tbuckley/cabot-search huggingface dataset:
Abortion numbers halve in Northern Ireland as doctors fear prison
Authors: Clare Dyer
Journal: BMJ (2016)

The number of NHS pregnancy terminations in Northern Ireland has more than halved in a year, as official draft guidelines issued in 2013 have had a chilling effect on doctors in a province where the abortion law is among the strictest in Europe.

“We don’t know whether giving advice specifically about abortion is legal or illegal,” John O’Kelly, Northern Ireland chair for the Royal College of General Practitioners, told The BMJ .

Since 1970 an estimated 60 000 women have travelled for an abortion to England, where the more liberal 1967 Abortion Act applies. But Northern Ireland residents are not eligible for free NHS abortions in England, and the costs, including flights and accommodation where necessary, range from £400 to £2000 (€2695; $2920). As a result, growing numbers of women faced with unwanted pregnancies are turning to the internet to …
Abstract 19525: Knockout of CD38 Preserves Endothelial Function in the Postischemic Heart through Reduced Nicotinamide Adenine Dinucleotide Phosphate Salvage
Authors: James J Boslett, Eduardo N Chini, Jay Zweier
Journal: Circulation (2014)

Introduction: Cardiac ischemia/reperfusion (I/R) injury causes dysfunction in the coronary endothelium, resulting in loss of vascular relaxation and decreased tissue perfusion. Prior data with pharmacological inhibitors suggests that CD38 plays a role in I/R-induced vascular endothelial dysfunction (VED) through consumption of NADPH precursor NADP, limiting the supply of NADPH for nitric oxide (NO) production from endothelial NO synthase (eNOS) and decreasing NOS-dependent coronary flow (NDCF). In order to definitively determine the role of CD38 in cardiac I/R injury and endothelial dysfunction, we performed studies on hearts of wild type (WT) and CD38 -/- mice. Methods: Isolated Langendorff perfused hearts of WT (n=9) and CD38 -/- mice (n=7) were subjected to 30 min ischemia (I) and contractile function and coronary flow were monitored through 30 min reperfusion (R) with an intraventricular balloon and Doppler flow probe, respectively. At 30 min R, NDCF was measured with administration of NOS inhibitor L-NAME and then hearts were frozen for high performance liquid chromatography (HPLC) measurements of NADP(H) and NAD(H). Results: There was no difference in contractile function recovery between groups. However, hearts from CD38 -/- mice had enhanced recovery of both NADP(H) and NAD(H) (47.4 +/- 3.2 and 42.2 +/- 3.3% higher). Furthermore, at 30 min R, hearts from CD38 -/- mice had much higher post-ischemic recovery of coronary flow (14.64 +/- 3.50% higher) and NDCF (48.7 +/- 5.5% higher) compared to WT mice (Fig 1 &amp; 2). Conclusion: Thus, we observe that CD38 activation is a key mechanism contributing to NADP(H) depletion and VED in the postischemic heart.
Upregulation of thymidine phosphorylase (TP) by radiation (XRT): Phase II study of capecitabine (CAP) with XRT in pts with locally advanced (LA) pancreatic cancer
Authors: S. Roy, S. Russo, G. Black, M. A. Eloubeidi, A. Steg, D. Zelterman, M. R. Johnson, R. B. Diasio, M. W. Saif
Journal: Journal of Clinical Oncology (2006)

14001 Background: Preliminary studies have shown that XRT unregulates TP, the main enzyme responsible for activity of CAP. The objectives of this phase II study were to further evaluate effect of XRT on TP, DPD, and TNF-alpha as well as response and efficacy of CAP with concurrent XRT in pts with LA pancreatic cancer. Methods: Pts received 50.4 Gy XRT with CAP at 1600 mg/m 2 M-F × 6 wks determined from our phase I study (JCO, Dec 2005). Following CAP-XRT, stable and responding pts on CT scan were treated with CAP 2000mg/m 2 × 14 days q 3 wks till progression. Restaging was performed every 9 wks. Tumor specimens were procured with EUS-FNA 1 wk prior and 2 wks after CAP-XRT to evaluate TP, DPD, and TNF-alpha mRNA levels by RT-PCR. A sample size of 20 was selected (mean 1 vs. S with mean 0=13.5; alpha = 0.05; power = .99; t-test). Results: 19 pts (median age: 67; M/F: 7/12) were enrolled at UAB between March 2004 and June 2005. 4 pts (21%) had confirmed partial responses and 13 (68%) had stable disease. 2 pts underwent surgery (R o in 1; extensive fibrosis in 1). Six-month survival rate was 89%. We have not met enough deaths to estimate median survival. Grade 3 and 4 toxicities included: nausea/vomiting (5%), thrombosis (5%), hyperbilirubinemia (5%), and grade 3 GI bleeding (5%). No hematological toxicities except grade 1 thrombocytopenia (5%) and grade 1 anemia (10%). All pts completed full CAP-XRT with 3 dose reductions (by 20%). Pts received mean of 5.4 cycles (range: 3–15) of CAP alone with a total of 104 cycles with dose reductions in 7 cycles (by 25%). TP was elevated during wk 2 when compared to pre-XRT TP (P = .005) but DPD was not (P = .13) nor was TNF-alpha (P = .37). No correlation between TP and TNF-alpha was noticed. No association between TP/DPD ratio and efficacy of CAP was identified. Tumor TP expression was higher (183.16) in pt with GI bleeding. Conclusions: This Phase II study further confirms our Phase I results that CAP-XRT is an effective, tolerable, and an easy alternative to infusional 5-FU regimen for pts with LA pancreatic cancer. Also TP upregulation by XRT was statistically significant. While these results support use of CAP-XRT in pancreatic cancer, there appears to be additional genes (other than TP, DPD) associated with response to CAP and CAP-XRT. [Table: see text]
Prevalence and predictors of sexual dysfunction in long-term survivors of marrow transplantation.
Authors: K L Syrjala, S L Roth-Roemer, J R Abrams, J M Scanlan, M K Chapko, S Visser, J E Sanders
Journal: Journal of Clinical Oncology (1998)

PURPOSE To describe the prevalence of sexual difficulties in men and women after marrow transplantation (MT), and to define medical, demographic, sexual, and psychologic predictors of sexual dysfunction 3 years after MT. PATIENTS AND METHODS Four hundred seven adult MT patients were assessed pretransplantation. Survivors repeated measures of psychologic and sexual functioning at 1 and 3 years posttransplantation. RESULTS Data were analyzed from 102 event-free 3-year survivors who defined themselves as sexually active. Men and women did not differ in sexual satisfaction pretransplantation. At 1 and 3 years posttransplantation, women reported significantly more sexual dysfunction than men. Eighty percent of women and 29% of men reported at least one sexual problem by 3 years after MT. No pretransplantation variables were significant predictors of 3-year sexual satisfaction for women. For men, pretransplantation variables of older age, poorer psychologic function, not being married, and lower sexual satisfaction predicted sexual dissatisfaction at 3 years (R2=.28; P &lt; .001). Women who were more dissatisfied 3 years after MT did not receive hormone replacement therapy (HRT) at 1 -year posttransplantation and were less satisfied at 1 year, but not pretransplantation (R2=.35; P &lt; .001). CONCLUSION Sexual problems are significant in the lives of MT survivors, particularly for women. Although HRT before 1 year posttransplantation improves sexual function, it does not ensure sexual quality of life. Intervention for women is needed to apply hormonal, mechanical, and behavioral methods to prevent sexual difficulties as early after transplantation as possible.
Efficacy and safety of sunitinib in previously treated, advanced non-small cell lung cancer (NSCLC): Preliminary results of a multicenter phase II trial
Authors: M. A. Socinski, S. Novello, J. M. Sanchez, J. A. Brahmer, R. Govindan, C. P. Belani, J. N. Atkins, H. H. Gillenwater, C. Palleres, R. C. Chao
Journal: Journal of Clinical Oncology (2006)

7001 Background: Sunitinib malate (SU11248) is an oral, multitargeted tyrosine kinase inhibitor targeting VEGFR, PDGFR, KIT, FLT3 and RET on tumor cells, tumor neovasculature and pericytes. This is the initial report of an open-label, two-stage, multicenter phase II trial evaluating the single-agent activity of sunitinib in refractory NSCLC. Methods: Eligibility criteria included confirmed diagnosis of NSCLC, ECOG PS 0–1, no recent gross hemoptysis, no brain metastases, patients (pts) previously treated with 1–2 chemotherapy regimens, and adequate end-organ function. Pts received sunitinib at 50 mg/day po for 4 weeks (wks) followed by 2 wks off treatment (6 wks considered a cycle). Results: A total of 64 pts were enrolled and 63 pts treated, median age 61 yrs (range 33–87); adenocarcinoma (64%), squamous cell carcinoma (22%), other (14%); 66% male; PS 0:1, 45%:55%; median number of prior regimens: 2 (range 1–4); median time since the prior regimen: 2 months (range 1–21). To date, 63 pts have started cycle 1, 46 cycle 2, 22 cycle 3, 6 cycle 4 and 1 cycle 5. Grade 3–4 toxicities included fatigue/asthenia (21%), nausea (7%), vomiting (7%), abdominal pain (7%), and hypertension (5%). Most toxicities were grade 1–2 and included asthenia/fatigue (68%), anorexia (40%), dyspnea (37%), cough (35%), nausea (33%), mucositis (32%), dysgeusia (25%), diarrhea (21%), vomiting (19%), and constipation (19%). Grade 5 toxicities include pulmonary hemorrhage (n=2) and cerebral hemorrhage (n=1). Thus far, 6 confirmed partial responses have been observed among 63 treated pts (9.5%, 95% CI: 3.6–19.6%). Stable disease has been observed in an additional 12 pts (19.0%). Survival data are pending and will be presented. Conclusions: Sunitinib has provocative single-agent activity in previously treated pts with recurrent and advanced NSCLC, with the level of activity similar to currently approved agents. Sunitinib is well tolerated in this population. The trial is being extended to explore a continuous dosing strategy of sunitinib at 37.5 mg/day po. Based on these results, further trials are warranted and are ongoing with sunitinib in combination with standard agents/regimens. [Table: see text]
Is the natural history of prostate cancer different according to serum neuroendocrine profile?
Authors: E. Banu, F. Scotte, A. Banu, J. Medioni, M. Brizard, E. Levy, S. Oudard
Journal: Journal of Clinical Oncology (2007)

15536 Background: Elevated neuron-specific enolase (NSE) and chromogranine (CgA) values correlate with poor prognosis in prostate cancer (PC) patients (pts). They are correlated with the histological phenotype and a short hormone-sensitivity interval. The impact on the outcome was less explored. Methods: Eligible PC pts were required to have serial CgA and NSE specimens after the initial diagnosis in the venous blood, using commercial kits. Markers were defined as abnormal (+) or normal (-) with a threshold of 20,6 and 100 ng/mL for NSE and CgA, respectively. The endpoint was to evaluate the clinical impact of serum NSE and CgA on the natural history (NH) of the PC using the multivariate Cox regression analysis, stratified by Gleason score and adjusted by age at diagnosis. NH was calculated between the initial diagnosis and death or last follow-up for censored pts. Results: Blood samples were obtained from 213 PC pts, 53% with a metastatic hormone-refractory disease at the moment of the analysis. Seven, 36% and 10% of pts had either an abnormal NSE, CgA or both. Normal serum NSE and CgA were found in 47% of all pts and only in 35% of metastatic hormone-refractory PC pts. Median age was 64 years (range 41–82), 41% of pts had a Gleason score 8–10. Median NSE and CgA levels were 13.3 and 92 ng/mL, respectively. The median of the NH was not reached yet. The adjusted risk of death was multiplied by 3.1 for pts with abnormal NSE or/and CgA (HR=3.5, unadjusted for age). A borderline relationship was observed at the multivariate analysis between NH and the neuroendocrine profile ( Table ). Conclusions: NSE was the most powerful predictor of the NH in PC pts, regardless the moment of the rise during the NH. A systematic NSE and CgA assessment could be proposed for all pts. [Table: see text] No significant financial relationships to disclose.
Breast self examination: Instruction videos and palpation aids improve the tumor recognition?
Authors: R. von Georgi, F. Thele, K. Münstedt
Journal: Journal of Clinical Oncology (2005)

1019 Background: Breast self-examination (BSE) is believed to be an important method for early detection of breast cancer and likewise promoted. Furthermore many additional tools to make BSE more efficient such as palpation aids and instruction video tapes are offered. However, until today no empirical study has ever proven the assumed connection between tumor recognition and the guidance videos or palpation aids. Methods: The presented experimental study was to clarify whether BSE after video instructionand or the use of palpation aids results in higher rates of tumor recognition. 24 silicone breast forms (AMOENA, Germany) were prepared with tumor equivalents of different size and position. 50 male and 50 female students were assigned by random selection to four experimental conditions (using palpation aids (Vital Aid BSE Sentida Corporation, Preston WA, USA (Y/N)); seeing 4:45min guidance video (FINGADO 2004) (Y/N)). Afterwards they had to investigate all 24 models regarding the possible presence of tumor equivalents (time for each scan: 20 sec; pressure: max 800g). As dependent variable the mean sum of correct positive hits were calculated and analyzed by 2x2x2-ANOVA (gender, foil, video). Results: Neither gender nor the video instruction was related to a better recognition of the tumor equivalents (p>.80). Also no interaction effect was found (p>.17). However, use of the palapation aid resulted in lower numbers of correct results (p<0,001). The analysis of the single models gives a comparable Result: Personality variables (e.g. anxiety) did not affect tumor recognition. Conclusions: The study shows that palpation aids reduce the chances of tumor detection. Furthermore, the method of BSE tought in guidance videos has no causal relationship to a better tumor recognition. This implies that a possible positive effect of these videos does not lie in the teaching of the correct method of BSE but rather in creatin a general awareness towards the topic. No significant financial relationships to disclose.
Medical Research Council trial of 2 versus 5 CT scans in the surveillance of patients with stage I non-seminomatous germ cell tumours of the testis
Authors: G. M. Mead, G. J. Rustin, S. P. Stenning, P. Vasey, N. Aass, R. Huddart, M. Sokal, S. Kirk
Journal: Journal of Clinical Oncology (2006)

4519 Background: Surveillance is a standard management approach for stage 1 non seminomatous germ cell tumours (NSGCT), yet there is no agreement on the number of CT scans that are required to detect relapses. A randomised trial of 2 versus 5 CT scans was performed to determine whether the number of scans influenced the prognostic group (J Clin Oncol 15:594–603, 1997) at relapse. Methods: Patients with clinical stage 1 NSGCT opting for surveillance were randomised to chest and abdominal CT scans at either 3 and 12 or 3, 6, 9, 12, and 24 months, with all other investigations (clinical exams, markers, chest X-rays) carried out at equal frequency in the two arms. 3/5 patients were allocated to the 2 scan schedule. 400 patients were required to exclude a 3% increase in the proportion of patients relapsing with IGCCCG intermediate or poor prognosis disease with 90% power at the 5% significance level (1-sided). Results: 247 patients were allocated to 2 CT scans and 167 to 5 CT scans. With a median follow up of 40 months 37 (15%) relapses have occurred in the 2 scan arm and 33 (20%) in the 5 scan arm. No patients were poor prognosis at relapse but 2 (0.8%) of those relapsing in the 2 scan arm were intermediate prognosis compared to 1 (0.6%) in the 5 scan arm a difference of 0.2% (90% CI −1.2%, +1.6%). The mean diameter of abdominal mass at relapse was 2.1 cm in the two scan arm and 2.2 cm in the five scan arm. After chemotherapy a residual mass was present in 35% in the 2 scan and 36% in the 5 scan arm. No deaths have been reported. Conclusions: This study can exclude with 95% probability an increase in the proportion of patients relapsing with intermediate or poor prognosis disease of more than 1.6% if they have 2 rather than 5 CT scans as part of their surveillance protocol. CT scans at 3 and 12 months after orchidectomy should be considered as the new standard and will be associated with a reduction in radiation exposure. No significant financial relationships to disclose.
Injury surveillance programmes, ethics, and the Data Protection Act Sharing data to prevent injuries Potential problems for tenants The legal position Ethical viewpoint
Authors: R. A Lyons, J. Sibert, M. McCabe, P. D Donnelly, T. Shellens, D. Evans
Journal: BMJ (1999)

# Injury surveillance programmes, ethics, and the Data Protection Act {#article-title-2}

Public health is the arena in which clinical medicine, epidemiology, management, politics, and the law all meet—or perhaps more accurately, collide. Often there seem to be conflicting imperatives. Even within a department colleagues may disagree on policy. Such disagreement can be productive if as a result important policy issues are explored. The case described here raises important issues about the legal and ethical basis of the government's injunction to health authorities to work with other agencies, which is central to the current green papers on public health. A consultant, a director of public health, a health authority lawyer, and an ethicist present their views. 

# Sharing data to prevent injuries {#article-title-3}

The purpose of the NHS is to improve the health of the population. This guiding principle was first laid down in the Strategic Intent and Direction for the NHS in Wales: “Working with others, the NHS should aim to take the people of Wales into the 21st century with a level of health on course to compare with the best in Europe.”1 This was subsequently taken up by the Health of the Nation and Our Healthier Nation initiatives in England and Better Health, Better Wales , the most recent green paper in Wales.1–4 In England, the prevention of injury is one of four areas for health gain in the population and in Wales it is one of 10 areas for health gain. Both old and new English and Welsh documents identify the need for injury surveillance systems and that the NHS needs to work with others to prevent injuries. Thus, the Welsh Protocol for Investment in Health Gain for Injuries sets targets for health authorities, among which are “working with others, each health authority purchasing team and local authority should develop a multidisciplinary, multiagency strategy for addressing injury prevention, based upon targeting …
Patterns of care among breast cancer patients with financial need: Information from a Medicaid-claims and tumor registry linked database
Authors: G. G. Kimmick, F. Camacho, R. Balkrishnan, R. Anderson
Journal: Journal of Clinical Oncology (2005)

6037 Background: There is little information describing patterns of health care in financially needy women with breast cancer in the United States. Methods: We previously created and validated a hybrid database linking Medicaid-claims and tumor registry data in a sample of patients with breast cancer in North Carolina. Here, we describe patterns of care among this sample of low income women. Logistic regression was used to determine predictors of type of surgery, radiation therapy use after breast conserving surgery, and chemotherapy use. Results: The sample consisted of 984 women. Ages ranged from 23–102, with 21% < 50, 28% 50–64, 20% 65–74, and 32% ≥ 75. Fifty-eight percent were Caucasian. Mean Charlson comorbidity score was 3.4 (SD 3.1). Twelve percent had tumors <1 cm, 30% 1–2 cm, 46% 2–5 cm, and 13% >5 cm. Nodes were negative in 47%. Hormone receptors were positive in 47%. Main results are tabulated below. 67% were managed with mastectomy, 41% received adjuvant chemotherapy, 60% of women who had breast conserving therapy received adjuvant radiation. BCS = breast conserving therapy 1reference category <50; 2reference category 0–1 cm; 3reference category 4+ nodes Conclusions: In this low income insured group of breast cancer patients, black women were more likely than white women to have breast conserving surgery and higher Charlson scores predicted greater mastectomy rate and higher likelihood of chemotherapy use. No significant financial relationships to disclose.
High-dose dexamethasone corrects impaired myeloid-derived suppressor cell function via Ets1 in immune thrombocytopenia
Authors: Yu Hou, Qi Feng, Miao Xu, Guo-sheng Li, Xue-na Liu, Zi Sheng, Hai Zhou, Ji Ma, Yu Wei, Yuan-xin Sun, Ying-yi Yu, Ji-hua Qiu, Lin-lin Shao, Xin-guang Liu, Ming Hou, Jun Peng
Journal: Blood (2016)
P24 Cytokine biomarker profiling in acetaminophen-induced acute liver failure: importance of monocyte chemotactic protein-1 in prognosis and hepatic encephalopathy
Authors: H Antoniades, B Mathew, M McPhail, R Srirajaskanthan, P Berry, W Bernal, M Hussain, G Auzinger, J Wendon
Journal: Gut (2010)

Introduction  Inflammatory cytokines have recently been described as reflecting severity of liver injury, grade of encephalopathy and prognosis in acute liver failure (ALF). The role of monocyte chemotactic protein-1 and peripheral monocyte count has not been well studied.  Method  35 consecutive patients admitted to our institution with a diagnosis of acetaminophen induced ALF were studied for the effect of a biomarker profile of inflammatory cytokines (IL-4, IL-6, IL-10, MCP-1, TNF-a, IFN-g) levels at admission on grade of hepatic encephalopathy (HE) and prognosis. Modified King9s College Criteria (KCC) was used in deciding whether to perform ELT. Assessment of HE and prognostic markers was investigated using logistic regression and receiver operating characteristic (ROC) curve analysis.  Results  MCP-1 levels were significantly correlated with standard markers of severity of liver injury (INR: R=0.737, p 0.05 for all; De Long method). MCP-1 performed better than peripheral monocyte count (AUROC 0.75 (0.57–0.85). TNF-α, TGF-β1 and IFN-γ levels did not predict outcome. IL-6 better predicted the development of severe (grade 3–4) HE (AUROC 0.91 (0.72–0.98) compared with MCP-1 (AUROC 0.71 (0.49–0.87), p=0.087 (De Long method)).  Conclusion  MCP-1 has similar behaviour to IL-4, IL-6 and IL-10 in outcome prediction in acetaminophen induced acute liver failure and better reflects poor prognosis than peripheral monocyte count. IL-6 may better reflect the severity of HE suggesting different roles for interleukins and MCP-1 in the pathogenesis of the inflammatory milieu in ALF.