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The adenoid-cystic carcinoma represents Shanghai Chest Hospital blood pressure chart over 60 discount indapamide 2.5 mg with visa, Shanghai Jiao Tong University hypertension nos discount indapamide 1.5mg, Shanghai/China an exemption from this rule blood pressure jumps up order 1.5 mg indapamide visa. Due to high blood pressure medication z purchase indapamide from india its low-malignant tumor biology and the susceptibility to blood pressure 300200 cheap indapamide 1.5mg amex radiotherapy arrhythmia etiology generic indapamide 2.5 mg with amex, even incomplete Surgical excision and reconstruction remain the recommended resection is acceptable in this tumor entity. However, it is carcinoma is characterized by a longitudinal, submucosal growth associated with signifcant trauma and the risk of severely damaged pattern (Figure 1), there might be a discrepancy between the pulmonary function, and not all patients are therefore willing to resection length needed to obtain a complete resection and the receive or ft for surgical resection. Traditional chemotherapy and technical possibility to perform a tension-free anastomosis. An radiotherapy cant improve the prognosis of these patients, which incomplete resection combined with an adjuvant radiation therapy requires a multidisciplinary treatment. Although the treatment of patients with tracheal tumors in the treatment of the trachea tumors. For tracheostenosis caused is demanding, an excellent perioperative and long-term outcome by malignant tumors, the frst thing we should do is to relieve the of patients with tracheal tumors can be achieved. In experienced symptoms and keep stable vital signs, so that we can seek chance hands, the peri-operative mortality after tracheal resection is <1%. Ablation therapy only or Moreover, surgery in multimodality treatment concept provides ablation therapy combined with stent placement are recommended a very good long-term overall survival, which is especially true for for intraluminal obstructive stenosis. Endobronchial ultrasonography can evidence-based clinical practice guidelines (2nd edition). Chest 2007; help determine the depth of tumor invasion of the tracheobronchial 132(3 Suppl):221S-233S. Thorax demonstrated that cryotherapy was an efective method in early 2011; 66(11):1014-1015. Kurimoto N, Murayama M, Yoshioka S, et superfcial bronchogenic carcinoma, which could be proposed as a al. Assessment of usefulness of endobronchial ultrasonography in frst-line therapy in the population with high carcinogenic risk [4]. Chest Hybrid technology, an innovate technique, combining water jet 1999; 115(6):1500-1506. Chest a water cushion, providing shelter for the tissues under submucosa, 2001; 120(1):26-31. Initial Experience and then the lesion can be ablated efectively and safely (Figure 1) with Hybrid-Argon Plasma Coagulation as a Novel Local Treatment [5]. Endoscopic treatments are performed through natural orifce Method for Tracheobronchial Mucoepidermoid Carcinoma. After 2-week exposure, we have made the novel observation that there was a hierarchy in the infammatory M. Goniewicz response in the lung following exposure to the diferent products, with tobacco cigarettes causing the strongest and e-cigarette the Roswell Park Comprehensive Cancer Center, Bufalo/United States of America weakest responses. Summary: HnB are diferent from conventional Introduction: Although combustible tobacco cigarettes remain cigarettes and overall appears to deliver less of some toxicants. It is the most popular nicotine-containing products worldwide, noncurrently not clear whether HnB products may pose lower, the same cigarette products are evolving rapidly. Use of combustible tobacco or higher health risks than combustible cigarettes depending on the remains the number one preventable cause of disease, disability, and disease. HnB products emit more of several important toxicants and death, however the efects of non-cigarette products on populationcarcinogens with more adverse health efects than e-cigarettes. Over the last 10 years electronic cigarettes (e-cigarettes) have gained considerable popularity, especially among Comparison of tobacco cigarettes, Heat-Not-Burn (HnB) prodsmokers and youth. The introduction of HnB products in Japan in 2014 has been accompanied by an enormous decline in combustible cigarettes. Perceptions of HnB products are more similar Keywords: Tobacco, E-cigarettes, Heat-not-Burn (HnB) tobacco to e-cigarettes than combustible tobacco. Toxicity: HnB tobacco products products purport to deliver nicotine while reducing exposure to toxicants compared with combustible nicotine products such as tobacco cigarettes by avoiding directly burning tobacco and instead heating tobacco. In general, yields of carbonyl and aromatic compounds Thomas Jeferson University, Philadelphia/United States of America and amines (except for nicotine) in HnB products have been shown to be between one and two orders of magnitude lower than yields of this presentation discusses the introduction, development, and combustible cigarettes, but relatively similar to those of e-cigarettes. The result in lower emissions of tobacco combustion byproducts and use of these products is considered a means for improving public reduced toxicity as compared to conventional tobacco cigarettes. To date, multiple studies indicate that, of tobacco curing rather than during combustion, and may be despite diferences in toxicity, there is insufcient evidence that use transferred from the HnB into the aerosol that it generates. Potential health efects: Claims of lowered risk or health benefts for HnB compared to conventional cigarettes are based almost exclusively on industry-funded research, and except limited number of product testing studies, independent research is not available to support these claims as of 2019. To determine the cytotoxic and proinfammatory efects of HnB products, we exposed bronchial epithelial cells aerosol generated from HnB, e-cigarette aerosol, tobacco smoke or air (control) using an airliquid interface system. Exposure to HnB resulted in decreased cell viability and increased release of pro-infammatory interleukins as compared to air controls. However, the landscape is changing rapidly with the National Jewish Health, Napa/United States of America legalization of medical and recreational cannabis. Other areas of urgent need, as related to Act classifed cannabis as a Schedule I drug with high abuse potential this review, for controlled clinical trials include: 1) Do cannabinoids and no medical use. Guckenberger and physically intense and efects may include paranoia, anxiety, University Hospital Zurich, Zurich/Switzerland panic attacks and hallucination. A limitation of these pooled studies is the small number of heavy infuencing the decision making process: patient performance and chronic users of cannabis. From a local treatment perspective, cancer efects in cell cultures and animal studies. However, there radiosurgery and neurosurgical resection are treatment options, are no convincing clinical trials demonstrating that cannabis is which have shown to improve survival in patients with limited brain efective in cancer patients. Whole brain radiotherapy is not recommended after to support the use of cannabinoids in cancer patients, in spite of radiosurgery and neurosurgical resection; however stereotactic claims on the web/internet that concentrated cannabis oils can cure radiotherapy should be added to the resection cavity to improve cancer. There is evidence that use of cannabinoids are of beneft for local metastasis control. The value of radiosurgery without whole treating chronic pain, including neuropathy. Whiting et al performed brain irradiation for multiple brain metastases is currently under a meta-analysis of 28 studies that mainly used pharmaceutical investigation. All but one was metastases; whether hippocampal avoidance can reduce the risk placebo controlled. There have been patient reported outcomes that existence of efective targeted drugs. Additionally, treatment with suggest that cannabis is benefcial for pain, anxiety and depression immune checkpoint inhibition has also shown intracranial activity. Nabilone or dronabinol may be used for rescue or refractory nausea and vomiting as backup treatment options. Smit Princess Margaret Cancer Centre, Toronto/Canada Netherlands Cancer Institute, Amsterdam/Netherlands Dr. Questions to Be Toronto Lung Cancer Site Group Leader, Radiation Medicine Program Addressed M. Management of patients with brain metastases today a course of defnitive radiotherapy. Although the best outcomes have been obtained of symptoms and neurological defcits; presence and extend of with concurrent chemoradiotherapy, higher rates of toxicity have extracranial disease; histology and presence of activating driver also been observed. From a local treatment perspective, management of pneumonitis in particular has become even more radiosurgery and neurosurgical resection are treatment options, of a challenge given the potential overlapping toxicities. For poorer which have shown to improve survival in patients with limited brain performance status patients, radical radiotherapy may be used alone. The value of radiosurgery without whole can be given adjuvantly post-operatively for positive margins and brain irradiation for multiple brain metastases is currently under can be considered in pathological N2 disease. References of activating driver mutations and the existence of efective targeted (max 10) Baker S, Fairchild A. Acute and Late brain metastases may also be sensitive to tyrosine kinase inhibitors Toxicities of Concurrent Chemoradiotherapy for Locally-Advanced against a variety of targets and emerging data suggest that immune Non-Small Cell Lung Cancer. Radiation Pneumonitis: Old Problem, New asymptomatic brain metastases at diagnosis when the primary lung Tricks. Previous symptomatic brain metastases at diagnosis may be managed in a radiotherapy and the clinical activity and toxicity of pembrolizumab similar manner, especially when refractory to high dose steroids, is in the treatment of non-small-cell lung cancer: A secondary analysis less clear. Thus, also in this clinical situation, systemic treatment cranial irradiation compared with observation in patients with locally plays an important role in delaying radiotherapy in particular whole advanced non-small-cell lung cancer: neurocognitive and qualitybrain radiotherapyas long as possible. Date Graduate School of Medicine, Kyoto University, Kyoto/Japan Complete resection of residual lung tumor after induction or defnitive chemoradiotherapy may be indicated for selected patients with advanced lung cancer. Here, we present videos of four cases requiring surgical intervention for perioperative complications. Case 1 A 59-year-old man was diagnosed with squamous cell carcinoma invading right diaphragm, left atrium and subcarinal lymph node (cT4N2M0). After induction chemoradiotherapy, he was downstaged to cT4N1M0 and underwent right thoracotomy. Cardiopulmonary bypass was established and left lower lobectomy with combined resection of diaphragm, liver and left atrium was performed. Case 2 A 50-year-old man was diagnosed with unresectable left upper lobe squamous cell carcinoma invading aorta and #6 lymph node (cT4N2M0). The left basal bronchus was accidentally stabled by false recognition of lingula bronchus. The staple lines were removed, and the basal bronchus was reconstructed by end-to-end anastomosis. Then the left upper lobectomy with combined resection of aortic adventitia was performed. Case 3 A 69-year old man was diagnosed with right lower lobe adenocarcinoma with right #2 lymph node metastasis (cT2N2M0). After induction chemoradiotherapy, he underwent uneventful left lower lobectomy with extensive hilar and mediastinal lymph node dissection. Although a heterogeneous1 group of diseases, invariably, it is associated with a restrictive defect on pulmonary function testing, and a reduced ability for gas exchange. Despite the generally favorable toxicity Satisfactory bronchial healing was obtained (Figure 2b). These reports have largely been retrospective in nature, heterogeneous in the radiation doses employed, with fndings of extreme ranges in treatment related death rates. Although much pneumonitis (defned as grade fi3), and a 15% risk of treatmenthas been accomplished over the last 15 years, with regulatory related grade 5 toxicity. Arguably, the most impactful advance in the a signifcant background risk of acute exacerbations of their disease, systemic treatment of lung cancer over the last several decades has with an annual reported range of 5-19%. Clin Oncol (R Coll failure of chemotherapy as endorsed by the National Comprehensive Radiol)1993;5:72-79. Lung cancer and interstitial lung disease: and tremendous impact on treatment paradigms for lung cancer, a literature review. Management of early-stage non-small cell most of those who do respond will ultimately develop resistance lung cancer using stereotactic ablative radiotherapy: Controversies, with recurrence/ progression of their cancer. Treatment-Related Toxicity across cancer centers will be required to understand both acquired in Patients with Early-Stage Non-Small Cell Lung Cancer and Coand primary resistance (to date, we are only aware of two published Existing Interstitial Lung Disease: A Systematic Review. International reports describing potential mechanisms of acquired resistance to Journal of Radiation Oncology*Biology*Physics. Frailty other, loss of tumor specifc neoantigens through elimination of is common and strongly associated with dyspnoea severity in fbrotic tumor subclones or chromosomal loss of truncal alterations) (ref: interstitial lung disease. Stereotactic body radiation therapy versus novel immunotherapeutic agents, including other immune no treatment for early stage non-small cell lung cancer in medically checkpoint inhibitors, costimulatory agonists, vaccines, oncolytic inoperable elderly patients: A National Cancer Data Base analysis. In clinical practice, a handful of unanswered questions repeatedly surface when treating lung cancer patients with immunotherapy. Although there is little data to guide us here, we generally consider treatment holiday after 2 years of therapy without progression. What is the role of immunotherapy in never smokers and those with targetable molecular alterations driving their diseasefi CheckMate 227) (8), who do respond, and eforts are underway to understand these indicate also that the two predictive assays are not competing but responses. Other candidate biomarkers are be allowed to exclude delayed response or pseudo-progression. Should salvage nivolumab combined with ipilimumab be considered in patients with extensive stage small cell lung cancer after progression on standard chemotherapy plus/ minus G. It is unclear if the the diagnostic revolution started in 1999 when the group of Prof. Keywords: Immunotherapy Subsequently in 2006 the I-elcap published 80% cancer specifc survival rate at 10 years of the 484 patients with a screening cancers detected in 31. We needed to wait additional 6 years to have the released data of Nelson study, the F. One of the potential obstacle is how to select the right treatment to the right patients and how to related to uncertainties on sustainability. Diferent retrospective studies have shown that sublobar any therapy) is still not clear with conficting reported outcomes in resection are adequate oncological operation for very early stage the literature. On this stage, it is make minimally invasive segmentectomy easier to adoptand perform. In this way many small centrally located tumors with while a high cure rate for individuals diagnosed with lung cancer high suspiciousness of malignancy can be treated with a diagnostic can be obtained (1,3,4). One involved in multidisciplinary tumor board have the important of the most discussed issue in the treatment of lung cancer is related responsibility to minimize the risk of useless invasive procedures to extension of lymph node dissection. Major goals of surgical participation in both programs approximately 3,5% of individuals participating in in lung cancer screening programs include: 1. Optimization of the the screening were sent for the diagnostics, lung cancer detection management of screen detected nodules; 2. Reduction of false rate in these groups were 30% and 57% respectively so diagnostic positive rates and surgical diagnosis of benign diseases; 3. Collect sample for biomarker research for in majority of the institutions they perform biopsies. Participate nodules biopsy in the best institutions is performed with 80-90% to multidisciplinary meeting with radiologists; 7.

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Br J ommended for all patients who are newly consisting of only fresh papaya or pineOphthalmol hypertension pamphlet indapamide 1.5 mg on-line. While xanthelasma is considered a days; niacin supplements; and exercise 2013;40(4):380-6 prehypertension workout purchase indapamide 1.5mg mastercard. While the blue sue thinning enabling visualization of the genital Bowmans layer agenesis blood pressure healthy range discount 1.5 mg indapamide with amex. The key to lennox pulse pressure test kit discount 2.5mg indapamide otc managing Nevus of Ota blood pressure 7050 buy indapamide mastercard, also known as congenital dominant multisystem connective tissue patients is recognizing its appearance blood pressure medication used for sleep cheap indapamide online american express, and melanosis bulbi and oculodermal melanosis, disorder resulting from mutations in referring for the proper medical workup. When these cells invade lens subluxation (typically superiorlya health for the ocular complications. Diagnosis and management of dural carotidcorneal complications may receive strucwith systemic collagen dysfunction that cavernous sinus fistulas. Nat Clin tural architectural rehabilitation/stabilizaincludes Ehlers-Danlos syndrome, Pract Neurol. Bevacizumab treat35 ment for subfoveal choroidal neovascularization from causes bengal green light procedures. Marfan syndrome: clinical diagnosis and managesurface abnormalities can be managed Danlos syndrome or Marfans syndrome ment. Methods Mol solutions and ointments, topical cyclospowith blue sclera should be monitored for Med. Blue sclerae and keratoglo Cases presenting with ocular inflam Corneal thickness has been reported bus. Marfan syndrome cycloplegia, topical and oral steroids, topiesis imperfecta and blue sclera. Presenting signs and tions and oral antimetabolite medications have increased risk for glaucoma or exhibit clinical diagnosis in individuals referred to rule out Marfan syndrome. Osteogenesis imperfecta: epidemioloincluding gonioscopy, photodocumentagy and pathophysiology. Clinical study of hereditary disorders of thickness is lower in osteogenesis imperfecta and negatively can be treated using any topical anticonnective tissues in a Chilean population: joint hypermobilcorrelates with the presence of blue sclera. Medical testing is required to genetics and osteogenesis imperfecta classificationfi The laboratory testing of bilateral full thickness macular holes in a patient with blue ritis and episcleritis. Ehlers-Danlos synserotype-1, newborn disease can result thalmic comanagement can take place drome: insights on obstetric aspects. Ehlers-Danlos syndrome-a historiconjunctivitis, corneal irregularities, irical review. The mother in such cases should papillomacular rash affecting the skin of and the innate immune system; when be examined for concurrent gynecological the lids or lips (fever blister or cold the immune system prevails, the signs infection. When the In cases involving serotype-2, concurthe cornea may or may not be virus prevails, more substantial signs and rent systemic infection or issues where involved, exhibiting marginal subepithelial symptoms ensue. With concurrent conjunctivitis, pes virus migrates along local nerves to to trifluridine. Additionally, ganciclovir demdyes have been reported as part of the rence, stimuli postulated by other reports onstrates greatly reduced corneal toxicity, syndrome. The disease is generally Vision may or may not be affected, While many of the ocular manifestaself-limiting and can be managed with depending upon the amount of watery tions related to the herpes simplex virus palliative therapies such as artificial tear discharge and presence of corneal epitheare immune (delayed hypersensitivity drops and ointments along with oral overliopathy. Delayed type hypersensitivity in the pathogenesis of recurrent herpes stromal keratitis. Antiviral activity and mechanism of Blepharoconjunctivitis from active herpes simplex virus infection is typically self-limiting but palliative action of ganciclovir. The impact of the herpetic eye disdritic microulcerations, frank dendriform one cornea is less sensitive to the touch of ease studies on the management of herpes simplex virus ocular infections. Herpes simplex epithelial and stroticularly if the individual has a previous mal keratitis: an epidemiologic update. Disorders of the conjunctiva and manifestations such as follicles or papillimbus. Predictors of recurrent herpes from serous to mucopurulent, depending simplex virus keratitis. Etiology of acute conjunctivitis race or gender may be affected by condue to coxsackievirus A24 variant, human adenovirus, herpes ment, topical steroids should not be used simplex virus, and Chlamydia in Beijing, China. Pediatric herpes simplex cal medications used, atopic disease or a of the anterior segment: characteristics, treatment, and outing, burning, scratchiness or other irritahistory of immunosuppression can significomes. Endogenous dissemination of cantly alter the presentation and risk of genital Herpesvirus hominis type 2 to the eye. Trends in herpes sim If corneal involvement is present, plex virus type 1 and type 2 seroprevalence in the United States. Oculogenital transmismucus accumulation in the eyes, or even sion of type 2 herpes simplex virus in adults. For example, if symblepharon may simply be a matter of degree and Finally, membranes and pseudomemdevelops and the conjunctival fornices intensity of inflammation. Pseudomembranes, by tissues, such infections can involve the T-cells with host antigen presenting definition, lack blood and lymphatic mouth, trachea, colon and skin. True certain bacteria, including Corynebacterium tival tissues can be affected, resulting in membranes, on the other hand, penetrate diphtheriae, hemolytic Streptococci and dry eye disease, conjunctival scarring and and adhere to the necrotic epithelium and Neisseria gonorrhoeae are the most frepseudomembrane induction in severe the substantia propria of the affected tisquently implicated pathogens. This tight adherence causes greater Plasminogen deficiency (both congenidifficulty with removal, and results in an tal and acquired) has also been associated Management increased likelihood and volume of bleedwith the formation of membranes and Appropriate management of membranous ing upon their extraction. In addition to to loosen the pseudomembrane from the ciations with systemic disorders, including mechanical removal of any membranes, underlying conjunctiva, progressively gathhypoplasminogenemia, Crohns disease, most sources now recommend topical ering up fibrinous tissue as one proceeds juvenile colloid milium and congenital treatment with corticosteroids and cyclofrom nasal to temporal, or vice-versa. It is recommended that condition is frequently followed by rapid acid and autologous serum tears have the physician first dissect the edge of the regrowth and, hence, requires supplealso been used with some success. The etiology is 30 to 60 seconds in office, followed by suspended over a polymethyl methacrylate believed to involve a loss of goblet cells, thorough rinsing with sterile saline). Hyperacute conjunctivitis, is often necessary despite primary care such a product is not available commerif associated with N. Successful use physicians including burn surgeons, intenof topical retinoic acid in severe dry eye due to chronic graft-verdisease. Topical tranilast for gous serum tears after haematopoietic progenitor cell transplanin the management of such disorders. Epidemic keratoconjunctivitis: a review of current corneal perforation due to chronic Graft versus Host Disease; a nomodulatory therapies are most approclinicopathologic report. Membranous conjunctivitis from ogen as adjunctive treatment in recurrent ligneous conjunctivitis. Bacterial conjunctivitis: a review for of ligneous conjunctivitis with topical fresh frozen plasma in an infant. Diagnosis and treatment Clinical presentation involves a wellof Stevens-Johnson syndrome and toxic epidermal necrolysis 36. Iatrogenically induced Stevenscoalesced blood between the bulbar conJohnson syndrome after a car accident. Observations on the pathogenesis of lesions in the management of ocular manifestations of acute Stevensin severe eye disease. Pseudomembranous disease (ligneous inflammation) of the female genital tract, peritoneum, gingiva, and paranasal sinuses associated with plasminogen deficiency. Ligneous gingivitis associated with plasminogen deficiency: a challenge in diagnosis. Ligneous cervicitis in a woman with plasminogen deficiency associated with an atypical form of microglandular hyperplasia: a case report and review of literature. Ligneous conjunctivitis in a patient of juvenile colloid milia: a rare association. In most instancesespepatient may also relay or confirm a history abdominal pressure. It is typically self-limiting, untary expulsion of air against a closed orbital and choroidal veins are subject to and resolves completely within a week or glottis, causing rapidly and often severely rapidly expansive forces; smaller tributwo in the vast majority of cases. A prospective study of 151 testing may include (but is not limited which may result from a variety of factors. Clinical characteristics of conjunctivochalasis with or without aqueous tear cell preparation and human immunodefiwith or without narcotic or non-narcotic deficiency. Correlation between recurrent subconjunctival hemorrhages and conjunctivochalasis Ingelheim Pharmaceuticals) should obtain the medical workup of a patient by clinical profile and successful surgical outcome. Virological and epidemiological analysis of coxsackievirus A24 variant epidemic of be adjusted. Adenoviral keratoconjunctivimodified, communication and discussion cases that are recurrent or persistent in tis. Bilateral eyelid ecchymosis and subconjunctival haemorrhage manifesting as presenting It is not unusual for patients with injury or similar singular event likely does feature in a case of dengue haemorrhagic fever. What we know about ocular uation, assuming the patient is otherwise manifestations of Ebola. A one-year followobserved this many times in clinical prac One simple systemic investigation up study of ocular and systemic complications of intravitreal injection of bevacizumab (Avastin). Even a small drop of ketchup (blood) can temic conditions are usually the causative 2008;36(6):581-2. Natural history of valsalva retilarge area by a tight layer of plastic wrap nopathy in an adolescent. Valsalva retinopathy in pregmon household items nearly always helps nancy: a case report. It should only be considered in cases and the tortuosity of vessels of the bulbar conjunctiva. Subconjunctival hemorrhages: cant ophthalmic morbidity to adjacent presenting sign for hereditary hemochromatosis. Periorbital ecchymosis and that eye rubbing may increase reand subconjunctival hemorrhage following ear surgery. Subconjunctival hemorecchymosis and petechial hemorrhages rhage in a patient on dabigatran (Pradaxa). Location and extent hemorrhage renal dysfunction international normalized ratio of of subconjunctival hemorrhage. Recent causes of submaking: hyposphagma prior to intravenous tissue plasminogen nant tumors of the conjunctiva may conjunctival hemorrhage. Concisely communicate your diagnosis & treatment plan utilizing an EyeRes Digital Imaging System. The condition may also most notably herpes simplex and syphilis, ingly difficult to culture. Vision panosomiasis, Acanthamoeba, sarcoidosis hemagglutination assay for Treponema is often reduced, although the severand Hodgkins disease. When patients these remaining viral components are Ophthalmology, oral antiviral medicapresent with this array of findings in the highly immunogenic and potentiate tions are preferable to topical agents due absence of acute inflammation, the disease the formation of cytokines, chemokines to potential toxicity associated with triis said to be in the inactive stage. Its characteristic presentation phage inflammatory proteins, monocyte clovir 500mg once daily. However, these drugs are not sufficiently effective in cases of neurosyphilis; therefore, those with late-stage disease first require penicillin desensitization. Treatment in this case requires oral antivirals as typically addressed with the concurrent well as topical corticosteroid therapy. Today, syphilis is recognized patients, recommending a longer period visual outcome. Predictors of recurrent ophthalmia syndrome, glaucoma, optic 29-31 herpes simplex virus keratitis. Treatment of herpes simplex virus stromal keratitis disk pits, Ehlers-Danlos syndrome, Stromal inflammatory infiltration unresponsive to topical prednisolone 1% with topical cyclospoWaardenburgs craniofacial syndrome, rine 0. Effective treatment with Norries syndrome, Turners syndrome microbial keratitis. Topical ophthalmic cycloglaucoma, iris coloboma or retinal/optic presents with frank epithelial ulceration. Bevacizumab as a for the development of secondary opendemonstrates a substantially more rapid potent inhibitor of inflammatory corneal angiogenesis and lymangle, primary angle-closure and secondphangiogenesis. Subconjunctival bevacizumab for cortion who develops hearing loss, vertigo, neal neovascularization in herpetic stromal keratitis. Amniotic membrane transplantation viral suppressant therapy, ensure that the combined with antiviral and steroid therapy for herpes necrotizwere found to have thicker central corneal ing stromal keratitis. Successful diagnosis and treatment of a single case of bilateral necrotizing keraPathophysiology 2. A young immunocompetent patient Signs and Symptoms the corneal endothelium and trabecular with bilateral immune stromal keratitis due to varicella zoster and A number of corneal anomalies are presmeshwork. Incidence of ocular complications in patients with multibacillary leprosy after cometer at birth measures between 9. Who (what) pays toll slightly smaller, as the horizontal limbus fifth month of fetal growth. Therapeutic effect of growth occurs with final dimensions measyndromes, or it may occur as an iso0. Herpes Simplex Virus Keratitis: Microcornea is defined as an adult cornea Microcornea with cataract has been A Treatment Guideline 2014. American Academy of measuring less than 10mm in either the identified as a unique syndrome, associOphthalmology. Herpetic becomes apparent or detected during association with conditions such as Peters Eye Disease Study. Acyclovir for the prevenof microcornea often present with normal from microphthalmos, also referred to tion of recurrent herpes simplex virus eye disease. Oral acyclovir for herpes ocular and systemic complications such describes a condition in which the entire simplex virus eye disease: effect on prevention of epithelial keratitis and stromal keratitis. This condition Pedigree analysis and genetic counmay result from arrested developseling may be indicated given the multiple ment at a number of stages of fetal genetic associations with microcornea. Bilateral microcornea, coloboma, short stature and other skeletal anomalies a is increased.

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Clinical significance of alpha1-adrenoceptor selectivity in the management of benign prostatic hyperplasia heart attack jack 1 life 2 live generic 1.5mg indapamide overnight delivery. A comparison between the response of patients with idiopathic detrusor overactivity and neurogenic detrusor overactivity to heart attack help purchase cheap indapamide online the first intradetrusor injection of botulinum-A toxin arteria tapada del corazon buy line indapamide. Testosterone gel supplementation for men with refractory depression: a randomized ulterior motive definition discount 1.5mg indapamide overnight delivery, placebo-controlled trial blood pressure medication olmetec side effects effective indapamide 1.5mg. Nephrogenic adenoma of the urinary bladder: our experience and review of the literature blood pressure 200120 purchase 2.5mg indapamide visa. Impact of early pelvic floor rehabilitation after transurethral resection of the prostate. Absence of lower urinary tract symptoms is an independent predictor for cancer at prostate biopsy, but prostate-specific antigen is not: results from a prospective series of 569 patients. Ureteroscopic laser lithotripsy for upper urinary tract calculi with active fragment extraction and computerized tomography followup. Atrophy in prostate needle biopsy cores and its relationship to prostate cancer incidence in screened men. Association of ureaplasma urealyticum with abnormal reactive oxygen species levels and absence of leukocytospermia. Transurethral electrovaporization vs transurethral resection for symptomatic prostatic obstruction: a meta-analysis. Erectile dysfunction after transurethral prostatectomy for lower urinary tract symptoms: results from a center with over 500 patients. A randomized, double-blind, placebo-controlled trial to determine the effectiveness of botanically derived inhibitors of 5-alpha-reductase in the treatment of androgenetic alopecia. Symptomatic and asymptomatic benign prostatic hyperplasia: molecular differentiation by using microarrays. Elevated serum procalcitonin values correlate with renal scarring in children with urinary tract infection. Potential mechanisms of action of superselective alpha(1)-adrenoceptor antagonists. The dynamics of prostate-specific antigen in benign and malignant diseases of the prostate. The uristatin dipstick is useful in distinguishing upper respiratory from urinary tract infections. Stimulation of Hyaluronan synthetase by platelet-derived growth factor bb in human prostate smooth muscle cells. Demethylation-linked activation of urokinase plasminogen activator is involved in progression of prostate cancer. Impact of age, benign prostatic hyperplasia, and cancer on prostate-specific antigen level. Do we know everything about alpha-blockade in the management of lower urinary tract symptoms. Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Expression of thyroid hormone receptors is disturbed in human renal clear cell carcinoma. Long-term clinical and biologic effects of the lipidosterolic extract of Serenoa repens in patients with symptomatic benign prostatic hyperplasia. Chromatofocusing fractionation and two-dimensional difference gel electrophoresis for low abundance serum proteins. Boosted decision tree analysis of surface-enhanced laser desorption/ionization mass spectral serum profiles discriminates prostate cancer from noncancer patients. Factors affecting health-related quality of life among patients with lower urinary tract symptoms. Reliability and validity of the Malay version of the Health-Related Quality of Life instrument in a Malaysian population. Construction of the Mandarin version of the International Prostate Symptom Score inventory in assessing lower urinary tract symptoms in a Malaysian population. Quality of life assessment before and after transurethral resection of the prostate in patients with lower urinary tract symptoms. The effects of treating lower urinary tract symptoms on health-related quality of life: a short-term outcome. The male marital satisfaction following treatment for lower urinary tract symptoms. The sensitivity of the Malay version of Brief Manual of Sexual Function Inventory in assessing erectile dysfunction secondary to benign prostatic hyperplasia. Reliability and validity of the International Prostate Symptom Score in a Malaysian population. Reliability and validity of the Malay version of the International Prostate Symptom Score in the Malaysian population. Effect of treating lower urinary tract symptoms on anxiety, depression and psychiatric morbidity: a one-year study. Successful in utero endoscopic ablation of posterior urethral valves: a new dimension in fetal urology. Dutasteride: a potent dual inhibitor of 5-alpha-reductase for benign prostatic hyperplasia. Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus. Renal functional changes in relation to hemodynamic parameters during exercise test in normoalbuminuric insulindependent children. Role of intravenous urography and transabdominal ultrasonography in the diagnosis of bladder carcinoma. Under what conditions is feedback microwave thermotherapy (ProstaLund Feedback Treatment) cost-effective in comparison with alpha-blockade in the treatment of benign prostatic hyperplasia and lower urinary tract symptoms. Efficacy and safety of tamsulosin hydrochloride compared to doxazosin in the treatment of Indonesian patients with lower urinary tract symptoms due to benign prostatic hyperplasia. Current status of transrectal ultrasound-guided prostate biopsy in the diagnosis of prostate cancer. Botulinum toxin: a new dimension in the treatment of lower urinary tract dysfunction. Plasma osteopontin in comparison with bone markers as indicator of bone metastasis and survival outcome in patients with prostate cancer. The effect of high grade prostatic intraepithelial neoplasia on serum total and percentage of free prostate specific antigen levels. Durability of results obtained with transurethral microwave thermotherapy in the treatment of men with symptomatic benign prostatic hyperplasia. Practice patterns of Canadian urologists in benign prostatic hyperplasia and prostate cancer. Management strategies and results for severely encrusted retained ureteral stents. Immunohistochemical study of the expression of epidermal growth factor receptor in benign prostatic hypertrophy, prostatic intraepithelial neoplasia and prostatic carcinoma. Comparative study of human steroid 5alpha-reductase isoforms in prostate and female breast skin tissues: sensitivity to inhibition by finasteride and epristeride. Lower urinary tract symptoms in dementia with Lewy bodies, Parkinson disease, and Alzheimer disease. The alpha1adrenergic antagonist prazosin ameliorates combat trauma nightmares in veterans with posttraumatic stress disorder: a report of 4 cases. Ureteral reimplantation for management of ureteral strictures: a retrospective comparison of laparoscopic and open techniques. Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma: is it better than open surgery. Bipolar transurethral resection of the prostate-technical modifications and early clinical experience. Dualspecificity phosphatase 1 and serum/glucocorticoid-regulated kinase are downregulated in prostate cancer. Endogenous immune response to gangliosides in patients with confined prostate cancer. Epidermal growth factor modulates the expression of vascular endothelial growth factor in the human prostate. Seminal vesicle cyst presenting with lower urinary tract symptoms and huge abdominal mass. Laser prostatectomy versus transurethral resection of prostate in the treatment of benign prostatic hyperplasia. Prospective detection of clinically relevant prostate cancer in the prostate specific antigen range 1 to 3 ng. Y-27632, a Rho-kinase inhibitor, inhibits proliferation and adrenergic contraction of prostatic smooth muscle cells. Proteomic analysis of voided urine after prostatic massage from patients with prostate cancer: a pilot study. Dysregulated expression of S100A11 (calgizzarin) in prostate cancer and precursor lesions. Promoter hyper-methylation of calcium binding proteins S100A6 and S100A2 in human prostate cancer. Extraperitoneal laparoscopic prostatectomy (adenomectomy) for obstructing benign prostatic hyperplasia: transvesical and transcapsular (Millin) techniques. High power (80 W) potassiumtitanyl-phosphate laser vaporization of the prostate in 66 high risk patients. What is the optimal time of surgical intervention after an acute attack of sigmoid diverticulitis: early or late elective laparoscopic resection. Electrophysiological assessment of sensations arising from the bladder: are there objective criteria for subjective perceptions. Urodynamic evaluation in children with lipomeningocele: timing for neurosurgery, spinal cord tethering and followup. Rapid onset of action with alfuzosin 10 mg once daily in men with benign prostatic hyperplasia: a randomized, placebo-controlled trial. Laparoscopic adenectomy: a novel technique for managing benign prostatic hyperplasia. Inherent high peritoneal transport and ultrafiltration deficiency: their mid-term clinical relevance. Does anticholinergic medication have a role for men with lower urinary tract symptoms/benign prostatic hyperplasia either alone or in combination with other agents. Urinary tract infection in infants and children: an update with special regard to the changing role of reflux. Acupuncture reflexotherapy in the treatment of sensory urgency that persists after transurethral resection of the prostate: a preliminary report. Immunohistochemical localization of the retinoic Acid receptors in human prostate. Combined cystolithotomy and transurethral resection of prostate: best management of infravesical obstruction and massive or multiple bladder stones. Pro-apoptotic tumor necrosis factor-alpha transduction pathway in normal prostate, benign prostatic hyperplasia and prostatic carcinoma. A comparison of the efficacy and tolerability of tamsulosin and finasteride in patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Early evaluation of hematuria in a patient receiving anticoagulant therapy and detection of malignancy. Renal enlargement in the fetus and newborn with congenital diaphragmatic hernia: a refuted hypothesis. Transurethral microwave thermotherapy of the prostate without intravenous sedation: results of a single United States center using both lowand highenergy protocols. Dimensional and hemodynamic differences between native and transplanted kidneys, evaluated by color Doppler ultrasonography. Clinical characterization of the prostatitis patient in Italy: a prospective urology outpatient study. Piezoelectric shockwave lithotripsy of urinary calculi: comparative study of stone depth in kidney and ureter treatments. Androgen receptor gene polymorphisms and increased risk of urologic measures of benign prostatic hyperplasia. Polymorphisms in genes involved in sex hormone metabolism may increase risk of benign prostatic hyperplasia. Insulin-like growth factor I, insulin-like growth factor binding protein 3, and urologic measures of benign prostatic hyperplasia. A populationbased study of daily nonsteroidal anti-inflammatory drug use and prostate cancer. Limitations of using outcomes in the placebo arm of a clinical trial of benign prostatic hyperplasia to quantify those in the community. Focused ultrasound ablation of renal and prostate cancer: current technology and future directions. Behaviour of the human bladder during natural filling: the Newcastle experience of ambulatory monitoring and conventional artificial filling cystometry. Optimal dosing of intravenous tacrolimus following pediatric heart transplantation. Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Expression of adrenomedullin and peptide amidation activity in human prostate cancer and in human prostate cancer cell lines. Assessing the clinical impact of prostate-specific antigen assay variability and nonequimolarity: a simulation study based on the population of the United Kingdom. Magnetic stimulation of sacral roots for assessing the efferent neuronal pathways of lower urinary tract. Alfuzosin 10 mg once daily prevents overall clinical progression of benign prostatic hyperplasia but not acute urinary retention: results of a 2-year placebo-controlled study. Alfuzosin: overview of pharmacokinetics, safety, and efficacy of a clinically uroselective alpha-blocker.

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To plan for the sustainable and rational utilization heart attack prevention buy genuine indapamide on line, protection hypertension first line quality 1.5mg indapamide, conservation and management of water resources based on community needs and priorities within the framework of national economic development policy; c pulse pressure 43 generic 1.5mg indapamide with visa. To design heart attack low blood pressure cheap 1.5mg indapamide visa, implement and evaluate projects and programmes that are both economically efficient and socially appropriate within clearly defined strategies arteriovenous shunt purchase indapamide 1.5 mg on line, based on an approach of full public participation blood pressure medication effect on heart rate purchase indapamide 2.5 mg with mastercard, including that of women, youth, indigenous people and local communities in water management policy-making and decision-making; d. To identify and strengthen or develop, as required, in particular in developing countries, the appropriate institutional, legal and financial mechanisms to ensure that water policy and its implementation are a catalyst for sustainable social progress and economic growth. In the case of transboundary water resources, there is a need for riparian States to formulate water resources strategies, prepare water resources action programmes and consider, where appropriate, the harmonization of those strategies and action programmes. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including the United Nations and other relevant organizations as appropriate, could set the following targets: a. To have designed and initiated costed and targeted national action programmes, and to have put in place appropriate institutional structures and legal instruments; ii. To have established efficient water-use programmes to attain sustainable resource utilization patterns; b. It is understood that the fulfilment of the targets quantified in (i) and (ii) above will depend upon new and additional financial resources that will be made available to developing countries in accordance with the relevant provisions of General Assembly resolution 44/228. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including the United Nations and other relevant organizations as appropriate, could implement the following activities to improve integrated water resources management: a. Formulation of costed and targeted national action plans and investment programmes; b. Integration of measures for the protection and conservation of potential sources of freshwater supply, including the inventorying of water resources, with land-use planning, forest resource utilization, protection of mountain slopes and riverbanks and other relevant development and conservation activities; c. Development of interactive databases, forecasting models, economic planning models and methods for water management and planning, including environmental impact assessment methods; d. Optimization of water resources allocation under physical and socio-economic constraints;. Implementation of allocation decisions through demand management, pricing mechanisms and regulatory measures; f. Flood and drought management, including risk analysis and environmental and social impact assessment; g. Promotion of schemes for rational water use through public awareness-raising, educational programmes and levying of water tariffs and other economic instruments; h. Promotion of international scientific research cooperation on freshwater resources; j. Development of new and alternative sources of water-supply such as sea-water desalination, artificial groundwater recharge, use of marginal-quality water, waste-water reuse and water recycling; k. Integration of water (including surface and underground water resources) quantity and quality management; l. Promotion of water conservation through improved water-use efficiency and wastage minimization schemes for all users, including the development of water-saving devices; m. Development of public participatory techniques and their implementation in decisionmaking, particularly the enhancement of the role of women in water resources planning and management; o. Development and strengthening, as appropriate, of cooperation, including mechanisms where appropriate, at all levels concerned, namely: a. At the lowest appropriate level, delegation of water resources management, generally, to such a level, in accordance with national legislation, including decentralization of government services to local authorities, private enterprises and communities; b. At the national level, integrated water resources planning and management in the framework of the national planning process and, where appropriate, establishment of independent regulation and monitoring of freshwater, based on national legislation and economic measures; c. At the regional level, consideration, where appropriate, of the harmonization of national strategies and action programmes; d. At the global level, improved delineation of responsibilities, division of labour and coordination of international organizations and programmes, including facilitating discussions and sharing of experiences in areas related to water resources management; p. Dissemination of information, including operational guidelines, and promotion of education for water users, including the consideration by the United Nations of a World Water Day. The Conference secretariat has estimated the average total annual cost (1993-2000) of implementing the activities of this programme t o be about $115 million from the international community on grant or concessional terms. The development of interactive databases, forecasting methods and economic planning models appropriate to the task of managing water resources in an efficient and sustainable manner will require the application of new techniques such as geographical information systems and expert systems to gather, assimilate, analyse and display multisectoral information and to optimize decisionmaking. In addition, the development of new and alternative sources of water-supply and low-cost water technologies will require innovative applied research. This will involve the transfer, adaptation and diffusion of new techniques and technology among developing countries, as well as the development of endogenous capacity, for the purpose of being able to deal with the added dimension of integrating engineering, economic, environmental and social aspects of water resources management and predicting the effects in terms of human impact. Pursuant to the recognition of water as a social and economic good, the various available options for charging water users (including domestic, urban, industrial and agricultural water-user groups) have to be further evaluated and field-tested. Further development is required for economic instruments that take into account opportunity costs and environmental externalities. Field studies on the willingness to pay should be conducted in rural and urban situations. Water resources development and management should be planned in an integrated manner, taking into account long-term planning needs as well as those with narrower horizons, that is to say, they should incorporate environmental, economic and social considerations based on the principle of sustainability; include the requirements of all users as well as those relating to the prevention and mitigation of water-related hazards; and constitute an integral part of the socio-economic development planning process. A prerequisite for the sustainable management of water as a scarce vulnerable resource is the obligation to acknowledge in all planning and development its full costs. Planning considerations should reflect benefits investment, environmental protection and operation costs, as well as the opportunity costs reflecting the most valuable alternative use of water. Actual charging need not necessarily burden all beneficiaries with the consequences of those considerations. Charging mechanisms should, however, reflect as far as possible both the true cost of water when used as an economic good and the ability of the communities to pay. The role of water as a social, economic and life-sustaining good should be reflected in demand management mechanisms and implemented through water conservation and reuse, resource assessment and financial instruments. The setting afresh of priorities for private and public investment strategies should take into account (a) maximum utilization of existing projects, through maintenance, rehabilitation and optimal operation; (b) new or alternative clean technologies; and (c) environmentally and socially benign hydropower. The delegation of water resources management to the lowest appropriate level necessitates educating and training water management staff at all levels and ensuring that women participate equally in the education and training programmes. Particular emphasis has to be placed on the introduction of public participatory techniques, including enhancement of the role of women, youth, indigenous people and local communities. Skills related to various water management functions have to be developed by municipal government and water authorities, as well as in the private sector, local/national non-governmental organizations, cooperatives, corporations and other water-user groups. Education of the public regarding the importance of water and its proper management is also needed. Those who establish the framework for water development and management at any level, whether international, national or local, need to ensure that the means exist to build those capacities. Awareness-creation programmes, including mobilizing commitment and support at all levels and initiating global and local action to promote such programmes; b. Training of water managers at all levels so that they have an appropriate understanding of all the elements necessary for their decision-making; c. Appropriate training of the necessary professionals, including extension workers;. Sharing of appropriate knowledge and technology, both for the collection of data and for the implementation of planned development including non-polluting technologies and the knowledge needed to extract the best performance from the existing investment system. Institutional capacity for implementing integrated water management should be reviewed and developed when there is a clear demand. Existing administrative structures will often be quite capable of achieving local water resources management, but the need may arise for new institutions based upon the perspective, for example, of river catchment areas, district development councils and local community committees. Although water is managed at various levels in the socio-political system, demand-driven management requires the development of water-related institutions at appropriate levels, taking into account the need for integration with land-use management. In creating the enabling environment for lowest-appropriate-level management, the role of Government includes mobilization of financial and human resources, legislation, standard-setting and other regulatory functions, monitoring and assessment of the use of water and land resources, and creating of opportunities for public participation. International agencies and donors have an important role to play in providing support to developing countries in creating the required enabling environment for integrated water resources management. Water resources assessment, including the identification of potential sources of freshwater supply, comprises the continuing determination of sources, extent, dependability and quality of water resources and of the human activities that affect those resources. Such assessment constitutes the practical basis for their sustainable management and a prerequisite for evaluation of the possibilities for their development. There is, however, growing concern that at a time when more precise and reliable information is needed about water resources, hydrologic services and related bodies are less able than before to provide this information, especially information on groundwater and water quality. Major impediments are the lack of financial resources for water resources assessment, the fragmented nature of hydrologic services and the insufficient numbers of qualified staff. At the same time, the advancing technology for data capture and management is increasingly difficult to access for developing countries. Establishment of national databases is, however, vital to water resources assessment and to mitigation of the effects of floods, droughts, desertification and pollution. Based upon the Mar del Plata Action Plan, this programme area has been extended into the 1990s and beyond with the overall objective of ensuring the assessment and forecasting of the quantity and quality of water resources, in order to estimate the total quantity of water resources available and their future supply potential, to determine their current quality status, to predict possible conflicts between supply and demand and to provide a scientific database for rational water resources utilization. To make available to all countries water resources assessment technology that is appropriate to their needs, irrespective of their level of development, including methods for the impact assessment of climate change on freshwaters; b. To have all countries, according to their financial means, allocate to water resources assessment financial resources in line with the economic and social needs for water resources data; c. To ensure that the assessment information is fully utilized in the development of water management policies; d. To have all countries establish the institutional arrangements needed to ensure the efficient collection, processing, storage, retrieval and dissemination to users of information about the quality and quantity of available water resources at the level of catchments and groundwater aquifers in an integrated manner;. To have sufficient numbers of appropriately qualified and capable staff recruited and retained by water resources assessment agencies and provided with the training and retraining they will need to carry out their responsibilities successfully. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including cooperation with the United Nations and other relevant organizations, as appropriate, could set the following targets: a. By the year 2000, tohave studied in detail the feasibility of installing water resources assessment services; b. As a long-term target, to have fully operational services available based upon highdensity hydrometric networks. All States, according to their capacity and available resources, and through bilateral or multilateral cooperation, including the United Nations and other relevant organizations as appropriate, could undertake the following activities: a. Establish and strengthen the institutional capabilities of countries, including legislative and regulatory arrangements, that are required to ensure the adequate assessment of their water resources and the provision of flood and drought forecasting services; c. Establish and maintain effective cooperation at the national level between the various agencies responsible for the collection, storage and analysis of hydrologic data; d. Cooperate in the assessment of transboundary water resources, subject to the prior agreement of each riparian State concerned; b. Review existing data-collection networks and assess their adequacy, including those that provide real-time data for flood and drought forecasting; b. Improve networks to meet accepted guidelines for the provision of data on water quantity and quality for surface and groundwater, as well as relevant land-use data; c. Upgrade facilities and procedures used to store, process and analyse hydrologic data and make such data and the forecasts derived from them available to potential users;. Establish databases on the availability of all types of hydrologic data at the national level; f. Implement "data rescue" operations, for example, establishment of national archives of water resources; g. Implement appropriate well-tried techniques for the processing of hydrologic data; h. Assimilate remotely sensed data and the use, where appropriate, of geographical information systems; c. Provide forecasts and warnings of flood and drought to the general public and civil defence; d. Establish or strengthen research and development programmes at the national, subregional, regional and international levels in support of water resources assessment activities; b. Monitor research and development activities to ensure that they make full use of local expertise and other local resources and that they are appropriate for the needs of the country or countries concerned. The Conference secretariat has estimated the everage total annual cost (1993-2000) of implementing the activities of this programme to be about $355 million, including about $145 million from the international community on grant or concessional terms. Actual costs and financial terms, including any that are non-concessional will depend upon, inter alia, the specific strategies and programmes Governments decide upon for imp lementation. Important research needs include (a) development of global hydrologic models in support of analysis of climate change impact and of macroscale water resources assessment; (b) closing of the gap between terrestrial hydrology and ecology at different scales, including the critical water-related processes behind loss of vegetation and land degradation and its restoration; and (c) study of the key processes in water-quality genesis, closing the gap between hydrologic flows and biogeochemical processes. The research models should build upon hydrologic balance studies and also include the consumptive use of water. Water resources assessment necessitates the strengthening of existing systems for technology transfer, adaptation and diffusion, and the development of new technology for use under field conditions, as well as the development of endogenous capacity. Prior to inaugurating the above activities, it is necessary to prepare catalogues of the water resources information held by government services, the private sector, educational institutes, consultants, local water-use organizations and others. Water resources assessment requires the establishment and maintenance of a body of well-trained and motivated staff sufficient in number to undertake the above activities. Education and training programmes designed to ensure an adequate supply of thesetrained personnel should be established or strengthened at the local, national, subregional or regional level. In addition, the provision of attractive terms of employment and career paths for professional and technical staff should be encouraged. Human resource needs should be monitored periodically, including all levels of employment. Plans have to be established to meet those needs through education and training opportunities and international programmes of courses and conferences. Because well-trained people are particularly important to water resources assessment and hydrologic forecasting, personnel matters should receive special attention in this area. The aim should be to attract and retain personnel to work on water resources assessment who are sufficient in number and adequate in their level of education to ensure the effective implementation of the activities that are planned. Education may be called for at both the national and the international level, with adequate terms of employment being a national responsibility. Identifying education and training needs geared to the specific requirements of countries; b. Establishing and strengthening education and training programmes on water-related topics, within an environmental and developmental context, for all categories of staff involved in water resources assessment activities, using advanced educational technology, where appropriate, and involving both men and women; c. Developing sound recruitment, personnel and pay policies for staff of national and local water agencies.

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