Prediabetes Linked to Higher Risk of Cancer, Study Finds


People with high blood sugar may be at increased risk for developing cancer, a new review study finds.
The researchers looked at 16 studies that included nearly 900,000 participants from several countries. They found that the risk of developing cancer is 15 percent higher in people with prediabetes, a condition characterized by having abnormally high blood sugar levels but not high enough to be classified as diabetes.
When the researchers adjusted the results for high body mass index (BMI), which is an indicator of obesity and a risk factor for both prediabetes and cancer, they found that prediabetes was linked with a 22 percent higher risk of cancer.

The researchers also found that prediabetes was linked with higher risks of cancer of the stomach or colon, liver, pancreas, breast and endometrium, but was not associated with cancer of the lung, prostate, ovary, kidney or bladder, according to the study, published today (Sept. 8) in the journal Diabetologia. [10 Do’s and Don’ts to Reduce Your Risk of Cancer]
In the United States, about 86 million people, or more than 1 in 3 people, have prediabetes, and another 29 million people have Type 2 diabetes, according to a 2012 report from the Centers for Disease Control and Prevention. If left untreated, about 15 percent to 30 percent of people with prediabetes may develop full-blown diabetes within five years, according to the CDC.
The percentage of people who have prediabetes has been on the rise, too. In the United States, 36 percent of adults were found to have prediabetes from 2007–2010, up from 29 percent from 1999–2002. “Many other countries, both developed and developing, are also seeing steep rises in the number of people with both full-blown Type 2 diabetes and prediabetes,” the researchers said.
Of the studies included in the review, four were from Asia, 11 were from the United States and Europe, and one was from Africa.
The researchers found risks were highest for liver, endometrial, stomach and colon cancer –people with prediabetes were about twice as likely to develop liver cancer, 60 percent more likely to develop endometrial cancer and 50 percent more likely to develop stomach or colon cancer, than people without the condition. The condition was also linked with about 20 percent higher risk for developing breast cancer, according to the study.
Several possible mechanisms could explain why high blood sugar is linked with cancer risk, the researchers said. For example, people with high blood sugar have increased resistance to the hormone insulin, which can result in higher secretion of insulin-like proteins that also promote growth of cancer cells. It is also possible that people with some genetic variations are more likely to develop both prediabetes and cancer, the researchers said.
For people with prediabetes, eating a healthy diet and exercising regularly can lower the risk of progressing to diabetes, according to the CDC. For people who have diabetes, recommended treatments include increasing activity and changing diet, and taking insulin and oral medications to lower blood sugar levels.

Hawking Says Higgs Boson Could Destroy The Universe, But Here’s Why You Shouldn’t Worry


Could the Higgs boson destroy the universe?

Stephen Hawking says it’s possible, the U.K. newspaper Daily Express reported. As the celebrated physicist writes in the preface to a new book, “Starmus, 50 Years of Man in Space:

The Higgs potential has the worrisome feature that it might become megastable at energies above 100bn giga-electron-volts (GeV). This could mean that the universe could undergo catastrophic vacuum decay, with a bubble of the true vacuum expanding at the speed of light. This could happen at any time and we wouldn’t see it coming.

STEPHEN HAWKING HIGGS BOSON

Did you catch that? Hawking warns that if scientists accelerate the Higgs to incredibly high energy levels, the particle could lead to the complete collapse of space and time as we know it.

That sounds pretty bad. But don’t worry. Hawking says a Higgs calamity is highly unlikely since a particle accelerator large enough to create such conditions doesn’t exist — in fact, the device would have to be larger than Earth itself.

Whew.

Evidence confirming the existence of the Higgs boson was found in 2012.

Near Death, and Overmedicated .


How sick and disabled, how far into advanced dementia, how close to death do elderly nursing home patients have to be before their physicians stop prescribing drugs that can cause uncomfortable side effects but show scant evidence of helping them?

Let me quickly acknowledge that this was my own reaction to a study published on Monday in JAMA Internal Medicine, part of its weekly “Less Is More” series. Researchers use far more measured terms; sometimes the things they report make you wonder how they manage that.

Consider this nationwide sample of 5,406 people with a diagnosis of advanced dementia who spent at least 90 days in a nursing home between 2009 and 2010. Most were over age 85 and had other diseases as well. The great majority, almost 70 percent, had a do-not-resuscitate order.

It’s always a heartbreaking situation. Dementia is a terminal disease, although family members don’t always recognize that and health care professionals don’t always explain it. By definition, these patients can no longer recognize family members; most are bedridden, with a vocabulary that has shrunk to five words or fewer.

“They can’t walk or feed themselves or communicate meaningfully,” said Dr. Jennifer Tjia, a geriatrician and palliative care specialist at the University of Massachusetts Medical School and the study’s lead author. “A lot also have severe swallowing difficulties.”

Moreover, Dr. Tjia added: “These folks have a very high mortality rate. Many die within six months.” A number of previous studies have shown that health care proxies, who make medical decisions for such patients, overwhelmingly say that their primary goal is comfort.

Yet pharmacy records revealed that most of these patients, almost 54 percent,received at least one of what the researchers delicately called “medications of questionable benefit.” More than a third were given a cholinesterase inhibitor (Aricept is the best known) and a quarter received memantine (Namenda), both commonly prescribed for dementia. More than 20 percent were on statins to lower cholesterol, and 7 percent were on blood thinners.

All these drugs were deemed “never appropriate” for palliative care patients with advanced dementia, in a list developed by a panel of geriatricians and published in the Journal of the American Geriatrics Society. And the United States Preventive Services Task Force recently concluded that in some patients with mild to moderate (not advanced) dementia, drug therapies brought “small improvements” in cognitive measures, but “the clinical significance of these improvements is uncertain.”

(Then why, I asked Dr. Tjia, describe them as of “questionable benefit?” Why not call them “medications of zero benefit”? She said that the drugs had their proponents and that discontinuing them remained controversial in some quarters, despite little evidence of effectiveness.)

If the only problem with such medications was uselessness (and cost, which averaged $816 per quarter), perhaps we would shrug. But as with any medical treatment, they can also do harm.

“I was a nursing home doc for years,” Dr. Tjia told me. “There’s an unappreciated personal cost to these patients in continuing these medications.”

Aricept and Namenda, for instance, can induce nausea and fainting and uncomfortable urinary retention. They can also cause heart arrhythmia, which in turn can lead to implanting a pacemaker. “A classic prescribing cascade,” Dr. Tjia said. “We’re treating the side effect of a drug with more drugs or, in this case, devices.”

People with severe dementia, one recent study found, are more likely than seniors with normal cognition to receive pacemakers. Statins have a documented risk of muscle pain, along with elevated blood glucose.

People who have lost the ability to speak can’t tell their doctors that they ache or constantly feel like vomiting. But the agitation or lashing out sometimes seen in patients with dementia — possibly triggering another round of drugs — sometimes reflects their physical discomfort. Discontinuing drugs sometimes helps them to remain alert and relaxed, although, again, there’s no strong published evidence either way.

Why are so many people in this unhappy situation, being given questionable drugs when even swallowing pills can be difficult?

As with many treatments, geography is destiny. In the Census Bureau’s Middle Atlantic Region — New York, New Jersey, Pennsylvania — about 45 percent of patients got at least one of these drugs. In the West South Central Region (Texas, Arkansas, Oklahoma, Louisiana), 65 percent did. Moreover, they were more frequently prescribed in nursing homes with higher use of feeding tubes.

“That indicates that there’s a level of discretion in what’s happening,” Dr. Tjia said. “It’s not just clinical need driving this.”

Nursing homes, hospitals, even cities and regions have their own cultures and practice patterns, and professionals often tend to follow their peers.

But emotions play a part as well, Dr. Tjia said. And who could disagree? The idea that a family is “doing everything” for a failing loved one, or a doctor for his or her patient, remains potent despite many warnings that not every drug or procedure is benign, despite full-fledged campaigns to persuade people to weigh the pluses and minuses.

“The idea that there could be benefits to stopping medication is still a pretty radical issue for most people,” Dr. Tjia said — and she meant both professionals and families. “For some folks, it’s a marker that the end is near, and that’s hard.”

In an editorial accompanying the study, Dr. Greg A. Sachs, an Indiana University geriatrician, said the findings “should cause all clinicians to reconsider their prescribing practices and other decision-making for a broad population of patients late in life.”

That would be nice. But meanwhile, family members can question the purpose and value of drugs their loved ones continue to receive as they decline. Especially when they’ve lost the ability to speak for themselves.

Children’s health encoded into them by their parent’s decisions long before conception.


Parents’ life experiences and dietary habits before conception are encoded into egg and sperm and projected into the very existence of their child, influencing the child’s habits, health and ability to adapt later in life. Parenting essentially begins before conception, according to new research coming from the University of Adelaide. The lifestyle choices of the generation before are imprinted into the up-and-coming generation. In a way, children are preprogrammed before conception by the environmental factors that affect their parents. In a way, it’s as if children are already being thought of and created before egg and sperm even meet.

“Many things we do in the lead up to conceiving is having an impact on the future development of the child – from the age of the parents, to poor diet, obesity, smoking and many other factors, all of which influence environmental signals transmitted into the embryo,” said Professor Sarah Robertson, Director of the University’s Robinson Research Institute.

child

When egg and sperm meet, there’s more than just DNA being passed on

The University of Adelaide researchers found that children’s destiny of health and well-being is programmed before they are even conceived in the womb. The researchers aren’t talking about genetic predisposition. It’s as if parental decisions before pregnancy project a certain kind of energy into the lives of their future children. It’s as if the child is more than just a part of their parents — they are a piece of their parent’s history spiraling out into the future.

“People used to think that it didn’t matter, because a child represented a new beginning, with a fresh start. The reality is, we can now say with great certainty that the child doesn’t quite start from scratch – they already carry over a legacy of factors from their parents’ experiences that can shape development in the fetus and after birth. Depending on the situation, we can give our children a burden before they’ve even started life,” Professor Robertson says

The findings were published in a recent issue of the top international journal Science, and featured as “Parenting from before conception,” which represents a new frontier for developmental and reproductive research.

What they found was that egg and sperm bring more than just genetic material together to create a child. The paper revealed that there are stored environmental factors in the parents’ egg and sperm that also contribute to the development of the child. They found that health problems such as diabetes, heart issues and immune disorders in children can originate from the lifestyle of the parents in the months before conception. And it isn’t just the mother’s behaviors that play a role. The man’s dietary habits, whether poor or positive, are also recorded in his sperm and are projected into the child along with his genetic material.

This is how the human species survives through evolutionary changes between generations

What the study comes down to is the need of each generation to adapt to their changing environment. Epigenetic factors are passed to a baby so the new generation can survive through the evolutionary changes taking place in their environment. Three months before conception, the sperm and eggs are collecting information from the parents’ experiences and environment, encoding it.

If famine is part of the parents’ history, that experience is encoded into the parents’ sperm and eggs. The life conceived from this condition grows up and is able to cope with less food later in life. Their metabolic system is hardwired from the start by their parent’s experiences and decisions. If the child ate normal amounts of food, their body might respond by developing metabolic diseases like diabetes, because the child was programmed from the start to eat less. On the other hand, if the two parents were overeaters before they conceived, then their child’s body will likely expect lots of food later in life or health problems could result.

Professor Robinson brings hope to expecting parents, encouraging healthy lifestyles leading up to conception: “A few lifestyle changes by potential parents and improvements in the right direction, especially in the months leading up to conception, could have a lasting, positive benefit for the future of their child.”

Sources for this article include:

http://www.adelaide.edu.au

http://www.dailymail.co.uk

http://science.naturalnews.com

Learn more: http://www.naturalnews.com/046762_epigenetics_environmental_factors_conception.html?utm_content=bufferbabc3&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer#ixzz3CvbEm0yS

Handsome Men Have Poorer Sperm Quality, New Study Shows


Sure, he looks good. But how about his sperm?

That might not be such a ridiculous-sounding question, now that a new study has identified a link between men’s facial attractiveness and the quality of their semen–with handsome, masculine-looking guys having slightly lower-quality semen than other men.

“To [the] best of our knowledge, this is the first demonstration of the phenomenon,” study co-author Dr. Jukka Kekalainen, adjunct lecturer in the Centre for Evolutionary Biology at the University of Australia in Crawley, told The Huffington Post in an email.

SEMEN ANALYSIS

The researchers have no readyexplanation for their finding, although previous research has shown that high testosterone levels can harm sperm production, the New York Daily News reported. And the finding seems to be at odds with the so-called phenotype-linked fertility hypothesis, which holds that females prefer handsome males because their offspring may enjoy hereditary benefits, such as better health and higher intelligence.

For the new study, which was published in the September 2014 issue of the Journal of Evolutionary Biology, a team of researchers from Spain, Australia, and Colombia performed semen analyses on 50 Caucasian students recruited from the University of Valencia. Next, photos of the men’s faces were shown to heterosexual men and women in their twenties, including Caucasians and blacks.

The women evaluators were asked to rate the men as if they were looking for a long-term mate. The men evaluators were asked to rate the men as they thought women would rate them.

The researchers also performed an “anthropometric analysis” of the facial characteristics of all 50 men, measuring the size of their eyes, the width of their cheekbones and nostrils, and other markers that previous research identified as masculine features. And finally the researchers compared the men’s facial features with the motility (movement), morphology (structure), and concentration of the men’s sperm cells.

In addition to looking for the link between masculine-looking faces and sperm quality, the researchers wanted to know if men’s sperm quality was related to their handsomeness.

“And we found that in fact it is,” Kekalainen said in the email.

But does that mean women eager to find a mate capable of fathering children should be wary of handsome men? Maybe not–at least not until more research corroborates the finding. As Kekalainen said in the email, “we would need more studies to demonstrate the causation and mechanism behind this finding…before giving any mating tips to the females.”

Long-term use of pills for anxiety and sleep problems may be linked to Alzheimer’s


Taking benzodiazepines—widely prescribed drugs to treat anxiety and insomnia—is associated with an increased risk of developing Alzheimer’s disease, particularly for long-term users, suggests a study published in BMJ today.

The warn that unwarranted long-term use should be considered a public health concern.

Dementia currently affects about 36 million people worldwide and this number is expected to double every 20 years, reaching 115 million by 2015. Although a of has been identified in benzodiazepine users, the nature of this association, whether causal or not, remains unclear.

So a team of researchers based in France and Canada set out to investigate the relationship between the risk of Alzheimer’s disease and benzodiazepine exposure over a several years, as well as a potential dose-response relationship.

Using data from the Quebec health insurance program database (RAMQ), they tracked the development of Alzheimer’s disease in a sample of elderly residents living in Quebec, Canada who had been prescribed benzodiazepines.

Over a period of at least six years, they identified 1,796 cases of Alzheimer’s disease. They then compared each case with 7,184 matched for age, sex, and duration of follow-up.

Results show that past use of benzodiazepines for three months or more was associated with an increased risk (up to 51%) of Alzheimer’s disease. The strength of association increased with longer exposure and with use of long-acting benzodiazepines rather than short-acting ones.

Further adjustment for symptoms that might indicate the start of dementia, such as anxiety, depression or sleep disorders, did not meaningfully alter the results.

In this large case-control study, benzodiazepine use was associated with an increased risk of Alzheimer’s disease, say the authors. They emphasise that the nature of the link is still not definitive, but say the stronger association seen with long-term exposures “reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia.”

Benzodiazepines are “indisputably valuable tools for managing anxiety disorders and transient insomnia” they write, but warn that treatments “should be of short duration and not exceed three months.”

They conclude that their findings are of “major importance for public health, especially considering the prevalence and chronicity of use in elderly populations and the high and increasing incidence of dementia in developed countries.”

In view of the evidence, they conclude that “it is now crucial to encourage physicians to carefully balance the benefits and risks when initiating or renewing a treatment with benzodiazepines and related products in elderly patients.”

In an accompanying editorial, Professor Kristine Yaffe of the University of California at San Francisco and Professor Malaz Boustani of the Indiana University Center for Aging Research, point out that in 2012 the American Geriatrics Society updated its list of inappropriate drugs for older adults to include benzodiazepines, precisely because of their unwanted cognitive side effects.

Yet almost 50% of older adults continue to use these drugs, they say. And without any formal monitoring system, the potential long term consequences on brain health are likely to be missed, adding to the growing prevalence of cognitive impairment among older people, they suggest.

Activated Gene Slows the Aging Process


Scientists at UCLA say they have identified a gene that can slow the aging process throughout the entire body when activated remotely in key organ systems.

Activated Gene Slows the Aging Process

Working with fruit flies, the researchers activated the AMPK gene that is a key energy sensor in cells. It gets activated when cellular energy levels are low.

Increasing the amount of AMPK in fruit flies’ intestines increased their lifespans by about 30% (to roughly eight weeks from the typical six) and the flies stayed healthier longer as well.

The study (“AMPK Modulates Tissue and Organismal Aging in a Non-Cell-Autonomous Manner”), published in Cell Reports, could have important implications for delaying aging and disease in humans, said David Walker, Ph.D., an associate professor of integrative biology and physiology at UCLA and senior author of the research.

“We have shown that when we activate the gene in the intestine or the nervous system, we see the aging process is slowed beyond the organ system in which the gene is activated,” noted Walker, who added that the findings are important because extending the healthy life of humans would presumably require protecting many of the body’s organ systems from the ravages of aging. However, delivering anti-aging treatments to the brain or other key organs could prove technically difficult.

The study suggests that activating AMPK in a more accessible organ such as the intestine, for example, could ultimately slow the aging process throughout the entire body, including the brain.
Humans have AMPK, but it is usually not activated at a high level, according to Dr. Walker.

“Instead of studying the diseases of aging—Parkinson’s disease, Alzheimer’s disease, cancer, stroke, cardiovascular disease, diabetes—one by one, we believe it may be possible to intervene in the aging process and delay the onset of many of these diseases,” said Dr. Walker, a member of UCLA’s Molecular Biology Institute. “We are not there yet, and it could, of course, take many years, but that is our goal and we think it is realistic. The ultimate aim of our research is to promote healthy aging in people.”

The fruit fly, Drosophila melanogaster, is a good model for studying aging in humans because scientists have identified all of the fruit fly’s genes and know how to switch individual genes on and off. The biologists studied approximately 100,000 of them over the course of the study.

“Upregulation of AMPK in the adult intestine induces autophagy both cell autonomously and non-cell-autonomously in the brain, slows systemic aging, and prolongs the lifespan,” wrote the investigators. “We show that the organism-wide response to tissue-specific AMPK/Atg1 activation is linked to reduced insulin-like peptide levels in the brain and a systemic increase in 4E-BP expression. Together, these results reveal that localized activation of AMPK and/or Atg1 in key tissues can slow aging in a non-cell-autonomous manner.”

According to Dr. Walker AMPK is thought to be a key target of metformin, a drug used to treat type 2 diabetes, and that metformin activates AMPK.

Use Portable Test to Diagnose Your Sleep Apnea at Home.


For a person without significant health problems, home-based tests for obstructive sleep apnea are just as accurate and effective as those performed in a sleep disorder lab.

This was one of the key findings of new guidelines for diagnosing sleep apnea in people with unexplained daytime sleepiness, published recently by The American College of Physicians (ACP.

According to the guidelines, doctors still should refer patients with congestive heart failure, chronic lung disease and neurological disorders to a sleep laboratory.

Physicians consider obstructive sleep apnea a serious health condition linked to heart disease, stroke, high blood pressure and diabetes.

“It still is an under-recognized and under-treated condition, which is related to various health consequences,” says sleep physician Harneet Walia, MD.

What is obstructive sleep apnea?

A disorder caused by repetitive obstruction of the upper airway, the condition can lead to reduced airflow during sleep, called hypopnea, or it can lead to apnea, which is complete cessation of airflow during sleep. This can occur several times during the night.

Either of these can interfere with a good night’s rest and then leave you fatigued during the day. This can lead to drowsy driving. Or you may not be able to concentrate as well.

Diagnosing obstructive sleep apnea

In the past, you might see a sleep specialist at the recommendation of your primary care physician. You would be scheduled you for a polysomnography, which is a full night of diagnostic testing in a sleep laboratory. A trained attendant or the lab staff could monitor your sleep overnight.

However, portable monitors people can use at home have become much more widely used in the last few years. People with a high likelihood of obstructive sleep apnea have used them without significant health issues. In addition to providing an effective diagnosis, the monitors are much less costly than using a sleep laboratory.

Don’t wait for testing

If you find yourself frequently feeling sleepy during the day or you suffer from snoring or restless sleep, talk with your physician as soon as possible. The sooner you get checked, the better, according to Dr. Walia.

It is very important that primary care physicians or doctors seeing patients on a regular basis are aware of this condition, Dr. Walia says. “They should be cognizant about screening patients for obstructive sleep apnea,” she says.

More about the new study

The new guidelines include recommendations that shed light on the disorder and help sleep specialists develop a treatment plan.

According to ACP researchers, approximately 9 percent of Americans have moderate to severe sleep apnea. The condition is more common in elderly people. Additionally, roughly 90 percent of sleep apnea sufferers have not been diagnosed.

The ACP prepared its new guidelines as a follow-up to earlier recommendations for the diagnosis of sleep apnea from the Agency for Healthcare Research and Quality. They were founded on research from studies performed over the last several decades.

Physician Variation in Management of Low-Risk Prostate Cancer A Population-Based Cohort Study.


mportance  Up-front treatment of older men with low-risk prostate cancer can cause morbidity without clear survival benefit; however, most such patients receive treatment instead of observation. The impact of physicians on the management approach is uncertain.

Objective  To determine the impact of physicians on the management of low-risk prostate cancer with up-front treatment vs observation.

Design, Setting, and Participants  Retrospective cohort of men 66 years and older with low-risk prostate cancer diagnosed from 2006 through 2009. Patient and tumor characteristics were obtained from the Surveillance, Epidemiology, and End Results cancer registries. The diagnosing urologist, consulting radiation oncologist, cancer-directed therapy, and comorbid medical conditions were determined from linked Medicare claims. Physician characteristics were obtained from the American Medical Association Physician Masterfile. Mixed-effects models were used to evaluate management variation and factors associated with observation.

Main Outcomes and Measures  No cancer-directed therapy within 12 months of diagnosis (observation).

Results  A total of 2145 urologists diagnosed low-risk prostate cancer in 12 068 men, of whom 80.1% received treatment and 19.9% were observed. The case-adjusted rate of observation varied widely across urologists, ranging from 4.5% to 64.2% of patients. The diagnosing urologist accounted for 16.1% of the variation in up-front treatment vs observation, whereas patient and tumor characteristics accounted for 7.9% of this variation. After adjustment for patient and tumor characteristics, urologists who treat non–low-risk prostate cancer (adjusted odds ratio [aOR], 0.71 [95% CI, 0.55-0.92]; P = .01) and graduated in earlier decades (P = .004) were less likely to manage low-risk disease with observation. Treated patients were more likely to undergo prostatectomy (aOR, 1.71 [95% CI, 1.45-2.01]; P < .001), cryotherapy (aOR, 28.2 [95% CI, 19.5-40.9]; P < .001), brachytherapy (aOR, 3.41 [95% CI, 2.96-3.93]; P < .001), or external-beam radiotherapy (aOR, 1.31 [95% CI, 1.08-1.58]; P = .005) if their urologist billed for that treatment. Case-adjusted rates of observation also varied across consulting radiation oncologists, ranging from 2.2% to 46.8% of patients.

Conclusions and Relevance  Rates of management of low-risk prostate cancer with observation varied widely across urologists and radiation oncologists. Patients whose diagnosis was made by urologists who treated prostate cancer were more likely to receive up-front treatment and, when treated, more likely to receive a treatment that their urologist performed. Public reporting of physicians’ cancer management profiles would enable informed selection of physicians to diagnose and manage prostate cancer.

The Expendables 3


Story: Barney Ross (Stallone) and his battle-hardened warriors are back, this time augmented by the addition of new recruits. After springing their buddy out of prison, the Expendables are thwarted by arms dealer Conrad Stonebanks (Gibson) while on an intercept mission. Stonebanks is also wanted by the US government. What’s worse, Conrad used to be Barney’s old friend.

Review: Expendables 3 brings together almost every Hollywood action star you’ve seen on screen from the 1980s and 1990s and gathers them together in a movie that has all the finesse of a tank and a helicopter in a glorious head-on collision. The barely-there plot seems like an afterthought, almost like a token concession given to the main thrust of this movie, which is really all about dishing out some good ol’ school mayhem.
What is complex, however, is the cast list (evidenced by the over-crowded movie poster). Ross is the leader, Lee Christmas (Statham) has a way with knives, Yin Yang (Li) is the obligatory martial arts expert, Trench (Schwarzenegger) still has an appetite for large caliber weapons and fat cigars, Doc (Snipes) is a former medic who is liberated from prison (and thereafter almost forgotten) and Gunnar Jensen (Lundgren) is a loose cannon with a volatile temperament. Drummer (Ford’s debut in the franchise) is the mission organizer.

Among the new entrants, Galgo (Banderas), a sharpshooter with a motor-mouth and Gibson, who adds a snarky sort of finesse to his character, are impressive. On the receiving end of a hail of bullets this time aren’t Chinese or Russians, but random bad guys, including some former Communist bloc baddies.

While an ensemble cast is indeed impressive, you might feel that so much more could have been done with the story in terms of excitement. Stallone and Arnie fans might also feel a bit shortchanged regarding how much screen time their two favourite characters have got. While the action is indeed high gear, the gore (evidenced in the previous film) is turned down a notch. Nonetheless, it does serve up a decent chunk of old-school action.