USA news on Youtube Jan 27 2018

Hi.

I'm Leslie Zimmerman from the Pulmonary and Critical Care Medicine Department.

This module will be on lung cancer.

Terms of objectives, we're gonna describe the rates of lung cancer in men and women.

We're gonna list the most common risk factors for

lung cancer including tobacco, asbestos and radon.

We will describe the clinical presentation,

including signs of advanced lung cancer such as the SVC syndrome.

Horner's syndrome, recurrent laryngeal nerve involvement, and pleural and

pericardial effusions.

We will describe common paraneoplastic syndromes,

including hypercalcemia, hyponatremia, and clubbing.

We will describe the role of the CT scan, PET scan,

and pulmonary function testing In the work up of a patient with lung cancer we will

summarize the effectiveness of screening for lung cancer with low dose CT scans.

And then we'll talk about the basics of management of lung cancer.

First, let's start with a definition.

Lung cancer refers to malignancies that originate in the airways or

pulmonary parenchyma.

Lung cancer and bronchogenic carcinoma are actually the same term, so

they mean the same thing.

But let's more specifically talk about where does lung cancer originate.

In this cartoon we, can see here are some airways.

And down here is more the parenchyma of the lung.

And these are some pathology sections, gross pathology.

And you can see that lung cancer can originate from an actual airway.

In this case, it originates in a right main stem bronchus.

But lung cancer can also originate down the alveolar area

away from the major airways.

But all together this is referred to as lung cancer or bronchogenic carcinoma.

Now let's start with some epidemiology of lung cancer.

Lung cancer is common, these are rates in the United States.

And men and women together, there's over 200,000 cases of lung cancer per year.

Now looking at this chart in more detail, you can see that actually prostate cancer

is more common in men, lung cancer is number two.

In women, breast cancer is actually more common than lung cancer,

but lung cancer is second in women.

Now, this chart excludes non-melanoma skin cancer,

those are squamous cell skin cancers and basil cell skin cancers.

And the reason that's excluded, is because typically they don't cause much morbidity,

they're simply resected without any long term or distant problems from it.

Now let's move on to lung cancer mortality.

Lung cancer has a high mortality.

You can see here that while prostate cancer is more common,

lung cancer causes more death in men.

In fact, in men lung cancer causes more death than prostate,

colon, and pancreas cancer combined.

In women, you'll see a similar process.

Lung cancer causes the most cancer death in woman.

Even though breast cancer is more common, lung cancer in women cause

more cancer death than breast and colon cancer combined.

Let's show the same data in a different way.

Here you can see that this shows the incidence of cancers per

100,000 people in blue, and then the death rate in red.

Again, prostate in men and breast cancer in women

are much more common, but much less likely to cause death.

Compare that to lung cancer, while not quite as common as prostate and

breast cancer, it's much more likely to cause death.

In fact, lung cancer, as we showed in the previous one,

is the leading cause of cancer death in both men and women in the United States.

Patient with lung cancer only have a 15% five-year survival.

That means five years after diagnosis, only 15% of patients will still be alive.

We'll talk in the second module about how we hope that early detection

will change this dismal statistics on lung cancer.

Now, that was overall US lung cancer rates.

There is data even more specific state by state, and even county by county.

So there is significant regional variation in the incidents of lung cancer.

This is not just a population map.

This is cases per 100,000 people.

So you can see there's a belt of lung cancer

where lung cancer is very prevalent.

And there are some other states where lung cancer is much more unusual.

Now, let's overlay the smoking rates.

In this map, you'll see that the highest smoking rates are in darkest colors, and

the lowest smoking rates are in the lightest color.

Now let's go back, and again, you see again, the highest lung cancer rates

coincide with the states that have the highest smoking rates.

Now there has been some improvement in lung cancer rates in the United States

in both men and women.

This seemed to peak in men in about 1985 and

we're just now seeing that lung cancer rates in women have peaked and

slightly declined over the past few decades.

Moving on to worldwide lung cancer rates, in this map, the darkest colors have

the highest rates and the lightest colors have the lowest rates of lung cancer.

The highest rates for lung cancer in the world are in central and

eastern Europe, eastern Asia and the United States and Canada.

The highest rate is actually in Hungary.

Now, lung cancer is the most common cancer in the world.

And it's been that way for several decades.

There was 1.8 million new cases in the year 2012.

Now we talked about in the United States, prostate and

breast cancer actually more common, although lung causes higher mortality.

But in the world, lung cancer is the most common cancer.

And that may be because, in other parts of the world,

they don't do screening for breast cancer and prostate cancer.

So for example, if an older man has asymptomatic prostate cancer,

that may never be discovered if it's not screened for.

Let's move back to the United States and

show a little bit more detail about mortality by different diseases.

So this is mortality per decade in men.

And you see here in the teens and the twenties, mortality is low and

unfortunately is dominated by accidents, suicides and homicide.

But as men get older, then Cancer and heart disease take over.

Now, there is a peak of cancer in about the 60 to 80 year old men and

about 28% of that cancer death is related to lung cancer.

Now, heart disease takes over as men get older and older.

And, is the number one cause of death in men.

With cancer being a close second.

Now in a similar chart, oops, one more thing.

Lung cancer, specifically, has an average age of onset of 70.

So you can see that it would be unusual for

someone who is in age 30 or even up to 35 to have lung cancer.

And unusual to have lung cancer death before age 45.

Moving on, and showing the same data in women, you can see again,

a later onset in the 60s to 70s for cancers.

And in this of cancer deaths 26 is related to lung cancer.

But, heart disease is the number one cause of death in women

because it takes over as women age.

The other thing you'll notice for younger women,

there's a much lower rate of accidents, homicide and suicide.

Let's move on to the specific risk factors for lung cancer.

80 to 90% of lung cancer is attributable to cigarette smoking.

The risk increases with a number of cigarettes smoked per day.

So using this chart here, this is men and women, you can see the risk

of developing lung cancer increases with the number of cigarettes smoked per day.

So this is someone who smoked less than a half a pack per day.

Here's about a pack per day.

And here's a pack to two packs per day.

And the risk increases as someone smokes more.

Similarly for women, risk increases as women smoke more cigarettes per day.

The other thing is that risk decreases with the number of years quit.

So, for example, quitting before the age of 40 in both men and

women will significantly decrease the risk of developing lung cancer.

Now, because cigarettes and lung cancer are tied so closely together,

let's talk about milestones in cigarette consumption in the United States.

So first of all you'll see here that lung cancer was an extremely

unusual cancer in the early 1900s.

If a physician saw one or

two patients in their whole career with lung cancer, that would be very unusual.

But you can see this peak happened and

parallels the peak of cigarette consumption.

So talking about cigarette consumption, in about 1900,

there developed the manufacture of machine made cigarettes.

It would simply be very hard for

someone to smoke two packs a day, if they had to hand roll every cigarette.

So the manufacture of machine made cigarettes

made the consumption of more cigarettes per day easier for people.

Then you'll see an increase as the US entered World War I.

There's a slight decrease during Depression,

as people had less discretionary income, and

then there's a marked increase in cigarette consumption in World War II.

Now, in World War II, soldiers were given free cigarettes in their ration kits.

And in fact, 75% of cigarette consumption during

the period of World War II was done by soldiers.

And so what happens when these soldiers come back in the US, and

are addicted to cigarettes, they continue to smoke.

In about 1950, it became evident of the first sort of

modern connection between lung cancer and smoking.

Then in 1964, the Surgeon General report was released that linked

lung cancer, COPD and other health effects to cigarettes.

Then in the mid to late 60s there was the ban on TV and radio ads for cigarettes.

Then you can see a marked decrease when there was a doubling of the federal tax.

Now, the more expensive the cigarette does influence some smokers to quit,

but the biggest influence is that it stops new smokers from starting,

because of the cost.

In the mid 1980s, the Surgeon General report

discussed the ill effects of secondhand smoke.

This was the basis for much legislation that limited smoking in public places.

Then in the late 1990s,

nicotine replacement became an over the counter medication.

So you didn't have to have a physician's prescription to buy it.

And then along the way there were further increases in federal taxes on cigarettes.

So at the peak, in the 1950s, 44% of US men smoked.

Again, many of them became addicted to cigarettes

in World War II when they were soldiers.

Currently, about 16.8% of US adults over 18 smoke cigarettes.

Now, 16.8% breaks down to about 18.8% of

US adult men and about 14.8% of US adult women.

Now, when do people smoke?

Well most smokers are in the age group of 25 to 44.

But you can see most of them started

earlier than that in the late teens to early twenties.

You have seen this map before.

This is smoking prevalence throughout the United States state by state.

And you can see that there are some states that have very high rates of smoking.

Here in California the rate is much lower, and you tend to not appreciate

how many people smoke until you visit some of those states and you see many more

people walking around on the sidewalk smoking or in other public places.

Now, cigarette consumption worldwide.

Now, this looks very similar to the lung cancer prevalence.

Again, showing that link between cigarette consumption and lung cancer.

You can see cigarette consumption is highest In those same areas in

Eastern Asia, the United States, Canada, and Eastern Europe.

And that's men and women.

The other interesting thing we see about lung,

excuse me cigarette consumption is that it's very different between men and

women depending on the income of the particular country.

So in a low income country,

the vast majority of smokers are men, and very few women smoke.

But as income rises,

There's a much more of an equalization in a number of smokers between men and women.

In fact, over and over again, we've seen this interesting phenomenon of

a country that may start off as resource poor, has an economic growth period and

becomes more resource rich, that you see this occurring in the population.

Men are early initiators of smoking, as there's more discretionary income.

And then, it peaks and then, it becomes less of a status symbol.

And then, there is more dissemination of the ill effects of smoking.

And as the economic growth continues to rise in the country,

the percentage of male smokers declines.

Unfortunately, it never declines back to its first state.

And so there's a significant number of men who remain addicted to cigarettes.

And in women, this happens a little bit later.

Even though there's economic growth in the country, it may be that women are later

initiators because they have less access to discretionary income or

for another variety of social reasons.

But then as economics increase in the country,

you'll see an increase in the number of women smokers and

then a decline as again the information about the ill effects of smoking

is widely disseminated but, unfortunately again, it never goes back

to the state before cigarettes were introduced into the population.

Now in terms of countries that have made good progress in cigarette consumption,

these countries have had the biggest reduction in smokers.

That's the United States, Japan, the United Kingdom.

Unfortunately, this is, by far,

exceeded by the countries that have had an increase in the number of smokers.

Now, this is not a percentage increase in smoking.

This is actually a change in millions of smokers.

So this is an actual number increase in smokers in these countries.

Let's talk specifically about the carcinogen in cigarettes.

So tobacco smoke is a mixture of over 5000 chemicals.

And these are just some of the most recognized products that

are known carcinogens that are inhaled with cigarette smoking.

Now, this is different than this term called tar.

Tar is actually the resin of partially combusted particulate matter, so that sort

of black tarry stuff that one sees after smoking cigarettes perhaps on the filter.

Now this led to the advertisement of low tar cigarettes.

Now tar is the resin and many of these carcinogens are volatile gases or product.

So these are not related,

despite the fact that these were advertised as a healthier cigarette.

So finally in 2001, the Institute of Medicine concluded that smoking

these lower tar cigarettes did not benefit smokers.

So these lower tar cigarettes are not a safer cigarette.

Now, the carcinogen and tar are not why people smoke.

The smoke because of the nicotine and

the addiction of nicotine that occurs with tobacco smoking.

Now first of all, what is a substance addiction?

So a substance is addictive if it's characterized by the following behaviors

in the user.

There's impaired control over use, there's compulsive use,

there's continued use despite knowing harm, and there's craving.

So a smoker that even maybe they have a cold that day, will wake up and

the first thing they want to do or need to do is smoke a cigarette.

They will smoke a cigarette even if they have to go outside and it's raining.

They will have to smoke multiple times a day because as their nicotine level drops

in their system, they'll feel the urge to smoke and replace that nicotine.

And you can see there's a variety of addictive drugs and tobacco,

which is essentially nicotine, falls right in the middle of it.

So active smoking is the biggest risk factor for the development of lung cancer,

but there are a few others So, passive smoking or

second hand smoke is the smoke that is involuntary, inhaled by non-smokers.

So, is the combination of two things.

It's exhaled smoke after the smokers exhaled the cigarette

smoke, but also the sidesteam smoke.

That is smoke when just the cigarette is burning, and

all that smoke that comes from that.

It is estimated that living with a smoker causes

a 20% increased risk of lung cancer.

Now, in terms of second hand smoke in the workplace, that is, in the United States,

at least very dependent on the job and current local state and

even county and city laws.

I do wanna mention the risk of passive smoking in multi-unit housing,

especially in low income housing, you might have multiple units that

all share the same common air duct or ventilation system.

So if one person is smoking in one apartment, essentially,

many people may be exposed to passive smoking.

In terms of other risk factors for lung cancer, another one is asbestos.

Now, asbestos is a mineral that's mined and

you can see it forms these long, stringy sheets.

And these can be woven into cloth and then made into insulation,

even clothing or gloves, and they're very protective against heat.

So they were used for many years any time that there was something hot that you

needed to pick up, so in industry and even in home use.

Unfortunately, the fibers can break off and

these little needle-like fibers can be inhaled into the lung.

Now, most but not all asbestos has been removed from production.

You can still find it being used and

incorporated in low doses in things like brakes or clutch pads,

things that get very hot and you need to have that heat insulation.

But let's look at the short video to find out other ways that people can be exposed

to asbestos.

>> As a worker or homeowner,

the hazard exists when undertaking a renovation or demolition.

The danger is releasing the asbestos fibers into the air.

[SOUND] When

a worker breaths, asbestos fibres enter the mouth and

nose and flow down the air passages deep into the lungs.

[SOUND] The fibers lodge

in the delicate lung

tissue where oxygen is

absorbed into the blood.

Immune system cells try and break down the asbestos fibers and

become damaged and die.

Scar tissue forms around the dead cells and

spreads as more fibers embed in the lungs.

>> Now the other thing that's about asbestos exposure,

many people that worked in asbestos injury were also smokers.

And the risk for lung cancer

was not just additive if you were a smoker and also exposed to asbestos.

It was something called synergistic.

So, for example, if you were exposed to asbestos and

did not smoke you had a five times increased risk of developing lung cancer.

And if you smoked, but were not exposed to asbestos, that risk was 11 times.

But if you smoked and were exposed to asbestos,

it was more than just additive, the risk increased to 53 times.

Another risk factor we'll talk about is radon.

Now radon is a gaseous product of uranium and

radium, and what happens is, leaks up from the ground and

can then get into the water and ventilation system of houses.

Now this is a specific problem in certain states that sit on bedrock,

especially granite.

And so many people in these states have radon detecting kits in their home

to determine whether radon is a particular problem for their household.

And that concludes our section on the epidemiology and

the most common risk factors for lung cancer.

For more infomation >> Leslie Zimmerman, MD, Lung Cancer Part 1: Epidemiology and Risk Factors - Duration: 25:48.

-------------------------------------------

Coco Peat:How To Use it Correctly in Container Gardening - Duration: 10:53.

Use of coco peat is common in gardening

Either you use it in backyard gardening

container gardening or in hydroponics

In this video I will show

how to use coco peat correctly

For promoting organic gardening

share this video to all social media

I will tell how to use coco peat correctly

before that I would request you to subscribe

as similar gardening tips and ideas are shared here

Subscription link is given here

go and click for automatic subscription

Subscription is totally free

therefore subscribe without hesitating

You will get new videos for free whenever posted

Come let's start

Coco peat we bought from market or gardening store

is sold either in brick form or dust fiber

But that coco peat may contain fungus

and impurities harmful for plants

Therefore sterilization is

necessary to avoid damage in gardening

While using coco peat

It is necessary to pre treat coco peat

as it is made from coconut

Mostly Coconut is grown in coastal areas

therefore salty material gets mixed with coco peat

Many impurities get mixed during handling and storage

I would like to add one more aspect

After taking yields from plants

it is necessary to treat coco peat

as in process of plant life cycle

many impurities and fungus gets developed in coco peat

When you use this coco peat for growing other plants

you must sterilize coco peat before growing other plants

Now I will show how to sterilize coco peat

then we can use coco peat easily in gardening

and the sterilization method is very simple

I can do it

so you can do it easily

This coco peat is already mashed from coco peat brick

As I was telling earlier in the video

why it is necessary to sterilize coco peat

as it contains harmful impurities

which can damage your plants

Now I will show you how to sterilize

coco peat so that you can use it properly

where ever you want to use it

correct and in proper way

I will use hydrogen peroxide to sterilize coco peat

Hydrogen peroxide used here is 35% food grade

Take 5 ml hydrogen peroxide with one liter of water

Add 5 ml hydrogen peroxide with one liter of water

then add coco peat in the solution

Keep coco peat for at least 4 hours in the solution

It is better to wet coco peat for a night

Then wash or rinse with water properly

After drying you can use coco peat in containers

There is another method

If hydrogen peroxide is not available

You can use chlorine bleach for sterilization of coco peat

You have to mix one kg chlorine bleach

with 5 liter of water

then wet coco peat in the solution

After wetting for 4 hours wash it properly

Wash coco peat until odor of chlorine bleach vanishes

But many gardeners claim that it damages plant

I would like to tell that

plant will survive in small traces of chlorine bleach

But it is better to use hydrogen peroxide

to sterilize coco peat

Now I will show how to use

hydrogen peroxide with water to

pre treat coco peat and dry

Come let's watch

I will take some coco peat in a bucket

and after mixing one liter of water

I will add 5 ml 35% food grade hydrogen peroxide

I have mixed one liter water and

now I will add 5 ml hydrogen peroxide

You have to use

35 % food grade hydrogen peroxide sterilize coco peat

I will show you mixture closely

Now you have to keep the solution of

coco peat hydrogen peroxide and water for at least 4 hours.

It is better to keep for night

but for purpose of making video

I will keep solution only for 4 hours and wash it

4 hours is completed

care for one thing

You have to wash 3 times,

first with hydrogen peroxide and

twice with plain water

Before drying rinse it properly with

water to wash impurities well

Then filter it

Dry coco peat after filtering

After drying coco peat you can use it in gardening

I am repeating once more

you have to wash coco peat three times

first in solution of hydrogen peroxide

and keep for 4 hours

then wash it with water twice

and keep it for drying

then after drying coco peat is ready

to use for gardening purpose

As you are watching after washing 3 times and

drying coco peat is nearly dried

When it dries completely

then you can use it in container

or use where ever you want to use

You have noticed that

I have washed coco peat first with hydrogen peroxide

and after that I have washed twice with water

Then I have dried it

By sterilization it becomes fungus and germs free

And other impurities get washed by washing twice

Now coco peat is sterilized and

you can easily use coco peat in container gardening

Coco peat we buy from

market or gardening store is not washed

Many manufacturers sell washed coco peat

but without Fungal and chemical treatment

If you buy washed coco peat from market

Then you should buy coco peat which is washed thrice

For self satisfaction you should wash it

and treat with hydrogen peroxide for fungus removal

I would suggest you,

even if you buy washed coco peat from market

use it in gardening after fungal and chemical treatment

Share this video with other gardeners

Do not forget to like this video

And be sure to subscribe this channel

Many gardening tips are shared here

subscription is totally free

You will recieve new tip directly Whenever posted here

Thanks for watching this video

See you again with some new information

Till then enjoy gardening at your home