tbuckley/cabot-search huggingface dataset:
Lie to me: Tell me bald is beautiful
Authors: Meredith L. Clements
Journal: Annals of Internal Medicine (2018)

Ad Libitum6 March 2018Lie to me: Tell me bald is beautifulMeredith L. Clements, PhDMeredith L. Clements, PhDTampa, Florida (M.L.C.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2270 Audio Reading - “Lie to me: Tell me bald is beautiful” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Lie to me: Tell me bald is beautiful," by M.L. Clements. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail I need you to lie to me.We have lied to each other before.As your husband, I am asking you to pretend cancer did not steal your confidence.Say you are beautiful bald, “just in a different way.”Will yourself into “a new normal.”Sacrifice your truth to better our marriage.Lie to yourself.Say tying scarves is “part of the journey” and wearing wigs is “easier” than real hair.Be playful please,For I fear I can no longer shoulder the guilt of being the healthy husband.Back ... Author, Article, and Disclosure InformationAffiliations: Tampa, Florida (M.L.C.)Current Author Addresses: Meredith L. Clements, PhD, Department of Communication, University of South Florida, Tampa, FL 33620; e-mail, [email protected]usf.edu. PreviousarticleNextarticle Advertisement Audio Reading - “Lie to me: Tell me bald is beautiful” Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads "Lie to me: Tell me bald is beautiful," by M.L. Clements. Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics 6 March 2018Volume 168, Issue 5Page: 373-374KeywordsFearOvarian cancerShoulders ePublished: 6 March 2018 Issue Published: 6 March 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...
Consultants condemn deterioration of terms and conditions
Authors: Helen Jaques
Journal: BMJ (2011)

Senior doctors have spoken out against regional pay variation, erosion of supporting professional activities (SPAs), and the proposed reform of the clinical excellence award scheme, demanding that the BMA act against “piecemeal picking off of contracts.”

Hamish Meldrum, chairman of BMA council, said that consultants have had to face the “double whammy” of attacks on their clinical excellence awards and their SPAs on top of three …
Risk factors for and characteristics of pneumonitis in patients treated with anti-programmed death-1 therapy.
Authors: YI HU, Pengfei Cui, Jing Zhang
Journal: Journal of Clinical Oncology (2018)

128 Background: Pneumonitis is an uncommon but potentially fatal toxicity of anti–programmed death-1 (PD-1) monoclonal antibodies (mAbs), but its prevalence, risk factors and clinical features are poorly described. Methods: The medical records of 234 patients with advanced cancer who underwent anti–PD-1mAbs therapies between September 2015 and September 2017 at the Cancer Center of the Chinese PLA (People’s Liberation Army) General Hospital were analyzed with regard to patient background and clinical features. Pneumonitis was diagnosed by the treating investigator; cases with confirmed malignant lung infiltration or infection were excluded. Univariate and multivariate analyses were performed to identify independent predictive factors for pneumonitis. Clinical features, management and prognosis of pneumonitis were also collected. Results: A total of 55 patients (23.5%) developed pneumonitis. Anti–PD-1mAbs induced pneumonitis was significantly associated with male sex, a history of prior thoracic radiotherapy, combination therapy and underlying lung condition (odds ratios 3.380, 3.081, 2.538 and 2.559, respectively). Time to onset of pneumonitis ranged from 2 days to 277days (median time was 85days). 85.4% (47 of 55) of cases were grade 1 to 2, 25.5% (14 of 55) were treated with steroid therapy, of which 85.7% (12 of 14) resolved/ improved. Nine (16.4%) patients worsened clinically and one died during the course of pneumonitis treatment. Conclusions: Pneumonitis associated with anti–PD-1 mAbs is a serious adverse effect in the clinical setting that cannot be ignored. However, patient selection based on sex, history of prior thoracic radiotherapy, combination therapy and underlying lung condition can minimize pneumonitis risk. Most events are low grade and resolved/ improved with steroid therapy. Rarely, pneumonitis worsens despite steroid therapy, and may result in death.
Abstract 18159: Association Between Ankle-Brachial Index Values, Symptom Classification, and PAD-Specific Health Status in Patients With Intermittent Claudication
Authors: Abigail Johnston, W. Schuyler Jones, Kensey Gosch, Manesh Patel, Sreekanth Vemulapalli, Herbert Aronow, Dawn Abbott, Mehdi Shishebor, John Spertus, Kim Smolderen
Journal: Circulation (2016)

Introduction: The association between ankle brachial index (ABI) values and patients’ perceptions of their health status is poorly characterized. In the PORTRAIT study of patients with new or an ex...
Opioid Prescribing Patterns and Complications in the Dermatology Medicare Population
Authors: Severine Cao, Ryan Karmouta, David G. Li, Ryan S. Din, Arash Mostaghimi
Journal: JAMA Dermatology (2018)

The ongoing opioid epidemic in the United States has been fueled by prescription opioids. Increases in opioid-related deaths and complications mandate clinicians in all fields to scrutinize their prescribing patterns.To characterize the current status and potential complications of opioid prescribing practices among dermatologists for Medicare beneficiaries.A cross-sectional study used Medicare Part D prescriber data to evaluate opioid prescriptions by dermatologists from January 1 to December 31, 2014. The number of prescribers, opioid claims, beneficiaries, and days supplied as well as the type of opioid and geographic location of prescribers were extracted and analyzed. The top 1% of dermatologists prescribing opioids were identified and compared with a random sample of the same size among the remaining dermatologists based on sex, geographic location, type of practice, and time in practice. A systematic literature review was conducted to estimate the outcome of opioid prescribing practices on the exposed population.Practice characteristics, epidemiologic factors, and consequences of opioids prescribed by dermatologists.Of the 12 537 dermatologists in the study, 5305 (42.3%) prescribed no opioid claims, 5408 (43.1%) prescribed 1 to 10 opioid claims, and 1824 (14.5%) prescribed more than 10 opioid claims. Among dermatologists prescribing at least 10 opioid claims, a mean of 1.0 opioid claims was given to each beneficiary, with a supply lasting a mean of 4.4 days. A total of 108 dermatologists (93.9%) in the top 1% of opioid prescribers (n = 115) work in a surgical practice. Estimates suggest that opioids prescribed by dermatologists could annually lead to 3877 to 7602 beneficiaries continuing to use opioids at 1 year and 1825 to 4209 continuing to use opioids at 3 years. A total of 9882 to 22 806 beneficiaries could experience gastrointestinal tract or central nervous system adverse effects and 588 to 999 could experience fractures.Opioid prescribing among dermatologists is limited and concentrated in the surgical setting, but it may be associated with a substantial number of adverse events that serve as a reminder to emphasize nonopioid pain medications in the postoperative setting.
Tight Junction Protein Claudin-2 Promotes Self-Renewal of Human Colorectal Cancer Stem-like Cells
Authors: Sophie Paquet-Fifield, Shir Lin Koh, Lesley Cheng, Laura M. Beyit, Carolyn Shembrey, Christina Mølck, Corina Behrenbruch, Marina Papin, Meritxell Gironella, Sophie Guelfi, Ramona Nasr, Fanny Grillet, Michel Prudhomme, Jean-Francois Bourgaux, Antoni Castells, Jean-Marc Pascussi, Alexander G. Heriot, Alain Puisieux, Melissa J. Davis, Julie Pannequin, Andrew F. Hill, Erica K. Sloan, Frédéric Hollande
Journal: Cancer Research (2018)

Posttreatment recurrence of colorectal cancer, the third most lethal cancer worldwide, is often driven by a subpopulation of cancer stem cells (CSC). The tight junction (TJ) protein claudin-2 is overexpressed in human colorectal cancer, where it enhances cell proliferation, colony formation, and chemoresistance in vitro While several of these biological processes are features of the CSC phenotype, a role for claudin-2 in the regulation of these has not been identified. Here, we report that elevated claudin-2 expression in stage II/III colorectal tumors is associated with poor recurrence-free survival following 5-fluorouracil-based chemotherapy, an outcome in which CSCs play an instrumental role. In patient-derived organoids, primary cells, and cell lines, claudin-2 promoted colorectal cancer self-renewal in vitro and in multiple mouse xenograft models. Claudin-2 enhanced self-renewal of ALDHHigh CSCs and increased their proportion in colorectal cancer cell populations, limiting their differentiation and promoting the phenotypic transition of non-CSCs toward the ALDHHigh phenotype. Next-generation sequencing in ALDHHigh cells revealed that claudin-2 regulated expression of nine miRNAs known to control stem cell signaling. Among these, miR-222-3p was instrumental for the regulation of self-renewal by claudin-2, and enhancement of this self-renewal required activation of YAP, most likely upstream from miR-222-3p. Taken together, our results indicate that overexpression of claudin-2 promotes self-renewal within colorectal cancer stem-like cells, suggesting a potential role for this protein as a therapeutic target in colorectal cancer.Significance: Claudin-2-mediated regulation of YAP activity and miR-222-3p expression drives CSC renewal in colorectal cancer, making it a potential target for therapy. Cancer Res; 78(11); 2925-38. ©2018 AACR.
Mesenchymal stem cells in multiple myeloma: a therapeutical tool or target?
Authors: Song Xu, Kim De Veirman, Ann De Becker, Karin Vanderkerken, Ivan Van Riet
Journal: Leukemia (2018)

Multiple myeloma (MM) is a malignant plasma cell (PC) disorder, characterized by a complex interactive network of tumour cells and the bone marrow (BM) stromal microenvironment, contributing to MM cell survival, proliferation and chemoresistance. Mesenchymal stem cells (MSCs) represent the predominant stem cell population of the bone marrow stroma, capable of differentiating into multiple cell lineages, including fibroblasts, adipocytes, chondrocytes and osteoblasts. MSCs can migrate towards primary tumours and metastatic sites, implying that these cells might modulate tumour growth and metastasis. However, this issue remains controversial and is not well understood. Interestingly, several recent studies have shown functional abnormalities of MM patient-derived MSCs indicating that MSCs are not just by-standers in the BM microenvironment but rather active players in the pathophysiology of this disease. It appears that the complex interaction of MSCs and MM cells is critical for MM development and disease outcome. This review will focus on the current understanding of the biological role of MSCs in MM as well as the potential utility of MSC-based therapies in this malignancy.
Unleashing natural killer cells upon immunization with a carbohydrate mimetic peptide vaccine.
Authors: Thomas Kieber-Emmons, Issam Makhoul, Angela Pennisi, Peter D. Emanuel, Laura Fulper Hutchins, Eric R Siegel, Behjatolah Monzavi-Karbassi
Journal: Journal of Clinical Oncology (2018)

16 Background: Immunotherapies that activate Natural Killer (NK) cells can lend to their tumor infiltration or help shape the adaptive response toward a T helper type 1 (Th1) profile thought to favor anti-tumor responses. Methods: We have analyzed the functional NK response to immunization with a carbohydrate mimetic peptide (CMP) vaccine in preclinical tumor models and in humans. This CMP, referred to as P10s, is the N-terminal half of a peptide vaccine named P10s-PADRE, the C-terminal half of which (PADRE) is a Pan-T-cell epitope. Syngeneic mouse models associated with mammary 4T1, mouse lymphoma cell line EL4, and human breast cancer MDA-MB-231 in athymic mice were immunized with the vaccine. NK infiltration was identified by staining mouse tumor tissue before and after immunization. For NK cell depletion studies Athymic mice were injected intraperitoneally with anti-asialo GM1 rabbit serum prior to challenge with MDA-MB-231 tumor cells after the last immunization and then every 4-5 days for the period of a month. A Phase 1 trial was conducted with the vaccine and the NK phenotype assessed by flow cytometry. Serum Th1/Th2 cytokine profile was determined using multiplex MSD ® kits (Meso Scale diagnostics). Results: Immunization of murine models with the P10s vaccine results in infiltration of NK cells into tumors and depletion of NK cells in these models abrogate anti-tumor responses. An early phase clinical trial in Stage IV metastatic Breast Cancer patients indicated that the activates the natural cytotoxicity receptor NKp46 phenotype, which has a mouse Ortholog, with a Th1 cytokine environment marked by significant elevation of IFN-γ levels. While P10s-PADRE immunization induced proapoptotic antibodies that are caspase-3 dependent, the induced antibodies also led to ADCC targeting of human breast cancer tumor cell lines in vitro further emphasizing a role for activated NK cells. Conclusions: Our results reveal that immunization with a CMP vaccine can mediate the activation of an anti-tumor NK response that can affect tumor growth in preclinical models that might translate to humans. Clinical trial information: NCT01390064.
Phase II study of enzalutamide monotherapy with radiation therapy for intermediate risk prostate cancer.
Authors: Glenn Bubley, Irving D. Kaplan, Lillian Werner, Rupal Satish Bhatt, Mary Ellen Taplin, Kathleen Margaret Mahoney, Paul Nguyen
Journal: Journal of Clinical Oncology (2018)

58 Background: Castrating androgen deprivation therapy (ADT) is standardly prescribed in combination with radiation therapy (RT) for intermediate or high-risk prostate cancer (PCa). ADT is associated with multiple side effects including weight gain, loss of libido, hot flashes and muscle atrophy. In contrast, enzalutamide monotherapy is associated with much fewer side effects. Methods: At Dana-Farber/ Harvard Cancer Center we performed an open label phase II study of enzalutamide for 6 months as neo- and adjuvant treatment for intermediate risk PCa patients (NCCN criteria) receiving RT. The primary endpoint was the proportion of patients achieving a PSA response of ≤0.2 . This endpoint is predictive of long term PSA response in a similar risk-group of patients treated with RT and ADT. PSA values were obtained at baseline and monthly on 6 cycles of enzalutamide (160mg/day). 79.2 Gy in 44 fractions of IMRT was started between 6 and 10 weeks after the initiation of enzalutamide. Quality of life questionnaires, hormone levels and anthropomorphic measurements were obtained. Results: 45 of 60 evaluable patients had a PSA ≤0.2 at the end of 6 months of enzalutamide. With a sample size of 64 evaluable patients, if the number achieving a PSA level is ≤0.2 is 44 or more, the null hypothesis is rejected with a target error rate of alpha = 0.10. Also 54 of 60 evaluable patients had a PSA of ≤0.5ng/ml. Importantly, less than half of the participants experienced erectile dysfunction or decreased libido and these were predominantly grade I. Less than a quarter of patients reported hot flashes (all grade I). Waist circumference did not change with therapy. The most frequent grade 2 or greater events were hypertension and gynecomastia. Testosterone and free testosterone levels rose significantly on enzalutamide therapy. Conclusions: Enzalutamide monotherapy with RT may be as effective as castrating ADT, and associated with fewer side effects. Larger, randomized trials are needed to further evaluate enzalutamide monotherapy, instead of ADT, to be used in combination with RT. Clinical trial information: NCT0208988.
Can post-operative prostate fossa radiation be omitted in patients with high-risk features using a genomic classifier?
Authors: Joseph Anthony Marascio, Matthew Bloom, Mark Hurwitz, Leonard G. Gomella, Costas D. Lallas, Edouard John Trabulsi, Mark Mann, James Ryan Mark, Anne Calvaresi, W. Kevin Kelly, Jean H. Hoffman-Censits, James Luke Godwin, Adam Dicker, Robert Benjamin Den
Journal: Journal of Clinical Oncology (2018)

101 Background: At our institution, based upon the AUA/ASTRO guidelines, discussion of adjuvant radiation therapy (ART) for patients with adverse pathologic features (APF) (pT3/positive margins) occurs in a multidisciplinary setting. We had previously offered ART to approximately 50% of these patients. We describe our evaluation of Decipher genomic testing to select patients to offer observation following prostatectomy (RP). Methods: Since March 2014, patients at Thomas Jefferson University with APF and undetectable post-operative PSA underwent Decipher genomic testing. Collectively, we decided to offer observation with salvage radiation therapy (SRT) for patients with low or intermediate risk Decipher scores. The primary outcome of this analysis was biochemical progression free survival (bPFS) with failure defined as a PSA ≥0.1 ng/mL. Results: From March of 2014 through September of 2016, 47 patients met the above criteria. The median patient age was 64 and median follow up was 16 months. Median pre-treatment PSA was 6.0 ng/mL (2.94 to 22.7 ng/mL). With regard to pathologic stage: 19% had T2c, 68% had T3a, and 13% had T3b disease. Pathologic Gleason grouping was 6%, 49%, 34%, 6%, and 4% for groups 1-5, respectively. 51% of patients had positive margins, 36% had lymph-vascular space invasion, and 53% had perineural invasion. Four patients received ART and 1 patient was lost to follow up after his initial visit. Of the remaining 42 patients, 3 patients experienced biochemical failure at 8, 27, and 44 months. Conclusions: This is the first prospective report utilizing Decipher genomic testing to stratify men with undetectable PSA and adverse pathologic features into an observation cohort following RP. Despite the stringency of our definition of biochemical failure, our observed bPFS was 87% at 3 years. Historically, in an unselected population the 3 year bPFS was 90% in those receiving ART and 65% in those receiving SRT. While these initial findings are promising, longer follow up is warranted. Our findings demonstrate the utility of genomic classifiers in patient selection and provide a safe approach to reducing over treatment in the post RP setting.
Biomimetic Architectures for Peripheral Nerve Repair: A Review of Biofabrication Strategies
Authors: Paul A. Wieringa, Ana Rita Gonçalves de Pinho, Silvestro Micera, Richard J. A. van Wezel, Lorenzo Moroni
Journal: Advanced Healthcare Materials (2018)

Abstract Biofabrication techniques have endeavored to improve the regeneration of the peripheral nervous system (PNS), but nothing has surpassed the performance of current clinical practices. However, these current approaches have intrinsic limitations that compromise patient care. The “gold standard” autograft provides the best outcomes but requires suitable donor material, while implantable hollow nerve guide conduits (NGCs) can only repair small nerve defects. This review places emphasis on approaches that create structural cues within a hollow NGC lumen in order to match or exceed the regenerative performance of the autograft. An overview of the PNS and nerve regeneration is provided. This is followed by an assessment of reported devices, divided into three major categories: isotropic hydrogel fillers, acting as unstructured interluminal support for regenerating nerves; fibrous interluminal fillers, presenting neurites with topographical guidance within the lumen; and patterned interluminal scaffolds, providing 3D support for nerve growth via structures that mimic native PNS tissue. Also presented is a critical framework to evaluate the impact of reported outcomes. While a universal and versatile nerve repair strategy remains elusive, outlined here is a roadmap of past, present, and emerging fabrication techniques to inform and motivate new developments in the field of peripheral nerve regeneration.
Why are low-risk prostate cancers (PCa) treated aggressively? A population-based cohort analysis.
Authors: Ramsankar Basak, Deborah S Usinger, Paul Alphonso Godley, Ronald C. Chen
Journal: Journal of Clinical Oncology (2018)

127 Background: Per AUA guidelines, active surveillance (AS) is the best option for very low-risk PCa and preferred for all low-risk patients. However, AS continues to be underused. This study examines decision-making factors in low risk patients. Methods: Using Rapid Case Ascertainment of the North Carolina (NC) Cancer Registry, 1,456 patients were enrolled from 2011-13 across NC soon after diagnosis. NCCN risk group and treatments received (or AS) were determined using medical records and registry data. Phone survey asked patients about their perceived cancer aggressiveness, most important decision-making factor (i.e., cure, quality of life, family burden, cost, daily activity), and desire to be involved in the decision process. Results: Of 585 low-risk patients, 38% pursued AS. Multivariable analysis showed that patient desire to pursue aggressive treatment and perceived cancer aggressiveness were significantly associated with aggressive treatment instead of AS (Table). Further, patients indicating primary decision was self (instead of physician) were more likely to receive aggressive treatment (Odds ratio [OR] 1.76). In the subgroup of 346 very low-risk patients, 48% received AS; patient desire for aggressive treatment and perceived aggressiveness remained significant factors. Conclusions: Patient desire for aggressive treatment and (mis)perception of cancer aggressiveness were dominant factors for low-risk patients receiving aggressive treatment instead of AS. Ascertaining patient goals for treatment and more accurate information about low-risk PCa may improve physician counseling and reduce underutilization of AS. [Table: see text]