tbuckley/cabot-search huggingface dataset:
Abstract P1-08-06: Changes in breast cancer diagnosis and treatment after Medicaid expansion in Pennsylvania
Authors: N Spada, E Geramita, G van Londen, L Sabik
Journal: Cancer Research (2019)

Abstract Background: In January 2015, Pennsylvania expanded Medicaid eligibility to all legally present adults in the Commonwealth of Pennsylvania with household incomes up to 138 percent of the federal poverty level under the Affordable Care Act. Pennsylvania is the most populous state to expand Medicaid that did not previously have a large expansion of the program to adults, making it an ideal setting to study the impacts of the program. By March 2017, an estimated 716,000 people had enrolled in Pennsylvania's expanded Medicaid program. We aim to determine how Pennsylvania's Medicaid expansion has impacted breast cancer diagnosis and treatment in the state. Methods: The Pennsylvania Cancer Registry was queried for all women aged 18 to 64 years newly diagnosed with breast cancer between 2007 and 2015. Demographic, tumor, and treatment characteristics were evaluated for each year during this time span. In order to assess the impact that Medicaid expansion had on these variables, they were compared for the years 2007 to 2014 (before Medicaid expansion) and the year 2015 (after). Results: Between 2007 and 2015, 49,606 cases of invasive breast cancer were diagnosed among women aged 18-64 and residing in the state of Pennsylvania, 43,920 of which were diagnosed and treated between 2007 and 2014, and 5,686 of which were diagnosed and treated in 2015. Initial analysis indicates that more women were diagnosed with localized breast cancer (SEER summary stage 1) following Medicaid expansion in 2015 compared to the period of 2007 to 2014 (63.07% v. 60.62%, p = 0.0004). Meanwhile, the proportion of women diagnosed with metastatic breast cancer did not change before and after Medicaid expansion (6.52% v. 6.86%, p = 0.3298). Subsequent analysis will assess changes in treatment outcomes including time to treatment and receipt of guideline-concordant care. Conclusion: The expansion of Medicaid in Pennsylvania in 2015 under the Affordable Care Act resulted in an increase in the proportion of localized (SEER summary stage 1) breast cancer diagnoses, though there was no change in the proportion of metastatic cases in the first year following expansion. The results suggest a possible increase in earlier stage diagnosis associated with increased access to health insurance. Additional analysis will examine the impact on treatment-related outcomes. Citation Format: Spada N, Geramita E, van Londen G, Sabik L. Changes in breast cancer diagnosis and treatment after Medicaid expansion in Pennsylvania [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-06.
Is more choice always better?
Authors: Richard Bagshaw
Journal: BMJ (2010)

Greater choice is always better for patients, right? The regulatory body for doctors in the United Kingdom, the General Medical Council, certainly thinks so. At the heart of their guidance for doctors is the principle that patients have the right to self determination. The doctor’s role is to inform, counsel, and empower but not to choose on the patient’s behalf. UK policymakers also aspire to promote patient choice. Reforms of the National Health Service aim to transform it from state monopoly to a diverse healthcare marketplace, where patient-consumers can shop around for the doctors, hospitals, and treatments they want. The result is that, increasingly, doctors and healthcare systems are divesting themselves of responsibility for decision making. By …
Abstract 3839: Is recent decline in breast cancer incidence equal across different US racial groups?
Authors: Dezheng Huo, Olufunmilayo I Olopade
Journal: Cancer Research (2008)

Abstract Background: Recently, a sharp decline in breast cancer incidence rate was observed between 2002 and 2003 in the United States, evident only in women aged 50 years or older and for estrogen-receptor positive breast cancer. The plausible explanations for the decline have been controversial. Moreover, it is unclear if the reduction in incidence is equally distributed across all racial groups or whether the trends in breast cancers of different stages are similar. Methods: We examined temporal trends between 2000 and 2004 in invasive and in situ female breast cancer by race and tumor stage, using data from 17 cancer registries of the Surveillance, Epidemiology, and End Results program. Incidence rates were age-adjusted to the 2000 US standard population. We used jointpoint regressions to fit a series of joined straight lines on a log scale to the trends of quarterly, age-adjusted rates in women aged 50 to 69 years. Results: In Caucasian women, the incidence rate of invasive breast cancer was stable from 2000 to mid-2002 (-0.15% per quarter), significantly decreased to the end of 2003 (-2.41% per quarter, p=0.004), and stable to the end of 2004 (0.63% per quarter). Similar trends were seen for the rates of localized tumors and regional and distant tumors in Caucasians. The incidence rate of invasive breast cancer did not change significantly in the other racial groups: the quarterly changes throughout the study period were 0.07% in African Americans, -0.14% in American Indian/Alaska Natives, and -0.46% in Asian American/Pacific Islanders. The incidence rate of in situ breast cancer was stable in Caucasians (-0.23% per quarter), African Americans (0.26% per quarter), and American Indian/Alaska Natives (-0.97% per quarter). In Asian American/Pacific Islanders, the rate of in situ breast cancer was marginally significantly increased from 2000 to the mid-2002 (2.09% per quarter, p=0.054) but decreased to the end of 2004 (-3.20% per quarter, p=0.01). Conclusions: The decline in breast cancer incidence was not equal across US racial groups and the benefit was confined to Caucasians. This racial disparity is consistent with the hypothesis that discontinuation of hormone replacement therapy (HRT) may have caused the dramatic reduction. Compared with Caucasians, African Americans are more likely to have estrogen receptor negative tumors and less likely to use HRT, and thereby less likely to show a benefit from discontinuation of HRT. The finding that the rate of invasive breast cancer (but not in situ cancer) decreased suggests that exogenous estrogen serves as a promoter rather than an initiator of breast cancer. The trend of in situ cancer in Asian American/Pacific Islanders may be a result of slower uptake of mammographic screening in this population.
Abstract 1210: Mifepristone abrogates repopulation of ovarian cancer cells in between courses of cisplatin treatment
Authors: Elizabeth M Freeburg, Alicia A Goyeneche, Carlos M. Telleria
Journal: Cancer Research (2008)

Abstract Repopulation of cancer cells that escape cytotoxic chemotherapy is a critical factor that negatively impacts treatment success. Thus, any strategy that prevents this phenomenon from occurring would be beneficial for the outcome of the treatment. One such strategy to inhibit tumor cell repopulation is the use of cytostatic compounds among courses of cytotoxic therapy. In this study, we tested the hypothesis that mifepristone, a steroid compound displaying a potent cytostatic effect in ovarian cancer as recently demonstrated in our laboratory (Clin Cancer Res 2007, 13, 3370-3379), should be efficacious to induce cytostasis and to prevent ovarian cancer repopulation if given in between rounds of cisplatin therapy. We established an in vitro approach in which OV2008 cisplatin-sensitive ovarian cancer cells were exposed to three rounds of a cytotoxic dose (20 μM) of cisplatin for 1 h, twelve days apart. Every four days the number of cells, their viability, and their distribution within the cell cycle were assessed by micro-cytometry using exclusion fluorochromes and propidium iodide, respectively. Further, the colony-forming capacity of the viable cells was evaluated along the experiment. Although cisplatin killed the vast majority of OV2008 cells, there were cells that escaped cisplatin toxicity and repopulated the culture. This phenomenon occurred each one of the three times the cells were challenged by cisplatin during the 36 days the study lasted. Post-cisplatin repopulation was evidenced by the increase in number and clonogenic capacity of the viable cells, the normalization in the distribution of cells within the different phases of the cell cycle (S, G1 and G2/M), and the concomitant reduction in sub-diploid DNA content (as marker of cytotoxicity). Instead, when the cells were exposed to cisplatin for 1 h, but 5, 10 or 20 μM mifepristone was present in the culture medium after removal of the platinum agent, both number of cells and their clonogenic capacity were reduced in a dose-related manner. Remarkably, the cultures exposed to cisplatin for 1 h followed by chronic exposure to 20 μM mifepristone did not have remaining viable cells to allow performing the clonogenic survival assay by day 12 of the study, suggesting an added lethality to the cytostatic effect of mifepristone. In conclusion, this study demonstrates that presence of cytostatic concentrations of mifepristone prevents the repopulation of ovarian cancer cells surviving the lethality of cisplatin, and further suggests mifepristone may potentiate cisplatin toxicity. The scheduling of mifepristone between courses of cisplatin-based therapy for human ovarian cancer has potential for improving treatment success. Supported by NIH grant CA121991.
Abstract P6-06-01: Lobular involution reduces breast cancer risk through downregulation of invasive and proliferative cellular processes
Authors: DC Radisky, DW Visscher, ML Stallings-Mann, MH Frost, TM Allers, AC Degnim, LC Hartmann
Journal: Cancer Research (2012)

Abstract Background: Age-related lobular involution (LI) is a physiological process, usually accelerated with menopause, in which the epithelial tissue of the breast gradually regresses. Our previous analysis of a cohort of more than 14,000 women who had a benign breast biopsy at the Mayo Clinic revealed that women who had undergone LI were at significantly reduced risk of subsequent breast cancer development. In our studies of postmenopausal women specifically, we found that more than 40% had not completed the process of LI, and that the increased breast cancer incidence in older women was strongly associated with incomplete LI. We sought to determine the potential protective mechanistic effects of lobular involution. Methods: We generated primary human mammary epithelial cell lines (HMECs) from breast biopsies of women who showed no LI (N = 6), partial LI (N = 7), or complete LI (N = 6). These cell lines were analyzed for proliferation in culture and profiled for genomic signatures using Affymetrix gene arrays. We also analyzed RNA isolated from a cohort of archived formalin-fixed, paraffin-embedded (FFPE) benign breast biopsy samples from postmenopausal women who had either completed the process of LI (N = 4) or who had not initiated LI (N = 8) for genomic signatures using Whole-Genome DASL Assays. Results: We found that LI was associated with decreased cellular proliferation and inhibition of processes associated with tumor development and progression. Specifically, we found that HMECs derived from benign breast biopsies in which LI was not evident showed increased proliferation and elevated expression of Twist (p = 0.002), a transcription factor associated with epithelial-mesenchymal transition (EMT) and breast cancer development. We are assessing differentially expressed genes for association with breast cancer risk using a nested case:control group of benign breast biopsies from women in our cohort who subsequently developed breast cancer (N = 85) vs those who did not (N = 142) and for whom LI status at the time of initial biopsy was known. Conclusions: LI may decrease cancer risk through inhibition of key tumorigenic processes. Identification of processes associated with the physiologic risk reduction seen with LI may provide insight into novel avenues for risk reduction. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-06-01.
Elective ethics: doing more harm than good?
Authors: Neil Graham
Journal: BMJ (2010)

Did you hear the one about the medical student who did a caesarean section on elective? It goes a little like this: a woman arrives at hospital miles from anywhere with an obstructed labour. The medics are away on “urgent business” elsewhere, and the student seizes the scalpel, saving mother and baby. Backslapping occurs all round.

Less well known is the tale of the student who, rather too comfortable in a borrowed white coat, intervenes, kills both, and contracts HIV from a needlestick injury. Probably he’ll be less inclined to boast about this when he gets home. It would seem that gossip, not unlike research, is subject to a publication bias of sorts.

It’s the classic pre-elective conundrum, but there are broader ethical issues to consider before deciding to take an elective in a resource poor setting than whether non-experts should perform new procedures in emergencies. Many of these questions don’t receive the attention they should, and with changing consensus about what constitutes ethically sound practice, hosts …
Abstract P1-15-01: Withdrawn
Authors: O Metzger Filho, M Janiszewska, H Guo, D Yardley, I Mayer, L Spring, C Arteaga, E Wrabel, M DeMeo, R Freedman, S Tolaney, A Waks, A Bardia, H Parsons, A Partridge, E Mayer, T King, K Polyak, G Viale, E Winer, I Krop
Journal: Cancer Research (2019)

Abstract This abstract was withdrawn by the authors. Citation Format: Metzger Filho O, Janiszewska M, Guo H, Yardley D, Mayer I, Spring L, Arteaga C, Wrabel E, DeMeo M, Freedman R, Tolaney S, Waks A, Bardia A, Parsons H, Partridge A, Mayer E, King T, Polyak K, Viale G, Winer E, Krop I. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-01.
DNA Nanostructures: The Growing Development of DNA Nanostructures for Potential Healthcare‐Related Applications (Adv. Healthcare Mater. 9/2019)
Authors: Divita Mathur, Igor L. Medintz
Journal: Advanced Healthcare Materials (2019)

Deoxyribonucleic acid (DNA) nanotechnology is a versatile tool for engineering complex nanostructures. Among bioapplications currently being pursued is healthcare. In article number 1801546, Divita Mathur and Igor L. Medintz discuss aspects of DNA nanotechnology that make it useful for this purpose, how its biocompatibility is being optimized, and the state-of-the-art developments in biomolecular sensing, imaging, and drug delivery along with major challenges remaining for translation.
CD8+ T Cells Promote Maturation of Liver‐Resident NK Cells Through the CD70‐CD27 axis
Authors: Lu Bai, Hui Peng, Xiaolei Hao, Ling Tang, Cheng Sun, Meijuan Zheng, Fubao Liu, Zhexiong Lian, Li Bai, Haiming Wei, Rui Sun, Zhigang Tian
Journal: Hepatology (2019)

Liver‐resident natural killer (LrNK) cells are a unique subset of NK cells that are distinct from conventional NK cells. However, little is known about the mechanisms by which LrNK cells mature. In this study, we discovered that LrNK cells exhibit a relatively immature phenotype and impaired cytotoxic capacity in the absence of CD8 + T cells. The provision of CD8 + T cells to Cd8‐/‐ or Rag1‐/‐ mice led to the restoration of LrNK cell maturation. Furthermore, co‐culture with CD8 + T cells induced immature CD27 + LrNK cells to convert into mature CD27 ‐ LrNK cells, whereas blocking the interaction of CD70 and CD27 abrogated the ability of CD8 + T cells to promote the maturation of LrNK cells. Conclusion: Our findings indicate that CD8 + T cells promote the maturation of LrNK cells through the CD70‐CD27 axis, and therefore highlight a previously unknown mechanism responsible for the mediation of LrNK cell maturation.
Abstract 218: Nuclear Remodeling Following Mechanical Circulatory Support
Authors: Jun Luo, Stephen Farris, Deri Helterline, April Stempien-Otero
Journal: Circulation Research (2017)

Rationale: Cardiomyocytes increase DNA content in normal growth and in response to stress in humans by both increases in nuclear number and ploidy. This observation complicates the analysis of human cardiomyocyte proliferation as DNA content can increase in the absence of cytokinesis. Proliferation has been reported in cardiomyocytes following LVAD unloading which may represent a reversal of this process. However, cardiac recovery from LVAD is rare. Thus, we sought to analyze changes in cardiomyocyte nuclear characteristics for clues to this paradox. Objective: We used a novel technique-imaging flow cytometry-to determine changes in nuclear content to test the hypothesis that adult cardiomyocytes can complete cell cycle progression by mitosis after long-term hemodynamic unloading of the failing heart. Methods and Results: Cardiomyocytes were isolated from 8 subjects undergoing primary heart transplantation and 15 subjects following unloading with left ventricular assist device (LVAD, mean unloading time 13.7 ± 9.1 months). Myocyte size, nuclear number and size, DNA content (per cell and per nucleus) and the frequency of cell cycling markers were evaluated by imaging flow cytometry. Myocyte size and nuclear morphology was not significantly different between the groups. However, DNA content per nucleus was significantly decreased (P &lt; 0.01) and the correlation between nuclear size and DNA content lost. The frequency of the cell cycle markers, Ki67 and phospho-histone3 (H3P) were not increased after hemodynamic unloading. Conclusions: Our data demonstrate that unloading of failing hearts with mechanical ventricular assist devices does not alter nucleation state of cardiomyocytes. However, unloading is associated with decreased DNA content of nuclei independent of nucleation state within the cell. As these changes were associated with a trend to decreased cell size but not increased cell cycle markers, they may represent a regression of hypertrophic nuclear remodeling.
Axitinib plus pembrolizumab in patients with advanced sarcomas including alveolar soft-part sarcoma: a single-centre, single-arm, phase 2 trial
Authors: Breelyn A Wilky, Matteo M Trucco, Ty K Subhawong, Vaia Florou, Wungki Park, Deukwoo Kwon, Eric D Wieder, Despina Kolonias, Andrew E Rosenberg, Darcy A Kerr, Efrosyni Sfakianaki, Mark Foley, Jaime R Merchan, Krishna V Komanduri, Jonathan C Trent
Journal: The Lancet Oncology (2019)
The plot against the NHS: what you need to know
Authors: Fady Atia
Journal: BMJ (2014)

If you are a medical student in the United Kingdom, you will know something about the NHS reorganisation, but you might not fully understand the impact the changes will have on the health system. In The Plot against the NHS , Colin Leys and Stewart Player analyse the reforms and the ideas behind them. It is an essential read for medical students wanting to work in the UK who will need to understand where our health system is heading.

Starting with the concordat between the Department of Health and the Independent Healthcare Association in 2000 and finishing with the Health and Social Care Bill in 2011, the authors draw a clear picture of the vision …
Abstract P1-08-01: Withdrawn
Authors: MJ Schoemaker, HB Nichols, LB Wright, MN Brook, ME Jones, KM O'Brien, H-O Adami, L Baglietto, L Bernstein, KA Bertrand, M-C Boutron-Ruault, Y Chen, AE Connor, M Dorronsoro, L Dossus, AH Eliassen, GG Giles, IT Gram, SE Hankinson, R Kaaks, TJ Key, VA Kirsh, CM Kitahara, W-P Koh, SC Larsson, MS Linet, H Ma, G Masala, MA Merritt, RL Milne, K Overvad, K Ozasa, JR Palmer, E Riboli, TE Rohan, A Sadakane, M Sund, RM Tamimi, A Trichopoulou, G Ursin, CH Van Gils, K Visvanathan, E Weiderpass, WC Willett, A Wolk, J-M Yuan, A Zeleniuch-Jacquotte, DP Sandler, AJ Swerdlow
Journal: Cancer Research (2019)

Abstract This abstract was withdrawn by the authors. Citation Format: Schoemaker MJ, Nichols HB, Wright LB, Brook MN, Jones ME, O'Brien KM, Adami H-O, Baglietto L, Bernstein L, Bertrand KA, Boutron-Ruault M-C, Chen Y, Connor AE, Dorronsoro M, Dossus L, Eliassen AH, Giles GG, Gram IT, Hankinson SE, Kaaks R, Key TJ, Kirsh VA, Kitahara CM, Koh W-P, Larsson SC, Linet MS, Ma H, Masala G, Merritt MA, Milne RL, Overvad K, Ozasa K, Palmer JR, Riboli E, Rohan TE, Sadakane A, Sund M, Tamimi RM, Trichopoulou A, Ursin G, Van Gils CH, Visvanathan K, Weiderpass E, Willett WC, Wolk A, Yuan J-M, Zeleniuch-Jacquotte A, Sandler DP, Swerdlow AJ. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-01.
The symptom‐specific efficacy of antidepressant medication vs. cognitive behavioral therapy in the treatment of depression: results from an individual patient data meta‐analysis
Authors: Lynn Boschloo, Ella Bekhuis, Erica S. Weitz, Mirjam Reijnders, Robert J. DeRubeis, Sona Dimidjian, David L. Dunner, Boadie W. Dunlop, Ulrich Hegerl, Steven D. Hollon, Robin B. Jarrett, Sidney H. Kennedy, Jeanne Miranda, David C. Mohr, Anne D. Simons, Gordon Parker, Frank Petrak, Stephan Herpertz, Lena C. Quilty, A. John Rush, Zindel V. Segal, Jeffrey R. Vittengl, Robert A. Schoevers, Pim Cuijpers
Journal: World Psychiatry (2019)

A recent individual patient data meta‐analysis showed that antidepressant medication is slightly more efficacious than cognitive behavioral therapy (CBT) in reducing overall depression severity in patients with a DSM‐defined depressive disorder. We used an update of that dataset, based on seventeen randomized clinical trials, to examine the comparative efficacy of antidepressant medication vs. CBT in more detail by focusing on individual depressive symptoms as assessed with the 17‐item Hamilton Rating Scale for Depression. Five symptoms (i.e., “depressed mood” , “feelings of guilt” , “suicidal thoughts” , “psychic anxiety” and “general somatic symptoms”) showed larger improvements in the medication compared to the CBT condition (effect sizes ranging from .13 to .16), whereas no differences were found for the twelve other symptoms. In addition, network estimation techniques revealed that all effects, except that on “depressed mood” , were direct and could not be explained by any of the other direct or indirect treatment effects. Exploratory analyses showed that information about the symptom‐specific efficacy could help in identifying those patients who, based on their pre‐treatment symptomatology, are likely to benefit more from antidepressant medication than from CBT (effect size of .30) versus those for whom both treatments are likely to be equally efficacious. Overall, our symptom‐oriented approach results in a more thorough evaluation of the efficacy of antidepressant medication over CBT and shows potential in “precision psychiatry” .
When is the best time in your career to start a family?
Authors: Caroline Elton
Journal: BMJ (2016)

#### Dear Caroline

I will be 30 years old at graduation and I would like to have a family at some point. Is there any particular point during specialty training where it is easier to take time out to have a child?

Natalie Smith, fourth year medical student, King’s College London

Planning a baby is not like planning a holiday, or even a wedding. Some couples are lucky enough to conceive the first month they try—but for many others, the issue of timing is much less straightforward. I …