Researchers at The University of Texas MD Anderson Cancer Center developed a novel chimeric mouse model to test the combination therapy using immune checkpoint blockades with therapies targeting myeloid-derived suppressor cells (MDSCs). MDSCs are immune cells originating from bone marrow stem cells that possess strong immunosuppressive abilities and are known to play a role in tumor formation and metastasis. The team’s findings were published in the March 9 online issue of Nature.
“A significant number of advanced prostate cancer patients treated with a chemical castration therapy called androgen deprivation therapy (ADT) experience relapse with relentless progression to lethal metastatic, castration-resistant prostate cancer,” said Ronald DePinho, M.D., professor of Cancer Biology. “While immune checkpoint blockade therapy is effective in many cancers, it has been less successful for this particular form of prostate cancer, which has motivated a search for targeted therapies that overcome this resistance.”
The investigation first tested anti-CTLA4 and anti-PD1 checkpoint blockades in combination, but found only “modest efficacy,” said the paper’s first author Xin Lu, Ph.D., formerly a DePinho trainee, now an independent investigator at the University of Notre Dame. Targeted therapy using MDSC-inhibiting drugs, such as cabozantinib (Cabo) and BEZ, also demonstrated minimal anti-tumor capabilities. However, the combination of both therapeutic approaches proved successful.
“Strikingly, both primary and metastatic castration-resistant prostate cancer responded to a combined checkpoint blockade and MDSC targeted therapeutic approach,” said DePinho. “These observations in mouse models of prostate cancer, using a sophisticated genetic approach developed by James Horner at MD Anderson, illuminate a clinical path hypothesis for combining immune checkpoint blockades with MDSC-targeted therapies in the treatment of this aggressive cancer.”
DePinho added that clinical trials will be needed to substantiate the team’s findings and to further explore the combination therapy with selective anti-androgen drugs for both established castration-resistant prostate cancer and newly diagnosed cases to achieve “durable clinical response.”
“These findings raise the possibility that by determining the gene expression profile of a patient’s tumor, physicians may be able to identify aggressive disease at the outset of diagnosis and start treatment earlier,” said Sungyong You, PhD, an instructor in the Cedars-Sinai Department of Surgery and the first author of the study.
Although other studies have used genetic data to identify subtypes of prostate cancer, this is the first large-scale study to link clinical outcomes to subtypes based on the processes by which genes are turned on and off in the cancer cells. The study was published in the journal Cancer Research by the American Association for Cancer Research.
Prostate cancer affects about 1 in 7 men during their lifetimes and is the second-leading cause of cancer deaths among U.S. men, according to the American Cancer Society. Most tumors grow slowly and are not life threatening, but certain types of prostate cancer can spread to other organs and be fatal.
The new findings divide prostate tumors into three subtypes based on each tumor’s gene activation pathways. When the researchers matched this data with clinical outcomes for more than 4,600 patient specimens in medical databases, they found these subtypes were associated with different levels of disease progression.
The study’s conclusions address a major challenge in current standards of care for prostate cancer: Without knowing a tumor’s underlying biology, physicians cannot reliably predict which of their patients will develop dangerous forms of the disease.
It was the start of a three day walk into Romania’s Retezat Mountains. Nik, my son-in-law, and I were going with Iulian Panescu, a mountain guide and photographer. Instinctively I’m not keen on being guided in the mountains, preferring to do my own thing. However, I began to consider the advantages of being with somebody with local know-how after learning of the aggressive Romanian sheep dogs. Iulian knows what to say and do with such creatures like a Transylvanian Crocodile Dundee. Also, local maps are not always reliable.
The Retezat Mountains are one of the highest massifs in Romania, being part of the Southern Carpathians. The highest peak is Peleaga, at an altitude of 2509 metres.
For some time we had been wanting to visit these mountains whose 80 lakes seem to mirror the sky. The Retezat region was Romania’s first national park and has over twenty peaks higher than 2000 metres (over 6,500 feet). It is strictly protected both nationally and internationally.
We strode upwards on a path into an autumnal mountain forest. Leaves, like free-fall butterflies, fluttered downward as we zig-zagged between tangled roots, colourful fungi and scattered rocks. We settled into our stride.
After six kilometres of walking, we spotted Gentiana Cabin, our temporary abode. I regard all mountain huts as places of undeniable charm, simply because of their very location. This cabin was more than able to wear that mantle with its attractive wooden construction and cosy situation amid the trees. Inside, a huge shiny Transylvanian terracotta stove provided the majestic centre piece for the interior along with solid wooden bunks, chairs, tables and solar powered light. Petre, the hut guardian, brought us all large mugs of mountain tea and so we ate a little, enjoyed some chatter, laughter and then crawled into our sleeping bags but not before a meditative moment staring at myriad of stars that shone from every corner of the crystal clear sky.
The following morning Iulian led the way up the Valea Pietrele through thinning trees, onto a stony path and into a zone of one metre high dwarf pines. We came across the paw-print of a bear; its claw marks were easily discernible where it had tried to steady itself over the mud. There are estimated to be around 6,000 bears in the Romanian forests, one of the largest populations in Europe that roam around the park fauna along with chamois, wolves, lynx, otters and marmots.
Read also: Climbing Gunung Merapi, Southeast Asia’s most active volcano
Eventually we arrived at Pietrele Lake, the first of many ‘blue eyes’, born like all the other Retezat lakes, at a time when glaciers were receding. Higher, we entered a vast world of pure rock. Facing us was a ridge of pinnacles and sculptured rock faces.
“Valeu Pietrele translates as the Valley of the Stones”, explained Iulian.
Now, as a professional guitarist, such imagery provided Nik with much to muse upon as he began seeing the features of his ‘Stones’ heroes, Jagger, Richards and Watts, within each weathered slab of rock. As the path zig-zagged to the saddle of Curmãtura Buccurei we could now see over into the next valley and a further four tarns. Even on an overcast day such as ours, these glacial lakes possessed a turquoise and mystical gaze. Iulian pointed to a scrambly route ascending Bucura Peak at 2433 metres (7982 feet). From a summit of stacked rocks the panorama revealed numerous peaks with draping ridge lines and yet more glacial lakes.
We began clambering downward and then along a ridge towards our next peak. Peering into the valley below us, we counted over a dozen chamois grazing on patches of grass, no doubt stocking up before the inevitable onset of winter.
We reached the final scramble which would take us to the very top of Peleaga Peak, the highest of the Retezat mountains at 2509 metres (8231 feet). Snow and ice had gathered beneath a Romanian flag fluttering in the wind. Standing at the top we enjoyed a spectacular view of the entire Retezat mountain area with its peaks, ridges, valleys and shimmering lakes. A truly breathtaking scene. Luckily the weather remained clear but the cloud-base was gradually sinking.
Our day continued down the other side of Peleaga Peak. We paused briefly out of the wind to allow Iulian to photograph a nearby chamois scrambling amongst the rocks. The sure-footed deer with its brown coat, cream facial dapples and short curved horns searched for morsels of autumnal vegetation. In the far distance we noticed another mountain called Retezat Peak standing with a rather obvious truncated summit. Legend says that as two giants fought with their swords, the very top of the mountain was sliced off.
Our rocky meander descended down to the large Bucura Lake. Next to it was a small refuge, where we took a break. The cloud had followed close behind us as we had descended. We sat enjoying our food under the lean-to of this small hut just as drizzle began to gently fall. Continuing, we walked around Bucura Lake and on up to the saddle of Curmãtura Bucurei once again. We then retraced our steps back to Gentiana Cabin where a considerable amount of food, mugs of tea and some beers were enjoyed.
After another night in our mountain hut, we said our farewells to Petre and walked back down through the trees. We stopped periodically to enjoy and photograph a number of incredible forest waterfalls on our way back to where our trip had begun. It was agreed, the Retezat Mountains were indeed spectacular – the descriptions had not deceived! For those who love mountain environments with an abundance of nature, this corner of Romania just has to be visited.
Roger visited Romania’s Retezat Mountains with Iulian Panescu from Mountain Guide Sibiu (firstname.lastname@example.org)
I have always wanted to discover Ancient Egypt, to see the sheer scale of the great sites, such as Karnak – some 60 acres in size – for myself. There’s 5,000 years of history to discover, building techniques, mummification processes, the meanings of hieroglyphs and the extraordinary complexities of the Ancient Egyptians’ religion with all its divinities, sacred animals, obsession with and preparation for life after death. It’s spellbinding.
However, holiday-makers have been steering clear of Egypt recently and the shooting down of the Russian plane last November though hundreds of miles away in Sinai has meant numbers plummeted even further, down by as much as 90 per cent. What’s more, out of the 350 cruise ships on the Nile only 70 are currently sailing.
Nevertheless, I boarded one of them – the five star vessel the Oberoi Philae. On the flight to Luxor and transfer to the ship everyone was desperately keen to stress their security measures: the bank of cameras in a control room in Luxor which scan almost every inch of the place (one foiled an attempt to put a bomb in car park last year); the guards on every Egyptair flight, the sniffer dogs, the scanners, the barriers at hotel grounds and attractions.
No guarantees can be given of course and the bizarre hijacking a month ago did not help the situation but it is worth remembering that the Foreign and Commonwealth Office does not advise against travel to Egypt’s main tourist areas. We all felt safe but we also felt sorry for all those welcoming strangers who begged us to tell people to please come to Egypt.
I was glad I did. Tarek our guide talks about the origin of the phrases light-hearted or blue-blooded or where the idea of haloes came from or who decided on circle with a cross on the bottom as the symbol for a woman? The answers, he tells us, may come from ancient Egypt.
After death, a person’s soul was weighed against a feather, bad deeds would weigh it down, good ones buoy it up. Divinities were painted blue hence an association over the years with high rank. They were also depicted with the sphere of the sun god Ra on their heads which Christians, hiding from Roman persecutions in the old temples, might have adapted for their new religion. And some academics think our sign for the female came from the ankh, the symbol of life and birth.
Perhaps one of the most astonishing aspects of ancient Egypt is how contemporary they were. They practised advanced dentistry, obstetrics and orthopaedics, who had female rulers as well as males and drew pictures with such simple lines that they were Picasso-esque. They also built extraordinary constructions to which today’s engineers still pay their respects.
Karnak has massive stone temples, giant statues, huge obelisks. The hand of one fallen statue currently being reassembled is the size of a man. To walk among them is to feel you have shrunk Alice-in-Wonderland style. And across the Nile on the West bank in the valleys of the dead are more than 700 tombs of pharaohs and their queens, of nobles and artisans. But even this number, say the experts, may be only a third of the still hidden total.
The temples at Luxor and Karnak are joined by a three kilometre avenue of rams’ headed sphinxes. They were impressive, but how much more so would they have been 3,500 years ago when the obelisks were topped with gold and every inch of stone covered with pictures and hieroglyphs in dazzling colours? Ongoing restoration work forbids retouching but even without that it is possible to see from the colours that have been revealed so far just how vibrant they must have been in their glory years.
The country’s dry heat has helped preserve the sites as has the fact that many of them were abandoned for centuries, submerged beneath the silt of the flooding Nile or the sands of the desert and largely ignored.
Three royal tombs are open at any one time plus the most famous of them all – that of the boy king Tutankhamun, discovered in 1922 by the British archaeologist Howard Carter. The house where he lived during his long years of study and searching supported by his patron Lord Carnarvon (whose seat, incidentally, Highclere Castle is the setting for Downton Abbey) is now open to the public and houses the young pharoah’s actual mummy: small – just over five feet – and slight, blackened and shrivelled by mummification, a poignant contrast to the glorious gold death mask, golden sarcophagus and 4,000 pieces of treasure entombed with him.
Carter though must have had a sentimental streak. He found the circle of withered flowers left by the young widowed queen as beautiful as the ‘wondrous things’ and ‘regal splendours’. There was for me something similarly touching in the scenes of domesticity on the walls of the artisans’ tombs. For these husbands and wives, buried together in contrast to the lonely splendour of their rulers, the afterlife was an idealised version of this life with all its comforts and joys and none of its sorrows.
The cruise ended at Aswan where we took a boat across to the temple of Philae. This originally stood on a site which would have been submerged when the great dam was built so it was completely dismantled, each one of its 41,000 stones marked with a letter and a number and the entire edifice relocated to its current location. Only one stone, our guide Tarek shows us, was wrongly placed upside down.
We say goodbye to him before flying to Cairo for a whistle-stop tour of the Pyramids and the Sphinx and the Museum of Egyptian Antiquities. This houses 120,000 items so we concentrate on a few highlights particularly the Tutankhamun treasures.
Cyplon Holidays offer a night in Luxor at the Maritim Jolie Ville hotel, four nights on the Oberoi Philae with full board and an English speaking Egyptologist on all excursions and two nights at the Conrad Hotel in Cairo, all five star, from £2489 per person. Price includes return flights from Heathrow with Egyptair and private transfers.
“The results of treatment are not as predictable as the patient, family, trainer, coach and doctor would like to think,” according to an article in the journal Physical Medicine and Rehabilitation Clinics of North America.
Nickolas Garbis, MD, an orthopedic surgeon who specializes in shoulder and elbow injuries at Loyola University Medical Center, is the primary author.
Shoulder pain occurs in athletes who play sports that require rapid acceleration and deceleration of the throwing arm. They include baseball pitchers, tennis players, softball pitchers and javelin throwers, as well as athletes who play handball and water polo.
Overhead throwing generates a large amount of stress on the shoulder, which is one of the most mobile joints in the body. This makes it vulnerable to injury.
It is difficult to diagnose the cause of shoulder pain. The shoulder is comprised of four joints, and a problem with any of them can cause pain and affect performance. Moreover, many of these structures are deep in the shoulder and therefore difficult to examine by touch. Also, the same kind of pain can be due to multiple causes. For example, pain in the front of the shoulder can be due to rotator cuff tendinitis, rotator cuff tears, biceps tendinitis, shoulder instability, shoulder stiffness and several other causes.
“A systemic approach, and some experience, can help the clinician become more familiar with which constellation of findings in these athletes is not normal,” Dr. Garbis and co-author Edward McFarland, MD, write.
Shoulder problems can begin during adolescence. Little League shoulder, an injury to the growth plate in the shoulder, is one of the most common. Adolescent pitchers most at risk for injuries are those who compete on traveling teams. Overuse injuries can lead to more serious mechanical injuries. Adhering to pitch counts should reduce injuries and decrease fatigue.
Treatment should be primarily nonsurgical. Nonsurgical options include icing the shoulder and judicial use of nonsteroidal anti-inflammatory medications such as ibuprofen and naproxen. Rehabilitation can restore a normal muscular balance. Rest can help, but it should not be prolonged, because the shoulder could become deconditioned.
If nonsurgical options fail, arthroscopic surgery can be considered. For example, surgical repair or trimming of partial rotator cuff tears can be highly successful, returning as many as 89 percent of college and professional pitchers back to play. However, the type of surgery needed depends upon the patient’s shoulder problem.
Autumn in America, otherwise known as fall lasts until 20 December and transforms landscapes across the country into a spectacular array of vivid colours and New York State is no different. From the Great Appalachian Valley which dominates eastern New York to the peaks of the Adirondacks in the north, New York State has some of the best places to experience fall in America.
The tree littered Adirondack Mountains in upstate New York transform into a vibrant display of autumnal colours and there are a couple of brilliant ways to witness it. One option is climbing Whiteface Mountain, which has a 4,872-foot summit that can also be reached by car or gondola and has incredible views for miles around. Alternatively, visitors can ride the Adirondack Scenic Railroad which winds its way through remote forests, sparkling rivers and into the magnificent beauty of Adirondack Park.
Stay at The Point, a five star private estate consisting of log cabins and guestrooms set next to a mountain lake. Rooms start from £1,310 a night for two people sharing.
2The Catskills Mountains
Heading up mountain in Catskill Park on Rt 23
Located only 100 miles from New York City and part of the Great Appalachian Valley, the Catskills Mountains have been a favoured destination of urban holidaymakers since the mid-20th century. Located within the mountains is the Catskills Forest Preserve, which is protected from many forms of development under New York State law and as such has retained its natural beauty and ‘wild forests’ making it one of the best places to enjoy fall. Hike along one of the many trails that include a number of lookout points over the Hudson Valley and as an added bonus the park has bountiful wildlife to glimpse including bobcats, black bears, minks and coyotes.
Stay at The Arnold House. This country retreat is set on seven acres in the forests of the western Catskills. Rooms start from £151 a night for two people sharing.
3Central Park, Manhattan
Fall in Central Park, New York City (c) Kelly Kopp
It’s not only rural areas that experience the best of fall, as Central Park in Manhattan blooms with striking autumnal hues creating a scenic collision between man-made structures and nature. Stroll through the park enjoying the colours from within or witness the scene on a grander scale by climbing the Empire State Building for a top-down look on the park. Another option is the 360-degree view from Top of the Rock Observation on the 70th floor of the Rockefeller Centre right in the heart of the city.
Stay at La Quinta Inn & Suites, a four minute walk from the Empire State Building and a 10 minute drive from Central Park. Rooms start from £103 a night for two people sharing.
Greater Niagara – Niagara Falls State park
Niagara Falls is the one of the top attractions in the world and undoubtedly worth a visit, but there is also some fantastic fall foliage in the wider region such as Devil’s Hole State Park and Whirlpool State Park that shouldn’t be ignored on a visit to Greater Niagara. Both parks offer several miles of panoramic views of the scenic Lower Niagara River gorge, while nearby Genesee Gorge at Letchworth State Park has been nicknamed “the Grand Canyon of the East.”
Stay at The Giacomo, a luxury boutique hotel in the Niagara Falls area. Rooms start from £108 a night for two people sharing.
Barnstormer Winery – Finger Lakes
The Finger Lakes is a group of 11 long, narrow lakes in upstate New York near the huge Lake Ontario and part of the Appalachian swathe. Many of the lakes are surrounded by dense foliage that morphs into a fascinating mirage of reds, yellows, oranges and browns in fall that reflect off the lake’s surface. The Finger Lakes region has been active in reform and utopian movements over the years and it was at Seneca Falls village that the first women’s rights convention was held marking the birth of the women’s suffrage movement.
Additionally, the Finger Lakes region is New York’s largest wine producing region with over 100 wineries and vineyards meaning travellers can enjoy a fine tipple along with the views.
Stay at Hampton Inn Brockport, minutes from Lake Ontario and the Finger Lakes. Rooms start from £110 a night for two people sharing.
Norway’s Oslo is one of Europe’s most beautiful capital cities: its natural surroundings of rolling hills and mountains, verdant islands and the sea, give this 1000 year-old city an abundance of natural beauty. Lining two scenic bays, it has 40 islands within the city limits (and scores more around the fjord), the city happily straddles both land and water.
Life here is idyllic. No one is in a rush, and the stresses are kept to a minimum. Yet this sleepy city has spent the past few years positioning itself as one of the foremost centres for contemporary art in Europe.
Tjuvholmen – an art district
The waterside district of Tjuvholmen (pronounced Shoohomen) has been regenerated, at great expense but with equally great success, and is now home to some stunning contemporary galleries, and an extraordinary art hotel. Street art and sculptures are popping up all over the place, and vast murals have been commissioned.
Astrup Fearnley Museum of Modern Art
A must-see is the Astrup Fearnley Museum of Modern Art, which began life in the 1960s as a private collection, and opened to the public as a museum in 1993. The museum’s two dramatic glass and timber structures were designed by the architect Renzo Piano, and have set the architectural style for the other new buildings in the area.
The collection includes thousands of contemporary artworks by Norwegian and international artists from the 1960s to the present. American contemporary artists are particularly well represented, though in recent years the curators have also sought out iconic photographs, sculptures, paintings, and multi-media works by emerging and established Brazilian, Japanese, Chinese, and Indian contemporary artists.
The big name artists include Francis Bacon, Andy Warhol, Damien Hirst, and Jeff Koons.
Here too you can see the work of American Tom Sachs, for whom branding is itself an art form. He takes the mass-produced images we are all familiar with — the McDonald’s golden arches, the seal of the President of the United States, household white goods — and recreates them by hand, using cheap materials such as cardboard, construction materials, wood, and adhesives. Sachs is interested in showing the way things work, the nuts and bolts inside, and so his life-sized sculptures are not only spectacularly detailed, but also often allow us to look inside, as though they were 3D exploded diagrams.
Perhaps the two longest-established artists whose work is displayed at the Astrup Fearnley are the duo Gilbert & George, Italian Gilbert Proesch and British George Passmore. Having met at art school in London in the 1960s, they led a rebellion against what they believed to be the elitism of traditional sculpture. To bring this medium back within the reach of ordinary people, they pioneered “living sculptures”, performing for up to eight hours at a time on the streets of London, as well as in galleries. For Gilbert & George, life and art are inseparable, and they explore a number of complicated issues in their work, including religion, sexuality, identity, urban life, terrorism, superstition, AIDS, old age and death.
Tjuvholmen Sculpture Park
Surrounding the museum on the waterfront is the Tjuvholmen Sculpture Park, created as the result of a collaboration with Poul Erik Tøjner, director of the Louisiana Museum of Modern Art, near to Copenhagen.
The park was designed at the same time as the Museum, also by Renzo Piano, and it contains seven significant sculptures, one each by Louise Bourgeois, Antony Gormley, Anish Kapoor, Ellsworth Kelly, Ugo Rondinone, Franz West, and the duo Peter Fischli & David Weiss. If you have just half an hour to spare in Oslo, you should come here, to walk amongst the sculptures, and then to sit on a bench, peacefully, staring out across the fjord.
Stay in an art hotel
Opposite the Astrup Fearnley Museum, and with a contemporary art collection to rival any museum, let alone hotel, in the world, is The Thief. As you approach the hotel’s main entrance, eagle-eyed guests will spot straight away the prostrate statue to the left of the door is a sculpture by Antony Gormley, and a very fine example of his work.
Inside, every wall, every space, is packed original artworks by Damien Hirst, Andy Warhol and Jeff Koons, video art installations by Charlotte Thiis-Evensen, and album covers by Roxy Music’s Bryan Ferry, just to mention a few.
Not surprisingly, the hotel’s art insurance cover is the highest for any hotel property in the world. You will want to allow plenty of time to explore the corridors and other public spaces, wondering which masterpiece will be around the next corner. Even the artworks displayed in your own room will seem as if you have put down your bed in the midst of a leading contemporary art museum, and to all intents and purposes, you have.
Some of the most famous, and impressive pieces are on show in Fru K, The Thief’s restaurant, where gastrophiles and art lovers alike compete for tables. Challenge yourself to identify the artists who have created the artworks around you. Many of them are instantly recognisable. The chances are that your fellow diners will be as famous as the artworks — The Thief is, after all, the preferred hotel of rock stars, super models, and film stars visiting Oslo — so you will want to sit back, a glass of Champagne or a signature cocktail in hand, and enjoy some quality people watching.
Munch Museum – The Scream
The Scream is undoubtedly the most famous artwork produced by a Norwegian artist, so you had better take time to visit the Munch Museum, dedicated to the life and work of Edvard Munch. Opened in 1963 to celebrate what would have been Munch’s 100th birthday, you can see both The Scream and Madonna, a naked and somewhat controversial depiction of the Virgin Mary. Both of these paintings were stolen to order from the Munch Museum in 2004, but they were recovered by the police after a international two-year hunt, and put back on public display.
Two more sculpture parks
If you prefer your art out in the open air, Oslo boasts two important sculpture parks, in addition to the one in Tjuvholmen.
The Vigeland Park has been created by a single artist, Gustav Vigeland, and contains some 200 works in bronze, granite and wrought iron. Vigeland was also responsible for the park’s design, which was laid out in the mid-20th century and is a popular spot for Oslo’s residents to walk, picnic, and spend time with their families.
Newer than the Vigeland Park, and exhibiting the works of multiple sculptors, is the Ekebergparken Sculpture Park opened in a woodland in southeastern Oslo in 2013. Here you can see sculptures by Rodin, Renoir and Dali, but also 21st century works in stainless steel, bronze, and marble by the likes of Dan Graham, Diane Maclean, and Lynn Chadwick. Entrance to the park is free, but there is a small charge if you want to take the guided tour, or enter the Skyspace light installation.
You should also read: From Oslo to Bergen, and the spectacular scenery in between
Bhutan is a small kingdom wedged between two mighty countries, India and China, in the shadows of the Himalayas. It is a country steeped in Mahayana Buddhism, myths and legends under the sovereign rule of the Wangchuck Dynasty. The magnificent landscape is picture perfect with majestic mountains sweeping down to lush valleys carved by cascading rivers.
Locals still wear their national costumes as their daily attire with pride and success is measured via the Gross National Happiness index because here the welfare of the people is paramount.
Bhutan has never been big on tourism and slow to progress. The internet only arrived here in 1999 and it’s infrastructure is still a work in progress.
Thimphu – the capital of Bhutan
Thimphu the capital city has no skyscrapers or traffic to blot its cityscape. The mini roundabout is a pavilion with statues of goddesses while policemen physically conduct the traffic instead of traffic lights.
There are hints of modernity creeping in slowly with new buildings but this is tightly controlled by the government who insist that they be inkeeping with Bhutanese tradition.
On a hill overlooking the city, the colossal Dordenma Buddha statue of 51.5m high cast in bronze and gilded in gold is like a spiritual beacon to the people. Dzongs (a type of fortress), which are found everywhere in the country, were built in ancient time as fortresses and monasteries. Today they are used as monasteries as well as government administration offices.
Punakha District – the heart of Bhutan
Travelling into Punakha, the old capital, the heart of Bhutan, is on bone-shaking unfinished road hewn out of the mountainside. The scenery is the jaw-dropping natural beauty of the country which unfolds at every turn of the road. Prayer flags are installed everywhere to send prayers to the universe.
Punakha Dzong, also known as Palace of Great Happiness, was built in 1637 by Zhabdrung Ngawang Namgyal. He was a Tibetan Lama, who unified Bhutan as a nation-state and instilled a unique cultural identity. The mighty fortress has glorious allegorical frescos, intricate artwork and carvings and houses the most sacred relic known as Ranjung Karsapani and the resting place of Zhabdrung’s embalmed body.
The most esoteric temple in the Punakha District is the fertility temple of Chimi Lhakhang where the phallus symbol is worshipped notably by women to beget children. We walked through the village amidst rice fields where every house has a phallus image painted on the walls for good luck. The gift shops sell penis talisman for fertility much to the amusement of tourists.
Valley of Phobijkha – flight of the cranes
The valley of Phobjikha is a breath-taking vista where the wide sweeping valleys are flanked by lofty mountains. It is a vast wetland that welcomes the annual winter migration of the rare and endangered Black-Necked Crane where hundreds flock in from the Tibetan Plateau in late October till mid February for their winter roost.
This natural wonder is celebrated with the Black-Necked Crane Festival in November every year with crane-themed dances, folk songs and drama performances in the Gangtey Monastery. The ancient monastery sits atop a spur overlooking the stunning valley and houses a Buddhist school and prominent religious iconographies. It is said that the cranes circumambulate three times in their flight over the monastery on every arrival before landing on the wetland nearby and do the same on their return flight as if to pay respect to Gangtey Monastery.
Bound for Bumthang
The district of Bumthang in Central Bhutan is the nation’s religious heartland and home to some of the oldest temples and Dzongs in the country. Jakar, a small settlement that sprawls over an expansive valley is home to Jambay Lhakhang, one of the oldest temples in the country built in the 7th century dedicated to the Maitreya Buddha.
Trek to Tiger’s Nest
The ascent to Taktsang Lhakhang, the Tiger’s Nest, revered as the country’s most sacred site and iconic landmark is the climax of most visitors to Bhutan. Legend has it that their most revered saint Guru Rinpoche, flew to the mountains on the back of a celestial tigress in the 7th century at a time when the area was abound with demons to harm people.
He meditated in the cave for three years, three months and three days to subdue the evil spirits living in the caves. The temple was first built in 1692 to consecrate the sacred site and ever since it has been a place of pilgrimage for Buddhist saints, monks, devotees and a major tourist attraction.
The mountain is over 3,120 metres high and the temple is 900 metres from the car park. The path varies in steepness along the way, hugging the mountain ledge overlooking a picturesque valley of blue pine and rhododendrons. After the cafeteria half way up, a stretch of steep climb reaches the view point where a long flight of steps leads down to an iron bridge by a waterfall and then another tortuous flight of steps take you up to the temple complex. The path is festooned with colourful prayer flags fluttering in the wind. As in all Dzongs and temples, shoes have to be removed before entering and photography is strictly forbidden. Cameras and phones have to be surrendered at the security checkpoint at the entrance of the temples.
Bhutan is, after-all, about spiritual journeys and trekking in the wild terrain with the mystic of Shangri-La.
Bhutan can only be visited with prior arrangement with a tour operator for a minimum package from US$200 per day that includes hotel, guide, land transport and meals. Check out information and formalities of visiting Bhutan with Tourism Council of Bhutan
The statement came out of the April 2014 Oral Health and Performance in Sport collaboration led by Professor Ian Needleman of the UCL Eastman Dental Institute and Dr Mike Loosemore of the Institute of Sport Exercise and Health (ISEH). This resulted in a conference held at UCL where experts in oral health and sports medicine met with sporting associations and elite athletes to produce a consensus on how to improve oral health in sport.
A UCL survey at the London 2012 Olympic Games found that 18% of athletes said that their oral health had a negative impact on their performance and 46.5% had not been to the dentist in the past year. The latest consensus statement aims to address such issues by embedding oral health into the wider culture of sports healthcare and health promotion.
“Oral health could be an easy win for athletes, as the oral conditions that can affect performance are all easily preventable,” says Professor Needleman. “Professional athletes and their teams spend a lot of time and money on ways to marginally improving performance, as this can make all the difference in elite sports. Simple strategies to prevent oral health problems can offer marginal performance gains that require little to no additional time or money. Things like better tooth brushing techniques and higher fluoride toothpastes could prevent the toothache and associated sleeping and training difficulties that can make the crucial difference between gold and silver.”
The intense dietary and training pressures on athletes could put them at high risk of oral health problems for many reasons. Saliva helps to protect teeth from decay and erosion, so dehydration and drying of the mouth could increase the risk of oral health problems. The amount of energy that athletes need for training often means they have high-carbohydrate diets and regularly use sugary, acidic energy drinks. These may contribute to decay and erosion in athletes’ teeth.
“We do not want to demonize energy drinks and are not saying that athletes shouldn’t be using them,” says Professor Needleman. “However, people should be aware of the risks to oral health and can take simple measures to mitigate these. For example, water or hypotonic drinks are likely to be more suitable for simple hydration, and spit don’t rinse after tooth brushing. For sports where athletes need a lot of energy drinks, high fluoride toothpastes and mouthrinses should be seriously considered.”
The authors also recommend regular dental appointments to identify and address oral health issues before they can affect performance. Olympic athletes are all supposed to have a dental check-up within 12 months of the competition but, as the previous survey found, almost half of the athletes London 2012 had not. The consensus statement calls for national sport funders and policy organisations to take the lead in ensuring that oral health is regularly assessed, especially pre-season, to allow for personalisation of prevention plans and early treatment of any disease.
Dr Mike Loosemoore says: “I think this is an important consensus statement. My experience of instituting a programme of improving oral health in elite sportsman has had a very positive effect.”
Konstantin Kovtun, MD, a resident at BWH, Anthony D’Amico, MD, PhD, chief of Genitourinary Radiation Oncology at BWH, and colleagues, analyzed the medical records of over 7000 men from the Chicago Prostate Cancer Center who had low or favorable-intermediate risk prostate cancer, 20 percent of whom were treated with ADT in order to reduce the size of their prostate gland to make them eligible for brachytherapy. They found that African-American men who were treated with ADT had a 77 percent higher risk of death when compared to non-African American men, the causes of which were not due to prostate cancer.
“When African-American men were exposed to an average of only four months of hormone therapy, primarily used to make the prostate small enough for brachytherapy, they suffered from higher mortality rates due to causes other than prostate cancer than non-African American men,” Kovtun explained. “This leads us to believe that there may be something intrinsic to the biology of African-American men that predisposes them to this increased risk of death and that this deserves further study.”
ADT is an antihormone treatment that lowers a man’s testosterone level, and been used to reduce the size of the prostate and in turn make the subsequent brachytherapy treatment possible. This team of BWH researchers is the first to observe the negative effects of ADT in the context of racial differences, specifically comparing African-American men to non-African American men after adjusting for age, comorbidities such as heart disease and established prostate cancer prognostic factors.
“These results show that careful consideration should be taken by physicians when recommending treatment for low or favorable-intermediate prostate cancer, a cancer that very few men die of even without treatment,” D’Amico said. “There is no evidence that ADT followed by brachytherapy increases the chance of cure in comparison to other treatments, such an external beam radiation therapy alone, in these men with favorable risk prostate cancer. The subsequent risks of ADT, specifically linked to African-American men, deserve further study.”
Future research is indicated to explore the basis for the observation of shortened survival in African-American men following ADT use with the hope of developing effect and personalized treatments for all men with prostate cancer.
Investigators report no funding sources for this research.