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• Professor, Department of Anesthesia and Perioperative Care, University of California, San Francisco, School of Medicine, San Francisco, California

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Prognostic values of various morphometric measurements of tumour extent in prostate needle core tissue arrhythmia chapter 1 cheap 10 mg enalapril with amex. Clinical utility of the percentage of positive prostate biopsies in predicting prostate cancer-specific and overall survival after radiotherapy for patients with localized prostate cancer blood pressure chart elderly purchase 10mg enalapril visa. Biochemical outcome after radical prostatectomy or external beam radiation therapy for patients with clinically localized prostate carcinoma in the prostate specific antigen era arrhythmia quizzes generic enalapril 5 mg amex. Discontinuous foci of cancer in a single core of prostatic biopsy: when it occurs and performance of quantification methods in a private-practice setting pulse pressure ratio generic 5 mg enalapril. Should intervening benign tissue be included in the measurement of discontinuous foci of cancer on prostate needle biopsy? Does discontinuous involvement of a prostatic needle biopsy core by adenocarcinoma correlate with large tumor focus at radical prostatectomy? Extraprostatic extension of prostatic adenocarcinoma on needle core biopsy: report of 72 cases with clinical follow-up. Intraprostatic adipose tissue: a study of 427 whole mounted radical prostatectomy specimens. Intraprostatic fat in a prostatic needle biopsy: a case report and review of the literature. The prognostic significance of perineural invasion in prostatic cancer biopsies: a systematic review. Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes? Evidence of perineural invasion on prostate biopsy specimen and survival after radical prostatectomy. Perineural invasion in prostate cancer patients who are potential candidates for active surveillance: validation study. Intraglandular tumor extent and prognosis in prostatic adenocarcinoma: application of a grid method to prostatectomy specimens. Prognostic significance of tumor volume after radical prostatectomy: a multivariate analysis of pathological prognostic factors. Maximum tumor diameter is an independent predictor of prostatespecific antigen recurrence in prostate cancer. Should involvement of skeletal muscle by prostatic adenocarcinoma be reported on biopsies? Interobserver variability between expert urologic pathologists for extraprostatic extension and surgical margin status in radical prostatectomy specimens. Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup. The radial distance of extraprostatic extension of prostate carcinoma: implications for prostate brachytherapy. Radial distance of extraprostatic extension measured by ocular micrometer is an independent predictor of prostate-specific antigen recurrence: a new proposal for the substaging of pT3a prostate cancer. Quantification of extraprostatic extension in prostate cancer: different parameters correlated to biochemical recurrence after radical prostatectomy. The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. Bladder neck involvement in pathological stage pT4 radical prostatectomy specimens is not an independent prognostic factor. Prostate cancer with bladder neck involvement: pathologic findings with application of a new practical method for tumor extent evaluation and recurrence-free survival after radical prostatectomy. Bladder neck invasion is an independent predictor of prostate specific antigen recurrence. Microscopic bladder neck involvement by prostate carcinoma in radical prostatectomy specimens is not a significant independent prognostic factor. The prognostic significance of bladder neck invasion in prostate cancer: is microscopic involvement truly T4 disease? Prognostic indicators in patients with seminal vesicle involvement following radical prostatectomy for clinically localized prostate cancer. Adenocarcinoma of the prostate invading seminal vesicle: prognostic stratification based on pathologic parameters. The mechanisms and prognostic significance of seminal vesicle involvement by prostate cancer.

Nonbinary: transgender or gender nonconforming person who identifies as neither male nor female arteria hyaloidea persistens order 5mg enalapril with amex. Trans-masculine/trans-feminine: Terms to pulse pressure table discount enalapril 10mg with mastercard describe gender non-conforming or nonbinary persons heart attack toni braxton babyface buy enalapril 5mg without a prescription, based on the directionality of their gender identity blood pressure under 120 buy 10 mg enalapril otc. A trans-masculine person has a masculine spectrum gender identity, with the sex of female listed on their original birth certificate. A trans-feminine person has a feminine spectrum gender identity, the sex of the male listed on their original birth certificate. In portions of these Guidelines, in the interest of brevity and clarity, transgender men/women are inclusive of gender non-conforming or nonbinary persons on the respective spectrae. They/Them/Their: Neutral pronouns used by some who have a nonbinary or nonconforming gender identity. Transsexual: A more clinical term which had historically been used to describe those transgender people who sought medical intervention (hormones, surgery) for gender affirmation. Term is less June 17, 2016 15 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People commonly used in present day, however some individuals and communities maintain a strong and affirmative connection to this term. Cross dresser / drag queen / drag king: these terms generally refer to those who may wear the clothing of a gender that differs from the sex which they were assigned at birth for entertainment, self-expression, or sexual pleasure. Some cross dressers and people who dress in drag may exhibit an overlap with components of a transgender identity. The term transvestite is no longer used in the English language and is considered pejorative. Sexual orientation: Describes sexual attraction only, and is not directly related to gender identity. It is often described based on the lived gender; a transgender woman attracted to other women would be a lesbian, and a transgender man attracted to other men would be a gay man. For the purposes of clarity and simplicity, the term transgender will be used throughout these guidelines to refer to transgender, gender nonconforming, and genderqueer people as a set, unless otherwise indicated. June 17, 2016 16 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People 3. There are several key components to creating an appropriate setting for transgender care. Cultural humility is a concept through which individuals recognize that their own experiences or identities may not project onto the experiences or identities of others. Individual preferences of terminology, complex or novel gender identities, and differing desires for gender-affirming treatments will be encountered daily in the clinic. Meeting patients "where they are" without judgment or editorializing (including in some cases, even positive remarks about appearance) will enhance the patientprovider relationship and avoids the perception of stigma or pathologization. While some patients may be empowered by serving as a source of information for medical providers,[3] others may be uncomfortable doing so. It should not be routinely expected that patients explicitly "teach" their providers, and providers should limit historical questions to those that are relevant to the current visit or problem. Staff training: In addition to healthcare providers, front desk staff, nursing staff, lab and x-ray staff, etc. Training on transgender health issues should be provided to all clinic staff and providers, and should be integrated into the standard hiring and onboarding process for all employees. Waiting areas should include transgender-themed posters, artwork, pamphlets, magazines, etc. In this latter case, making at least one gender-neutral bathroom available will provide a safe space for nonbinary people as well as for those in transition and who feel uncomfortable in any gendered space. Fluency of terminology: Providers should be aware of basic terminology used by the trans community. In addition to the terminology described in these guidelines (which are based on North American English language use), other local or individual terms may exist and also may change over time. Providers should familiarize themselves with local terminology, and approach individuals with cultural humility when determining which specific terms to use. June 17, 2016 17 Guidelines for the Primary and Gender-Affirming Care of Transgender and Gender Nonbinary People Gender identity data includes chosen name, chosen pronouns, current gender identity, and sex listed on original birth certificate. Failure to collect and use gender identity data has several important repercussions, including invisibility of gender and sexual minority populations to policy makers and researchers,[4] difficulties in tracking the organ inventories and preventive health needs of transgender people,[5] and reduced patient satisfaction due to a failure to use chosen names and pronouns.

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Since each cell can only do this process a limited number of times it has been argued that this is a form of aging pulse pressure points buy cheap enalapril 10 mg on line. In addition blood pressure quiz pdf order enalapril 10mg mastercard, chronological lifespan can also be quantified and used as an estimate of aging blood pressure and diabetes generic enalapril 10 mg without prescription. A favorite model of researchers hypertension care plan purchase enalapril 5mg mastercard, the "aging process" of this yeast has been studied in detail. Pseudospora is a filamentous ascomycete that has also been the subject of gerontological research. Its lifespan is limited and, although the mechanism has not yet been fully elucidated, it can involve a process involving copper levels that in turn impact on the energy transduction apparatus of mitochondria as well as reactive oxygen species production (Osiewacz and Borghouts, 2000). Animals (kingdom: Animalia or Metazoa) Like in plants, vegetative propagation may occur among some animals, although usually coupled with sexual reproduction. Campanularia reproducing asexually have been claimed not to age despite showing a cycle of growth and involution (Brock and Strehler, 1963). Hydra and Cyanea capillata have also been claimed by some authors not to show senescence (Brock and Strehler, 1963; Martinez, 1998), despite contrasting opinions of others (Bell, 1988). Sponges and corals are other good examples of asexual vegetative reproduction leading to long lifespans-over 200 years in the case of corals and perhaps thousands of years in the case of sponges. Still, corals have high infant mortality rates and maybe a decrease in mortality with age, which makes them a fascinating case (Finch, 1990, p. One flatworm, Stenostomum tenuicauda, produced a calculated number of 1,000 asexual generations for 11 years and Ctenodrilus monostylos was kept reproducing by fission for 60 years. Asexually reproducing parasitic worms must have reproduced asexually for decades (Moore, 1981; Finch, 1990, p. For example, in Perophora viridis buds originate in certain lymphocytes that are, in effect, stem cells capable of creating a full organism with heart, neural structures, etc. One of the most widely studied species in the world is the soil nematode Caernohabditis elegans, composed mostly of post-mitotic cells (Murakami et al. This species has a very short lifespan-days to weeks-but it can be radically extended by making the animal enter an alternative developmental pathway called dauer. This pathway consists of a developmental arrest and is normally activated when animals are starved or under crowded conditions; it delays development leading to an increased adult phase (Klass and Hirsh, 1976). Another nematode worm, Strongyloides ratti, has both a short-lived free-living (~5 days) form and a parasitic form that can live over one year inside a host (Gardner et al. While these differences in lifespan are dramatic, I should note that the two forms are quite different morphologically and physiologically. The ability of a single genome to give rise to two or more morphologies is called polyphenism. Figure 2: Red sea urchin (Strongylocentrotus franciscanus), which has been estimated to live up to 200 years and is considered a species with negligible senescence. Rotifers are minute aquatic multicellular organisms that have short lifespans ranging from a few days to months; males, unlike females, typically lack excretory systems and therefore have even shorter lifespans (Finch, 1990, p. In contrast to the rapid growth and much shorter lifespans of similar species living in habitats richer in nutrients, animals living around hydrocarbon seeps grow very slowly and have longevities estimated to be between 170 and 250 years (Bergquist et al. Other long-lived invertebrate species include the bivalve mollusk ocean quahog (Arctica islandica) that has been estimated to live up to 400 years (Abele et al. These three species appear not to age and are referred to as species with negligible senescence (Finch, 1990). The AnAge database includes a list of the longest-lived animals and a list of species with negligible senescence. A common mechanical senescence process in insects involves aphagy (Weismann, 1891), or the inability to ingest a complete meal as an adult, generally related to defective mouthparts or a defective gut. Numerous examples exist among insects and include animals like mayflies and species in Ephemeroptera, Neoptera, Coleoptera, etc. For example, the fruit fly Drosophila, a common model of aging, is mostly composed of post-mitotic tissues and fragile organs, making it susceptible to wear and tear that affects irreplaceable organs and/or tissues. Not only are ant castes morphologically different, but ants have two distinct aging phenotypes in workers and queens. What makes them fascinating is the fact that they all share the same genome and both are probably postmitotic, except perhaps the gut and sex cells. The difference between workers and queens is that queens have specialized feeding; for example, larvae destined to become queens are fed ten times more often.

You can test this concept yourself by juicing large arrhythmia band purchase 10 mg enalapril with visa, white asparagus and drinking the product hypertension medical definition discount enalapril 5 mg on-line. Some personal rules about juicing Now we offer a bit of knowledge for you to blood pressure chart youth buy cheap enalapril 10mg on-line assimilate blood pressure 220120 cheap enalapril 5mg mastercard. Since the therapeutic enzymes in freshly produced plant juices do oxidize out of existence and into free radical destruction by exposure to the oxygen in air for any prolonged period, we must offer two parts of one definite rule to follow. Types (6) of Juicing devices Partly on an intuitive belief but mostly observing results in his patients, Dr. Gerson presumed that the method of juice extraction decidedly affected the concentration of nutrients his patient took into their bodies. Forty years after his death, we know from analyses of juices produced by each type of yuicing device that some machines are better than others for the production of quality drinking liquids. Also, the clinical results experienced by patients using each type of juicer provide further support for Dr. Although there are six types of juicers manufactured, which we will describe briefly, our preference focuses on one particular product type. We will cite the lesser machines first and move on the best kind to use this therapy. Below are descriptions of the forms of juicing mechanisms which do produce vegetable and fruit juices but, compared to the sixth one that we prefer, a few of them hardly provide anything really drinkable in acceptable qualities and quantities. The juice quality is fairly good, but the amount of vegetable or fruit pulp remaining is excessive with some of the plant enzymes being left behind in so much pulp. Also, a masticating juicer heats up inside its grinding chamber, which tends to damage the enzymatic quality of the resulting juice. A centrifugal jucer works by pushing the vegetable or fruit part against a rotating disk whose teeth reduce it to pulp. Centrifugal force then throws the plant pulp against a basket screen through which the juice is strained, while the pulp remains behind. Such a mechanism sounds just right, but there are problems with the centrifugal procedure. The exchange of positive and negative (ions) kills the oxidizing enzymes and renders the juice deficient. Even so, centrifugal juicers offer an overall lack of nutrients and a reduced quantity of juice when compared with other types. As with the masticator juice machines, the centrifugal types are moderately priced. The Gerson Therapy does not use wheatgrass inasmuch as most patients find it to be extremely harsh for assimilation by the stomach. Besides, the desirable components in wheatgrass are already found in the Gerson green leaf juice, which is recommended for ingestion two to four times every day and is much easier on the digestive tract. Since there is no reduction of bulk with a blender/liquefier, to derive the nutrients equivalent to those in 104 ounces of freshly produced organic plant juice, a person would need to ingest an alarming quantity of produce. According to our calculations, it would amount to at least 6 pounds of carrots, 8 pounds of apples, and four heads of lettuce every day, in addition to eating three regular meals. Even the less effective type of juice machine will furnish more nutrients than might be consumed in the equivalent quantity of produce. At the Gerson Institute, observations have repeatedly been made that some patients rigorously following the Gerson Therapy by use of a lower-cost centrifugal juicer have failed to experience either reductions in tumour masses or healing reactions even after many weeks on the program. Be advised, therefore, that the choice of an appropriate juicer may be a life-or-death matter. Among the various kinds of juice machines marketed today, we prefer only a couple of brands coming from the one particular extractor type to which we have alluded. Gerson recommended this type of machine above all others and suggested to his patients that they mix the pulp of different vegetables or fruits together thoroughly before pressing to enhance the extraction of certain nutrients. Such a course of action is possible only with a juicer that separates the grinding and pressing functions. Taken from a trituratur / press type of device, the vegetable or fruit juice is much fuller-bodies than that produced by other kinds of juicers. Moreover, it is free of pulp and furnishes about a 35 percent greater quantity of juice from the same amount of raw produce that might have been put through other juicing machines. Green leafy vegetables offer up even more quantity when processed by a triturator (grinder) / press extractor.

References:

• https://www.medschool.lsuhsc.edu/lungcancer/docs/Lung%20cancer%20preventions%20and%20early%20detection_american%20cancer%20society_booklet.pdf
• https://www.baycare.net/media/1473/stretchingexercisesforpiriformis.pdf
• https://www.giaging.org/documents/Natl_Academies_Pain_Management_and_the_Opioid_Epidemic_Balancing_Societal_and_Individual_Benefits_and_Risks_of_Prescription_Opioid_Use.pdf