The key is to get creative enough with uploaded digital designs that are allowed to be shared and printed out in file-sharing databases like MakerBot's Thingiverse. See, "The open source world of MakerBot & Thingiverse: objects for free." Volunteers would also have time to use the machine to create designs from their own imagination. In this way, imagination and creativity is enhanced through repeated practice.
The Makerspace Movement comes to Sacramento Public Library
It works by printing out in three dimensions in plastic from a design that's uploaded from a digital computer file. The 3-D printer can pop out designs such as working birdcages and artwork, for example a 3-inch high vase for decor. It's not only Sacramento public library that has installed a 3-D copier/printer. Nationally, numerous public libraries have done the same. See, "Juicer 3D Print from Thingiverse."
The movement is referred to by librarians as the "makerspace" movement. It changes libraries globally into places where people can make art, engineering designs, or various gadgets, focusing on creativity and design. This way, libraries are expanded into places where people can create objects, jewelry, gadgets, artwork, and practical devices in addition to reading books, listening to music, researching information online, bringing one's own laptop and plugging in, or viewing DVDs. See, Printable Jack in the Box
The MakerBot Replicator II 3-D copier cost Sacramento Public Library about $2,500
The library will soon own two of the MakerBot Replicator II 3-D copiers, which cost roughly $2,500, reports an April 21, 2013 Sacramento Bee news article by Edward Ortiz, "Sacramento library adds 3-D copier to its bag of tricks." With all the recent cuts of staff and funding as well as earlier closing hours, the library did receive funding from a state grant.
The 3-D copier will be available to the public in about a month. One machine will stay at the main library, another will be placed temporarily at a suburban branch, notes the Sacramento Bee article. See the YouTube video, "The MakerBot Replicator - Thingiverse to Thing."
Libraries are evolving into a multi-media sanctuary with public design areas for public creativity
If you notice how Sacramento public libraries have changed in the past decade, you'll see how they first evolved into places where you were able to do computer searches, use the Internet, get financial planning advice or tax help, bring your children to read to dogs, listen to storytelling performers, visit libraries weekly to be read to by staff or volunteers who read to children at story time, or choose numerous courses on DVDs to borrow, sometimes with long waiting lists for a course on DVD that might cost hundreds of dollars to buy. In the public library, you can watch the courses on DVDs free. See, "Rhombot by LeemonBaird from Thingiverse" and "Thingiverse Mario 3D Print Using Hot Glue Extruder In Color."
Libraries then expanded into lecture sanctuaries, genealogy searching seminars, places to share family and ethnic recipes and record them for posterity, or even attend book clubs or creative writing sessions. Now, public libraries, including those in Sacramento are moving into the era of designing, from designing your own self-published books and printing them out on library book publishing equipment to designing art work or engineering gadgets on 3-D printers.
Libaries are moving into the era of public design creativity, expanding the library's reputation as a place for more than reading books and magazines for free. See, "Printing Ball and Socket Chain Links from Thingiverse."
The 3-D printer uses a stylus-like device to deposit heated biodegradable plastic - the public can make replicas of other objects
Ankle Pain The stylus travels along a track, moving back and forth as it turns out designs that have been uploaded into the machine. The public can use the machine to replicate other objects such as a comb or similar gadget or print out plastic jewelry or containers in 3-D.
How the plastic is added is by one layer on top of another. The sheets of plastic can be very thin, for example – down to the minutiae of 100 microns – until the object is formed. At this stage, 3-D printers works something like dot matrix printers on steroids that create tangible 3-D objects, not words. So kids can have fun designing their own plastic jewelry or other gadgets and devices if they first learn how to design the object, keep the size realistic for the machine's capabilities, and see whether printing out the gadget is safe. It would also be great for plastic sculptures or turning photos into 3-D busts of faces, for example of people or pets. See, "A screwable case from thingiverse."
At first, the library's 3-D copiers or rather, replicator, is going to be demonstrated to motivate, enhance, and inspire creativity. Think about what design you'd create from imagination that fits the capabilities of the machine. Next, the library will be offering programs similar to those used in other cities. One example might be having volunteers be at a MakerBot space and manage the demonstrations of the 3-D printer-copier-replicator.
The library plans to partner with the 15-month-old Sacramento nonprofit Hackerlab on the MakerBot project
Hacker Lab members will be training others to use the machine Hackerlab is a nonprofit group whose goal is to nurture technology startups. The nonprofit operates out of a downtown Sacramento office on I Street using its own 3-D copier machines. At Hackerlab there are resident makers working on the next generation of 3-D printers, according to the Sacramento Bee article. See, "Hacker Lab – Sacramento Coworking – Maker Space."
The nonprofit, Hackerlab has 3,500 square feet of tools for protyping, fabrication, woodworking and more, including an electronics lab. The public become members and come there and build a creative design or innovation from your own imagination.
Hacker Lab has a community of programmers, designers, and entrepreneurs that work on designs such as mobile and web applications. The public is invited to join them to create imaginative 3-objects, also known as content. No longer is content limited to text, film, illustration on paper, or music. Hacker Lab is also home to 20 Meetups and technical classes a month, including user groups, group learning, and various events going on every night. You can join the community learning.
The new focus of public libraries on creating tactile content in 3-D
The focus of the library is on creating content, whether it's 3-D or in words, pictures, music, or video. In the past, the library has presented puppet shows and storytellers. Libraries have provided conference rooms for lectures on everything from starting one's business to offering tax advice.
The purpose of the library is to enrich the community in as many ways as will work in a public library, including a machine that publishes one copy of anyone's book for a fee. Now, the creativity of content has expanded to 3-D printing of gadgets, wearable art, or copying objects. A library is not limited to text materials.
Tactile-touch-feel multimedia and 3-D object creation in public libraries
The goal is creativity in as many ways as possible, from 3-D multimedia to copying a vase or comb. An example of the new library focus is to have a library be a tactile-touch-feel-create place in multimedia, including the 3-D movement. New media has evolved in libraries from digital media to 3-D printing of objects, even toys, plastic jewelry, and gadgets, such as small dolls or replicas of various objects.
Three dimensional printing is here. Turn your trash into cash and save energy. Plastic beverage or milk bottles don't have to go to waste anymore and clog landfills. Instead, every time you emptied a plastic milk or water jug, you would be stocking up on raw material to make anything from a cell phone case and golf tees to a toy castle and a garlic press? Make your own toys for kids from plastic bottles. It's possible with three dimensional printing. See, "Build Your Own CNC Router, CNC Machine, or 3D Printer."
If you like do-it-yourself technology, check out the website, Thingiverse - Digital Designs for Physical Objects. Thingiverse is dedicated to the sharing of user-created digital design files. The site provides primarily open source hardware designs licensed under the GNU General Public License or Creative Commons licenses, according to the Wikipedia site explaining the purpose of Thingiverse.
Choose your own license on what you design: Do-it-yourself technology in libraries
Thingiverse Users choose the type of user license they wish to attach to the designs they share. 3D printers, laser cutters, milling machines and many other technologies can be used to physically create the files shared by the users on Thingiverse.
Of all the inspirational, creative, artistic and engineering or even kitchen inventions and gadgets you could create, there also are going to be the dark side of 3-D printing just as there is with any technology. You might look to a future where people print their own gun designs or other weapons using 3-D printing. See, "3d Printing a Magic Fish thingiverse/thing:3206 with reprap mendelmax mm151."
The innovative idea is in the brain of the person using the technology. Just like the Internet, the technology can be used to make the world a kinder and gentler place, recycle plastic, or it can be used to make weapons in the hands of those who do things like that. In the meantime, focusing on 3-D printing to make the world a better place through recycling, you now have a chance to make practical use of your digital designs.
Create a toy or a device to make cans easier to open or any other innovation from a snowflake in plastic to jewelry designs and more. If you're going to use the design a container or gadget to hold or process food or water, make sure the plastic at least is BPA-free.
Thingiverse is a place for you to share your digital designs with the world
Computing has shifted away from the mainframe into the personal computer that you use today Next up on your horizon is digital fabrication. If you think laser cutters, cnc machines, 3D printers, and even automated paper cutters are all getting cheaper by the day, you're right. Now you can make gadgets from discarded plastic bottles and similar containers using 3-D printers. These machines are useful for a huge variety of things, but you need to supply them with a digital design in order to get anything useful out of them. See the You Tube video, Thingiverse Proof of Concept (Bottle Cutter).mp4.
If you check out the Thingiverse site, they're creating a community of people who create and share designs freely, so that all can benefit from them. You'll find some free software on the site that can inspire you to be more creative in a variety of applications.
3D printing lets anyone make almost anything with a simple machine and a roll of plastic filament
Now Michigan Technological University's Joshua Pearce has found a way to drive costs down even further by recycling empty milk jugs into filament. The process reduces landfill waste, saves on energy compared with traditional recycling, and makes 3D printing and even better deal. Joshua Pearce is working on it. His main tool is open-source 3D printing, which he uses to save thousands of dollars by making everything from his lab equipment to his safety razor, according to the March 1, 2013 news release by, Marcia Goodrich, "Turn trash into cash... and save energy."
Make toys for kids or household gadgets of all types with a three-dimensional printer. All those plastic jugs and other containers now become raw material from which you can make anything from kitchen equipment to process or juice vegetables to toys to donate or cell phone cases. It's all about recycling plastic bottles and similar containers in your own house or garage and turning these objects into usable other objects. That's the idea of recycling raw materials at home. Also check out the site, Michigan Technological University.
Use free software downloaded from sites such as Thingiverse
Using free software downloaded from sites such as Thingiverse - Digital Designs for Physical Objects which now holds over 54,000 open-source designs, 3D printers make all manner of objects by laying down thin layers of plastic in a specific pattern. While high-end printers can cost many thousands of dollars, simpler open-source units run between $250 and $500—and can be used to make parts for other 3D printers, driving the cost down ever further. See the You Tube video, The open source world of MakerBot & Thingiverse: objects for free.
“One impediment to even more widespread use has been the cost of filament,” explains Pearce, an associate professor of materials science and engineering and electrical and computer engineering in the March 1, 2013 news release by, Marcia Goodrich, "Turn trash into cash... and save energy." Though vastly less expensive than most manufactured products, the plastic filament that 3D printers transform into useful objects isn’t free.
Turning milk jugs into plastic filament to be used by industry
Milk jugs, on the other hand, are a costly nuisance, either to recycle or to bury in a landfill. But if you could turn them into plastic filament, Pearce reasoned, you could solve the disposal problem and drive down the cost of 3D printing even more. It's also motivation to children and teenagers to consider future careers or training in making 3D art, engineering, architecture, making gadgets, jewelry design, making mounts and cases for computer devices, or science-related designs. Or it can be a hobby for any age person interested in creativity from recycled waste done at home or in a garage.
So Pearce and his research group decided to make their own recycling unit, or RecycleBot. They cut the labels off milk jugs, washed the plastic, and shredded it. Then they ran it through a homemade device that melts and extrudes it into a long, spaghetti-like string of plastic. Their process is open-source and free for everyone to make and use at Thingiverse.com.
You can turn plastic objects such as milk or distilled water containers or bags into art objects as well such as unique snowflakes. Generate and print unique snowflakes. There's a snowflake generator that generates gcode. But you can make your own. How about making a snowflake generator that generates three-dimensional (3D) geometric shapes that can be used as art, toys, or containers. You slice and print the objects. The objects print out in three dimensions using a 3-D printer. Check out the images of such snowflake printed out from a 3-D printer at the "Featured Things" site.
Make your own recycling unit
The process isn’t perfect. Milk jugs are made of high-density polyethylene, or HDPE, which is not ideal for 3D printing. “HDPE is a little more challenging to print with,” Pearce says in the news release. But the disadvantages are not overwhelming. His group made its own climate-controlled chamber using a dorm-room refrigerator and an off-the-shelf teddy-bear humidifier and had good results. With more experimentation, the results would be even better, he says. “3D printing is where computers were in the 1970s.”
The group determined that making their own filament in an insulated RecycleBot used about 1/10th the energy needed to acquire commercial 3D filament. They also calculated that they used less energy than it would take to recycle milk jugs conventionally.
RecycleBots and 3D printers have all kinds of applications, but they would be especially useful in areas where shopping malls are few and far between, Pearce believes. “Three billion people live in rural areas that have lots of plastic junk,” he says in the news release. “They could use it to make useful consumer goods for themselves. Or imagine people living by a landfill in Brazil, recycling plastic and making useful products or even just ‘fair trade filament’ to sell. Twenty milk jugs gets you about 1 kilogram of plastic filament, which currently costs $30 to $50 online.”
Check out Pearce's two articles on recycling waste polymer into feedstock
Pearce’s research is described in depth in two articles: “Distributed Recycling of Waste Polymer into RepRap Feedstock,”coauthored with Christian Baechler and Matthew DeVuono of Queen’s University and published in the March issue of Rapid Prototyping ; and “Distributed Recycling of Post-Consumer Plastic Waste in Rural Areas,” coauthored by Michigan Tech’s Jerry Anzalone (CEE) and students Megan Kreiger (MSE), Meredith Mulder (MSE) and Alexandra Glover (MSE), which will appear in the Proceedings of the Materials Research Society.
Michigan Technological University is a leading public research university developing new technologies and preparing students to create the future for a prosperous and sustainable world. Michigan Tech offers more than 130 undergraduate and graduate degree programs in engineering; forest resources; computing; technology; business; economics; natural, physical and environmental sciences; arts; humanities; and social sciences. For more information, check out Rapid Prototyping Journal.
3-D printing for the rest of us
Three dimensional printing is here. Turn your trash into cash and save energy. Plastic beverage or milk bottles don't have to go to waste anymore and clog landfills. Instead, every time you emptied a plastic milk or water jug, you would be stocking up on raw material to make anything from a cell phone case and golf tees to a toy castle and a garlic press? Make your own toys for kids from plastic bottles. It's possible with three dimensional printing. See, "Build Your Own CNC Router, CNC Machine, or 3D Printer."
If you like do-it-yourself technology, check out the website, Thingiverse - Digital Designs for Physical Objects. Thingiverse is dedicated to the sharing of user-created digital design files. The site provides primarily open source hardware designs licensed under the GNU General Public License or Creative Commons licenses, according to the Wikipedia site explaining the purpose of Thingiverse.
Choose your own license on what you design
Thingiverse Users choose the type of user license they wish to attach to the designs they share. 3D printers, laser cutters, milling machines and many other technologies can be used to physically create the files shared by the users on Thingiverse. But if all the inspirational, creative, artistic and engineering or even kitchen inventions and gadgets you could create, there also are going to be the dark side of 3-D printing just as there is with any technology. You might look to a future where people print their own gun designs or other weapons using 3-D printing.
The innovative idea is in the brain of the person using the technology. Just like the Internet, the technology can be used to make the world a kinder and gentler place, recycle plastic, or it can be used to make weapons in the hands of those who do things like that. In the meantime, focusing on 3-D printing to make the world a better place through recycling, you now have a chance to make practical use of your digital designs.
Create a toy or a device to make cans easier to open or any other innovation from a snowflake in plastic to jewelry designs and more. If you're going to use the design a container or gadget to hold or process food or water, make sure the plastic at least is BPA-free.
Thingiverse is a place for you to share your digital designs with the world
Computing has shifted away from the mainframe into the personal computer that you use today Next up on your horizon is digital fabrication. If you think laser cutters, cnc machines, 3D printers, and even automated paper cutters are all getting cheaper by the day, you're right. Now you can make gadgets from discarded plastic bottles and similar containers using 3-D printers. These machines are useful for a huge variety of things, but you need to supply them with a digital design in order to get anything useful out of them. See the You Tube video, Thingiverse Proof of Concept (Bottle Cutter).mp4.
If you check out the Thingiverse site, they're creating a community of people who create and share designs freely, so that all can benefit from them. You'll find some free software on the site that can inspire you to be more creative in a variety of applications.
3D printing lets anyone make almost anything with a simple machine and a roll of plastic filament
Now Michigan Technological University's Joshua Pearce has found a way to drive costs down even further by recycling empty milk jugs into filament. The process reduces landfill waste, saves on energy compared with traditional recycling, and makes 3D printing and even better deal. Joshua Pearce is working on it. His main tool is open-source 3D printing, which he uses to save thousands of dollars by making everything from his lab equipment to his safety razor, according to the March 1, 2013 news release by, Marcia Goodrich, "Turn trash into cash... and save energy."
Make toys for kids or household gadgets of all types with a three-dimensional printer. All those plastic jugs and other containers now become raw material from which you can make anything from kitchen equipment to process or juice vegetables to toys to donate or cell phone cases. It's all about recycling plastic bottles and similar containers in your own house or garage and turning these objects into usable other objects. That's the idea of recycling raw materials at home. Also check out the site, Michigan Technological University.
Use free software downloaded from sites such as Thingiverse
Using free software downloaded from sites such as Thingiverse - Digital Designs for Physical Objects which now holds over 54,000 open-source designs, 3D printers make all manner of objects by laying down thin layers of plastic in a specific pattern. While high-end printers can cost many thousands of dollars, simpler open-source units run between $250 and $500—and can be used to make parts for other 3D printers, driving the cost down ever further. See the You Tube video, The open source world of MakerBot & Thingiverse: objects for free.
“One impediment to even more widespread use has been the cost of filament,” explains Pearce, an associate professor of materials science and engineering and electrical and computer engineering in the March 1, 2013 news release by, Marcia Goodrich, "Turn trash into cash... and save energy." Though vastly less expensive than most manufactured products, the plastic filament that 3D printers transform into useful objects isn’t free.
Turning milk jugs into plastic filament to be used by industry
Milk jugs, on the other hand, are a costly nuisance, either to recycle or to bury in a landfill. But if you could turn them into plastic filament, Pearce reasoned, you could solve the disposal problem and drive down the cost of 3D printing even more. It's also motivation to children and teenagers to consider future careers or training in making 3D art, engineering, architecture, making gadgets, jewelry design, making mounts and cases for computer devices, or science-related designs. Or it can be a hobby for any age person interested in creativity from recycled waste done at home or in a garage.
So Pearce and his research group decided to make their own recycling unit, or RecycleBot. They cut the labels off milk jugs, washed the plastic, and shredded it. Then they ran it through a homemade device that melts and extrudes it into a long, spaghetti-like string of plastic. Their process is open-source and free for everyone to make and use at Thingiverse.com.
You can turn plastic objects such as milk or distilled water containers or bags into art objects as well such as unique snowflakes. Generate and print unique snowflakes. There's a snowflake generator that generates gcode. But you can make your own. How about making a snowflake generator that generates three-dimensional (3D) geometric shapes that can be used as art, toys, or containers. You slice and print the objects. The objects print out in three dimensions using a 3-D printer. Check out the images of such snowflake printed out from a 3-D printer at the "Featured Things" site.
Make your own recycling unit
The process isn’t perfect. Milk jugs are made of high-density polyethylene, or HDPE, which is not ideal for 3D printing. “HDPE is a little more challenging to print with,” Pearce says in the news release. But the disadvantages are not overwhelming. His group made its own climate-controlled chamber using a dorm-room refrigerator and an off-the-shelf teddy-bear humidifier and had good results. With more experimentation, the results would be even better, he says. “3D printing is where computers were in the 1970s.”
The group determined that making their own filament in an insulated RecycleBot used about 1/10th the energy needed to acquire commercial 3D filament. They also calculated that they used less energy than it would take to recycle milk jugs conventionally.
RecycleBots and 3D printers have all kinds of applications, but they would be especially useful in areas where shopping malls are few and far between, Pearce believes. “Three billion people live in rural areas that have lots of plastic junk,” he says in the news release. “They could use it to make useful consumer goods for themselves. Or imagine people living by a landfill in Brazil, recycling plastic and making useful products or even just ‘fair trade filament’ to sell. Twenty milk jugs gets you about 1 kilogram of plastic filament, which currently costs $30 to $50 online.”
Check out Pearce's two articles on recycling waste polymer into feedstock
Pearce’s research is described in depth in two articles: “Distributed Recycling of Waste Polymer into RepRap Feedstock,”coauthored with Christian Baechler and Matthew DeVuono of Queen’s University and published in the March issue of Rapid Prototyping ; and “Distributed Recycling of Post-Consumer Plastic Waste in Rural Areas,” coauthored by Michigan Tech’s Jerry Anzalone (CEE) and students Megan Kreiger (MSE), Meredith Mulder (MSE) and Alexandra Glover (MSE), which will appear in the Proceedings of the Materials Research Society.
Michigan Technological University is a leading public research university developing new technologies and preparing students to create the future for a prosperous and sustainable world. Michigan Tech offers more than 130 undergraduate and graduate degree programs in engineering; forest resources; computing; technology; business; economics; natural, physical and environmental sciences; arts; humanities; and social sciences. For more information, check out Rapid Prototyping Journal.
Copyright 2006 Radoslaw Pilarski
Etiology
Etiology of prostate cancer development is not completely known. Factors that can influence the creation and development of this type of cancer include:
genetic factors – increase in risk of falling ill among men with a positive family history regarding the prostate cancer. Mutations of suppressor genes are also taken into consideration (p53)
dietetic factors – food rich in saturated fatty acids probably increases the risk of falling ill whereas the consumption of soya and rice may have a beneficial protective effect racial and geographical factors – Afro-Americans are 100% more likely to fall ill, whereas the lowest death rate is reported in Japan and in China
occupational factors – cancerogenous influence of heavy metals and toxins infectious factors – viral infection may lead to/ be the cause of anaplasia of adenocyte cells of prostate
Histopathologically, 95% prostate cancer cases occur in the form of adenocarcinoma. Other types (primary intracellular cancer, squamous carcinoma, anaplastic carcinoma, and sarcoma) are rarely met. Adenocarcinoma usually develops in the peripheral area of the prostate (85%), in the transition area (25% ) and in the central area (5%).
Symptoms
In symptomatology of the prostate cancer, 4 clinical forms are distinguished:
1) visible form with distinct pathological symptoms 2) latent form (carcinoma latens) with no distinct pathological symptoms found 3) hidden form (ca occultum) which is detected in the case of distinct ailments caused by the existence of remote metastases, however changes in prostate are not found in the course of per rectum examination 4) accidentally detected form - based on histopathological test of the gland that was removed because of prostate overgrowth, or based on biochemical tests (PSA) During the development of prostate cancer, an induction phase that lasts about 30 years which is clinically invisible can be distinguished. During the next stage - in situ phase (5-10 years) and invasive phase (1 year), ailments connected with the local growth of tumour start to appear. During this period, symptoms connected with sub bladder obstacle appear including mainly: - pallakiuria - nycturia - weak urine stream - painful vesical tenesmus - impression of incompletion of bladder emptying The above-mentioned symptoms are typical of cancer and in some cases they may suggest mild overgrowth of prostate, or neurogenic or athermatous bladder disorders. During the dissemination phase (about 5 years), prostate cancer develops continuously infiltrating surrounding organs, such as: urinary bladder, rectum, ureters, pelvic walls and leading to urinary retention in kidneys and to secondary failure of function. Ailments typical for this period include: - haematuria - dysuria - urinary incontinence - erection disorders - aches of perineum, lumbar area and anus - haematospermia Metastases spread through the lymphatic vessels and the vascular system. Symptoms caused by the existence of remote metastases are as follows: - osteodynia and pathological fractures - pressure symptoms and spinal paralysis - lymphadema of limbs - clotting disorders - cachexy - coma
DIAGNOSTICS
In order to diagnose the prostate cancer, patient should undergo per rectum tests (DRE), PSA concentration (prostate specific antigen) in blood serum should be determined, ultrasonography per rectum examination (TRUS - transrectal ultrasound) should be done and if there is a suspicion of prostate cancer, histopathological test of the material obtained through a per rectum thick-needle biopsy done under the ultrasound control should take place. Histopathological test is the only test that confirms the presence of cancerous cells in the prostate gland area. DRE, which is an examination of sensitivity of 80% sensitivity and of specificity of 60%, enables to seize changes in the area of the prostate such as consistency change, palpable nodules and hardenings. It is the base for sending a patient to a diagnostic biopsy. At present, it is believed that cytological diagnosis achieved through a fine-needle biopsy is not sufficient to make a right diagnosis. It results from the fact that the assessment according to Gleason's classification is an important prognostic factor for the prostate cancer (see: prognostic factors). That is why a thick-needle biopsy is performed. Ultrasound use enables to take precise samples from suspicious foci. If there are no changes in TRUS picture, "sextant biopsy" is done (samples got for several places).
Recommendations for the biopsy of prostate gland: 1) palpable suspicion of the prostate cancer 2) PSA value over 15ng/ml regardless of DRE or TRUS tests 3) PSA value between 4 and 15 ng/ml with abnormalities detected during DRE or TRUS tests 4) PSA value exceeds the norm for a given age in the case of a positive family history regarding the prostate cancer
Recommendations for TRUS: 1) PSA between 4 and 12 ng/ml with abnormalities detected 2) questionable result of DRE test 3) necessity of a thick-needle biopsy Other diagnostic tests, such as CT and urography are not routinely performed because their value is questionable as far as the assessment of local stage and invasion of adjacent lymph nodes is concerned. Nowadays, magnetic resonance tomography done using transrectal coli (endorectal coil MRI - ERMR) to observe the prostate arouses great interest. Despite the increased sensitivity of the degree of the local stage, costs of the test do not allow for its routine use in the prostate cancer diagnosis. Scintigraphy of the skeleton is the most sensitive test (97%) in bone metastases detection. It is assumed that a patient with PSA under 10 ng/ml does not undergo scintigraphy because the probability of metastases is low.
Screening:
Screening: It is recommended that patients aged over 50 should undergo per rectum tests and PSA level tests every year.
PROGNOSTIC FACTORS:
Three groups of prognostic factors can be distinguished in the case of the prostate cancer:
1) development stage according to TNM 2) differentiation degree of the cancer based on the classification of Gleason and Mostofi 3) PSA level (prostate-specific antigen) in serum TNM classification
Preoperative assessment of the stage of the prostate cancer is made based on the above-mentioned tests.
T-stage: primary tumour
Tx - primary tumour cannot be assessed T0 - no evidence of primary tumour T1 - clinically unapparent tumour; not palpable or visible by per rectum imaging T1a - incidental tumour found in histopathological tests after transurethral resection of the prostate or after operational adenectomy: found in 5% or less resected tissue T1b - as above; found in more than 5% resected tissue T1c - tumour identified histopathologically by a needle biopsy (because of high PSA) T2 - tumour confined within the prostate gland T2a - tumour involves less than half of one lobe T2b - tumour involves more than half of one lobe only T2c - tumour involves both lobes T3 - tumour extends through the prostatic capsule T3a - extracapsular extensions (unilateral) T3b - extracapsular extensions (bilateral) T3c - tumour invades seminal vesicles T4 - tumour is fixed, invades adjacent structures other than seminal vesicles T4a - tumour invades bladder neck and/or external sphincter and/or rectum T4b - tumour invades levator muscles and/or pelvic wall N-stage: regional lymph nodes
Nx - regional lymph nodes cannot be assessed N0 - no regional lymph node metastases N1 - metastasis to a single regional lymph node with the diameter under 2cm N2 - metastasis to a single regional lymph node with the diameter > 2cm but < 5cm N3 - metastases to regional lymph nodes with the diameter over 5cm M-stage: remote metastases
Mx - remote metastasis cannot be assessed M0 - no remote metastases M1 - remote metastases M1a - non-regional lymph nodes M1b - bones M1c - other sites According to Whitmor-Catalon classification, grades A, B, C, and D correspond to T1, T2, T3 and T4 of TNM classification respectively.
Degree of cancer differentiation:
Degree of differentiation is defined according to 2 classifications: by Mostofi and by Gleason.
Mostofi's classification uses a 3-grade assessment of differentiation dependent on the degree of cell anaplasia – grading (G1-G3). The higher grade, the lower differentiation of cancer tissue, the greater atypy and at the same time, malignancy. In the case of a 10-grade Gleason system, the two extreme histological images in the preparation are assessed and then, added to produce a final grade.
PSA is a proteolyctic enzyme responsible for sperm melting. It is mainly produced by glandular epithelium, it might be also produced in organs such as salivary glands, pancreas and mammary gland and by clear cell carcinoma. Commonly used norm is the following: 0-4 ng/ml. Such concentration of PSA is found among 97% of men over 40. The level over 12 ng/ml is always connected with pathology. Difficulties with diagnosis are found among patients who have this level between 5-10 ng/ml because it may both stem from the prostate cancer or a mild overgrowth of the prostate, which causes the necessity of diagnostic methods use, such as TRUS. This test makes it possible to determine PSA density (PSAD - PSA density) - PSA concentration converted to prostate volume unit. It should be under 0.15 ng/ml/g. In the case of prostate cancer differentiation and mild overgrowth of prostate, free to total PSA (PSA F/T) is used. If it is over 20%, one may assume the presence of cancerous cells in the gland. PSA level does not correlate well enough with the natural development of the prostate cancer. However, it is useful as a prognostic factor after the treatment applied and in prognosis determination. However, high final levels indicate low survival rate.
TREATMENT
Proceeding strategy in patients with the prostate cancer depends on the degree of histological malignancy, the degree of local stage of development, coexisting diseases and age of a patient. There are many controversies as far as the choice of treatment is concerned. Radical treatment is possible in T1, T2 and N0 and Mo stages. In advanced cases (T3, T4, N-+, M-+), the procedure is restricted to delay the cancer progression and mitigate its effects (palliative treatment).
Surgery treatment - radical prostatectomy
The surgery consists in the prostate gland removal together with spermatic vesicles and adjacent tissues. Surgery is done through retropubic, transcoccgeal, perineal approach or through laparoscopy. Lymphadenectomy constitutes an integral part of the surgery. If the approach makes it impossible to remove the gland and lymph nodes (perineal approach) at the same time, a separate surgery is carried out. It precedes the operation proper. It is believed that cancerous cells found in the removed lymph nodes are the reason why prostatectomy cannot be performed. Invasion of lymph nodes to a certain extent suggests PSA level over 40ng/ml together with grade >7 in Gleason's scale.
Recommendations for surgery:
1) cancer limited to the prostate gland (T1BN0M0Gx - T2N0M0Gx, T1AN0M0G3) 2) predictable life span over 10 years 3) consent of a patient If positive chirurgical margins, capsule infiltration or cancerous changes in the removed lymph nodes are found in postoperative microscopic assessment, the prognosis is worse – such patients are qualified for palliative treatment. The death rate in the postoperative period does not exceed 5%. Intraoperative complications first of all include: bleeding from Santorini's plexus, damage of rectum wall, underpinning of ureter. Early complications after surgery: thrombotic and embolic complications (phlebothrombosis 3-12%, lung embolism 2-5%) and lymphocele. Late postoperative complications after prostatectomy include: urinary incontinence, erection disorders and narrowing of urethro-vesicular junction).
Radiotherapy
Apart from radical prostatectomy, radiotherapy is an effective method of treatment for patients with regional
Corn Protectors advanced prostate cancer. In radical treatment, the most frequently done using radiation from external sources, the dose of 50-70 Gy in fractions continuing over 5-7 weeks are given. T1ABC - T2ABCG1 and T1ABCG2 stages require radiation limited to the prostate. In other cases, area that is radiated includes adjacent lymph nodes as well. In recent years, multidimensional imaging with CT (3D conformal radiotherapy) is used in the treatment planning.
Brachytherapy constitutes another method that is used.
Recommendations for radical radiotherapy of the prostate:
1) prostate cancer confined with the organ 2) sufficiently long predictable survival span 3) no disorders in lower urinary tract 4) no disorders in rectum and colon 5) consent of patient to carry out treatment 6) early complications of radiation energy treatment (30% of patients) include dysuria, haematuria, diarrhoea, rectal tenesmus, inflammation of large intestine and rectum. Among later complications (11% of patients) chronic diarrhea, ulceration of rectum, bladder neck stenosis and intestinal fistula stenosis are observed.
Control of patients after radical prostatectomy and radical radiotherapy:
- per rectum test, PSA level in blood serum each 3 months. PSA level should be lower than 1 ng/ml (after radical prostatectomy it should be near to 0). Increase over 0.5 ng/ml within a year means failure of radiotherapy. Hormonotherapy
Hormonal therapy is mainly used as palliative treatment in advanced prostate cancer. It makes it possible to stop symptoms of the disease for some time and then, further progression of the disease takes place. Nowadays, the use of therapy in pulsation system is considered as it delays the development of hormone-resistant cell clones.
Ways of hormonal treatment include: 1) surgery castration (orchidectomy) 2) anti-androgens a) non-steroid b) steroid 3) analogues LH-RH 4) oestrogens, progestogens, inhibitors of androgens synthetase Hormonotherapy by analogues LH-RH is also recommended before planned radical radiotherapy. In the case of hormone-resistant cancer, treatment with combined cytoctatic and hormone (estramustine), however without significant effects.
PROGNOSIS
Prognosis depends on the development stage, degree of differentiation and PSA level (see: prognostic factors).
In T1A, B stage prognosis is good. 10-years survival 35-80%, death rate of the cancer 7-30%. In T2 stage, overall survival equals 34-85%, death rate equals 8-26%. In T3 stage, among patients who undergo non-invasive treatment for 9 years, overall death rate equalled 63%, from cancer – 30%. Depending on the degree of cancer differentiation, 10-year survival of patients is the following: for cells well differentiated - 81%, for cells moderately differentiated - 58% and for cells poorly differentiated - 26%.
Spring break (and winter and summer, and the average weekend for that matter) always gives me a new appreciation for teachers. Over the course of our most recent 9-day break, I realized that I would rather be sitting in a middle class seat, in coach, on a 15-hour nonstop flight to Cairo than spend nearly two weeks at home with both children. As the image of this wondrous flight lingered in my brain, I began searching Expedia for hot deals.
Today is National Teacher Appreciation Day, and after the recent school vacation, I am feeling an extremely strong desire to thank the preschool teachers in my life. Below is a letter I drafted to the teachers at my daughters' preschool. However, I feel that it is pretty universal. Please feel free to copy, paste and change the underlined text so that you can send a nice note to the teacher/school that is keeping you from the nearest inpatient psychiatric facility. *****
To the amazingly patient staff at Gan Noe Preschool:
Although there are many people that love my children, the care and affection that you bring to each of them is beyond words. However, since I am too lazy to drag both the girls out of the house and into their car seats to drive a mile to the flower store (where they will inevitably beg for me to buy them their own in purple or pink), I thought that I would give words a try.
Thank you for always smiling and offering a hug when Maisy walks in the door. You make her feel welcomed, loved and safe (especially on days when Mommy is feeling irritable and just wants a child-free latte).
Thank you for appropriately oohing and aahing over each dress Elana proudly adorns for school. Because you do this, Elana eagerly dresses herself each morning in a variety of patterns and colors in anticipation of your joyous reaction. (Seriously, I am not the one pairing rainbow flowered leggings with a red and white candy-cane Christmas dress to our Jewish preschool.)
Similarly, thank you for not judging me when Maisy arrives wearing last night's pajamas. I know that there are yogurt stains on the sleeves and that it can be an arduous task trying to fit her tiny toddler shoes over the fleece footies, but you never complain. In fact, your eyes never hesitate in expressing just pure happiness in her entrance - is it the contacts?
Thank you for providing a safe, contained place for both girls to play with paint, glitter, beads and glue. Because you do this, I have an excuse to say "no" when they ask to make use of our own art supplies after I spent the morning cleaning the house.
Thank you for allowing Maisy to proudly sing her "favorite" Top 40 radio song, repeatedly. Yes, I know that she is completely off-tune, and that she often mixes up the words (I expect that "Set fire to the range" is a remark on my cooking ability), but you somehow manage to appear excited to hear Katy Perry's latest for the fourteenth time that morning.
Thank you for teaching Elana all about the solar system. Because she learned that "Saturn has those icy rings" and "Uranus spins on its side", my husband and I were able to take a much-needed break from reading the daunting Rainbow Magic Fairy series, while Elana requested books about stars and planets for a few precious weeks.
Thank you for never turning on the television. I know that there are days that you are absolutely knackered, and the last thing you want to do is manage twelve 3 and 4-year-old children running amok around a small enclosed space threatening to dump every bin of toys onto the train-track rug. Still, you never throw your hands in the air and sit them all in front of Dora. Because you don't do this, I feel less guilty when I do.
Thank you for providing a variety of gender-neutral toys for my daughters to play with. Because you offer them the opportunity to engage in car, bug and superhero play, I am less disgusted that Maisy's room looks like the Disney Princess aisle at Target.
Thank you for telling
hallux varus me that "it is just a normal phase," when Maisy began hitting her classmates. While part of me knew that this, as with all things in childhood, was just another stage, a larger portion of me was truly worried that I was raising a child that would one day turn my basement into a meth lab. However, you were right, it was just a phase. I am now more confident that she will stick to making bootleg liquor in abandoned bathtubs.
Thank you also for always being available to answer Elana's inexhaustible questions. "How are caves made?" "Is Saturn wider than Jupiter if you count the rings?" "Why is it hotter in Miami than San Francisco if they have the same sun?" "What does 'the one that got away' mean?" Yes, of course I could take the time and energy to try to explain the answers in terms a 4-year-old will understand, but you just do it so well! (And, I am sort of tired of talking to the kids.)
But most importantly, thank you for loving my children between the hours of 8:45 to 12:45. Because you do this, I can love them a little more the rest of the day.
Thank you, a thousand times, thank you!
Sincerely,
Elana and Maisy's exhausted, but ever-so-grateful, mother
Follow Rhiana Maidenberg on Twitter:www.twitter.com/marriedwtoddler