Upper rectal cancer management is controversial. The present series reports the outcomes of treatment comparing neoadjuvant chemoradiation (NCRT) versus upfront surgery.
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
This study was performed to analyze the efficacy and safety of con-current radiotherapy and weekly paclitaxel in the treatment of carcinoma of uterine cervix. Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-Intracavitary brachytherapy, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg ∕m2 during entire course of external beam radiotherapy. Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. The results of this study suggest that concurrent chemo radiotherapy is feasible in treatment of carcinoma cervix with acceptable and manageable toxicity and paclitaxel act as radio sensitizer in locally advanced cervical cancer.
Abstract—Colorectal cancer is leading cancer-related public health problem. This study was conducted to determine the effect of High-Dose-Rate intraluminal brachytherapy (HDR-BT) with or without interstitial brachytherapy during neoadjuvant chemoradiation for locally advanced rectal cancer. This randomized contrial was conducted on 28 patients attended with locally advanced rectal cancer (T3, T4 or N+) treated initially with concurrent capecitabine (800 mg/m2 twice daily for 5 days per week) and pelvic external beam radiation therapy (45Gy in 25 Fractions) after one week MRI for all patients; received intraluminal HDR-BT with 4Gy x 2 Fractions with one week interval for those had gross residual disease within 1cm of rectal wall and receiveed intraluminal and interstitial brachytherapy with 4Gy x 2 Fractions with one week interval for those had gross residual disease far from 1cm of rectal wall. All patients underwent surgery within 4-8 week after completion of neoadjuvant therapy. In the control group which were not randomized, twenty-eight patients underwent neoadjuvant chemoradiation (45Gy in 25 Fraction with concurrent capecitabine 800mg/m2 twice daily for 5 days per week) followed by surgery. It was found that in HDR-BT group pathologic complete response (pCR), pathologic partial response (pPR) and pathologic response rates (pCR+pPR) based on AJCC TNM staging for colorectal cancer were %35.7, %35.7, and %71.4 respectively. The pCR, pPR, and pRR were %25, %17, and %42 in the control group respectively. pCR, pPR, and pRR were improved with HDR-BT. However, only response rate improvement was statistically significant (p=0.031). There was no a statistically significant difference in the complications between the two groups (p > 0.05). So it can be concluded that HDR intraluminal with or without interstitial brachytherapy may be an effective method of dose escalation technique in neoadjuvant chemoradiation therapy of locally advanced rectal cancer with higher response rate and manageable side effects.
Background: Transanal total Mesorectal Excision (TaTME) combined with traditional laparoscopy might be a promising alternative for locally advanced mid-low rectal cancer. However, some potential complications were recorded and should be evaluated further. The aim of this prospective study was assessment the results of TaTME combined with traditional laparoscopy in treatment of locally advanced mid-low rectal cancer of a single institution.Methods: Prospective study of patients with mid-low locally advanced rectal cancer who were undergone rectal resection with TaTME technique.
This study was performed to analyze the efficacy and safety of con-current radiotherapy and weekly paclitaxel in the treatment of carcinoma of uterine cervix. Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-Intracavitary brachytherapy, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg ∕m2 during entire course of external beam radiotherapy. Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. The results of this study suggest that concurrent chemo radiotherapy is feasible in treatment of carcinoma cervix with acceptable and manageable toxicity and paclitaxel act as radio sensitizer in locally advanced cervical cancer.
Trimodal Management of Locally Invasive Urinary Bladder CancerNainaAnon
To evaluate the response of the modern bladder-preservation treatment modality; Trimodal Therapy (TMT) in Muscle-Invasive Bladder Cancer (MIBC). Aiming at bladder preservation in MIBC, TMT was to offer a quality- of-life advantage and avoid potential morbidity and mortality of Radical Cystectomy (RC) without compromising oncologic outcomes.
Chair & Moderator, Prof. Solange Peters, MD, PhD, Mark M. Awad, MD, PhD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to Cancer Immunotherapy for this CME/MOC/CC activity titled “Parsing the Practicalities of Pathologic Response Assessment After Neoadjuvant Immunotherapy to Facilitate Progress in Early-Stage Cancers.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/CC information, and to apply for credit, please visit us at https://bit.ly/3uRHyjk. CME/MOC/CC credit will be available until May 9, 2023.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
The article lays an emphasis on the laparoscopic surgical method used to treat colorectal cancer. It reviews the current status of the laparoscopic colorectal surgeries and recommendation of evidences for short- and long-term outcome. The early results were against laparoscopic approach. There was a need of properly designed study to validate or invalidate these findings. Seven large-scale trials compared laparoscopic and open colectomy for colon carcinoma and examined short-term and long-term outcomes. These trials included the Clinical Outcomes of Surgical Therapies (COST) trial funded by the National Cancer Institute in the United States, the Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in the United Kingdom, the Colon Cancer Laparoscopic or Open Resection (COLOR), a multicenter European trial.
For the validation of the argument that laparoscopy is safe, meta-analysis was performed. Certain conclusions of meta-analysis are also presented in this article. The individual merits and weaknesses of laparoscopic surgery as compared with open surgery as the primary treatment of colorectal cancer are being highlighted in this article.
Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Co-Chairs, Nasser Altorki, MD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC activity titled “How to Integrate Perioperative Immunotherapy Into Multimodal Treatment Plans to Improve Outcomes in Resectable NSCLC.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3xb6WS1. CME/MOC credit will be available until June 14, 2023.
IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...NainaAnon
The IRF family of proteins involves in the tumor progression. However, but the functions of IRF5 in the tumorigenesis are largely unknown. Here, IRF5 was found to be up-regulated in hepatocellular carcinoma (HCC). Interfering with IRF5 inhibited the growth and tumorigenic ability of HCC cells. When studying the molecular mechanism, it was found that TRIM35 interacted with IRF5, promoting the ubiquitination and degradation of IRF5. In the clinical specimens of HCC, TRIM35 was negatively correlated with the expression of IRF5. These observations reveal the oncogenic function of IRF5 in the progression of HCC, suggesting that IRF5 is a promising target for the therapy of HCC.
Alterations of Gut Microbiota From Colorectal Adenoma to CarcinomaNainaAnon
Gut microbiota has been implicated as a critical role in the development of colorectal cancer (CRC) and colorectal adenoma (CRA). However, few basic research has revealed the association between gut microbiota and the development of CRA and CRC. We aim to compare the diversity and composition of intestinal flora in CRA and CRC patients, to reveal the changes of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis, and to explore potential biomarkers. We analysed colorectal tissues (11 CRC, 11 CRA and 11 healthy volunteers (HC). Using 16S rRNA sequencing analysis to compare the gut microbiome of patients with CRC, CRA and HC. The microbial diversity including alpha diversity, beta diversity and identified the microbial compositions among the three groups were characterized. Intestinal microbial composition and diversity were significantly decreased in the CRA group, whereas those were obviously increased in the CRC group. The fourth most predominant microbial compositions in the three groups were Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes at the phylum level. Moreover, the relative abundance of Fusobacteria at the phylum level behaved a general trend of decreasing in CRA group first and then increasing in CRC group. When exploring the Fusobacteria abundance in MetaCyc database signaling in different groups, it was indicated that Fusobacteria was also higher in CRC than CRA especially in the ICME2-PWY, Cobalsyn-PWY and Anaglycolysi signal pathways. Taken together, the observed intestinal microbial difference among the three groups provides a basis for understanding the potential role of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis.
Prognosis of Invasive Micropapillary Carcinoma of the Breast Analyzed by Usin...NainaAnon
Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
To report the lessons we have learned in the management of uretero-enteric anastomosis stricture (UEAS) in a tertiary urology center over a decade of experience.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...NainaAnon
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Combined Analysis of Micro RNA and Proteomic Profiles and Interactions in Pat...NainaAnon
The Liquid Mass System(LMS) includes an Easy nLC1000 (Thermo Fisher) coupled ultra-high resolution mass spectrometer Orbitrap Fusion Lumos (Thermo Fisher) with a Thermo Fisher electrospray source. Each injection is sent to a preset column (Acclaim PepMap C18, 100 μm x 2 cm, Thermo Scientific) for adsorption at a flow rate of 3 L/min. The sample is then sent to the analyzer column (Acclaim PepMap C18, 75 μm x 15 cm, Thermo Scientific) for separation
Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
The Use of the Infrared Laser Therapy of 890-910 NM for the Treatment Breast ...NainaAnon
The experimental studies were conducted with Walker's carcinosarcoma n256 (from the U.S.A. bank), cancer of the mammary gland (RMK-1). Spontaneous –mice with mammary glands cancer (type B). The tasks were as follows: to study the effect of different doses LLLT on the growth of experimental tumors. Evaluation of the effectiveness by applying LLLT in combination with various chemotherapeutic agents (vincristin, 5-Fu, ciclophosphan). Research of LLLR effect on different types of tumors show that this treatment can be used for tumors-statistic effect and for increasing life-span in animals. Applying LLLR in combination with chemotherapeutic agents causes tumors-static action. The most effective combination was LLLT + vincristin which caused the inhibition of tumor growth in Walker's carcinosarcoma-by 92,87%, in RMK-1 - by 90,29% in comparing to controls. The combination of LLLT with HpD showed - the effect of laser therapy takes place in 30 min before the irradiation and is accompanied by a sharp reduction of the preparation's accumulation in the tumor cells.
The Use of the Infrared Laser Therapy of 890-910 NM for the Treatment Breast ...NainaAnon
The experimental studies were conducted with Walker's carcinosarcoma n256 (from the U.S.A. bank), cancer of the mammary gland (RMK-1). Spontaneous –mice with mammary glands cancer (type B). The tasks were as follows: to study the effect of different doses LLLT on the growth of experimental tumors. Evaluation of the effectiveness by applying LLLT in combination with various chemotherapeutic agents (vincristin, 5-Fu, ciclophosphan). Research of LLLR effect on different types of tumors show that this treatment can be used for tumors-statistic effect and for increasing life-span in animals. Applying LLLR in combination with chemotherapeutic agents causes tumors-static action. The most effective combination was LLLT + vincristin which caused the inhibition of tumor growth in Walker's carcinosarcoma-by 92,87%, in RMK-1 - by 90,29% in comparing to controls. The combination of LLLT with HpD showed - the effect of laser therapy takes place in 30 min before the irradiation and is accompanied by a sharp reduction of the preparation's accumulation in the tumor cells.
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To evaluate the response of the modern bladder-preservation treatment modality; Trimodal Therapy (TMT) in Muscle-Invasive Bladder Cancer (MIBC). Aiming at bladder preservation in MIBC, TMT was to offer a quality- of-life advantage and avoid potential morbidity and mortality of Radical Cystectomy (RC) without compromising oncologic outcomes.
Chair & Moderator, Prof. Solange Peters, MD, PhD, Mark M. Awad, MD, PhD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to Cancer Immunotherapy for this CME/MOC/CC activity titled “Parsing the Practicalities of Pathologic Response Assessment After Neoadjuvant Immunotherapy to Facilitate Progress in Early-Stage Cancers.” For the full presentation, downloadable Practice Aids, and complete CME/MOC/CC information, and to apply for credit, please visit us at https://bit.ly/3uRHyjk. CME/MOC/CC credit will be available until May 9, 2023.
Current evidence for laparoscopic surgery in colorectal cancersApollo Hospitals
The article lays an emphasis on the laparoscopic surgical method used to treat colorectal cancer. It reviews the current status of the laparoscopic colorectal surgeries and recommendation of evidences for short- and long-term outcome. The early results were against laparoscopic approach. There was a need of properly designed study to validate or invalidate these findings. Seven large-scale trials compared laparoscopic and open colectomy for colon carcinoma and examined short-term and long-term outcomes. These trials included the Clinical Outcomes of Surgical Therapies (COST) trial funded by the National Cancer Institute in the United States, the Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (CLASICC) trial in the United Kingdom, the Colon Cancer Laparoscopic or Open Resection (COLOR), a multicenter European trial.
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Colorectal cancer (CRC) has potential to spread within the peritoneal cavity, and this transcoelomic
dissemination is termed “peritoneal metastases” (PM).The aim of this article was to summarise the current
evidence regarding CRC patients at high risk of PM. Colorectal cancer is the second most common cause of cancer
death in the UK. Prompt investigation of suspicious symptoms is important, but there is increasing evidence that
screening for the disease can produce significant reductions in mortality.High quality surgery is of paramount
importance in achieving good outcomes, particularly in rectal cancer, but adjuvant radiotherapy and chemotherapy
have important parts to play. The treatment of advanced disease is still essentially palliative, although surgery for
limited hepatic metastases may be curative in a small proportion of patients.
Co-Chairs, Nasser Altorki, MD, and Jonathan D. Spicer, MD, PhD, FRCSC, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC activity titled “How to Integrate Perioperative Immunotherapy Into Multimodal Treatment Plans to Improve Outcomes in Resectable NSCLC.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3xb6WS1. CME/MOC credit will be available until June 14, 2023.
IRF5 Promotes the Progression of Hepatocellular Carcinoma and is Regulated by...NainaAnon
The IRF family of proteins involves in the tumor progression. However, but the functions of IRF5 in the tumorigenesis are largely unknown. Here, IRF5 was found to be up-regulated in hepatocellular carcinoma (HCC). Interfering with IRF5 inhibited the growth and tumorigenic ability of HCC cells. When studying the molecular mechanism, it was found that TRIM35 interacted with IRF5, promoting the ubiquitination and degradation of IRF5. In the clinical specimens of HCC, TRIM35 was negatively correlated with the expression of IRF5. These observations reveal the oncogenic function of IRF5 in the progression of HCC, suggesting that IRF5 is a promising target for the therapy of HCC.
Alterations of Gut Microbiota From Colorectal Adenoma to CarcinomaNainaAnon
Gut microbiota has been implicated as a critical role in the development of colorectal cancer (CRC) and colorectal adenoma (CRA). However, few basic research has revealed the association between gut microbiota and the development of CRA and CRC. We aim to compare the diversity and composition of intestinal flora in CRA and CRC patients, to reveal the changes of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis, and to explore potential biomarkers. We analysed colorectal tissues (11 CRC, 11 CRA and 11 healthy volunteers (HC). Using 16S rRNA sequencing analysis to compare the gut microbiome of patients with CRC, CRA and HC. The microbial diversity including alpha diversity, beta diversity and identified the microbial compositions among the three groups were characterized. Intestinal microbial composition and diversity were significantly decreased in the CRA group, whereas those were obviously increased in the CRC group. The fourth most predominant microbial compositions in the three groups were Proteobacteria, Firmicutes, Actinobacteria and Bacteroidetes at the phylum level. Moreover, the relative abundance of Fusobacteria at the phylum level behaved a general trend of decreasing in CRA group first and then increasing in CRC group. When exploring the Fusobacteria abundance in MetaCyc database signaling in different groups, it was indicated that Fusobacteria was also higher in CRC than CRA especially in the ICME2-PWY, Cobalsyn-PWY and Anaglycolysi signal pathways. Taken together, the observed intestinal microbial difference among the three groups provides a basis for understanding the potential role of intestinal microorganism in the evolution of normal intestinal mucosa-CRA-CRC axis.
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Invasive micropapillary carcinoma (IMPC) is a rare type of breast cancer with high frequency of regional lymph node metastasis. However, the prognosis of IMPC has remained controversial for decades. We aimed to compare the differences of prognosis between IMPC and Invasive ductal carcinoma(IDC) of the breast by utilizing Surveillance, Epidemiology, and End Results (SEER) database.
Uretero-Enteric Anastomosis Stricture after Urinary Diversion; Detailed Analy...NainaAnon
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Skeletal muscle channelopathy are rare heterogeneous episodic disorders with marked genotypic and phenotypic variability resulting in periodic paralysis, and falls in young people which often misdiagnosed or undiagnosed due to its rarity, often the symptoms are miscommunicated to the treating phycision due to its episodic nature and not uncommonly physical examination by the time patient attend the clinic or hospital will be unremarkable apart from periodic muscle paralysis where patient will presented to ED with flaccid weakness,
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The experimental studies were conducted with Walker's carcinosarcoma n256 (from the U.S.A. bank), cancer of the mammary gland (RMK-1). Spontaneous –mice with mammary glands cancer (type B). The tasks were as follows: to study the effect of different doses LLLT on the growth of experimental tumors. Evaluation of the effectiveness by applying LLLT in combination with various chemotherapeutic agents (vincristin, 5-Fu, ciclophosphan). Research of LLLR effect on different types of tumors show that this treatment can be used for tumors-statistic effect and for increasing life-span in animals. Applying LLLR in combination with chemotherapeutic agents causes tumors-static action. The most effective combination was LLLT + vincristin which caused the inhibition of tumor growth in Walker's carcinosarcoma-by 92,87%, in RMK-1 - by 90,29% in comparing to controls. The combination of LLLT with HpD showed - the effect of laser therapy takes place in 30 min before the irradiation and is accompanied by a sharp reduction of the preparation's accumulation in the tumor cells.
The Use of the Infrared Laser Therapy of 890-910 NM for the Treatment Breast ...NainaAnon
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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
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
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.
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
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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.
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.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- 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
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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
4. clinicsofoncology.com 4
Volume 6 Issue 1 -2022 Review Article
Response to NCRT did not influence OS. Distance from anal mar-
gin to tumor also did not affect OS. In the control group, no dif-
ferences in OS were seen between T3 and T4 or node status. After
using PSM, good matching was showed for all factors besides tu-
mor level in the rectum and clinical N-stage. Using genetic match-
ing the groups were well balanced besides clinical N-stage where
t-test p-value remained <.0001. Comparing the two groups, more
patients with stage III disease were significantly observed in the
first group (p<.003). After stratification by gender or accordingly
to disease stage OS remained equivalent. Only 2% of patients in
the study group relapsed locally. In the control group no local re-
lapses were observed.
Gastrointestinal (GI) and genitourinary (GU) toxicity are dis-
played in (Table 2). In the perioperative period, one patient (2%)
had anastomotic leakage (grade 4) and required second surgery,
and one patient (2%), with cT4 bladder involvement, developed
bladder fistula that required surgical repair as well (grade 4).
Figure 1: Overall survival of both groups (neoadjunat treatment vs. direct surgery) in patients with upper rectal cancer (p 0.869)
Figure 2: Overall survival curve comparing T3 vs. T4 upper rectal cancer (p<.014)
5. clinicsofoncology.com 5
Volume 6 Issue 1 -2022 Review Article
Table 1: Clinical and pathologic characteristics of ICO (study) and Ram bam (control) groups.
Characteristic ICO (Badalona) Rambam (Haifa) Statistical significance
gender NS
Male 24 17
female 26 15
Mean Age (±SD) 64.02 ±1.5 64.8±2.2 NS
Stage
T stage NS
T2 4 (8%) 2 (6.3%)
T3 40 (80%) 28 (87.6%)
T4 6 (12%) 2 (6.3%)
N-stage p<.001
N0 3 (6%) 20 (62.5%)
N1 20 (40%) 9 (28.1%)
N2 27 (54%) 3 (9.4)
Clinical stage grouping P<.001
II (cT3-4, cN0, cM0) 3 (6) 20 (62,6)
III (cTany, cN+, cM0) 47 (94%) 12 (37.4)
Pathology data NA
Pathologic complete response, n (%) 7 (14%) 0
T-Downstaging 27 (54%)
N-Downstaging
ypN0 30 (78.7%) of 47 N+
Median Follow-up 6,4 6,9 NS
Distant relapse 4 2
Local relapse 1 (2%) 0
Median time 6±0.3 6.6±0.3 NS
6. Discussion
The three parts of the rectum, or the upper, middle and lower
rectum, have been defined in several studies and national proj-
ects concluding that the uppermost boundary is at the level of 16
cm from the anal verge as measured by colonoscopy [21, 22, 23,
24]. Currently MRI is known to be a more reliable procedure to
evaluate tumor location. [17, 18, 19, 11, 20]. Since MRI is widely
accepted for both description and numeric measurement of upper
rectal tumors, we have accepted for this study to set the upper part
of rectum starting at 11 cm from the anal verge and to consider
tumors lying within 11 - 16 cm from the anal verge [11, 25, 26]
The benefit and input of a multidisciplinary evaluation and treat-
ment of patients with lower and mid rectal cancer tumor currently
is the standard approach. [27, 21, 28, 29, 30] However, there is a
paucity of data about the role of NCRT in upper rectal or distal
sigmoid colon cancer. [26, 31, 45], leading to the current summary
and evaluation of our experience with NCRT patients with upper
rectal and sigmoid cancer. The main focus of our study was to
analyze OS and influencing factors. Toxicity profile allowed us to
evaluate patient safety. Time frames of patient management were
appropriate and met ESMO/ESTRO guidelines for treatment of
rectal cancer patients. For all the patients, a resection with patho-
logically proven R0 margin status was performed. Analyzing the
results in terms of an efficiency, the study showed a portion of
complete pathological response (14%) after delivering NCRT
treatment which is within the reported range among patients with
lower and mid rectal cancer [1, 7, 32-36]. The surgical aspect of
the treatment protocol was not a part of the study. Total mesorectal
excision is a standard surgical approach that was adopted in both
our centers. Pathological report on resectional margins was suffi-
cient to assess the response to neoadjuvant chemoradiation.
Given the bicentric retrospective character of the present study,
there was an attempt made at pseudo-randomizing the patients
using a PSM approach. The PSM results showed well balanced
groups by all parameters except for clinical N-stage. The differ-
ence was clear in t-test results and remained a non-removable con-
founder.
Evaluating OS within this group of patients, it is important to note
that median survival in both NCRT and surgery groups were not
reached, and a five years OS around 80% is a good integrative
indicator of effectiveness and safety of this approach.
PTV was a factor having inverse impact on NCRT probability of
6. clinicsofoncology.com 6
Volume 6 Issue 1 -2022 Review Article
Grade Signs and Symptoms Events/%
Grade 1-2
Abdominal pain 3/2.7
Anal pain 2/1.8
Anemia 1/0.9
Anorexia 3/2.7
Anxiety 1/0.9
Constipation 2/1.8
Non-infectious Cystitis 15/13.6
Dermatitis radiation 14/12.7
Diarrhea 24/21.8
Disseminated intravascular coagulation 1/0.9
Erectile dysfunction 5/4.5
Fatigue 1/0.9
Fecal incontinence 6/5.5
Fever 2/1.8
Flatulence 2/1.8
Hematuria 1/0.9
Lip infection 1/0.9
Pain in extremity 1/0.9
Rash maculopapular 1/0.9
Rectal anastomotic leak 1/0.9
Rectal hemorrhage 7/6.4
Rectal mucositis 1/0.9
Renal and urinary disorders 1/0.9
Skin hyperpigmentation 1/0.9
Thromboembolic event 1/0.9
Urinary incontinence 1/0.9
Urinary urgency 3/2.7
Vomiting 1/0.9
Total Grage 1-2 103/93.6
Grade 3 - 4
Abdominal pain 2/1.8
Anemia 1/0.9
Constipation 1/0.9
Rectal mucositis 1/0.9
Surgical and medical procedures 1/0.9
Wound dehiscence 1/0.9
Total Grade 3-4 7/6.4
Table 2: Neoadjuvant chemoradiation toxicity profile, ICO group.
response (larger volume correlated with worse response). In our
consideration, the larger volumes were derived to cover larger vol-
umes so PTV has been used as a surrogate for larger tumor volume
and its lymphatic spread.
As in the lower and mid rectum, tumors located in the upper part
of rectum follow the well-known rule that T – stage is a more im-
portant prognostic factor for OS than N – stage. [37] Patients with
T3 did better than T4 in terms of OS.
Evaluation of toxicity profile was performed based on CTCAE v4.
To estimate type and severity of acute and late toxicity, published
materials on approaches to upper rectal cancer patients were used
for references [31, 38, 39]. Assessing the results of our study we
should note that the treatment was delivered with no significant
GU toxicity, although grade 4 toxicity was found in two patients
(Table 2). GI grade 1-2 toxicity with high incidence is partly ex-
plained by the chemotherapy agent and would not be fully attribut-
ed to RT. We made an additional t-test calculation and did not find
the correlation between PTV volume and high/low grade toxicity
(p>0.5) (results not showed). We can note that we used modern
treatment technique, and our paramount concern was not to exceed
the normal tissue tolerance, especially for small bowel wall [7].
In second group 15 (46.9%) patients and in the first group 12
patients (24%) did not receive adjuvant chemotherapy. In recent
publications there is increasing support for a “watch-and-wait”
treatment strategy after complete pathologic response [35, 40-43].
We understand that the study has several weak points such as its
retrospective nature, it rereflects independent experience of two
institutions, and the number of enrolled patients is relatively small.
Nevertheless, our results show that this retrospective study has
been performed in two centers with a high volume of patients
with rectal cancer and highly skilled radiation oncology, medical
oncology and surgical oncology teams. All patients were treated
accordingly to up-to-date guidelines and using modern treatment
techniques.
The small number of patients is explained by a non-standard sit-
uation when most of tumor mass is located at the rectosigmoid
junction, laying above and below the anterior peritoneal reflection,
which makes assigning a patient to a rectal or sigmoid cancer co-
hort equivocal. Decision were made on multidicsiplinary tumor
borads after achieving a consensus whenever a patient was re-
ferred to neoadjuvant chemoradiation.
Due to that the lack of observed differences in terms of OS and
local relapse between the study group and control group the benefit
of adding neoadjuvant treatment to these patients is questionable.
However, in the study group patients had more locally advanced
tumors and more nodes affected. As a consequence, the fact that
OS is very similar between the two groups it can be speculated that
neoadjuvant treatment may be beneficial to these patients in terms
of downsizing either for T (54%) or for N (79%) stage.
7. Conclusion
The results of this analysis demonstrated a high five-year OS, with
an excellent toxicity profile, suggesting that the NCRT is safe and
efficient for upper rectal cancer patients. However, the delivery
of NCRT for unselected patients with upper rectal tumors did not
provide an OS advantage in our series.
7. clinicsofoncology.com 7
Volume 6 Issue 1 -2022 Review Article
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related to preoperative assessment of the circumferential resection
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26. But-Hadzic J, Anderluh F, Brecelj E, Edhemovic I, Ermenc AS,
Hudej R, et al., Acute Toxicity and Tumor Response in Locally
Advanced Rectal Cancer After Preoperative Chemoradiation Ther-
apy With Shortening of the Overall Treatment Time Using Inten-
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Boost: A Phase 2 Trial. Int J Radiat Oncol Biol Phys. 2016; 96:
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27. Pillay B, Wootten AC, Crowe H, Corcoran N, Tran B, Bowden P, et
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2016; 42: 56-72.
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Cancer Surgery in the Spanish Association of Surgeons Project: The
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29. Chesney TR, Nadler A, Acuna SA, Swallow CJ. Outcomes of resec-
tion for locoregionally recurrent colon cancer: A systematic review.
Surgery. 2016; 160: 54-66.
30. Beets G, Sebag-Montefiore D, Andritsch E, Arnold D, Beishon M,
Crul M, et al., ECCO Essential Requirements for Quality Cancer
Care: Colorectal Cancer. A critical review. Crit Rev Oncol / Hema-
tol. 2017; 110: 81-93.
31. Qiu B, Ding P-R, Cai L, Xiao WW, Zeng ZF, Chen G, et al., Out-
comes of preoperative chemoradiotherapy followed by surgery in
patients with unresectable locally advanced sigmoid colon cancer.
Chin J Cancer. 2016; 35: 65.
32. Conde S, Borrego M, Teixeira T, Teixeira R, Corbal M, Sa A, et
al., Impact of neoadjuvant chemoradiation on pathologic response
and survival of patients with locally advanced rectal cancer. Reports
Pract Oncol Radiother J Gt Cancer Cent Poznań Polish Soc Radiat
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