She is someone that the author really admires. The author holds this person in high regard and looks up to them. Whoever "she" is, the author respects and appreciates her greatly.
She is someone that the author really admires. The author holds this person in high regard and looks up to them. Whoever "she" is, the author respects and appreciates her greatly.
She is someone that the author really admires. The author holds this person in high regard and looks up to them. Whoever "she" is, the author respects and appreciates her greatly.
1. The document is a test for English proficiency that contains two parts - speaking and writing ability.
2. The speaking section contains 10 questions testing conversational skills through dialogue choices.
3. The writing section contains 20 questions testing appropriate word and phrase choices to complete sentences.
The document expresses admiration for an unnamed person. In just a few words, it conveys positive feelings toward someone without providing details about who that person is or why they are admired. Overall the short statement communicates high regard for an individual.
This document provides information about One Minute News (OMN), a digital media company that produces short-form video news segments targeted at millennials. OMN was founded by Doug Greenlaw to be an alternative news source designed and created by millennials for millennials. OMN produces 60-second video segments covering trending news, entertainment, sports and other topics of interest to 18-34 year olds. These videos are distributed through OMN's global partners and platforms like YouTube to reach over 40 million young viewers each month. The document outlines OMN's content, talent, advertising opportunities and ability to help brands engage millennials through video sponsorships and custom content.
This document provides a summary of the village and house of Doctor Dolittle. Doctor Dolittle is a doctor who treats animals and lives in the village of Puddleby-on-the-Marsh with his sister and many animals. His house is usually chaotic due to all the animals living there. Doctor Dolittle goes on a trip to Africa with his animals but their ship sinks and they must swim to shore.
1) Temozolomide is an alkylating agent recommended for the adjuvant treatment of glioblastoma multiforme (GBM) along with radiation therapy.
2) A phase III trial showed that patients with GBM who received temozolomide concomitantly with radiation therapy and as maintenance therapy had improved progression-free survival and overall survival compared to radiation therapy alone.
3) The mechanism of action of temozolomide involves its metabolic activation to the reactive compound MTIC, which methylates guanine residues in DNA and inhibits DNA, RNA, and protein synthesis. However, increased activity of DNA repair enzymes such as O6-methylguanine DNA methyltransferase can lead to
This document discusses hypoxia and its effects in radiotherapy. It defines oxygen effect as the increased radiosensitivity seen in aerated tissues compared to hypoxic tissues. The mechanism is that oxygen helps fix radiation-induced DNA damage, making it irreparable. Fractionated radiotherapy can overcome hypoxia through reoxygenation of tumor cells between fractions. Strategies to overcome hypoxia include hyperbaric oxygen, chemical radiosensitizers, hypoxic cytotoxins, and boosting tumor oxygenation.
This document discusses the treatment of low-grade gliomas. It notes that maximal surgical resection is generally recommended when feasible and associated with more favorable outcomes. For pilocytic astrocytomas, no adjuvant therapy is necessary after complete resection. Postoperative radiotherapy may be considered for incompletely resected or higher risk nonpilocytic gliomas. Recent trials found no survival advantage from higher radiation doses compared to 45-54 Gy or from early radiotherapy versus delayed radiotherapy. Temozolomide is being tested in clinical trials for nonpilocytic gliomas.
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
This document discusses the management of neck nodes in head and neck cancer. It covers lymph node levels, risk factors for metastasis, diagnostic workup, staging, surgical and radiation treatment options. For clinically negative nodes, elective neck irradiation or dissection are equally effective at controlling subclinical disease. For clinically positive nodes, factors like number of positive nodes and size influence treatment planning. Combined modality treatment with surgery and radiation provides better control than either alone for more advanced neck disease.
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
This document discusses DNA damage and repair mechanisms in response to radiotherapy. It describes how ionizing radiation can cause DNA single and double strand breaks through energy deposition events. The two main pathways for repairing double strand breaks are nonhomologous end joining, which is error-prone and occurs in G1 phase, and homologous recombination repair, which is error-free and occurs in late S and G2 phases. Defects in various DNA repair pathways can result in increased radiosensitivity or cancer predisposition. Chromosomal aberrations seen in lymphocytes after radiation exposure can also be used as biomarkers to estimate radiation dose.
Hormone therapy is recommended for women with hormone receptor-positive, non-metastatic breast cancer. Ideal candidates include those who are post-menopausal or have undergone bilateral oophorectomy. Treatment options include tamoxifen, aromatase inhibitors like letrozole or anastrozole, and ovarian suppression with gonadotropin-releasing hormone agonists. While aromatase inhibitors are preferred for post-menopausal women, pre-menopausal high-risk women should receive ovarian suppression plus an aromatase inhibitor. Hormone therapy should be administered for 5 years or longer to reduce the risk of breast cancer recurrence and mortality.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
Nasopharyngeal carcinoma is typically treated with radiation therapy. Concurrent chemotherapy and radiation is the standard for locally advanced disease and improves survival compared to radiation alone. Intensity-modulated radiation therapy provides better tumor coverage and reduces side effects. Surgery has a limited role except for biopsy or salvaging recurrent tumors. Temporal lobe necrosis is a serious potential complication, so fractional doses above 2Gy should be avoided. Close follow-up is needed due to risk of recurrence or late effects.
She is someone that the author really admires. The author holds this person in high regard and looks up to them. Whoever "she" is, the author respects and appreciates her greatly.
1. The document is a test for English proficiency that contains two parts - speaking and writing ability.
2. The speaking section contains 10 questions testing conversational skills through dialogue choices.
3. The writing section contains 20 questions testing appropriate word and phrase choices to complete sentences.
The document expresses admiration for an unnamed person. In just a few words, it conveys positive feelings toward someone without providing details about who that person is or why they are admired. Overall the short statement communicates high regard for an individual.
This document provides information about One Minute News (OMN), a digital media company that produces short-form video news segments targeted at millennials. OMN was founded by Doug Greenlaw to be an alternative news source designed and created by millennials for millennials. OMN produces 60-second video segments covering trending news, entertainment, sports and other topics of interest to 18-34 year olds. These videos are distributed through OMN's global partners and platforms like YouTube to reach over 40 million young viewers each month. The document outlines OMN's content, talent, advertising opportunities and ability to help brands engage millennials through video sponsorships and custom content.
This document provides a summary of the village and house of Doctor Dolittle. Doctor Dolittle is a doctor who treats animals and lives in the village of Puddleby-on-the-Marsh with his sister and many animals. His house is usually chaotic due to all the animals living there. Doctor Dolittle goes on a trip to Africa with his animals but their ship sinks and they must swim to shore.
1) Temozolomide is an alkylating agent recommended for the adjuvant treatment of glioblastoma multiforme (GBM) along with radiation therapy.
2) A phase III trial showed that patients with GBM who received temozolomide concomitantly with radiation therapy and as maintenance therapy had improved progression-free survival and overall survival compared to radiation therapy alone.
3) The mechanism of action of temozolomide involves its metabolic activation to the reactive compound MTIC, which methylates guanine residues in DNA and inhibits DNA, RNA, and protein synthesis. However, increased activity of DNA repair enzymes such as O6-methylguanine DNA methyltransferase can lead to
This document discusses hypoxia and its effects in radiotherapy. It defines oxygen effect as the increased radiosensitivity seen in aerated tissues compared to hypoxic tissues. The mechanism is that oxygen helps fix radiation-induced DNA damage, making it irreparable. Fractionated radiotherapy can overcome hypoxia through reoxygenation of tumor cells between fractions. Strategies to overcome hypoxia include hyperbaric oxygen, chemical radiosensitizers, hypoxic cytotoxins, and boosting tumor oxygenation.
This document discusses the treatment of low-grade gliomas. It notes that maximal surgical resection is generally recommended when feasible and associated with more favorable outcomes. For pilocytic astrocytomas, no adjuvant therapy is necessary after complete resection. Postoperative radiotherapy may be considered for incompletely resected or higher risk nonpilocytic gliomas. Recent trials found no survival advantage from higher radiation doses compared to 45-54 Gy or from early radiotherapy versus delayed radiotherapy. Temozolomide is being tested in clinical trials for nonpilocytic gliomas.
The document discusses the role of chemotherapy in carcinoma of the stomach. It outlines several key trials investigating neoadjuvant, adjuvant and perioperative chemotherapy approaches. The MAGIC trial showed significantly improved 5-year survival with perioperative chemotherapy compared to surgery alone. The French FNCLCC trial also demonstrated improved disease-free and overall survival with perioperative chemotherapy. Adjuvant chemoradiation was shown in the INT0116/SWOG 9008 trial to improve 5-year overall and disease-free survival compared to surgery alone. The Japanese S-1 trial found significant benefit in 5-year disease-free and overall survival with adjuvant S-1 chemotherapy compared to observation after surgery.
This document discusses the management of neck nodes in head and neck cancer. It covers lymph node levels, risk factors for metastasis, diagnostic workup, staging, surgical and radiation treatment options. For clinically negative nodes, elective neck irradiation or dissection are equally effective at controlling subclinical disease. For clinically positive nodes, factors like number of positive nodes and size influence treatment planning. Combined modality treatment with surgery and radiation provides better control than either alone for more advanced neck disease.
This document summarizes the results of two randomized controlled trials (PORTEC-1 and PORTEC-2) that compared pelvic external beam radiotherapy (EBRT) to vaginal brachytherapy (VBT) or no additional treatment (NAT) for patients with endometrial carcinoma. PORTEC-1 showed that EBRT improves local control over NAT but does not provide a survival benefit and is associated with long-term side effects. PORTEC-2 found that VBT achieves similar local control as EBRT with fewer side effects, establishing VBT as the preferred adjuvant treatment for high intermediate risk patients.
This document discusses DNA damage and repair mechanisms in response to radiotherapy. It describes how ionizing radiation can cause DNA single and double strand breaks through energy deposition events. The two main pathways for repairing double strand breaks are nonhomologous end joining, which is error-prone and occurs in G1 phase, and homologous recombination repair, which is error-free and occurs in late S and G2 phases. Defects in various DNA repair pathways can result in increased radiosensitivity or cancer predisposition. Chromosomal aberrations seen in lymphocytes after radiation exposure can also be used as biomarkers to estimate radiation dose.
Hormone therapy is recommended for women with hormone receptor-positive, non-metastatic breast cancer. Ideal candidates include those who are post-menopausal or have undergone bilateral oophorectomy. Treatment options include tamoxifen, aromatase inhibitors like letrozole or anastrozole, and ovarian suppression with gonadotropin-releasing hormone agonists. While aromatase inhibitors are preferred for post-menopausal women, pre-menopausal high-risk women should receive ovarian suppression plus an aromatase inhibitor. Hormone therapy should be administered for 5 years or longer to reduce the risk of breast cancer recurrence and mortality.
This document discusses the management of endometrial carcinoma. It covers diagnosis through clinical examinations and investigations. Surgical staging is now standard practice to better guide adjuvant therapy. Prognostic factors include stage, grade, depth of invasion and nodal involvement. Treatment involves surgery, with radiation therapy and chemotherapy used for more advanced or high risk cases. Ongoing follow up is also recommended.
Nasopharyngeal carcinoma is typically treated with radiation therapy. Concurrent chemotherapy and radiation is the standard for locally advanced disease and improves survival compared to radiation alone. Intensity-modulated radiation therapy provides better tumor coverage and reduces side effects. Surgery has a limited role except for biopsy or salvaging recurrent tumors. Temporal lobe necrosis is a serious potential complication, so fractional doses above 2Gy should be avoided. Close follow-up is needed due to risk of recurrence or late effects.