Dynamic muscular strength of the upper and lower body will be assessed using the one repetition maximum (1RM) method [28]. The 1RM is the maximal weight an individual can move through a full range of motion without change in body position other than that dictated by the specific exercise motion. Participants will perform 1RM tests for the knee extension and chest press exercises using a standard 1RM protocol [23]. Participants with proximal femur bone lesion will be excluded from leg extension 1-RM. Participants with axial skeleton (thoracic/ribs) bone lesion will be excluded from chest press 1-RM. These exercises were selected as they do not involve compression of the spine or excessive load in the pelvic area.
Long-term survival in patients with hilar cholangiocarcinoma depends critically on complete tumor resection. 2,10 In the absence of widespread disease, the likelihood of achieving a complete resection requires examination of all factors related to local tumor extent, which increasingly has become possible with noninvasive imaging studies. 13,14 Tumor location and extent within the biliary tree, as provided by the Bismuth-Corlette classification system, 15,16 is only one component. Additional factors that must be addressed relate to radial tumor growth and its impact on adjacent structures, specifically portal venous involvement and consequent hepatic lobar atrophy. Both the modified Bismuth-Corlette and the American Joint Committee on Cancer 17 staging systems fail to account for all of these local, tumor-related factors, which frequently influence therapy. We have shown previously that a preoperative staging system that accounts fully for local tumor-related factors accurately predicts resectability and correlates with survival. 2
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The clinical staging system proposed in this report, derived from a thorough analysis of patients with resectable and unresectable tumors, is an approach aimed at full radiologic diagnosis using all the available preoperative data. By taking full account of local factors that influence resectability, the proposed scheme, in contrast to the AJCC staging system, 26 reliably stratified patients into treatment groups, predicted the need for hepatic resection to clear all tumor, and correlated with overall resectability and survival. Of the patients who underwent exploration with curative intent, the proposed classification accurately staged the local extent of disease in 86%. This system, in its current form, does not consider the presence of nodal or distant metastases, but the incidence of these findings increased with increasing T stage. The proposed staging classification thus fills a gap by allowing a more rational assessment of resectability and prediction of outcome. In addition, the correlation between more locally advanced tumors (i.e., higher T stage) and metastatic disease may be useful in identifying patients who would benefit from more intensive radiologic investigation or from staging laparoscopy, thereby sparing them an unnecessary laparotomy.
In past years, however, the new invasive imaging studies like MRCP were instrumental in assessing a more accurate staging by endoscopic ultrasound and refined ERC techniques. Together, in the clinical assessment, it seems we have a full armamentarium to select patients for surgery or drainage or even predict outcome.
And before concluding, this presentation demonstrates to my satisfaction that patients with this disease are best cared for in centers where surgeons and ancillary services have the special expertise to perform the full array of procedures and to understand the nuances of treatment planning. It is highly specialized. The number of centers prepared to deliver this type of quaternary care is few.
Advanced age of the mother, as well as the father, is known to be related to reduced fertility [6, 7], and the delay of parenthood seems to affect family size in the direction of fewer children born per couple [8]. Accordingly, a decline in total fertility rate (TFR) has been seen in OECD countries, where the average TFR dropped from 2.7 to 1.7 during the years 1970 to 2009 [9]. Higher maternal age is also associated with an increase in pregnancy-related complications and adverse outcome in the offspring [7] such as prematurity [10] and foetal death [11, 12]. With regards to paternal age, studies have found an association with the general reproductive function such as prolonged time-to-pregnancy, and with pregnancy outcomes such as miscarriage [7]. Postponement of parenthood moreover implies that medically assisted reproduction (MAR) is a reality for a growing number of couples. However, the biological decline in fertility by advanced parental age cannot fully be compensated for by MAR [13], and consequently society as a whole is affected. Moreover, the psychological strain of undergoing fertility treatment should not be ignored [14]. A large Finnish register-based study found that infertile women who had received MAR-treatment, that did not result in a childbirth, had higher rates of hospitalizations for psychiatric diagnoses compared with MAR-treated women, who did give birth [15].
The study was carried out among male and female students enrolled in a full degree study program at the Metropolitan University College, Copenhagen, where a range of professional bachelor degree programs are offered (see Table 1). All of the 995 students registered to attend a mandatory module called the Inter-professional module were considered eligible. We chose to recruit from this module, because it was an ideal opportunity to engage students from all bachelor programmes and because of the recruitment convenience of large classroom or auditorium lectures.
The two types of article metrics we measure are (i) more traditional full-text views and pdf downloads, and (ii) Altmetric data, which shows the wider impact of articles in a range of non-traditional sources, such as social media.
Credit is assigned for a score of 4 or 5 on the AP Statistics test. Those with STATS 180 credit may proceed to STATS 280 (while keeping full credit for STATS 180) or may take STATS 250, in which case they receive full credit for STATS 250 but lose their credit for STATS 180.
We gratefully acknowledge the funding support provided by COE, NACO (M-18017/72/ 2007/NACO (GF Rd6), India and Indian Council of Medical Research (ICMR), New Delhi for sponsoring the HIVDR genotyping under the HIV drug resistance database project (File No. AMR/28/2011-ECD-I).
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