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Two different tumors were localized cheap viagra vigour 800mg overnight delivery erectile dysfunction condom; a sarcoma in the right scapula (shoulder blade) and a lymphoma in the right axillary lymph buy viagra vigour 800mg line erectile dysfunction medication side effects. The cancers were treated by radiation and the result is seen on the series of pictures – the sarcoma to the left and the lymphoma to the right. You see that the large sarcoma in the right scapula is radioresistant – independent of the radiation dose given. The lymphoma in the right axillary lymph is however radiosensitive and is eliminated after a dose of 40 Gy. The images were taken before the start of radiotherapy (0 Gy), after 8 Gy (early treatment) and after 40 Gy (late treatment). For these methods no ionizing radiation is involved and no absorbed or scattered photons are making the pic- tures. However, Raymond Damadian in spite of this it was a sensation (born 1936) and a start of a technique that to- (photo from 2009) day is very important within med- ical diagnostics. The Nobel prize in physics for 1952 was awarded to Bloch and Purcell for nuclear magnetic resonance. Yevgeny Zavoisky Felix Bloch Edward Mills Purcell (1907 – 1976) (1905 – 1983) (1912 – 1997) 204 The physics of magnetic resonance In this book we are interested in the physical background for the different medical techniques rather than to the techniques themselves. Knowledge about x-rays and radioactive nuclides was important for the methods discussed so far. In the case of the electron it can be written as: Here b is the Bohr-magneton, S is the electron spin and “g“ is the spectroscopic splitting factor – which for free electrons is 2,0023. If these small magnets are placed in a magnetic feld B, they will attain an energy which depends on the spin state. B S S where mS is the spin quantum number for the electron, which can have two values; +1/2 and –1/2. The reonance phenomenon +1/2gbB Energy difference: hn = gbB –1/2gbB Increasing magnetic feld 205 The fgure show that all the small magnets have equal energy as long as the external magnetic feld is zero. However, in a magnetic feld the magnets will be oriented “with” or “against” the magnetic feld. The two states have different energies – and the energy difference increases with the feld B as shown. It is possible to induce transitions between the energy states by electromagnetic radiation. The condition for inducing transitions between the energy states is that the energy of the radiation (hn) is equal to the energy difference. The condition for an absorption can be written: hn = gbB for electrons and hn = g b B for protons N N The fgure indicates that we can have resonance at any given frequency as long as the magntic feld follows the resonance condition. However, it is a big difference since gb for electrons is much larger than g b for protons. The electromagntic radiation yields transitions in both directions with the same probability. Thus, if the populations of the two levels is equal, the net result would be nil – neither absorption, nor emis- sion. The population of the states follows a Boltzman distribution with the lowest level most popu- lated. In order to have a constant absorption, the difference in population must be kept. It appears that these relaxation times changes when going from normal to pathological tissue – and this can be used in diagnostics. It is therefore easy to understand that it is possible to fulfll the resonance condition for a small volume element. However, it is a long way from a volume element to a picture – and the question is: How is it possible to go from a point (a tiny volume element) to construct a whole picture? The frst solution of this came when Paul Lauturbur tried out his ideas in the early 1970s. He intro- duced magnetic feld gradients and by analysis of the characteristics of the emitted radio waves, he was able to determine their origin. In 1973 206 he demonstrated how it was possible to see the difference between tubes flled with water from an environment of heavy water.

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Some lifestyle factors in human lung cancer: A case control study of 792 lung cancer cases 800 mg viagra vigour visa impotence nitric oxide. Energy intake required to main- tain body weight is not affected by wide variation in diet composition purchase viagra vigour 800mg visa erectile dysfunction and diabetes a study in primary care. Relationship between urinary calcium and net acid excretion as determined by dietary protein and potassium: A review. Effects of soybean fiber on cecal digestion in rats previously adapted to a fiber-free diet. High propionic acid fermentations and mineral accumulation in the cecum of rats adapted to different levels of inulin. Nutrient intakes and body weights of persons consuming high and moderate levels of added sugars. Protection of conju- gated linoleic acids against 2-amino-3-methylimidazo[4,5-f]quinoline-induced colon carcinogenesis in the F344 rat: A study of inhibitory mechanisms. Effect of high-carbohydrate-low-fat diets on plasma glucose, insulin and lipid responses in hypertriglyceridemic humans. Modified lipoproteins, cytokines and macrovascular disease in non-insulin-dependent diabetes mellitus. Monounsaturated fatty acid-enriched diet decreases plasma plasminogen acti- vator inhibitor type 1. Linoleic acid intake and susceptibility of very-low-density and low density lipoproteins to oxidation in men. Role of fat, animal protein, and dietary fiber in breast cancer etiology: A case-control study. Dietary fiber, weight gain, and cardiovascular disease risk factors in young adults. Dietary habits and incidence of noninsulin-dependent diabetes mellitus in a population study of women in Gothenburg, Sweden. Reduction of blood pressure and plasma triglycerides by omega-3 fatty acids in treated hypertensives. Dietary (n-3) polyunsaturated fatty acids improve adipocyte insulin action and glucose metabolism in insulin-resistant rats: Relation to membrane fatty acids. Moderate intake of n-3 fatty acids for 2 months has no detrimental effect on glucose metabolism and could ameliorate the lipid profile in type 2 diabetic men: Results of a con- trolled study. Macronutrient energy intake and adiposity in non obese prepubertal children aged 5–11 y (the Fleurbaix Laventie Ville Santé Study). Diet and the risk of breast cancer in a case-control study: Does the threat of disease have an influence on recall bias? High-fat, low-carbohydrate diet and the etiology of non-insulin-dependent diabetes mellitus: The San Luis Valley Diabetes Study. High saturated fat and low starch and fibre are associated with hyperinsulinemia in a non-diabetic population: The San Luis Valley Diabetes Study. Comparison of effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on plasma lipids and lipo- proteins in man. Dietary fat and insulin sensitivity in a triethnic population: The role of obesity. Macronutrient dis- posal during controlled overfeeding with glucose, fructose, sucrose, or fat in lean and obese women. Comparison of the effect of canola oil and sunflower oil on plasma lipids and lipoproteins and on in vivo thromboxane A2 and prostacyclin production in healthy young men. Energy and macronutrient intakes of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988–91. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. Association of coronary heart disease risk factors with microscopic qualities of coronary atherosclerosis in youth. Relative effects of dietary saturated, monounsaturated, and polyunsaturated fatty acids on cardiac arrhythmias in rats. Effect of monounsaturated fatty acids versus com- plex carbohydrates on high-density lipoproteins in healthy men and women. Effect of dietary cis and trans fatty acids on serum lipoprotein[a] levels in humans.

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The aims of the Bonn Call for Action are: (a) to strengthen the radiation protection of patients and health workers overall viagra vigour 800 mg overnight delivery trazodone causes erectile dysfunction; (b) to attain the highest benefit with the least possible risk to all patients by the appropriate use of ionizing radiation medicine buy generic viagra vigour 800mg on-line erectile dysfunction drugs non prescription; (c) to aid the full integration of radiation protection into health care systems; (d) to help improve the benefit–risk dialogue with patients and the public; and (e) to enhance the safety of technical operations in medicine. The Bonn Call for Action highlights ten main actions, and related subactions, that were identified as being essential for the strengthening of radiation protection in medicine over the next decade. The views expressed remain, however, the responsibility of the named authors or participants. In addition, the views are not necessarily those of the governments of the nominating Member States or of the nominating organizations. Guidance provided here, describing good practices, represents expert opinion but does not constitute recommendations made on the basis of a consensus of Member States. Flory Opening address — World Health Organization European Centre for Environment and Health Malone Developing and implementing appropriateness criteria and imaging referral guidelines: Where are we and where are we going? Ortiz López Impact of new treatment technology on patient protection in radiotherapy. Yonekura Tools needed and tools available for safety improvement in radiation therapy Knöös Medical issues associated with radiotherapy accidents: Some examples and lessons learned. Rehani Improving protocols and procedures for strengthened radiation protection in interventional procedures Khong New developments in computed tomography technology and their impact on patient protection. Ebdon-Jackson Manufacturers’ role in medical radiation protection: The end users’ perspective Gilley The Revised International Basic Safety Standards and their potential impact on radiation protection in medicine Le Heron Working towards an appropriate level of radiation protection in medicine in the next decade. Action 1: Enhance the implementation of the principle of justification (a) Introduce and apply the 3As (awareness, appropriateness and audit), which are seen as tools that are likely to facilitate and enhance justification in practice; (b) Develop harmonized evidence based criteria to strengthen the appropriateness of clinical imaging, including diagnostic nuclear medicine and non-ionizing radiation procedures, and involve all stakeholders in this development; (c) Implement clinical imaging referral guidelines globally, keeping local and regional variations in mind, and ensure regular updating, sustainability and availability of these guidelines; (d) Strengthen the application of clinical audit in relation to justification, ensuring that justification becomes an effective, transparent and accountable part of normal radiological practice; (e) Introduce information technology solutions, such as decision support tools in clinical imaging, and ensure that these are available and freely accessible at the point of care; (f) Further develop criteria for justification of health screening programmes for asymptomatic populations (e. Action 3: Strengthen manufacturers’ role in contributing to the overall safety regime (a) Ensure improved safety of medical devices by enhancing the radiation protection features in the design of both physical equipment and software and to make these available as default features rather than optional extra features; (b) Support development of technical solutions for reduction of radiation exposure of patients, while maintaining clinical outcome, as well as of health workers; (c) Enhance the provision of tools and support in order to give training for users that is specific to the particular medical devices, taking into account radiation protection and safety aspects; (d) Reinforce the conformance to applicable standards of equipment with regard to performance, safety and dose parameters; (e) Address the special needs of health care settings with limited infrastructure, such as sustainability and performance of equipment, whether new or refurbished; (f) Strengthen cooperation and communication between manufacturers and other stakeholders, such as health professionals and professional societies; (g) Support usage of platforms for interaction between manufacturers and health and radiation regulatory authorities and their representative organizations. Action 5: Shape and promote a strategic research agenda for radiation protection in medicine (a) Explore the re-balancing of radiation research budgets in recognition of the fact that an overwhelming percentage of human exposure to man-made sources is medical; (b) Strengthen investigations in low-dose health effects and radiological risks from external and internal exposures, especially in children and pregnant women, with an aim to reduce uncertainties in risk estimates at low doses; (c) Study the occurrence of and mechanisms for individual differences in radiosensitivity and hypersensitivity to ionizing radiation, and their potential impact on the radiation protection system and practices; (d) Explore the possibilities of identifying biological markers specific to ionizing radiation; (e) Advance research in specialized areas of radiation effects, such as characterization of deterministic health effects, cardiovascular effects, and post-accident treatment of overexposed individuals; (f) Promote research to improve methods for organ dose assessment, including patient dosimetry when using unsealed radioactive sources, as well as external beam small-field dosimetry. Action 6: Increase availability of improved global information on medical exposures and occupational exposures in medicine (a) Improve collection of dose data and trends on medical exposures globally, and especially in low and middle income countries, by fostering international cooperation; (b) Improve data collection on occupational exposures in medicine globally, also focusing on corresponding radiation protection measures taken in practice; (c) Make the data available as a tool for quality management and for trend analysis, decision making and resource allocation. Action 8: Strengthen radiation safety culture in health care (a) Establish patient safety as a strategic priority in medical uses of ionizing radiation, and recognize leadership as a critical element of strengthening radiation safety culture; (b) Foster closer cooperation between radiation regulatory authorities, health authorities and professional societies; (c) Foster closer cooperation on radiation protection between different disciplines of medical radiation applications as well as between different areas of radiation protection overall, including professional societies and patient associations; (d) Learn about best practices for instilling a safety culture from other areas, such as the nuclear power industry and the aviation industry; (e) Support integration of radiation protection aspects in health technology assessment; (f) Work towards recognition of medical physics as an independent profession in health care, with radiation protection responsibilities; (g) Enhance information exchange among peers on radiation protection and safety related issues, utilizing advances in information technology. Action 10: Strengthen the implementation of safety requirements globally (a) Develop practical guidance to provide for the implementation of the International Basic Safety Standards in health care globally; (b) Further the establishment of sufficient legislative and administrative framework for the protection of patients, workers and the public at national level, including enforcing requirements for radiation protection education and training of health professionals, and performing on-site inspections to identify deficits in the application of the requirements of this framework. Heinen-Esser Parliamentary State Secretary, Federal Ministry for the Environment, Nature Conservation and Nuclear Safety, Bonn, Germany As the host of this conference in the former German capital, I would like to extend a warm welcome to you all, and to express my heartfelt thanks to you, Mr. Matić — the Acting Director of the World Health Organization European Centre for Environment and Health, who likewise supports this conference; — Mr. Hendee, you have made a major contribution to the content and structure of this excellent, well balanced programme. Weiss, you may have officially retired from active working life in the summer, but you have been far from idle over the past few months. You have invested a huge amount of time and commitment, and this conference has benefited enormously from your wide ranging professional expertise. You have been instrumental in helping to ensure its success — thank you very much. The outcome of that conference was the adoption of an Action Plan, which has guided international efforts on protecting patients from ionizing radiation ever since. New diagnosis and treatment techniques using ionizing radiation and radioactive substances have become well established. At the same time, there is also a growing awareness of both the benefits and risks of using ionizing radiation on humans. The increasing use of ionizing radiation in medicine worldwide (4 billion diagnostic procedures in 2008) is an indication of its benefits.

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The mitochondrial content is most likely greatest in which of the following types of cells? A 45-year-old man without a history of bleeding or excessive bruising dies suddenly due to rupture of an aortic dissection discount viagra vigour 800 mg on line erectile dysfunction medicine pakistan. A 42-year-old woman comes to the physician for a follow-up examination after two separate Pap smears have shown dysplastic epithelial cells buy viagra vigour 800mg cheap erectile dysfunction drugs in nigeria. The viral E6 protein binds to the cellular p53 tumor suppressor gene, causing it to be degraded. Which of the following best describes the mechanism by which the E6 protein causes cervical cancer? Which of the following is the correct sequence of events in the initiation of contraction of a skeletal muscle fiber? Conformational Release of Ca2+ from Change in Acetylcholine Depolarization Troponin-Tropomyosin Sarcoplasmic Propagation into Binding to of Sarcolemma Complex Reticulum Transverse Tubules Receptors (A) 1 2 3 4 5 (B) 2 5 4 3 1 (C) 3 5 2 4 1 (D) 4 2 5 3 1 (E) 5 3 4 1 2 14. A 90-year-old woman is brought to the emergency department 30 minutes after she fell while climbing the steps into her house. Increased activity of which of the following cell types is the most likely cause of the decrease in bone mass in this patient? A 50-year-old man comes to the physician because of a cough productive of large quantities of mucus for 6 months. Which of the following cell types is the most likely cause of the increase in this patient’s secretion of mucus? A 65-year-old man with severe atherosclerotic coronary artery disease comes to the emergency department because of a 12-hour history of chest pain. During an experimental study, an investigator finds that the regulation of cell cycle and programmed cell death may be initiated by the mitochondrion. The interaction of the mitochondrion with the activation of the caspase family of proteases and subsequent apoptosis is most likely mediated by which of the following? He enrolls in a clinical study of a novel chemotherapeutic agent that, as a side effect, blocks kinesin, a component of the cellular microtubular transport system. An alteration in which of the following components of the neuromuscular junction is the most likely cause of the muscle weakness? A pathologist uses monoclonal antibodies against several intermediate filament proteins and finds that a tumor section stains positive for cytokeratin only. B - 30 - Microbiology Microbiology Module (125 items) Systems General Principles of Foundational Science 70%–75% Biology of tissue response to disease Pharmacodynamic and pharmacokinetic processes Microbial identification and classification Bacterial biology Antibacterial agents Viral biology Antiviral agents Fungal biology Antifungal agents Parasitic biology Antiparasitic agents Prions Immune System 1%–5% Blood & Lymphoreticular System 1%–5% Nervous System & Special Senses 1%–5% Skin & Subcutaneous Tissue 1%–5% Musculoskeletal System 1%–5% Cardiovascular System 1%–5% Respiratory System 1%–5% Gastrointestinal System 1%–5% Renal & Urinary System 1%–5% Pregnancy, Childbirth, & the Puerperium 1%–5% Female Reproductive & Breast 1%–5% Male Reproductive 1%–5% Multisystem Processes & Disorders 1%–5% Immunology Module (25 items) Systems Immune System 75%–80% Development of cells of the adaptive immune response Structure, production, and function Cellular basis of the immune response and immunologic mediators Basis of immunologic diagnostics Disorders associated with immunodeficiency Immunologically mediated disorders Adverse effects of drugs on the immune system Blood & Lymphoreticular System 5%–10% Nervous System & Special Senses 1%–5% Skin & Subcutaneous Tissue 1%–5% Respiratory System 1%–5% Pregnancy, Childbirth, & the Puerperium 1%–5% - 31 - 1. A 45-year-old woman comes to the physician because of progressive facial swelling and pain during the past week. Physical examination shows ecchymoses over the left orbital and periorbital regions with proptosis. Findings on microscopic examination of material from the lesion include broad, irregularly shaped, nonseptate hyphae with branches at right angles. A 21-year-old woman who is a college student is brought to the emergency department 2 hours after the onset of fever, chills, severe headache, and confusion. Physical examination shows numerous petechial lesions over the upper and lower extremities. Analysis of cerebrospinal fluid shows numerous leukocytes and gram-negative diplococci. Administration of which of the following vaccines is most likely to have prevented this patient’s condition? A sexually active 37-year-old woman comes to the physician because of a 2-day history of pain in the area of her genitals. Pelvic examination shows shallow, small, extremely tender ulcers with red bases in the vulvar and vaginal regions. Which of the following infectious agents is the most likely cause of these findings? During an experimental study, an investigator develops a new member of the class of non-nucleoside reverse transcriptase inhibitors. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with which of the following host phagocyte functions?

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