The RAPIDO trial compared short-course radiotherapy followed by chemotherapy and surgery to standard chemoradiotherapy, surgery, and optional adjuvant chemotherapy for locally advanced rectal cancer. The trial found that short-course radiotherapy and chemotherapy led to fewer disease-related treatment failures at 3 years compared to standard treatment, mainly by reducing distant metastases. Short-course treatment resulted in a higher rate of pathological complete response, which could allow for organ preservation in some patients.
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomized, open-label, phase 3 trial
Highlights in the treatment of Rectal cancer.pptxMona Quenawy
rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
Highlights in the treatment of Rectal cancer.pptxMona Quenawy
rectal cancer treatment updates in simple way and the advances in the molecular techniques .the role of the neo adjuvant chemoradiotherapy and the state of the art in the management by each stage.radiotherapy role and technique by using the RTOG guidance in target definition
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...daranisaha
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...JohnJulie1
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...eshaasini
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...NainaAnon
Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Clinics of Oncology | Oncology Journals | Open Access JournalEditorSara
Clinics of OncologyTM (ISSN 2640-1037) - Impact Factor 1.920* is a medical specialty that focuses on the use of operative techniques to investigate and resolve certain medical conditions caused by disease or traumatic injury.
Upper Rectal Cancer: Benefit After Preoperative Chemoradiation Versus Upfront...semualkaira
In this retrospective study we enrolled patients with upper rectal or sigmoid junction locally advanced tumors (stages II-III). At the first Institution patients received NCRT followed by surgery (study group); at the second Institution patients were referred to upfront surgery (control group). Overall survival was the main endpoint of the analysis. Local relapse and other clinical variables were also analyzed.
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
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.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- 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.
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
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.
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
1. TOTAL NEOADJUVANT THERAPY
OF RECTAL CANCER
• Journal Club
• Mr.Mekki Hassan
• Post CCT colorectal Fellow
• Bradford Teaching hospitals Foundation trust
2. TOTAL NEOADJUVANT THERAPY
OF RECTAL CANCER
Short-course radiotherapy followed by chemotherapy
before total mesorectal excision (TME) versus
preoperative chemoradiotherapy, TME, and optional
adjuvant chemotherapy in locally advanced rectal cancer
(RAPIDO): A randomised, open-label, phase 3 trial
3. BACKGROUND
• Standard of care for locally advanced rectal cancer consists
of chemoradiotherapy followed by surgery according to total
mesorectal excision principles after 6–8 weeks. In several
countries, adjuvant chemotherapy is also part of the
standard of care. Preoperative chemoradiotherapy aims to
downstage tumours, leading to improved locoregional
control with local recurrence rates of approximately 5–
9%.unfortunately the occurrence of distant metastases has
not decreased accordingly
• Downstaging also occurs after short-course radiotherapy
followed by delayed surgery.
4. SUMMARY OF NEO ADJUVANTRECTAL
CANCER TREATMENT
Threatened CRM,T4 Dx,lateral
l.nodes
yes
TNT
no
T3b/ +ve L.nodes
no
surgery
yes
chemoradiotherapy for
5/52Short course for 1/52
5. SUMMARY OF RECTAL CANCER
SURGICAL APPROACHES
Rectal
cancer
cT1/2 No
M0
Suitable for
local
excision
TEMS/TAMIS
Not suitable
for local
excision
>cT2 orN
+ve
> 5cm
above anal
verge
AR
<5cm of
anal verge
APER/ELAPE
6. AIM
• The main objective of the RAPIDO trial was to reduce disease-
related treatment failure at 3 years with short course
radiotherapy followed by chemotherapy and total mesorectal
excision compared with standard chemoradiotherapy, total
mesorectal excision, and optional adjuvant chemotherapy.
• Disease-related treatment failure, defined as the first occurrence
of locoregional failure, distant metastasis, a new primary
colorectal tumour, or treatment-related death.
• Locoregional failure included locally progressive disease leading
to an unresectable tumour, local R2 resection, or local recurrence
after an R0–R1 resection.
7. METHODOLOGY
• Open label, randomised, controlled, phase 3 trial, done at in 54
hospitals and radiotherapy centres in seven countries (the Netherlands,
Sweden, Spain, Slovenia, Denmark, Norway, and the USA)
• Inclusion if they were aged 18 years or older, with a biopsy-proven,
newly diagnosed, primary, locally advanced rectal adenocarcinoma with
distal extension less than 16 cm from the anal verge. A pelvic MRI with
at least one of the following high-risk criteria was required: clinical
tumour (cT) stage cT4a or cT4b, extramural vascular invasion, clinical
nodal (cN) stage cN2, involved mesorectal fascia (tumour or lymph node
≤1 mm from the mesorectal fascia), or enlarged lateral lymph nodes
considered to be metastatic
8. • Exclusion criteria included extensive growth of the rectal tumour
into the cranial part of the sacrum or the lumbosacral nerve
roots.
• Recruited at the participating hospitals before commencement
of any treatment and randomly assigned (1:1) by use of the
ProMISe data management system.
• Patients in the experimental group were assigned to short-
course radiotherapy (5×5 Gy) administered over a maximum of 8
days. Chemotherapy was preferably started within 11–18 days
after the last radiotherapy fraction
• Chemotherapy: CAPOX(X8 cycles) or FOLFOX4(X12 cycles)
9. RESULTS
• Between June 21, 2011,
and June 2, 2016, 920
patients were randomly
assigned to the
experimental group (468)
or standard of care group
(452), of whom 912 (99%)
were eligible (462 in the
experimental group and
450 in the standard of care
group.
10. RESULTS
• 128 disease-related treatment
failure events in the
experimental group and 152
events in the standard of care
group, the difference between
groups in disease-related
treatment failure at 3 years was
significant, with fewer disease-
related treatment failure events
in the experimental group than
in the standard of care group
(3-year cumulative probability
of 23·7% [95% CI 19·8–27·6] vs
30·4% [26·1–34·6]; HR 0·75 [95%
CI 0·60–0·95]; p=0·019
11. eligible patients, 25
(3%) were followed
up according to the
watch-and-wait
strategy due to a
clinical complete
response (14 in the
experimental group
and 11 in the
standard of care
group).
3-year overall survival
was 89·1% (95% CI
86·3–92·0) in the
experimental group
and 88·8% (85·9–91·7)
in the standard of care
group (HR 0·92 [95% CI
0·67–1·25]
12. CONCLUSION
• Patients with high-risk locally advanced rectal cancer, the
RAPIDO trial shows that short-course radiotherapy followed
by 18 weeks of chemotherapy before surgery decreases the
probability of disease related treatment failure compared
with chemoradiotherapy with or without adjuvant
chemotherapy, mainly by reducing the probability of distant
metastases. Additionally, the high rate of pathological
complete response in the experimental group can potentially
contribute to organ preservation.
13. DISCUSSION
• Large multicentral study , randomised
• Watch and wait !
• Possible MRI downstaging or overstaging
• More chemo related adverse effects.
• Longer duration between treatment and surgery
(chance for dx progression).
14. • Thank You
• Further reading:
1- Locoregional Failure During and After Short-course
Radiotherapy followed by Chemotherapy and Surgery Compared
to Long-course Chemoradiotherapy and Surgery - A Five-year
Follow-up of the RAPIDO Trial
https://pubmed.ncbi.nlm.nih.gov/36661037/
2-Multicenter, Randomized, Phase III Trial of Short-Term
Radiotherapy Plus Chemotherapy Versus Long-Term
Chemoradiotherapy in Locally Advanced Rectal Cancer (STELLAR)
https://ascopubs.org/doi/full/10.1200/JCO.21.01667