Acute cocoa Flavanols intake has minimal effects on exercise-induced oxidative stress and nitric oxide production in healthy cyclists: a randomized controlled trial

Cocoa flavanols (CF) can stimulate vasodilation by improved nitric oxide (NO) synthesis and have antioxidant and anti-inflammatory capacities. This study aimed to examine whether acute CF intake can affect exe...

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Salivary diagnostic markers in males and females during rest and exercise

Saliva is a useful diagnostic tool for analysis in sports, exercise and nutrition research, as collection is easy and non-invasive and it contains a large number of analytes affected by a range of physiologica...

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Salvage high-dose-rate brachytherapy and external beam radiotherapy for isolated vaginal recurrences of endometrial cancer with no prior adjuvant therapy

Publication date: Available online 10 August 2017
Source:Brachytherapy
Author(s): Christopher H. Chapman, Kaveh Maghsoudi, Ramey D. Littell, Lee-May Chen, I-Chow Hsu
PurposeTo evaluate clinical outcomes for isolated vaginal recurrence of endometrial cancer without adjuvant therapy treated with salvage external beam radiation therapy (EBRT) and high-dose-rate CT-based inverse-planned brachytherapy.Methods and MaterialsThirty women were included in this retrospective study. Median time to first recurrence was 16.7 months, and median age at recurrence was 73 years. Initial grade was 1 or 2 in 19 patients (63%), and 2009 FIGO stage IA in 19 patients. All patients received pelvic EBRT in 1.8 Gy daily fractions to a total of 45 or 50.4 Gy. Interstitial brachytherapy was used in 27 patients (90%). The median total EQD2 dose was 68.3 Gy. Kaplan-Meier estimates of overall survival (OS), cause-specific survival (CSS), progression free survival (PFS), locoregional failure-free survival, and distant failure–free survival (DFFS) were calculated.ResultsMedian follow-up was 76.4 months for vital status and 57.7 months for disease status after salvage therapy. The 5-year OS, CSS, PFS, locoregional failure-free survival, and DFFS after salvage therapy were 77%, 83%, 75%, 87%, and 86%. Initial high-grade disease was prognostic for OS, CSS, and DFFS (5-year OS 95% vs. 29%, p = 0.005). Initial stage beyond IA was prognostic for CSS, PFS, and DFFS (5-year CSS 93% vs. 74%, p = 0.025).ConclusionsSalvage EBRT and high-dose-rate brachytherapy resulted in a high rate of locoregional control. Initial high-grade and advanced stage disease were associated with greater distant failure and cancer-related mortality after salvage therapy.



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[Perspectives] Reflex hammer

Medical students were traditionally taught that, in their initial encounter with their patients, gastroenterologists relied mostly on the patient's history and neurologists on the physical examination. The neurologist needed skill, knowledge, careful powers of observation, and two simple pieces of equipment: a safety pin and a reflex hammer. Sometimes the hammer came with an integral pin, and a brush for further testing of sensation.

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[Editorial] Yemen and cholera: a modern humanity test

Urgent warnings began in May as aid agencies called for an immediate response to the growing cholera outbreak in Yemen. By mid-July, over 330 000 cholera cases were reported, with 1700 deaths. Since 2015, a civil war has left 14·5 million people (half the country's population) without access to clean water and sanitation. The UN has called it the "world's worst cholera outbreak in the context of the world's worst humanitarian crisis". The war, unpaid worker salaries, a decimated health system, controversies around the undeployed cholera vaccine stockpile, and slow global funding efforts are all somehow to blame.

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[World Report] Treating and preventing cholera in Bangladesh

Cholera and diarrhoea remain major health problems in Bangladesh, but some effective, low-cost interventions are preventing the spread of the disease and saving lives. Sam Loewenberg reports.

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[Obituary] Angela Mary Hartley Brodie

Pioneer of aromatase inhibition in breast cancer. Born in Oldham, UK, on Sept 28, 1934, she died of the complications of Parkinson's disease in Fulton, MD, USA, on June 7, 2017, aged 82 years.

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[Correspondence] False and real, but avoidable, dichotomies – Authors' reply

We agree with Gorik Ooms and colleagues that the dichotomies we discussed in our Viewpoint1 are artificial and avoidable. We call these dichotomies false not because they do not exist, but because they are not genuine or true, which is another meaning of this adjective. They are real and have had very negative consequences. The divide between the proponents of the vertical and the horizontal approaches to dealing with the HIV/AIDS challenge, which Ooms and colleagues refer to, was indeed gruelling.

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[Correspondence] False and real, but avoidable, dichotomies

Although we join Julio Frenk and Octavio Gómez-Dantés (Feb 11, p 667) in calling for integrative thinking in global health,1 we believe it is important to distinguish between avoidable and false dichotomies. Some of the dichotomies mentioned as false are indeed artificial and avoidable, but nonetheless real; they require conscious effort to be resolved.

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[Perspectives] Insight into autism: a view from inside

In June this year, soon after the UK general election, WikiLeaks founder Julian Assange levelled an insult at Prime Minister Theresa May on Twitter. This wasn't particularly newsworthy; a great many people were doing the same. But the words he chose were striking: "It's OK for Theresa May to be awkward, unfeeling or even autistic…The problem is that her policies match". Sadly, the use of the term "autistic" to mean cold, emotionless, and unempathic is not a rare occurrence. Naoki Higashida's latest book Fall Down 7 Times Get Up 8: A Young Man's Voice From the Silence of Autism is, however, a stark demonstration that this damaging and enduring assumption is incorrect.

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[Correspondence] Aggregate health spending

The Article on disaggregated data on health spending by the Global Burden of Disease Health Financing Collaborator Network (May 20, p 1981)1 offers great insight into the patterns of spending by countries. Spending is presented per capita in the Article; however, global totals present a more vivid picture of global health finances. By multiplying per capita spending by estimates of population in each country,2 we were able to calculate that total global spending on health was US$8982 billion in 2014.

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[Perspectives] Arts-based learning for a Circle of Care

Over the past 3 years, staff at Guy's and St Thomas' NHS Foundation Trust have been offered courses that draw on ideas from theatre, dance, and the visual arts as part of a collaboration between the Simulation and Interactive Learning Centre (SaIL) and the Performing Medicine programme. The stories we have heard during this time leave no doubt that a career in health care is intensely demanding: a nurse sitting in a mortuary with a grieving mother, wondering "was it ok that I cried too?"; an anaesthetist attempting to save the life of a pregnant woman with her terrified husband looking on; team reactions after the terrorist attack on Westminster Bridge; a senior nurse enforcing the use of the WHO checklist to a sceptical surgeon; an A&E consultant punched in the face by a drunk patient; or a pharmacist frustrated by the snail's pace of the computer system.

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[Comment] Building virtual communities of practice for health

Advances in medical research and innovation mean little if they do not reach the patients who need them. Too often, specialised medical knowledge remains within the walls of academic and tertiary care centres in capitals and major cities, inaccessible to much of the world's population due to geographical distance and economic disparity. To "ensure healthy lives and promote well-being for all at all ages", UN Sustainable Development Goal 3, a more efficient and equitable way to disseminate new scientific knowledge and evidence-based expertise is needed.

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[Editorial] Genome editing: science, ethics, and public engagement

Over the past 5 years, genome editing has been rapidly emerging in the biological sciences. In 2015, the American Association for the Advancement of Science chose the genome editing technique known as clustered regularly interspaced short palindromic repeats (CRISPR) as the most promising scientific advancement that year. CRISPR are short sequences that can be used as templates by the CRISPR-associated protein 9 (Cas9) or similar exogenous nucleases. When delivered to a cell, the CRISPR-Cas9 system can cut the genome to excise DNA sequences or introduce new ones.

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[Comment] Born to run: our future depends on it

On May 6, 2017, a Kenyan distance runner ran the marathon in 2 h 25 s at the Monza racetrack in Italy. Although Eliud Kipchoge's time marks the fastest marathon ever run, his performance cannot be considered an official world record (currently at 2 h 2 min 57 s) because the race did not conform to rules required by the International Association of Athletics Federations.1 Yet, this astonishing performance suggests that a sub 2-h marathon under official conditions might not be far away and shows the remarkable capacity of the human body, as exemplified by Kipchoge's ability to endure a gruelling training regime (>120 miles per week at an altitude of about 2400 m) that helped him achieve a performance previously considered impossible.

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[Correspondence] George Gershwin's death and Duret haemorrhage

George Gershwin (born Sept 26, 1898) was one of the greatest American composers in history. He died, aged 38 years on July 11, 1937, after surgery for his brain tumour. His olfactory hallucinations, a sign of temporal lobe epilepsy, had begun in early 1934,1–3 but he continued active musical works despite the gradual deterioration of his health status until several months before his premature death. His headaches, spells of blurred consciousness and abnormal behaviours, and other symptoms were ascribed to mental health problems.

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[Correspondence] Defending academic and medical independence in Turkey

We write on behalf of 207 health professionals, academics, and researchers, and 25 health and human rights organisations from many countries (appendix). We wish to bring to the attention of The Lancet's readers alarming events taking place in Turkey, where the state has been waging a campaign of terror and punishment against thousands of health professionals and academics.

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[Comment] Azithromycin in uncontrolled asthma

Asthma is a highly prevalent chronic airway disease affecting more than 300 million people worldwide. Despite treatment with inhaled corticosteroids and long-acting bronchodilators, asthma is uncontrolled in a substantial number of patients who remain symptomatic and are at risk of asthma exacerbations. These asthma attacks are often triggered by viral respiratory infections and might lead to emergency room visits, hospitalisations, and rarely, death; they result in a huge personal and societal burden.

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[Articles] Effect of azithromycin on asthma exacerbations and quality of life in adults with persistent uncontrolled asthma (AMAZES): a randomised, double-blind, placebo-controlled trial

Adults with persistent symptomatic asthma experience fewer asthma exacerbations and improved quality of life when treated with oral azithromycin for 48 weeks. Azithromycin might be a useful add-on therapy in persistent asthma.

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[Comment] Oral misoprostol for induction of labour in hypertensive pregnancies

Oral misoprostol is simple to use and is thus an attractive and easy option in low-resource settings where the doctor–patient ratio is suboptimum and close monitoring of intravenous drug dosage is often not possible.1 Results of the PROBAAT-II study2 in women with a wide range of indications for induction of labour at term showed oral misoprostol treatment to be non-inferior to Foley catheterisation. Now, the findings of Shuchita Mundle and colleagues' INFORM study3 in The Lancet advance the role of oral misoprostol for induction of labour.

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