tbuckley/cabot-search huggingface dataset:
Interaction of 1970–2010 breast cancer in-situ (brca, DCIS) rates with invasive breast cancer (brcainv) and mortality (brcamor): Comparative analysis of two regions with different screening mammography and therapy guidelines (ScreenMam).
Authors: Joseph Ragaz, Joel Fox, Shayan Shakeraneh, Kenneth S. Wilson, Hong Qian, Hubert Wong
Journal: Journal of Clinical Oncology (2016)

e13069 Background: To correlate age-standardized rates [ASRs] of DCIS, BrCaINV and BrCaMOR, separately for ages <50 vs >50. British Columbia [BC] is known for earlier introduction, tighter adherence to, and more uniformity of ScreenMam than the Atlantic Provinces [AP]. Methods: Annual age-specific rates [ASRs] of DCIS, BrCaINV, and BrCaMOR were obtained for 17 five-year age groups (years 0-4 to 85+) in BC and AP, and averaged over 5-year1970-1974 to 2005-2009 periods [Lustrum], separately for ages <50 and >50. BrCaINV and BrCaMOR rates were expressed in percentages, relative to 1970-74 average. Data were obtained from Canada Public Health Agency and Canada Ca Registry database at Statistics Canada. Results: See Tables. Conclusions: DCIS: Rates are substantially increased since 1970s in both regions. For ages >50, rate stabilization is seen after 2000s, particularly in BC where the rate decrease is seen after 2005. BrCaINV: In both regions, rates for ages <50 have been stable. For ages >50, rates are initially increasing and then decreasing, with reduction observed to a lower extent in BC, and much earlier than in AP BrCaMOR: For both age groups, rate decrease is more substantial in BC than AP. Difference is particularly evident for ages >50, with reduction in BC observed at least a decade earlier, and to a much lower degree. SUMMARY: Levelling or decrease of DCIS rates in regions with more adherent ScreenMam is a new observation which may antedate a more substantial delayed rate reduction of both BrCaINV and BrCaMOR. Earlier diagnosis & therapy of less resistant BrCa lesions, as enabled by ScreenMam, are the likely causes for these outcome improvements. Age < 50. DCIS BrCaINV [%] BrCaMOR [%] Lustrum BC AP BC AP BC AP 1980-84 1.7 0.9 91 96 89 90 1985-89 3.3 1.4 95 99 88 94 1990-94 3.8 2.5 95 104 82 86 1995-99 4.5 2.9 89 109 71 80 2000-04 4.9 3.4 87 101 53 63 2005-09 5.4 3.6 90 103 49 53 Age > 50. DCIS BrCaINV [%] BrCaMOR [%] Lustrum BC AP BC AP BC AP 1980-84 11.1 6.8 103 109 100 108 1985-89 23.0 9.9 119 126 101 103 1990-94 32.2 19.7 124 142 95 118 1995-99 45.2 31.8 121 149 86 113 2000-04 46.4 38.1 107 142 71 94 2005-09 44.9 40.0 106 138 64 78
Incidence, persistence and determinants of human papillomavirus: A prospective cohort study of 10,000 HIV-negative Nigerian women.
Authors: Sally Nneoma Adebamowo, Michael Kolawole Odutola, Ayo Famooto, Eileen Dareng, Amos Adebayo, Peter Achara, Bunmi Alabi, Rasheed Bakare, Kayode Obende, Richard Offiong, Olayinka Olaniyan, Sanni Ologun, Clement Adebayo Adebamowo
Journal: Journal of Clinical Oncology (2017)

1510 Background: Cervical cancer is the second commonest cancer in Africa. Persistent High-risk HPV (HRHPV) infection is a necessary cause but little is known about the persistence and associated risk factors of HRHPV infection in African women. The aim of this study was to determine risk factors and incidence of HPV infection in Nigerian women. Methods: ACCME is a multicenter prospective cohort study of host germline, cervical somatic and HRHPV genomics, epigenomics, and vaginal microenvironment; and their association with HPV. From February/2014 to January/2016, 10,000 HIV-negative women were enrolled into the cohort and are being followed up every 6 months. We used SPF 25 /LiPA 10 to characterize HPV infection and defined persistent infection as 2 consecutive positive tests done at least 12 months apart. Logistic regression models were used to estimate the associations between risk factors and persistent HPV. Results: The mean (SD) age of the study participants at baseline was 40 (10) years and the mean (SD) vaginal pH was 5.2 (0.6). About 42% of the participants were positive for any HPV positive and 21% had persistence of any HPV infections. Some, 35% of the participants had multiple infections with any HPV. About 54% of those with persistent any HPV infections had HRHPV; HPV types 52 (25%) and 18 (15%) were the most prevalent and persistent HRHPV types. The incidence of any HPV infection was 6.6/1,000 person-months while that of HRHPV was 2.6/1,000 person-months. Age, body mass index, level of education, marital and socio-economic status and total number of lifetime sexual partners were associated with HPV infection in these women. Conclusions: We defined the incidence, risk factors and commonest types of HRHPV in a large cohort of women in West Africa.
Phase 1 Clinical Trial Of The Candidate Anti-Sickling Agent Aes-103 In Adults With Sickle Cell Anemia
Authors: Gregory J. Kato, Marlene Peters Lawrence, Laurel G. Mendelsohn, Rehan Saiyed, Xunde Wang, Anna K. Conrey, Judith M. Starling, George Grimes, James G Taylor, John McKew, Caterina P. Minniti, Warren Stern
Journal: Blood (2013)
OP0127 Prevention of periarticular ossification (pao) after total hip replacement (thr) with rofecoxib 25 mg
Authors: J Zacher, E Walther, A Gursche
Journal: Annals of the Rheumatic Diseases (2001)

<h3>Background</h3> Heterotopic periarticular ossification (PAO) is very common (more than 60%) after total hip replacement (THR). Without any prevention severe grades of Brooker 3 and 4 occur in about 20%. Grade 3 and 4 means also loss of function and sometimes pain. Prevention of severe grades (Brooker 3–4) is indicated in all cases of THR and is possible by radiation therapy or oral administration of NSAIDs like indometacin or diclofenac. <h3>Objectives</h3> Standard NSAIDs have the potential risk of severe gastrointestinal events (perforation, ulceration and bleeding, PUB). Especially patients with THR are usually old and suffering from many diseases. These patients have an increased risk of GI-complications. Rofecoxib is a selective inhibitor of COX-2 with reduced risk of PUBs. Although the cause and actions of PAO are not well understand it is generally accepted that COX-2 plays an important role. <h3>Methods</h3> In a prospective study we compared the results of 25 mg rofecoxib once daily on preventing severe PAO after THR with results of diclofenac out of the literature. Our 137 patients take 25 mg rofecoxib once daily starting on the first or second day after THR. The mean duration of drug administration was 13.8 days. 72 hips could be evaluated after 3 months, further 65 hips after 6 months. <h3>Results</h3> The ossification was evaluated on pre- and postoperative x-rays of the pelvis. There was no difference between the results after 3 and 6 months. 96 (70%) of the hips showed no signs of PAO, 40 (29%) hips had Brooker 1 (ossifications up to one cm), only one hip (1%) Brooker 2 and none of the hips had severe bone formation Brooker 3 or 4 (bridging ossification between femur and pelvis). Results of diclofenac or irradiation therapy in the literature show similar results: Brooker 1 and 2: 11–40% and no severe Brooker 3 and 4. <h3>Conclusion</h3> 25 mg of the COX-2 inhibitor Rofecoxib administered once daily after THR starting one or two days after surgery for 2 weeks can securely prevent the formation of periarticular ossification (PAO) of severe grade (Brooker 3 and 4). Minor ossification without functional impairment (Brooker 1–2) were found in 30%. 70% of the hips showed no signs of postoperative ossification. These findings are comparable to the results of prevention with irradiation therapy or standard NSAIDs like diclofenac (100–150 mg). <h3>References</h3> Brooker AF, Bowermann JW, Robinson RA, Riley LH. Ectopic ossification following THR: incidence and a method of classification. J Bone Joint Surg Am. 1973;55:1629–32 Eulert J, Knelles D, Barthel T. Heterotope Ossifikationen. Orthopäde 1997;6:399–406 Sell S, Willms R, Jany R, <i>et al</i>. The suppression of heterotopic ossification: radiation versus NSAID therapy – a prospective study. J Arthroplasty 1998;13:854–9
The Effectiveness of a Patient-Centred Assessment with a Solution-Focused Approach (DIALOG+) for Patients with Psychosis: A Pragmatic Cluster-Randomised Controlled Trial in Community Care
Authors: Stefan Priebe, Lauren Kelley, Serif Omer, Eoin Golden, Sophie Walsh, Husnara Khanom, David Kingdon, Clare Rutterford, Paul McCrone, Rosemarie McCabe
Journal: Psychotherapy and Psychosomatics (2015)

&lt;b&gt;&lt;i&gt;Background:&lt;/i&gt;&lt;/b&gt; DIALOG+ was developed as a computer-mediated intervention, consisting of a structured assessment of patients' concerns combined with a solution-focused approach to initiate change. This study tested the effectiveness of DIALOG+ in the community treatment of patients with psychosis. &lt;b&gt;&lt;i&gt;Method:&lt;/i&gt;&lt;/b&gt; This was a pragmatic, exploratory, parallel-group, cluster-randomised controlled trial. Clinicians within community teams - along with patients with psychosis under their care - were randomised to use DIALOG+ once per month for 6 months or an active control. The primary outcome (subjective quality of life, SQOL) and secondary outcomes were assessed after 3, 6 and 12 months by blinded assessors and analysed using mixed-effect models. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; A total of 49 clinicians and 179 patients were randomised. Implementation of DIALOG+ was variable, with an average of 1.8 sessions (SD = 1.6) in the first 3 months and 1.1 (SD = 1.2) in the following 3 months. Patients in the DIALOG+ arm had better SQOL at 3, 6 and 12 months (p = 0.035, 0.058 and 0.014, respectively; Cohen's d = 0.29-0.34). They also had significantly fewer unmet needs at 3 and 6 months, fewer general psychopathological symptoms at all time points and better objective social outcomes at 12 months, with no significant differences in other outcomes. Overall care costs were lower in the intervention group. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Despite variable implementation, DIALOG+ is a beneficial intervention for community patients with psychosis. As a non-expensive and potentially cost-saving, generic intervention, DIALOG+ may be widely used and may improve the effectiveness of community treatment. Further trials should test DIALOG+ in different patient groups and contexts.
Analysis of real world patient compliance to everolimus-based therapy among post-menopausal women with hormone receptor positive and human epidermal growth factor receptor 2 negative (HR+/HER2-) metastatic breast cancer (mBC).
Authors: Nicole Princic, Matthew Brouillette, Derek Tang, Chinjune Lin, Brad Lanoue, Victoria E. Barghout
Journal: Journal of Clinical Oncology (2017)

e12546 Background: Patient compliance, typically not captured in clinical trials, may have profound effects on treatment effectiveness. As there has been limited real-world data, the objective of this analysis was to examine compliance among HR+/HER2- mBC patients treated with everolimus as a second or later line of therapy in the US across age groups. Methods: In this retrospective cohort study, the MarketScan Commercial and Medicare Supplemental claims databases were used to select post-menopausal HR+/HER2- mBC women who initiated an everolimus-based line of therapy during 1/1/2013- 7/31/2016 study period. The first secondary malignancy diagnosis was the index date. Patients had 6 months of continuous enrollment in their health plans pre- and post- index, and were followed until the earliest of disenrollment, inpatient death, or end of study. Compliance was measured using medication possession ratio (MPR) during a second (2L), third (3L) and fourth (4L) line of therapy. MPR was defined as total days of supply of everolimus during the line of therapy divided by total duration of the line. Results: Of 645 eligible mBC patients treated with everolimus during follow-up, there were 239, 142, and 80 with a 2L, 3L, and 4L of therapy respectively. Mean age overall was 61.1 + 11.7 years and average duration of follow-up was 718.3 + 304.1 days. Across all patients the median MPR ranged during each line from 0.90-0.92 and the majority (93.8%-97.5%) were highly compliant to therapy (defined as MPR&gt;80%). These results were consistent for patients aged &lt;65 and 65+ years across a 2L, 3L, and 4L of therapy (Table). Conclusions: This study shows high compliance for everolimus-based therapy within a 2L, 3L, and 4L of therapy and this is consistent across ages. This real world data suggests good drug manageability and may provide valuable information for clinicians in selecting treatment for mBC. [Table: see text]
Anger is a means of coping with illness
Authors: R P Snaith
Journal: BMJ (1995)

Dying for palliatve care General practitioners have a crucial role EDrTOR,-The anonymous diary of a surgeon's death arouses compassion but also suggests that the general practitioner, who has a crucial role in palliative care, played a small part.'The general practitioner made a referral to hospital in August 1993 but seems to have had no part in the first two admissions, the decision to go to South Africa, or the subsequent hospital based treatment in March 1994 after the diagnosis of leukaemia.Serious difficulties in communication and considerable distress are described, but all we are told is that, three days after discharge from hospital, on 12 July, "Our GP called: asked for the third time
Improved use of clinical variables for prognosis of distant recurrence in patients with ER+ breast cancer treated with 5 years endocrine therapy.
Authors: Ivana Sestak, Belinda Yeo, Andrew Dodson, Mitch Dowsett, Jack M. Cuzick
Journal: Journal of Clinical Oncology (2016)

566 Background: We have previously reported the development and prognostic performance of the Clinical Treatment Score (CTS) within the transATAC cohort of 1125 patients. In the old model, tumour size was categorised into three and nodal status into two categories, and it became clear that prognostic information was lost. The aim of this analysis was to re-model the CTS by allowing for finer gradation of tumour size and number of positive nodes in postmenopausal women with ER+, HER2-negative disease treated with tamoxifen or anastrozole. Methods: 1009 postmenopausal women with ER+ and HER2-negative breast cancer were included. Women with HER2-positive disease were excluded due to non-applicable prediction value for this subgroup. Distant recurrence was the primary endoint. Proportional hazard models were used to re-estimate the new CTS and Akaike Information Criterion (AIC) was used to compare models. Results: The new CTS model included five categories for nodal status, a continuous term for tumour size, and excluded age as not informative compared to the old model. Our results showed that the log hazard was almost linear on five nodal status groups but not for continuous tumour size alone and therefore a quadratic term was necessary (ΔLR-chi2= 18.07). Treatment and grade remained highly significant in the new model. The final improved model included tumour size as a continuous term, quadratic tumour size, nodal status (five groups) and grade (three groups) in a linear fashion, and treatment (anastrozole versus tamoxifen). The new model performed better than the old one (AIC: 1385.32 vs. 1401.30, respectively). The model performed similarly well in 4392 patients from the main ATAC trial who did not receive chemotherapy, but were of unknown HER2-status. Conclusions: The new CTS model is more accurate in its prediction of residual distant recurrence risk than the old model. Most importantly the new model avoids inappropriate changes of risk groups as tumour size and nodal status are used in a linear fashion. Our results apply only to postmenopausal women with HER2-negative disease. Independent validations are needed to determine the general applicability of this new CTS model.
EFFECTIVENESS OF AN INTERMITTENT EXERCISE-HEAT EXPOSURE PROTOCOL TO SUSTAIN HEAT ACCLIMATION ADAPTATIONS
Authors: J. Luke Pryor, Riana Pryor, Douglas Casa, Lawrence Armstrong, Lindsay DiStefano, Jeffrey Anderson, Elaine Lee, Carl Maresh
Journal: British Journal of Sports Medicine (2017)

Background Heat acclimation (HA) reduces the risk of exertional heat illnesses (EHI). However, HA adaptations are temporary and must be sustained to safely perform physical activity in hot environments. Objective To determine if intermittent exercise-heat exposures every fifth day mitigates HA decay, 25 days after initial HA (+25 d). Design Randomized pair-matched design. Setting Laboratory. Participants Sixteen non-heat acclimatized recreationally active males (age=22.7±3.4 y; weight=72.9±7.8 kg; VO 2max =55.0±5.5 ml·kg −1 ·min −1 ). Interventions All participants heat acclimated by completing 10–11 days of low-to-moderate intensity exercise (90–240 min; 40°C, 40%RH). A heat stress test (HST; 120 min, 45% VO 2max ) before (Pre) and after (Post) HA in similar hot conditions assessed HA status. Matched participants were randomly allocated into a control group receiving no heat exposure (CON; n=7) or treatment group receiving intermittent heat exposure (IHE; n=9). After the Post HA HST, participants completed an HST every fifth day for 25 days in either a hot (IHE; 40°C, 40%RH) or mild environment (CON; 24°C, 21%RH) with both groups exercising in the hot environment +25 d. Main Outcome Measurements Rectal temperature (T re ), heart rate (HR), and sweat rate (SR). Results Both groups accomplished HA after the 10–11 day initial protocol, as evidenced by lower post-exercise HR and T re , with higher SR compared to Pre HA (p≤0.05). Moderate-to-large between-treatment mean differences (MD; CON-IHE) and effect sizes (ES) were observed for HR (MD=28 bpm, 95% CI [8, 48], ES=1.41) and T re (MD=0.47°C, 95% CI [−0.24, 1.19], ES=0.68) but not SR (−0.13 L·hr −1 , 95% CI [−0.47, 0.21], ES=0.36). At +25 d, HA adaptation decay was greater in CON than IHE (T re : 87% vs. 2.7%; HR: 163% vs. 53%; SR: 77% vs. 70%). Conclusions Periodic exercise-heat exposures every five days after initial HA better sustained HR and T re in the IHE, suggesting periodic exercise-heat exposures may help reduce EHI risk for up to one month after initial HA.
Optimum clinical outcome after nissen fundoplication is related to both acid normalisation and improved oesophageal motility
Authors: N Ravi, N Al-Sarraf, T Moran, J O'Riordan, S Rowley, PJ Byrne, JV Reynolds
Journal: Endoscopy (2005)

Background and Aims: Severe GORD can lead to oesophageal dysmotility. Total rather than partial wrap is controversial in the surgical treatment of GORD.
Copy number analysis by high resolution cytogenetic analysis affymetrix oncoscan FFPE array of intraductal papillary neoplasms of the pancreas.
Authors: Silvia Vecchiarelli, Sandra Durante, Elisa Grassi, Annalisa Astolfi, Riccardo Panzacchi, Donatella Santini, Salvatore Serravalle, Riccardo Casadei, Claudio Ricci, Mirella Falconi, Gabriella Teti, Guido Biasco, Mariacristina Di Marco
Journal: Journal of Clinical Oncology (2016)

e13009 Background: Intraductal papillary mucinous neoplasm (IPMN) is the most common cystic precancerous lesion of pancreatic cancer (PDA). We used an approach coupling high resolution cytogenetic analysis (Affymetrix Oncoscan FFPE Array) with a clinically-oriented bioinformatic interpretation of data to understand what are the most relevant pathways altered in precursor lesions and overt cancers to identify new therapeutic options for patients affected by PDA. Methods: High resolution cytogenetic analysis was performed in 20 formalin fixed paraffin embedded samples of IPMN by Oncoscan FFPE assay. Genomic data were analysed for copy number gains and losses, loss of heterozygosity and for a panel of recurrent somatic mutations. Results were validated by qPCR and FISH analysis. Results: Of the 20 IPMNs 8 (40%) were multifocal, 8 (40%) were in the pancreatic head and 4 (20%) involved pancreatic body and tail. Macroscopically 14 samples (70%) were mixed-type, while 4 (20%) branch-duct type and 2 (10%) main-duct type. In 5 IPMNs (25%) were identified micro-invasive carcinoma ( < 1 mm), while in 2 (10%) were associated an invasive carcinoma. We identified multiple copy number alterations and interestingly, differences were seen in 12 of the 20 tumor lesions ,8 IPMN with nearly normal karyotype ( < 4 alterations) and 12 IPMN with complex Karyotype ( > 10 alterations). A specific gain of arm 3q was found in IPMN with complex Karyotype (60%). This gain of 3q is particular interesting for the presence of oncogenes such as PIK3CA , GATA2 and TERC that are part of pathways that deregulate cell growth and increase the progression. Real Time and FISH results showed an amplification of 3q in patients IPMN complex Karyotype compared with IPMN normal Karyotype confirming the data obtained from the Oncoscan. Further demonstration of the overexpression of the gene PIK3CA contained within 3q them while as possible biomarkers in the early identification of patients with IPMN complex karyotype. Conclusions: The identification of these early-stage markers could aid the selection of patients that could benefit from surgery or a targeted therapy before the disease progression.
Assisted death in “healthy” old age needs consideration
Authors: Simon Kenwright
Journal: BMJ (2017)

Congratulations to the Dutch for considering old age as possible grounds for assisted death. Van Wijngaarden and colleagues reject this, emphasising the need to look at social context,1 but their weakness is in seeing marginalisation of the very old as preventable. Attempts at integration are often unsuccessful and sometimes paternalistic. Where skills are thought to be maintained into old age, …
Primary biliary cirrhosis (PBC) with positive anti-mitochondrial antibody (AMA) and negative M2 subfraction – a cautionary tale
Authors: D Kevans, N Ralph, M Keogan, EW Kay, FE Murray
Journal: Endoscopy (2006)

Introduction: PBC is almost invariably associated with M2-AMA positivity. We report a series of 4 patients who presented with a PBC-like syndrome, with positive AMA and invariably elevated IgM, in whom the M2 sub-fraction was negative by immunoblot technique. Subsequent external testing for M2 by ELISA was positive
Rate of breast conserving surgery versus mastectomy in Hispanic/Latina women with breast cancer in El Paso, TX.
Authors: Gehan Botrus, Alok kumar Dwivedi, Zeina A. Nahleh
Journal: Journal of Clinical Oncology (2016)

e12052 Background: Breast conserving therapy is one of the major advances in breast cancer over the past two decades. However, socioeconomic barriers and ethnic disparities still exist that preclude patients from receiving breast-conserving therapy. The current study aimed at determining the rate of mastectomy versus breast-conserving surgery in a low income Hispanic population at our institution and assesses factors that might affect disparity in surgical options. Methods: After obtaining IRB approval, we retrospectively used our Breast Cancer Database and reviewed consecutive cases between 2011-2013 and determined clinical characteristics. Unpaired and Fisher’s exact tests were used to compare the clinical and demographic characteristics between the two types of surgery. A multiple logistic regression was used to determine the factors associated with lumpectomy as compared with mastectomy. Results: A total of 265 patients were included a. The rate of lumpectomy was found to be 190(71.7%) while mastectomy was 75(28.3%). The distribution of age, BMI, ER, and PR were not significantly different between two types of surgery. Most of the early stage (1 and 2) patients received lumpectomy (79.8%) while only 20.2% of this stage received mastectomy (p < 0.0001). Conclusions: Our data showed that breast conserving surgery is higher than mastectomy in early stage breast cancer and higher than national average (60%) in our Hispanic breast cancer patients. This confirms that Hispanic women with early breast cancer in El Paso, TX have a lower rate of mastectomy. This is reassuring and indicates that Hispanic breast cancer patients treated at the Mexican-Border city of El Paso, TX receive their surgical care in accordance with accepted national guidelines.