapse,
having been associated with other predictive factors for recurrence:
stage pathological, surgical margin, vesicles seminal invasion and
preoperative PSA [9,10].
To determine the correlation between the Gleason score7, GP5
less or equal a 5 and biochemical relapse free survival was analyzed
compared patients with GP5 and patients without GP5.
The aim of our study is to evaluate the importance of the tertiary
Gleason 5 standard for the post radical prostatectomy prognosis, to
determine the influence of pattern 5 on the patient’s evolution by
biochemical relapse and to characterize normograms with adverse
histological parameters: extra-prostatic invasion, seminal vesicles and
margins, and lymph node metastases.
MATERIAL AND METHODS
The study comprised a retrospective cohort and was conducted at
the Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital
Complex and the Faculdade de Ciências da Saude de Porto Alegre,
RS, Brazil, in the period from January 2000 to December 2005. A
total of 219 patients subjected to radical retropubic prostatectomy
diagnose with Gleason score 7 (3+4 and 4+3) conventional acinar
adenocarcinoma were reviewed. The presence of GP5 findings
was estimated as a percentual less than 5% of the tumor volume,
examined by two pathologists based on slides with hematoxilin-eosin
at magnification at 20x-40x. The recurrence status was determined
by the PSA test, considering the second dosing in the postoperative
period.
Patients who were followed by serial serum PSA concentration
was under the detection limit of a regular assay (less or equal 0.2 ng/
ml) in the post chirurgical. Relapse biochemical was assessed using
coxregressionwith95%confidenceintervalsandbiochemicalrelapse-
free survival by the Kaplan Meyer curve and Log Rank analysis.
Surgical time was defined as the time interval between the date of
surgery and the last serum specimen collected in the study for PSA
test or in the second post-prostatectomy assessment.
The categorical variables considered were surgical margins,
extraprostatic extension, seminal vesicle invasion, Gleason score,
preoperative PSA and GP5. Absolute and frequencies were used.
For the continuous variables such as age and PSA, men, median
and interquartile deviation were used.
Were considered as significant value of p < or equal to 0.005.
All statistical analysis were conducted using the SPSS (SPSS Inc:
released 2009, version 18.0, Chicago, IL, USA).
This research was approved by the committee of ethics and
research of the Federal University of Health Sciences of Porto
Alegre under opinion number 1128/ 10; cadastro 635/ 10. Follow the
guidelines for research on humans.
ABSTRACT
Introduction: Biochemical recurrence after radical prostatectomy has been associated with Gleason pattern 5(GP5) and Prostatic
Specific Antigen (PSA) is a sensitive marker of relapse. Was analyzed the correlation between the Gleason score 7(group 2 e 3), pattern
Gleason 5, biochemical recurrence and its correlation with other adverse histological findings.
Material and Methods: Historic cohort comprising 219 patients, subjected to score 7 radical prostatectomy with acinar adenocarcinoma
and GP5 represents 5% or less of tumor size. Recurrence was determined as postoperative PSA less or equal 0.2/ ml in the second post-
prostatectomy assessment. Were considered as significant value of p < or equal to 0,005. All statistical analysis were conducted using
the SPSS (SPSS Inc: released 2009, version 18.0, Chicago, IL, USA).
Results: Of Patients Gleason score 7 and follow-up PSA 25.9% showed GP5. These 38% had biochemical relapse and the five year
survival was 77.8%. Of 74.1% that not showed GP5 24.2% biochemical relapse with the five survival of 91.7%. In the bivariate analysis,
seminal vesicle invasion and preoperative PSA have statistical significance. In multiple cox regression GP5 was no longer significance
with of p 0. 57.
Discussion: Studies demonstrated risk of recurrence for patients with GP5. Identified correlation between biochemical relapse
and seminal vesicle invasion and preoperative PSA. GP5 has no impact as an independent predictive factor in the multivariate analysis
probably due to the size of the sample. The combination with others variables is necessary.
Keywords: Prostate adenocarcinoma; Gleason score; Biochemical recurrence
3. SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 003
American Journal of Clinical Anatomy & Physiology
RESULTS
The median age of the patients in the series was 65 years taking
into account the date prostatectomy, with standard deviation of 8,4.
Among the 219 patients with Gleason score 7 and follow-up
PSA, 42 (25.9%) showed Gleason pattern 5 and of these 38% had
experienced biochemical relapse, and 120 (74.1%) not showed GP5
and these, 24.2% had biochemical relapse. Were excluded 57 patients
after review of Gleason grade migration for 6 or 10.
A median PSA follow-up was 102 months.
Patients GP 5 was associated with biochemical relapse using the
cox regression calculation with risk at a HR = 1.83 (95% CI: 0.99-
3.38). Patients with GP5 had biochemical relapse in 32% dos cases
and 20.3% showed extra prostatic and seminal vesicle invasion.
The median follow-up for PSA was 59 months.
For patients with Gleason 5 standard, five-year survival was 77.8%
and, at 10 years, 43%, considering the Log Rank test with p 0.004.
Five-year survival in patients without GPT was 91.7% (figure 1).
In the bivariate analysis the categorical variables seminal vesicle
invasion at (p = .017) and Pre-operative PSA (p = 0.053) were
significant for biochemical relapse risk. The remaining variables in
the group did not have any significance for biochemical relapse risk:
Circumferential surgical margin (p = .34), urethral surgical margin (p
= .41), extra prostatic extension (p = .18).
In a multiple the cox regression a presence of a Gleason pattern 5
with p 0.57 was limited and therefore we can not state in our research
that it represents a predictive factor probably due to the size of the
sample.
DISCUSSION
The Gleason grading system introduced in the 1960 s is still used
nowadays by pathologists for grading prostatic cancer. However due
to tumor heterogeneity with variable degrees of differentiation and
the presence of Gleason pattern 5 confers more aggressive tumor it
has been associated with biochemical relapse [5,6].
The PSA is a sensitive marker of occult prostatectomy cancer
relapse. Because of tumor heterogeneity, a PSA relapse does not equal
a clinical relapse or death from prostate cancer [11,12].
Manystudieshavebeenperformedonspecimensofprostatectomy
and involving GP5 and PSA postoperative. Pan et al. demonstrated
that finding Gleason 4 or 5 had a 5 year biochemical relapse-free
survival of 19% while those without GP5 on survival rate of 70% [13].
Whittemore et al. [14] also demonstrated the existence of risk for
biochemical relapse for patients with GP5 in 5-10 years.
Similary, Trock et al. [15] evaluated the cohort of 3230 patient’s
including 373 with GP 5 que was associated a greater risk for
biochemical relapse.
Rasiah et al. [16] found that patients with Gleason 4+3 and GP5
had greater biochemical relapse in comparison with patients with
4+3 sem GP5. Sim et al. assessed 509 radical prostatectomies with
Gleason score 7 and 66 patients with GP.GP4 or 5 was an independent
predictive of biochemical failure [17,18].
To determine in our series the prognostic value of the Gleason
scoreandcorrelationbetweenGP5inGleasonscore7andbiochemical
relapse free survival was measured in series. In the bivariate analysis,
seminal vesicle invasion and preoperative PSA showed statistical
significance for biochemical recurrence. Based on the multivariate
statistical analysis, it said that GP5 has no impact as an independent
predictive factor and a combination with other variables is necessary.
Just like in other studies, it is important to list the limitations of
this historic cohort. The small sample size influences the accuracy of
the statistical analysis, in addition to retrospective study is susceptible
to potential selection. On the other hand we had variable PSA follow-
up time and difficulties in obtaining data: small sample size, especially
for TGP5, retrospective cohort study to potential selection errors,
variable PAS follow-up time and difficulties in obtaining data.
ACKNOWLEDGEMENT
This work was in part supported by a grand-aid-masters
scholarship from CAPES (Coordenação de Aperfeiçoamento de
Pessoal de Nível Superior).
REFERENCES
1. National Cancer Institute Jose Alencar Gomes da Silva. Estimate 2018:
incidence of cancer in Brazil. Rio de Janeiro Inca. 2018. https://goo.gl/
moXRRe
2. Hashine K, Yuasa A, Shinomori K, Shirato A, Ninomiya I, Teramoto N. Tertiary
Gleason pattern 5 and oncological outcomes after radical prostatectomy. Jpn
J Clin Oncol. 2011; 41: 571-576. https://goo.gl/XvC9ob
3. Boorjian SA, Karnes RJ, Crispen PL, Carlson RE, Rangel LJ, Bergstralh EJ,
et al. The impact of positive surgical margins on mortality following radical
prostatectomy during the prostate specific antigen era. J Urol. 2010; 183:
1003-1009. https://goo.gl/DQV3Yx
4. Hattab EM, Koch MO, Eble JN, Lin H, Cheng L. Tertiary Gleason pattern 5
is a powerful predictor of biochemical relapse in patients with Gleason score
7 prostatic adenocarcinoma. J Urol. 2006; 175: 1695-1699. https://goo.gl/
CFRW4P
5. Mellinger GT, Gleason D, Bailar J. The histology and prognosis of prostatic
cancer. J Urol. 1967; 97: 331-337. https://goo.gl/rfBBFa
6. Gleason DF, Mellinger GT. Prediction of prognosis for prostatic
adenocarcinoma by combined histological grading and clinical staging. J
Urol. 1974; 111: 58-64. https://goo.gl/UhY4qC
Figure 1: Graph showing the time to biochemical relapse (in months) in
patients with and without tertiary Gleason pattern 5.
4. SCIRES Literature - Volume 1 Issue 1 - www.scireslit.com Page - 004
American Journal of Clinical Anatomy & Physiology
7. Epstein JI, Allsbrook WC Jr, Amin MB, Egevad LL. ISUP Grading Committee.
The 2005 International Society of Urological Pathology (ISUP) consensus
conference on gleason grading of prostatic carcinoma. Am J Surg Pathol.
2005; 29: 1228-1242. https://goo.gl/cqzKiq
8. Epstein JI, Egevad L, Amin MB, Delahunt B, Srigley JR, Humphrey PA.
The 2014 International Society of Urological Pathology (ISUP) consensus
conference on gleason grading of prostatic carcinoma: definition of grading
patterns and proposal for a new grading system. Am J Surg Pathol. 2016; 40:
244-52. https://goo.gl/rNdY9S
9. Vassilikos EJK, Yu H, Trachtenberg J, Nam RK, Narod SA, Bromberg IL,
et al. Relapse and cure rates of prostate cancer patients after radical
prostatectomy and 5 years of follow-up. Clin Biochem. 2000; 33: 115-123.
https://goo.gl/58D4j5
10. Taplin ME. Biochemical (prostate-specific antigen) relapse: an oncologist
perspective. Rev Urol. 2003; 5: 3-13. https://goo.gl/BVfoHi
11. Fonseca RP, Fernandes AS Jr, Lima VS, Lima SSS, Castro AF, Horta HL, et
al. Biochemical recurrence in prostate cancer: review article. 2007; 53: 167-
172.
12. Cronin AM, Godoy G, Vickers AJ. Definition of biochemical recurrence after
radical prostatectomy does not substantially impact estimates for prognostic
factors. J Urol. 2010; 183: 984-989. https://goo.gl/fyBMZT
13. Pan CC, Potter SR, Partin AW, Epstein JI. The prognostic significance of
tertiary Gleason patterns of higher grade in radical prostatectomy specimens:
a proposal to modify the Gleason grading system. Am J Surg Pathol. 2000;
24: 563-569. https://goo.gl/DCWYxW
14. Whittemore DE, Hick EJ, Carter MR, Moul JW, Miranda Sousa AJ, Sexton
WJ. Significance of tertiary Gleason pattern 5 in Gleason score 7 radical
prostatectomy specimens. J Urol. 2008; 179: 516-522. https://goo.gl/93NmiT
15. Trock BJ, Guo CC, Gonzalgo ML, Magheli A, Loeb S, Epstein JI. Tertiary
Gleason patterns and biochemical recurrence after prostatectomy: proposal
for a modified Gleason scoring system. J Urol. 2009; 182: 1364-1370. https://
goo.gl/i5MMRQ
16. Rasiah KK, Stricker PD, Haynes AM, Delprado W, Turner JJ, Golovsky D.
Prognostic significance of Gleason pattern in patients with Gleason score 7
prostate carcinoma. Cancer. 2003; 98: 2560-2565. https://goo.gl/Q89KWP
17. Sim HG, Telesca D, Culp SH, Ellis WJ, Lange PH, True LD. Tertiary Gleason
pattern 5 in Gleason 7 prostate cancer predicts pathological stage and
biochemical recurrence. J Urol. 2008; 179: 1775-1779. https://goo.gl/ayrbMc
18. Servoll E, Saeter T, Vlatkovic L, Nesland J, Waaler G, Beisland HO. Does a
tertiary Gleason pattern 4 or 5 influence the risk of biochemical relapse after
radical prostatectomy for clinically localized prostate cancer. Scand J Urol
Nephrol. 2010; 44: 217-222. https://goo.gl/2zPWBS