Burden of Proof: The Debate Surrounding Aerotoxic Syndrome.

Since the 1980s, some commercial airline pilots and flight crews in the United States, United Kingdom and Australia began to report an illness they believed was caused by exposure to contaminated cabin air. Despite a body of scientific research and health activism calling for this condition, termed Aerotoxic Syndrome (AS), to be classified an occupational illness, it has not been accepted as a clinical entity because its causation remains contested. This article contends that debates over the recognition of AS have been shaped by the politics of science and what can be considered evidence of a causal link; the burden of proof lay with survivors and their allies rather than with airlines and manufacturers.

What are acute NHS trusts in England doing to prevent the cross-border spread of carbapenem-resistant Enterobacteriaceae?

Background: Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat to global public health as these organisms have the potential to cause infections which are easily spread and are associated with high mortality rates.

Aim/objective: The aim of this study was to establish which screening strategies acute NHS trusts in England have chosen to adopt and whether or not that strategy has prevented or is likely to prevent the cross-border spread of CRE.

Methods: All acute NHS trusts in England were invited to participate in a multicentre quantitative study.

Borders and Blood Fractions: Gamma Globulin and Canada's Fight against Polio, 1950-55.

During the early 1950s, Canada's efforts to prevent polio became heavily influenced by developments in the United States. America's foremost polio charity, the National Foundation for Infantile Paralysis, sponsored University of Pittsburgh researcher Dr. William McD.

Two cases of monkeypox imported to the United Kingdom, September 2018.

In early September 2018, two cases of monkeypox were reported in the United Kingdom (UK), diagnosed on 7 September in Cornwall (South West England) and 11 September in Blackpool (North West England). The cases were epidemiologically unconnected and had recently travelled to the UK from Nigeria, where monkeypox is currently circulating. We describe the epidemiology and the public health response for the first diagnosed cases outside the African continent since 2003.

Background and Current Treatment of Squamous Cell Carcinoma of the Anus.

In this review, a summary of our current understanding of squamous cell carcinoma of the anus (SCCA) and the advances in our knowledge of SCCA regarding screening, prevention, the role of the immune system, current treatment and the potential for novel targets are discussed. The present standard of care in terms of treatment is 5-fluorouracil (5-FU) and mitomycin C (MMC) concurrently with radiation, which results in a high level of disease control for small early cancers. Preservation of the anal sphincter is achieved in the majority, although anorectal function is often impaired.

Squamous cell carcinoma antigen: a potentially useful prognostic marker in squamous cell carcinoma of the anal canal and margin.

Background: The objective of this retrospective study was to investigate the predictive value of pretreatment serum squamous cell carcinoma antigen (SCCAg) levels in 174 patients with squamous cell carcinoma of the anus who received concurrent chemoradiation between 1997 and 2010.

Methods: Pretreatment serum SCCAg measurements in patients with histologically diagnosed squamous cell carcinoma of the anal canal and margin who received chemoradiation were compared with clinical tumor classification and lymph node status for prognostic/predictive ability, including 1) tumor response after the completion of chemoradiation treatment, 2) disease recurrence, and 3) overall survival. Clinical measurements and scores were compared using Spearman rank tests, and survival was assessed in both univariate and multivariate survival analyses.

Clinical target volumes in anal cancer: calculating what dose was likely to have been delivered in the UK ACT II trial protocol.

Purpose: Preliminary results of the UK Anal Cancer Trial (ACT) II trial in squamous cell carcinoma of the anus (SCCA) are promising, but 2-D planning with parallel-opposed fields provoked significant toxicity. We calculated likely doses delivered in the ACT II protocol to the planning target volume (PTV), nodal clinical target volumes (n-CTV) and organs at risk (OARs).

Methods And Materials: Original planning CT datasets of 33 consecutive patients with SCCA, included in the ACT II trial or treated to an identical protocol, enabled dose to the primary tumour, involved nodal PTV's, uninvolved nodal CTVs (inguino-femoral and pelvic lymph nodes) and femoral heads to be retrospectively calculated.

Antiepidermal growth factor receptor radiosensitizers in rectal cancer.

The activation of the epidermal growth factor receptor (EGFR) pathway correlates with a worse prognosis in many solid tumours. Hence, EGFR inhibitors have been developed as a treatment for cancer. The EGFR inhibitor cetuximab has been successfully combined with radical radiotherapy in head and neck cancer.

"Dancing on eggs": Charles H. Bynum, racial politics, and the National Foundation for Infantile Paralysis, 1938-1954.

In 1938, President Franklin D. Roosevelt and his law partner Basil O'Connor formed the National Foundation for Infantile Paralysis (NFIP) to battle the viral disease poliomyelitis. Although the NFIP program was purported to be available for all Americans irrespective of "race, creed, or color," officials encountered numerous difficulties upholding this pledge in a nation divided by race.

Cetuximab and chemoradiation for rectal cancer--is the water getting muddy?

Unlabelled: The epidermal growth factor receptor (EGFR) inhibitor cetuximab has been successfully combined with radical radiotherapy in head and neck cancer. In colorectal cancer, increased response rates are achieved by cetuximab and panitumumab within standard chemotherapy schedules, but not in chemoradiation regimens. This review examines the clinical evidence and potential mechanisms for an interaction when EGFR inhibitors are added to fluoropyrimidine-based chemoradiation in rectal adenocarcinoma.

Anal cancer: is neoadjuvant cisplatin chemotherapy or chemoradiotherapy friend or foe?

This Practice Point commentary discusses the findings of the Intergroup RTOG 98-11 trial, which aimed to investigate both the potential role of cisplatin as neoadjuvant chemotherapy, and also its role concurrently in combination with radiotherapy, for anal-canal carcinoma. Although chemoradiotherapy has had an important effect on the treatment of anal cancer, and allows preservation of anorectal function with survival rates similar to or better than those of surgical treatment, overall survival rates for advanced tumors are still in the region of 50-60% at 5 years. A strong theoretical rationale for cisplatin-based treatment in anal cancer exists; several phase II trials have demonstrated a high response rate with reduced colostomy rates.

The clinical significance of the circumferential resection margin following preoperative pelvic chemo-radiotherapy in rectal cancer: why we need a common language.

Objective: The presence of microscopic tumour cells within 1 mm of the circumferential surgical resection margin (CRM) is the endpoint most strongly associated with local recurrence in rectal cancer and doubles the risk of developing distant metastases. Reporting on the CRM can monitor surgical quality assurance and over the past two decades has driven advances in surgical technique with the increasing use of total mesorectal excision. The aim of this review was to use the evidence from both phase II and phase III randomized trials of preoperative radiotherapy and chemoradiation in rectal cancer, to assess how often CRM involvement is currently documented and examine its utility as an early predictor of both disease-free and overall survival.

Alternative clinical end points in rectal cancer--are we getting closer?

Background: In rectal cancer a high risk of local recurrence has been reported for patients treated by surgery alone. It is also recognised that 20%-40% of rectal cancer patients continue to develop distant metastases and die, even when a very low risk of local recurrence has been achieved with the use of preoperative radiotherapy and total mesorectal excision (TME). Hence, the current design of randomised trials in rectal cancer continues to use the standard end points of local control and survival.

Can histopathologic assessment of circumferential margin after preoperative pelvic chemoradiotherapy for T3-T4 rectal cancer predict for 3-year disease-free survival?

Purpose: This study set out to determine the impact of a positive circumferential resection margin (CRM) (R1-R2) and pathologic downstaging on local recurrence and survival in patients with borderline resectable or unresectable rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy (CRT).

Methods And Materials: A total of 150 patients with locally advanced rectal cancer were treated with long-course neoadjuvant CRT using low-dose folinic acid and 5-fluorouracil. CRT was followed 6-12 weeks later by surgical excision.

The reliability of lymph-node staging in rectal cancer after preoperative chemoradiotherapy.

Aims: To determine the prognostic significance of the nodal stage and number of nodes recovered in the surgical specimen after preoperative synchronous chemoradiation (SCRT) and surgery for locally advanced or unresectable rectal cancer.

Materials And Methods: One hundred and eighty-two consecutive patients with locally advanced or unresectable (T3/T4) rectal carcinomas were entered on a prospective database and treated in this department with preoperative chemoradiation, followed 6-12 weeks later by surgical resection. Most patients received chemotherapy in the form of low-dose folinic acid and 5-fluorouracil (5-FU) 350 mg/m2 via a 60-min infusion on days 1-5 and 29-33 of a course of pelvic radiotherapy delivered at a dose of 45 Gy in 25 fractions over 33 days to a planned volume.

Preference for and satisfaction of Canadian women with the transdermal contraceptive patch versus previous contraceptive method: an open-label, multicentre study.

Objective: To document Canadian women's experience with the transdermal contraceptive patch, a method delivering 150 microg norelgestromin and 20 microg ethinyl estradiol daily.

Methods: We conducted an open-label, multicentre, descriptive cohort study of the contraceptive patch over 9 cycles in 392 women requiring contraception. A single treatment cycle consisted of 3 consecutive 7-day patch applications followed by 1 patch-free week.

Locally advanced pancreatic cancer treated with radiation and 5-fluorouracil.

A retrospective analysis was performed, in a single institution, of patients with locally advanced pancreatic carcinoma without evidence of distant metastases, who were treated with chemoradiation. Between 1994 and 2000, 24 patients were treated with radiation and 5-fluorouracil (5-FU). The standard dose of radiation prescribed was 45 Gy to the 95% isodose in 25 fractions over 5 weeks.

Outcome of the next labour in women who had a vaginal delivery in their first pregnancy.

This study reviews the outcome of the next labour in women who are delivered vaginally in their first pregnancy. The influence of the method of delivery in the first pregnancy and of factors in both the first and next labour on the type of delivery in the second pregnancy, are recorded in a group of 13,813 women. Those delivered spontaneously and by vacuum, low forceps and mid-forceps in their first pregnancy had a 96%, 91%, 88% and 82% chance, respectively, of spontaneous delivery in their next pregnancy.

Determinants of chronic infection with Staphylococcus aureus in patients with bronchiectasis.

Staphylococcus aureus is an uncommon pathogen in bronchiectasis not caused by cystic fibrosis (CF). The object of this study was to identify characteristics that cause patients to be prone to infection with S. aureus.

Death due to thyroid metastases from renal cell carcinoma.

Renal cell carcinoma is a tumour that is well recognized to metastasize widely and to behave in an unpredictable manner. We report a patient with a renal cell carcinoma that metastasized to the thyroid and resulted in death from associated respiratory compromise. The clinical features of cancers metastasizing to the thyroid are discussed and the apparent over-representation of renal cell carcinoma in symptomatic thyroid metastases is highlighted.