Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS system is recording the electrical conductance of 11 pathways of the human body.
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
Çalışmalar Işığında ExactVu US Biyopsi ile MRI Füzyon Biyopsi Karşılaştırması
http://e.andromed.com.tr/2020-Klotz-CUAJ-MulticenterMRIComparison
Abstract
Introduction: High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low
cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the
detection of clinically significant prostate cancer.
Methods: We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (PI-RADS >3 and micro-ultrasound targets (PRIMUS >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2.
advancements in the diagnostics help detect states like oligometastasis ,which can lead to selection of patients for local and MDT and prolong the time to adjuvant therapy, at present There is no consensus on the treatment of oligometastatic cancer and clinical trials can help in evidence formation.
Çalışmalar Işığında ExactVu US Biyopsi ile MRI Füzyon Biyopsi Karşılaştırması
http://e.andromed.com.tr/2020-Klotz-CUAJ-MulticenterMRIComparison
Abstract
Introduction: High-resolution micro-ultrasound has the capability of imaging prostate cancer based on detecting alterations in ductal anatomy, analogous to multiparametric magnetic resonance imaging (mpMRI). This technology has the potential advantages of relatively low
cost, simplicity, and accessibility compared to mpMRI. This multicenter, prospective registry aims to compare the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) of mpMRI with high-resolution micro-ultrasound imaging for the
detection of clinically significant prostate cancer.
Methods: We included 1040 subjects at 11 sites in seven countries who had prior mpMRI and underwent ExactVu micro-ultrasound-guided biopsy. Biopsies were taken from both mpMRI targets (PI-RADS >3 and micro-ultrasound targets (PRIMUS >3). Systematic biopsies (up to 14 cores) were also performed. Various strategies were used for mpMRI target sampling, including cognitive fusion with micro-ultrasound, separate software-fusion systems, and software-fusion using the micro-ultrasound FusionVu system. Clinically significant cancer was those with Gleason grade group ≥2.
Circulating Tumor Cells (CTC) and pathological Complete Response (pCR) are strong independent prognostic factors in Inflammatory Breast Cancer (IBC) in a pooled analysis of two multicentre phase II trials (BEVERLY 1 & 2) of neoadjuvant chemotherapy combined with bevacizumab
Vassili Soumelis - Programme d’analyse globale et intégrative du micro-enviro...SiRIC_Curie
Programme d’analyse globale et intégrative du
micro-environnement tumoral - Vassili SOUMELIS, MD, PhD
Laboratoire d’Immunologie Clinique et Inserm U932
Manuel Salto-Tellez on Personalised medicine and the future of tissue pathologyCirdan
Personalised / Precision Medicine has revolutionized cancer treatment and, in parallel, is also deeply transforming the way we practice tissue pathology. The aim of this talk is to briefly review the status of molecular diagnostic tests applicable to tissues and cells, as well as the main technical and conceptual areas that, in my opinion, will be dictating the evolution of tissue pathology and its integration with the molecular era. These areas are, among others – a) digital pathology in the pipeline of therapeutic pathology; b) tissue-based NGS and its integration in routine diagnostics; c) the promise of liquid biopsy diagnostics and its necessary “partnership” with tissue molecular testing; d) Pathology IT, databases and bioinformatics; and e) the training of future tissue pathologists. In the process of this review, it may be apparent that a solid, integrated, morpho-molecular approach to pathology may serve our patients better.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
Circulating Tumor Cells (CTC) and pathological Complete Response (pCR) are strong independent prognostic factors in Inflammatory Breast Cancer (IBC) in a pooled analysis of two multicentre phase II trials (BEVERLY 1 & 2) of neoadjuvant chemotherapy combined with bevacizumab
Vassili Soumelis - Programme d’analyse globale et intégrative du micro-enviro...SiRIC_Curie
Programme d’analyse globale et intégrative du
micro-environnement tumoral - Vassili SOUMELIS, MD, PhD
Laboratoire d’Immunologie Clinique et Inserm U932
Manuel Salto-Tellez on Personalised medicine and the future of tissue pathologyCirdan
Personalised / Precision Medicine has revolutionized cancer treatment and, in parallel, is also deeply transforming the way we practice tissue pathology. The aim of this talk is to briefly review the status of molecular diagnostic tests applicable to tissues and cells, as well as the main technical and conceptual areas that, in my opinion, will be dictating the evolution of tissue pathology and its integration with the molecular era. These areas are, among others – a) digital pathology in the pipeline of therapeutic pathology; b) tissue-based NGS and its integration in routine diagnostics; c) the promise of liquid biopsy diagnostics and its necessary “partnership” with tissue molecular testing; d) Pathology IT, databases and bioinformatics; and e) the training of future tissue pathologists. In the process of this review, it may be apparent that a solid, integrated, morpho-molecular approach to pathology may serve our patients better.
Cancer screening may discover many dormant, regressing, or slowly progressing tumors that would not have affected the screened individuals. Such findings with there therapies are obviously harmful. This lecture is highly based on the book "over diagnosed" by H. Gilbert Welch and was presented in 2013 to KFSH-Dammam physicians
Summary of clinical investigations es teck complex systemES-Teck India
Summary of the clinical investigations E.S.Teck Complex March, 20, 2010
Summary of Clinical Investigations ES Teck Complex system EIS System in adjunct to Treatments’ monitoring and to diagnosis with the conventional methods
EIS technology : bioimpedance application in selective serotonin reuptakeES-Teck India
Through the 6 tactile electrodes, a weak DC current is sending alternatively between 2 electrodes with a sequence and the EIS-GS system is recording the electrical conductance of 11 pathways of the human body.
Endobronchial Ultrasound Guidance of TBNA. Current Approach To Lung Cancer St...Bassel Ericsoussi, MD
EBUS-TBNA, EUS-FNA or their combination have finally gained acceptance as the tests of first choice in mediastinal staging. In suspected non-small cell lung cancer, endobronchial ultrasound may be preferred in the histologic sampling of paratracheal and subcarinal mediastinal adenopathy because the diagnostic yield can surpass mediastinoscopy
Journal of the Formosan Medical Association (2011) 110, 695e70.docxcroysierkathey
Journal of the Formosan Medical Association (2011) 110, 695e700
Available online at www.sciencedirect.com
journal homepage: www.jfma-online.com
ORIGINAL ARTICLE
A multivariable logistic regression equation to
evaluate prostate cancer
Jhih-Cheng Wang a, Steven K. Huan a, Jinn-Rung Kuo b, Chin-Li Lu c,
Hung Lin a, Kun-Hung Shen a,*
a Division of Urology, Departments of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
b Division of Neurosurgery, Department of Surgery, Chi-Mei Medical Center, Tainan, Taiwan
c Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
Received 29 January 2010; received in revised form 14 May 2010; accepted 9 August 2010
KEYWORDS
Logistic regression;
men’s health;
probability;
prostate cancer;
risk factor;
score
* Corresponding author. Division of U
Taiwan 710.
E-mail address: [email protected]
0929-6646/$ - see front matter Copyr
doi:10.1016/j.jfma.2011.09.005
Background/Purpose: A possible means of decreasing prostate cancer mortality is through
improved early detection. We attempted to create an equation to predict the likelihood of
having prostate cancer.
Methods: Between January 2005 and May 2008, patients who received prostate biopsies were
retrospective evaluated. The relationship between the possibility of prostate cancer and the
following variables were evaluated: age; serum prostate specific antigen (PSA) level, prostate
volume, numbers of prostatic biopsies, digital rectal examination (DRE) findings, and the pres-
ence of hypoechoic nodule under transrectal ultrasonography.
Results: A multivariate regression model was created to predict the possibility of having pros-
tate cancer, and a receiver-operating characteristic (ROC) curve was drawn based on the
predictive scoring equation. Using a predictive equation, P Z 1/(1 � e�x), where X Z
�4.88, þ 1.11 (if DRE positive), þ 0.75 (if hypoechoic nodule of prostate present), þ 1.27
(when 7 < PSA � 10), þ 2.02 (when 10 < PSA � 24), þ 2.28 (when 24 < PSA � 50), þ 3.93 (when
50 < PSA), þ 1.23 (when 65 < age � 75), þ 1.66 (when 75 < age), followed by ROC curve
analysis, we showed that the sensitivity was 88.5% and specificity was 79.1% in predicting
the possibility of prostate cancer.
Conclusion: Clinicians can tailor each patient’s follow-up according to the nomogram based on
this equation to increase the efficacy of evaluating for prostate cancer.
Copyright ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
rology, Department of Surgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan,
il.com (K.-H. Shen).
ight ª 2011, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
mailto:[email protected]
http://dx.doi.org/10.1016/j.jfma.2011.09.005
www.sciencedirect.com/science/journal/09296646
http://www.jfma-online.com
http://dx.doi.org/10.1016/j.jfma.2011.09.005
http://dx.doi.org/10.1016/j.jfma.2011.09.005
696 J.-C. Wang et al.
Prostate cancer is the most common solid malignancy ...
Assessment of Incidence and Prevalence of Prostate Cancer in Middle Aged Male...BRNSS Publication Hub
This study was conducted to evaluate the incidence of prostate cancer (PCa) in male patients with increased prostate-specific antigen (PSA), and normal or abnormal digital rectal examination (DRE) that underwent a prostate biopsy. From March 2018 to November 2018, a total of 98 consecutive males suspected of having PCa due to increased PSA levels underwent transrectal ultrasonography (TRUS)-guided sextant biopsy of the prostate. The total PSA (tPSA), demographic data, the incidence of PCa, benign prostate hyperplasia (BPH), and prostatitis were assessed. The patients were divided into two groups according to their PSA values (Group A serum tPSA level, 4–10 ng/mL; and Group B serum tPSA level, 10.1–20.0 ng/mL). Of the 98 biopsied cases, 56% had PCa, 23% had BPH, and 21% had prostatitis. The mean PSA and the age of the carcinoma group were significantly higher than those of the benign group (P < 0.01). The biopsy results were grouped as PCa, BPH, and prostatitis. The incidence of PCa for Group A and Group B cases was 51% and 65%, respectively. In the case of PCa, BPH, and prostatitis, the mean PSAs were 10.02 ng/mL, 8.76 ng/mL, and 8.41 ng/mL, respectively (P < 0.40). In conclusion, TRUS-guided prostate biopsy and interpretation by a skilled team are highly recommended for early detection of PCa or its ruling-out. Due to the very high incidence of PCa in the patients with PSA >10 ng/mL, TRUS-guided biopsy is indicated, whatever the findings on DRE and/or LUTS, since the PCa detection rate is high.
Bladder Cancer Diagnostic-Initial Team ProjectSagar Desai
A mini-project to find biomarkers for bladder cancer diagnosis. We narrowed down our list of viable candidates down to three that could be used in combination to provide sensitivity and specificity values greater than 94%. Furthermore, we calculated long-term monitoring and payor costs as well as potential profit.
Diagonsis of cancer through saliva.pptxZaidAhmad42
Human saliva is an ideal body fluid for developing non-invasive diagnostics. Saliva contains naturally-occurring nanoparticles with unique structural and biochemical characteristics.
Solid pseudopapillary neoplasm of the pancreas is a distinctive pancreatic neoplasm with low metastatic potential. This study examines clinical differences and prognosis between male and female patients.
http://www.drmarcel.com.br
Similar to EIS Technology: bioimpedance chronoamperometry in adjunct to screen the prostate cancer (20)
Photoplethysmographic assessment of pulse wave reflection: Blunted response to mellitus -adrenergic vasodilation in type II diabetes 2
endothelium-dependent beta
Comparison of Invasive vs Noninvasive Pulse Wave Indices in Detection of Signifi cant Coronary Artery Disease: Can We Use Noninvasive Pulse Wave Indices as Screening Test
Noninvasive Cardiac Output Estimation Using a Novel
Photoplethysmogram Index
31st Annual International Conference of the IEEE EMBS Minneapolis, Minnesota, USA, September 2-6, 2009
Guidelines heart rate_variability_ft_1996[1]ES-Teck India
Guidelines
Heart rate variability
Standards of measurement, physiological interpretation, and
clinical use
Task Force of The European Society of Cardiology and The North American
Society of Pacing and Electrophysiology (Membership of the Task Force listed in
the Appendix)
Hypertension:Volume 32(2)August 1998pp 365-370
Assessment of Vasoactive Agents and Vascular Aging by the Second Derivative of
Photoplethysmogram Waveform
[Third Workshop On Structure And Function Of Large Arteries: Part Ii]
Cerebral Perfusion Response
to Successful Treatment of
Depression With Different
Serotoninergic Agents with antidepressant therapy have been reported in a number of studies.2–4 In contrast, decreases in the ventral anterior cingulate blood flow were found in response to desipramine,5 electroshock therapy,6 and flu-7
Summary
Chronobiology International
1993, Vol. 10, No. 6, Pages 442-448
Effects of Intracisternally Injected Serotonin on Cerebral Blood Flow in Cats During Winter and Summer, and After Dark Exposure
The role of antioxidant supplement in immune system, neoplastic, and neurodegenerative disorders: a point of view for an assessment
of the risk/benefit profile. Nutritional Journal
Effects of dopamine on
posttraumatic cerebral blood flow, brain edema, and cerebrospinal fluid
glutamate and hypoxanthine concentrations. Critical Care Medicine,
28(12):3792-3798.
Article
Journal of Cerebral Blood Flow & Metabolism (1998) 18, 803–807; doi:10.1097/00004647-199807000-00010
Low Extracellular Dopamine Levels Are Maintained in the Anoxic Turtle (Trachemys scripta) Striatum Supported by the National Science Foundation grant IBN:9507961.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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 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
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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.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Abreu Dovepress
screened were estimated to have an abnormal PSA test (ie, Materials and methods
serum PSA $ 4.1 ng/mL by monoclonal assay) or had an This study was approved by the regional ethic committee
abnormal digital rectal examination, half of whom had no (Pesquisa CONEP, 125/10), and adhered to the ethical
identifiable pathology on biopsy.5 A further study has shown principles of the Declaration of Helsinki. Each patient
that about 66% of men with abnormally elevated PSA levels signed an informed consent form, and confidentiality was
go on to have a negative biopsy,6 and another showed that maintained for all participants.
19%–32% of men who agreed to undergo biopsy were found
to have prostate cancer.5 An indicator/marker adjunctive to the subjects
digital rectal examination and PSA would help the clinician Patients attending consultations for signs and/or symptoms of
in the decision to perform a biopsy. a prostatic disorder and not receiving any prostate treatment,
Bioimpedance is an electrical property of living tissue as well as responders to an advertisement were considered
that has been shown to be a safe technique when used for enrolment into this study. Inclusion criteria were a high
in a number of biomedical applications, including for PSA test result (.4 ng/mL) and/or a positive digital rectal
quantification of brain edema in neurosurgery7 and for examination with a clinical recommendation of prostate
differentiating between cancer and pneumonia on discovery biopsy. Patients were excluded if they had previously
of a pulmonary mass.8 Electric current is normally limited in undergone prostate-related chemotherapy or surgery, were
living tissue by highly insulating cell membranes. However, currently receiving treatment for a prostatic disorder, had
the abnormal architecture in cancerous tissue may impede a neurological disorder precluding the ability to sign a
current differently and allow detection of differences between consent form, if in the opinion of the investigator they were
normal and abnormal or malignant prostate tissue.9 clinically unsuitable candidates for the trial, and/or had any
The aim of this research was to assess the utility of contraindications to use of the EIS system. Use of the EIS
bioimpedance measurement as a rapid, cost-effective, and system is contraindicated in the presence of an external
noninvasive adjunct to digital rectal examination and PSA defibrillator, skin lesions likely to come into contact with
in differentiating tumor from normal prostatic tissue. the electrodes, excessive perspiration, sinusitis (particularly
One explanation as to why bioimpedance increases in frontal), cardiac pacemaker, electronic life support, any
cancer tissue is the distorted architecture of the gland, which implanted electronic device, inability to remain still for
prevents flow of current. Histologically, the prostate can be three minutes, metallic pins or prostheses in digits or joints,
thought of as being composed of multiple layers of hollow pregnancy from the third trimester onwards, and absence
glands (ie, tubes). Solid or gross tumor tissue is also composed of a limb.
of a histological array of tubes. The lumina in normal prostate Three hundred patients of mean age 65 (range 49–90)
tissue are open and have relatively large diameters, providing years were included in the study, and were examined
little resistance to flow. In contrast, as resistance increases, in the office for signs and symptoms. A digital rectal
the current flow will decrease. Accordingly, in cancerous examination was performed, and if indicated, the patients
prostate tissue, the normal architecture of the lumina becomes were sent to the laboratory for a PSA test. If the attending
distorted. The lumina of the tubes become much smaller, the clinician subsequently decided that a patient should have a
walls of the glands become crowded, and the flow of current prostate biopsy, the patient underwent an EIS bioimpedance
is impeded.9 measurement prior to the biopsy.
The second explanation could be the electrochemical
reaction in the anode related to the Chloride ions migration. Measurement of bioimpedance
The electrochemical reaction provides 4 H+ and is therefore The parameter used by the EIS is the delta of the electrical
an acid environment. resistance values between the pathway value for left foot to
The pronounced elevations in prostatic tissue palmitoleic right foot (anode to cathode) minus the pathway value for
acid in cancer patients highlight a possible role of this fatty right foot to left foot (cathode to anode), expressed in numeric
acid in neoplastic processes.10 form on a scale from 0 to 100.
We compared the results of PSA testing and biopsy The EIS is a programmable electromedical system
with the results of EIS measurement to determine if the EIS comprising a USB plug and hardware including an interface
system could be used as an adjunct to screening for prostate box, disposable electrodes, reusable plates, and reusable
cancer. cables, with software installed on a computer. The system
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3. Dovepress Bioimpedance/chronoamperometry for prostate cancer
uses bioimpedance in bipolar mode with direct current, Results
and measures the electrical conductivity of 11 pathways of The results of this investigation showed that PSA had a
the body, each recorded twice from anode to cathode and sensitivity of 73.9% and a specificity of 51.9% for the
then from cathode to anode. The pathways are measured detection of prostate cancer using a cutoff value .4
between four large tactile reusable electrodes (.270 cm2) (Figure 1) and a sensitivity of 52.2% and specificity of 81.5%
placed on the palms of the hands and soles of the feet, and using a cutoff value $5.7 (P = 0.03) (Figure 2).
smaller disposable electrodes (15 cm2) placed on the left The delta for the electrical conductivity (DE) of the
and right forehead. Electrode polarization does not affect pathway from left foot to right foot had a sensitivity of
the bioimpedance measurement,11 and the transmission of 62.5% and a specificity of 85.2% using a cutoff value #−5
the current from the electrode to the hardware is performed (P = 0.0001) (Figure 3).
by chronoamperometry.12 The algorithms All (PSA Value multiplied by the
delta value for the electrical conductivity) incorporating
eis and electrical conductivity/chronoamperometry the delta of electrical conductivity and PSA value had a
With direct current, the plasma membrane acts as an insulator sensitivity of 91.5% and a specificity of 59.3% using a cutoff
and the current is not able to penetrate the cell, so most of the value #−10.52 (P = 0.0003) (Figure 4).
current flows around the cell and therefore in the interstitial Raw analysis of the EIS data as an adjunct to the PSA
fluid.13 Analysis of the direct current at the cathode and anode value (Tables 1 and 2).
in electrolytic solution is performed at both the anode and
the cathode.13 Discussion
Although strategies for primary prevention of prostate cancer
Analysis at the cathode are being tested, to date none are known to be effective. The
The electrochemical reaction at the cathode is: most common strategy for reducing the burden of prostate
cancer is screening, but this remains controversial. Urologists
2H2O + 2e = H2 (gas) + 2 OH-(base) are often faced with the dilemma of elevated PSA in young
patients. This is a difficult situation, because these patients
Analysis at the anode often do not want to undergo a prostate biopsy and fear a
The electrochemical reaction for water at the anode is: diagnosis of prostate cancer due to the potential side effects
2H2O = O2 (gas) + 4H+ + 4e-(acid)
PSA
Parameters analyzed 100
Analysis of the specificity and sensitivity of the data was done
in accordance with the biopsy results. Receiver-operating
characteristic curves were constructed for the PSA value and 80
tissue diagnosis and for the EIS data and tissue diagnosis,
Sensitivity: 73.9
and algorithms were constructed for the PSA-EIS data and
Sensitivity
60 Specificity: 51.9
tissue diagnosis. Raw analysis of the EIS data as an adjunct
Criterion: >4
to the PSA value was also undertaken.
40
statistical analysis
Statistical analysis of the results was performed using
20
MedCalc software. The number of patients needed for
the study was calculated to be 50 on the basis of α = 5%,
at 80% power = F (∆, N, variability DS), taking into 0
account the judgment criteria ∆ at approximately 50 DS 0 40 80
(5% error). 100-specificity
A P value of ,0.005 was accepted as being statistically Figure 1 Receiver-operating characteristic curve: PsA cutoff value .4 ng/mL
significant. comparing positive biopsy group versus negative biopsy group.
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4. Abreu Dovepress
PSA
100 ROC curve
Variable PSA
80 Classification variable diagnosis
Sample size 50
Sensitivity
60 Positive group: DIAGNOSIS = 1 23
Negative group: DIAGNOSIS = 0 27
Sensitivity: 52.2
40 Specificity: 81.5 Standard Errora 0.0763
Criterion: >5.7 95% Confidence intervalb 0.548 to 0.816
20 z statistic 2.544
Significance level P (Area = 0.5) 0.011
a
DeLong et al., 1988
0
b
Binomial exact
0 40 80
100-specificity
Figure 2 Receiver-operating characteristic curve and data analysis: PsA cutoff value .5.7 ng/mL comparing positive biopsy group versus negative biopsy group.
of treatment, including the possibility of urinary incontinence • The potential for cure must be greater in patients detected
and erectile dysfunction. by screening
Criteria for a clinically useful screening test are: • Improved outcomes related to screening must be shown
• The disease must constitute a serious public health and, after these criteria are satisfied, the cost-effectiveness
problem of the screening program must also be justified.14
• The disease must be able to be diagnosed during an The importance of prostate cancer as a public health
asymptomatic, localized phase problem and the fact that it can be diagnosed during an
• The screening test must have an appropriate sensitivity, asymptomatic, localized stage easily satisfy using PSA and
specificity, and predictive value digital rectal examination as screening tools for the first two
Delta
100 ROC curve
Variable delta
Classification variable diagnosis
80
Sample size 50
Positive group: DIAGNOSIS = 1 23
Sensitivity
60 Sensitivity: 65.2 Negative group: DIAGNOSIS = 0 27
Specificity: 85.2
Disease prevalence (%) 46
Criterion: < = −5
40
Area under the ROC curve (AUC) 0.775
Standard Errora 0.0676
20 95% Confidence intervalb 0.634 to 0.881
z statistic 4.062
Significance level P (Area = 0.5) <0.0001
a
DeLong et al., 1988
0
b
Binomial exact
0 40 80
100-specificity
Figure 3 Receiver-operating characteristic curve and data analysis: Delta electrical conductivity (De) cutoff value #−5 comparing positive biopsy group versus negative
biopsy group.
*Deita of the electrical conductivity between the pathway conductivity ieft foot- right foot minus the pathway conductivity right foot-left foot expressed in numeric values from 0-100.
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5. Dovepress Bioimpedance/chronoamperometry for prostate cancer
ALL
100
ROC curve
Variable ALL
Sensitivity: 91.3
80 Classification variable diagnosis
Specificity: 59.3
Criterion: < = −10.52
Sample size 50
Sensitivity
60 Positive group: DIAGNOSIS = 1 23
Negative group: DIAGNOSIS = 0 27
40 Area under the ROC curve (AUC) 0.757
Standard Errora 0.0706
95% Confidence intervalb 0.615 to 0.867
20 z statistic 3.636
Significance level P (Area = 0.5) 0.0003
a
DeLong et al., 1988
0 b
Binomial exact
0 20 40 60 80 100
100-specificity
Figure 4 Receiver-operating characteristic curve and data analysis: Test All cutoff value #−10.52 comparing positive biopsy group versus negative biopsy group.
*ALL Delta of the electrical conductivity value multiplied by the PsA value.
of the above-listed criteria, but there are no clear answers than 50 years. The prevalence of these unsuspected prostate
for the rest. cancers is consistently estimated to be about 33%.15 These
An autopsy study in Detroit men found previously high rates of unsuspected prostate cancers are in sharp
undiagnosed prostate cancer in 30% of men in the age contrast with the 3.64% estimated lifetime risk of dying
range 20–40 years, and in more than one half of men older from prostate cancer, as well as the 1.8% detection rate
Table 1 Analysis of the positive patients group
Patient Age Positivie test = 1 Delta PSA ALL Delta PSA $-4 ALL Current
code Negative test = 0 DE [DE-PSA] DE #-0.5 [DE - PSA] treatment
,-10.52 #10.52
1Zh05 57 1 −6 200.2 −1201.2 X X X no treatment
1ZM13 90 1 2 45 90 X Diuretics/furosemide
1ZD19 67 1 −9 26.0 −234 X X X ACe
1ZL06 79 1 −4 4.4 −17.6 X X no treatment
1Zd26 62 1 −3 19 −57 X X Diuretics/furosemide
1Zs19 66 1 −8 3.1 −24.8 X X no treatment
1ZT15 64 1 −8 11 −88 X X X no treatment
1ZA31 69 1 −6 3.0 −18.06 X X no treatment
1ZL01 89 1 −6 4.1 −24.6 X X X ACe, insulin nPh
1ZB08 76 1 −10 3.5 −35 X X ACe, diuretics
1ZC30 56 1 −8 3.5 −28 X X no treatment
1ZA10 52 1 −8 3.3 −26.4 X X simvastatin, omeprazole
1ZF06 84 1 −2 7.5 −15 X X ACe, ranitidine
1Zs04 80 1 −4 14 −56 X X Diuretics, ACe
1ZF03 57 1 −8 2.3 −18.4 X X Angiotensin ii antagonists,
Crestor
1Zs02 62 1 −5 14.0 −70 X X X no treatment
1Zx17 68 1 −1 4.9 −4.9 X ACe, diuretics
1Zs28 76 1 −6 319 −1914 X X X Metformin ACe,
Diuretics
1ZD22 74 1 −10 6.5 −65 X X X ACe, simvastatin
1ZR25 50 1 −2 5.26 −10.52 X X no treatment
1ZF28 71 1 −5 6.0 −30 X X X no treatment
1ZM11 59 1 −2 9 −18 X X Alpha blockers
1WR28 55 1 −5 4.2 −21 X X X ACe, selozok
Note: X = Right results in reference to the biopsies.
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Table 2 Analysis of the negative patients group
Patient Age Positive test = 1 Delta PSA All Delta PSA .4 All Correct treatment
code Negative test = 0 DE (DE-PSA) DE #-5 (DE-PSA)
#-10.52 #-10.52
1Ze22 55 0 −3 3.2 −9.6 X X X no treatment
1ZC01 57 0 1 3.3 3.3 X X X insulin, corticosteroid, ACe,
Diuretics, metformin
1ZL10 73 0 −4 16 −64 X no treatment
1ZB11 65 0 0 2.6 0 X X X no treatment
1Zd08 64 0 6 4.9 29.4 X X no treatment
1ZD11 60 0 −6 4.4 −26.4 ACe, imipcamin, ranitidine
1Zd30 64 0 −4 4.7 −18.8 X no treatment
1ZC20 68 0 3 5.52 16.56 X X ACe
1ZP09 81 0 −6 5.61 −33.66 Angiotensin ii inhibitor,
simvastatin
1ZL20 76 0 5 2.8 14 X X X ACe
1ZA04 62 0 −2 3.1 −6.2 X X X no treatment
1Zd18 63 0 −2 2.7 −5.4 X X X no treatment
1Zg21 67 0 0 3.2 0 X X X simvastatin, bromazepan
1ZB01 71 0 −4 4.7 −18.8 X Chondroitin
1ZA26 77 0 −5 7.0 −35 X X Cefalexin
1ZF11 69 0 −4 3.0 −12 X X X Digoxin, ACe
1ZA09 53 0 −10 4.2 −42 no treatment
1ZD11 54 0 −1 3.3 −3.3 X X X no treatment
iZdi8 68 0 −4 7.1 −28.4 X no treatment
1ZL11 73 0 −4 4 −16 X X ACe
1ZC11 69 0 3 5.7 17.1 X X no treatment
1Zg13 62 0 −2 3.1 −6.2 X X X no treatment
1Zi28 61 0 −2 2.9 −5.8 X X X Omeprazol
1ZD10 69 0 −4 23 −92 X ACe
1ZL14 62 0 2 10 20 X X Angiotensin ii inhibitor,
Ranitidine
1ZM03 53 0 −3 2.8 −8.4 X X X Angiotensin ii inhibitor
1ZA31 49 0 −2 3.5 −7 X X X simvastatin, omeprazole
Note: X = Right results in reference to the biopsies.
of prostate carcinoma in pooled data from a recent meta- and 47% of men with histologically proven benign prostate
analysis. Once regional lymph node involvement is present, hyperplasia have PSA levels .4 ng/mL, and up to 43% of
the probability of death from prostate cancer is 70%, and men with prostate cancer will have a PSA level ,4 ng/mL.
50% of men with regional lymph node involvement will This overlap makes it harder to differentiate benign prostate
die in two years. Prostate cancer is a real risk for the aging hyperplasia from prostate carcinoma in the absence of a
man, because almost 10% of men older than 50 years are biopsy. PSA values also increase with age.17
likely to develop clinically serious disease. Therefore, it With prostate cancer, the risk of overdiagnosis is likely
should be detected at an early stage,16 and to improve early to be much more relevant than with other types of cancer
detection rates it is necessary to increase the sensitivity of screening, because in men aged 55–60 years, the risk of
the screening tests used. death from other causes is considerably higher than that
In the current study, the sensitivities of PSA and digital from prostate cancer. It is estimated that for every patient
rectal examination screening were 72.1% and 53.2%, who dies of prostate cancer, at least 380 others have prostate
respectively. Reducing the PSA cutoff point from 4 ng/mL cancer that cannot be detected clinically.18 The treatment of
to 3 ng/mL can increase the sensitivity, but doing so will prostate cancer consists of radical surgery or radiotherapy,
reduce further the positive predictive value.16 It is also well and both can cause complications, including a high frequency
known that PSA values for prostate cancer and benign of sexual impotence, rectal and urinary dysfunction, as well
prostate hyperplasia overlap considerably. Between 21% and a mortality risk of 1%–2%.
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7. Dovepress Bioimpedance/chronoamperometry for prostate cancer
The EIS technique, when used as a screening test, Conclusion
meets the requirements of the World Health Organization Using the EIS system as an independent predictor of
guidelines stating that a screening test should be acceptable prostate cancer, it has a good specificity of 85.2%. However,
to the population, be rapidly performed (no more than two the sensitivity of 62.5% will be a problem. Using the
minutes), cost-effective and noninvasive, and that the total PSA reference of $4.1 ng/mL, adjunctive use of the EIS
cost of finding a case should be economically balanced in system measuring bioimpedance and chronoamperometry
relation to medical expenditure as a whole. could raise the sensitivity from 73.9% to 91.5% and the
In the present study, the positive predictive values for specificity from 51.9% to 59.3% in prostate cancer screening.
PSA and digital rectal examination were about 25% and To our knowledge, this is the first study using a noninvasive
18%, respectively, which means one of four or five biopsies bioimpedance-chronoamperometry technique for prostate
is unnecessary. Unnecessary biopsies can lead to multiple cancer screening. A longitudinal study is now under way to
invasive procedures, anxiety for the patient, procedure- confirm our findings.
related complications, and a high cost of health care delivery.
To reduce further unnecessary procedures, a meta-analysis19 Acknowledgments
has proposed use of transrectal ultrasonography in Thanks are extended to all the people who contributed to this
patients with elevated PSA levels but benign digital rectal investigation, Dr Daniel Ianni Filho for collecting the data
examination findings, followed by biopsy only of visible for this study, Labclin Laboratorio de Análises Clínicas for
abnormal lesions. If findings on digital rectal examination are PSA testing, CEAP Hospital for the biopsies, and LapMed
abnormal, the patient should undergo transrectal ultrasound for analysis of the biopsies.
and then a biopsy, regardless of the PSA value. A small,
organ-confined prostate tumor has an estimated doubling Disclosure
time of about four years. Thus, it will take about 15 years This study was sponsored by LD Technology, Miami, FL.
for a 1 mL tumor to become life-threatening. It would be Otherwise; the author reports no conflicts of interest in
more straightforward to say that until there is evidence for this work.
effectiveness of screening in decreasing mortality, based
on these growth rates, a man would need to have at least
15 years of remaining life expectancy to benefit from PSA
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