This document discusses prostate cancer and its treatment with radiation therapy. It provides details on:
1) The anatomy of the prostate gland and the cell types that compose normal prostate epithelium.
2) A case presentation of a 72-year-old male with high-risk prostate cancer.
3) Guidelines for risk stratification and treatment recommendations including neoadjuvant androgen deprivation therapy followed by radiation therapy with concurrent and adjuvant androgen deprivation therapy.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
EBCTCG METAANALYSIS
INDICATION OF POST OP RADIOTHERAPY
Immobilization devices
Conventional planning
Alignment of the Tangential Beam with the Chest Wall Contour
Doses To Heart & Lung By Tangential Fields
This is a made easy summary of ICRU 89 guidelines for gynecological brachytherapy. Extra practical questions for MD/DNB Radiotherapy exams are also attached.
Audio and slides for this presentation are available on YouTube: http://youtu.be/ozNSEND5PbE
Erica Mayer, MD, MPH, of the Susan F. Smith Center for Women's Cancers at Dana-Farber Cancer Institute, discusses triple-negative breast cancer and what makes it different from other forms of breast cancer. Mayer also talks about treatment options for triple-negative breast cancer and what you need to know about clinical trials for the disease.
Results of Stereotactic Body Radiotherapy (SBRT) for Management of Hepatic Tu...Premier Publishers
PURPOSE: To evaluate early outcomes of hepatic tumors treated with robotic SBRT (cyberknife).
MATERIALS AND METHODS: Between March 2007 and December 2012; 59 patients: 48 Hepatic Metastases (HM), 8 Hepatocellular Carcinoma (HCC), 3 Cholangiocarcinoma (CC).
CTV margin for HCC and CC was 5 mm, PTV margin: 3 mm. no margin for HM.
Median dose: 47.61 Gy in 3 fractions prescribed to 80 % isodose line.
RESULTS: we report 1 grade 3 toxicity.
HCC; overall survival (OS): 41.7% at 1 year, local control (LC): 75% at 1 year.
At 1 and 2 years we report, respectively.
HM; OS: 83.6% and 57%, disease free survival (DFS): 69.5% and 46.1%, LC: 76.3% and 57.9%.
CC; OS: 100% and 50%, DFS and LC: 50% and 0%.
Factors influencing better OS; type of lesion, age < 65 years (p= 0.033), small PTV volume
(p= 0.002), for DFS; dose of 45 Gy (p= 0.001), dose per fraction of 15 Gy (p= 0.001), coverage > 95% for PTV (p= 0.001), For LC; type of lesion, dose to PTV (p= 0.037), coverage > 95% for PTV (p= 0.001).
CONCLUSION: Age, volume of tumor, dose, coverage of target volume are prognostic factors for survival and LC.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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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!
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- 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
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.
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
2. Prostate gland consists of:
The peripheral zone (70% of glandular prostate and site of nearly all
cancers).
The central zone (25% of the glandular prostate).
The transition zone (surrounding the urethra and the site of BPH).
The anterior fibromuscular stroma.
The normal prostate epithelium is composed of :
Basal epithelial cells, expressed cytokeratins 5,14 and p63.
Columnar secretory epithelial cells, which express the androgen
receptor, PSA, cytokeratins 8, 18, prostate-specific membrane antigen
(PSMA), and prostate-specific acid phosphatase(PAP).
Rare neuroendocrine cells, that secrete chromogranin A, neuron-
specific enolase, and synaptophysin.
3.
4.
5.
6. Male patient 72 years old.
Presented with hematuria, frequency for 2 months duration with
progressive course.
PA/US: enlarged prostate 45 cc with irregular borders.
TRUS guided biopsies ( 6 core biopsies ):
GS: 4+3= 7.
Involvement of more than 90% in one core biopsy.
Involvement of more than 50% in 4 core biopsies.
Total PSA: 40 ng/mL.
MRI Pelvis: Prostatic enlargement.
ECE
Invasion of SV.
No pelvic LNs detected.
Bone scan: Free. CT/ chest: Free.
7. Low: T1-2a and GS £6 and PSA <10 ng/ml.
Intermediate: T2b–T2c and/or GS 7 and/or PSA
10–20 ng/ml
High: T3a or GS 8-10 or PSA >20 (very high T3b-
T4).
NCCN risk categories added 2 risk groups:
Very low: T1c, GS</=6, PSA: <10, less than 3 core
biopsies + with </= 50% cancer in each core.
Very high: T3b,T4 (locally advanced).
12. As this patient falls in the high risk group.
Our unit committee advised for:
Neoadjuvant ADT 2months
Concommitant 3DCRT + ADT 2months
Long term adjuvant ADT 2-3 years.
13.
14. Another study by Nabid et al., Presented at ASCO 2013, revealed that 18
months of ADT is not inferior than 36 m in disease specific survival & OS.
15. AIM: Radical.
Positioning: patients are treated supine.
Immobilization: with alpha cradle or “knee sponge” to consistently align
thighs.
Patients are instructed to have comfortably full bladder and empty
rectum (following an enema) for simulation.
Retrograde urethrography is used in conjunction with CT for identifying
the inferior border of the prostate. The prostate apex is assumed to be
1–1.5 cm superior to the point at which the dye narrows.
Machine: linear accelerator.
Energy: high photon energy 6-15 MV.
16.
17. Planning & target volume definition:
Planning is CT-based, CT scan is taken with 3–5 mm, slices from
the L3-L4 to to 1 cm below the anus/ischium to include the
prostate, seminal vesicles, pelvic LNS rectum and bladder.
Target volume:
It is not possible to define the GTV accurately with current
imaging techniques.
It is therefore standard practice to define a CTV that includes
the whole prostate and any possible extracapsular extension.
Roach formulas: estimate pathologic stage based on original
PSA & GS data
ECE = 3/2 × PSA + 10 × (GS-3).
Seminal vesicle involvement = PSA + 10 × (GS-6).
LN involvement = 2/3 × PSA + 10 × (GS-6).
18. Indications for seminal vesicle irradiation include + biopsy, + TRUS, +
MRI, or calculated risk >15% (using the Roach formula).
Indications for whole pelvic RT include :involved LN, seminal vesicle
involvement, a calculated risk of lymph node involvement >15% (using
the Roach formula), patients with T3 GS 6 disease, and patients with
high intermediate risk (>50% + biopsies) or high-risk disease.
LNs included in the CTV : common, internal and external iliac, presacral,
hypogastric and obturator lymph nodes.
The PTV is defined with a 3D margin around the CTV to include an
internal margin accounting for physiological variations & motion and a
set-up margin.
The standard margin is 10 mm grown isotropically around the CTV. To
limit the dose to the rectum, the posterior margin is reduced to 5 mm if
verification studies allow
19. RTOG GU Consensus on pelvic LN CTV volumes:
Commence contouring the pelvic CTV LN volumes at the L5/ S1
interspace (the level of the distal common iliac and proximal
presacral lymph nodes).
Place a 7-mm margin around the iliac vessels connecting the
external and internal iliac contours on each slice, carving out
bowel, bladder, and bone.
Contour presacral lymph nodes from S1 through S3, posterior
border being the anterior sacrum, and anterior border
approximately 10 mm anterior to the anterior sacral bone
carving out bowel, bladder, and bone.
Stop external iliac CTV lymph node contours at the top of the
femoral heads (bony landmark for the inguinal ligament).
Stop contours of the obturator CTV lymph nodes at the top of
the symphysis pubis.
45. Our unit decide to treat:
Prostate + S.V & prophylactic Pelvic LNs in
phase1
Prostate + S.V phase 2
Delineation of our unit illustrated in the
following slides:
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57. Field arrangement:
When treating the pelvic lymph nodes, an anterior and two wedged lateral
beams are used, with a posterior beam if necessary.
When treating the prostate, the common approach is to use a technique
with an anterior and two wedged posterior oblique beams +/- wedged
lateral beams may spare more normal rectum, and four or six coplanar
beam arrangements may reduce doses to the OAR further.
CONVENTIONAL:
o AP/PA Fields:
superior = L5/S1
inferior = 0.5–1 cm below the area where the dye narrows on the
urethrogram.
lateral = 1.5 cm lateral to the bony pelvis.
o lateral fields:
Anterior border: anterior to the symphysis pubis.
Posterior border: splits the sacrum at S2/3.
61. Dose:
Single phase:
Prostate + base of the seminal vesicles (SV) (or whole SV if involved): 70-78GY.
Two phases (in case of prophylactic irradiation to SV):
Phase 1
Prostate + whole SV : 54-56 GY.
Phase 2
Prostate only : 70-78GY.
Three phases (in case of prophylactic irradiation to SV+LNs):
Phase 1
Prostate + whole SV + pelvic LNs ( WPI): 46 GY.
Phase 2
Prostate + base of the seminal vesicles (SV) (or whole SV): 54-56 GY.
Phase 3
Prostate only (+ SV if involved): 70-78GY.
63. Conventional versus hypofractionated high-dose
intensitymodulated radiotherapy for prostate cancer:
Preliminary safety results from the CHHiP randomized controlled
trial
TREATMENT ARMS:
1) 74 Gy in 37 fractions (n=153)
1) 60 Gy in 20 fractions (n=153)
3) 57 Gy in 19 fractions (n=151)
Radiotherapy with Hypofractionated high-dose radio-therapy
seems equally well tolerated as conventionally fractionated
treatment at 2 years.
Dearnaley D et al. Lancet Oncol.2012
64. Verification:
Electronic portal images are taken and compared with
DRRs from the planning CT scan, using bony
landmarks, the beam edges and centre.
The use of radio-opaque fiducial markers within the
prostate allows variations arising from prostate
movement to be identified and incorporated into the
local protocol.