Upfront boost to gross disease followed by elective pelvic radiation improves compliance to radiation therapy delivery metrics in locally advanced vulvar cancer.

Locally advanced cancer of the vulva (LACV) is commonly diagnosed in older women (>65 years), and is treated using combined multimodality therapy (CMT) that includes radiation therapy (RT). Compliance to optimal RT metrics, including completion of > 20 fractions, overall treatment duration of < 8 weeks (56 days), and < 1 week intra-treatment break is associated with better disease outcomes. However, published results note that a significant number of patients with LACV do not adhere to these metrics. The aim of our study is to evaluate whether a modified sequence of RT delivery, treating the localized boost volume upfront followed by the larger elective nodal volume is associated with improved compliance to optimal RT delivery metrics.

Pulmonary function in a cohort of New York City Police Department emergency responders since the 2001 World Trade Center disaster.

OBJECTIVE: Comparing pulmonary function since the 2001 World Trade Center disaster, with preexposure data, in a New York City Police Department Emergency Responder cohort, without history of repetitive respiratory exposures. METHODS: A total of 206 New York City Police Department Emergency Services Unit members reported Arrival Time, Exposure Location, Duration, Smoking History, Respirator Mask Usage, and Respiratory Symptoms, and underwent clinical evaluation and follow-up spirometry, in 2002 and 2007. RESULTS: A mean decline in forced vital capacity of 190 mL (3.7%) was observed 1-year postexposure in 2002, and 330 mL (6.4%) in 2007, compared with baseline data. Forced expiratory volume in the first second was not significantly changed in 2002 but declined 160 mL (3.9%) after 5 further years of follow-up. CONCLUSIONS: Abnormal spirometry was observed in (5.3%) of subjects, particularly individuals experiencing higher Exposure Intensity, Duration, or Respiratory Symptoms. The small number of smokers and subjects failing to wear protective respiratory masks showed greater declines.

Herbal medicine for dementia: a systematic review.

This systematic review aimed to assess the effectiveness and safety of herbal medicines (HM) for treating dementia. Databases in English and Chinese were searched from their inceptions to February 2007. References in reviews and randomized controlled trials (RCTs) were screened by hand. Trials comparing orally administered HM with placebo, no intervention or other therapy were considered. Trials on Ginkgo biloba and its extracts were excluded to avoid duplication of existing reviews. Pairs of authors independently applied eligibility criteria, extracted data and assessed methodological quality using the Jadad Scale. Thirteen RCTs met the inclusion criteria of three or above on this scale. Six trials compared herbal medicine with placebo, one with no treatment, and the remainder with pharmaceutical intervention. Meta-analyses were performed on common cognitive performance outcome measures. All studies reported HM had significant effects in improving symptoms. In studies that employed active controls, HM was at least as effective as the pharmaceutical intervention. Meta-analyses found HM more effective than no treatment or placebo and at least equivalent to control interventions, although the overall effect was small. No severe adverse events were reported. These trials provide overall positive evidence for the effectiveness and safety of certain HMs for dementia management.