tbuckley/cabot-search huggingface dataset:
Abstract P5-13-11: Impact of public health insurance “Seguro Popular” on breast cancer recurrence at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City
Authors: L Mejía-Fernández, H Medina-Franco, A Armengol-Alonso
Journal: Cancer Research (2019)

Abstract Introduction. Public health insurance called Seguro Popular (SP) for breast cancer treatment (BCT) was instituted in Mexico in 2007. Our third level center was enrolled until 2011. SP covers systemic BCT (WHO 20th model list essential medicines). The aims were: 1) Describe frequency and type of breast cancer recurrence (BCR), 2) compare which factors were contributing to recurrence of breast cancer patients (pts) before and after the implementation of SP. Methods. Pts with diagnosis of breast cancer (BC) from 2004 to 2018 were analyzed and pts with BCR whom primary tumor (PBC) was treated and followed at INCMNSZ were recruited. They were divided into two groups according to access to SP: pts without Seguro Popular (non-SP) and, pts with SP. Xi-square, non-parametric tests and Kaplan-Meier curves (log-rank test) were used. Logistic regression was done for multivariate analysis. A p-value &amp;lt;0.05 was considered significant. Results. Between 2004 and 2018, 929 pts with BC were diagnosed; 438 non-SP and 473 SP. Ninety-one (9.7%) had a BCR (loco-regional or distant) during this period. Median follow-up was 125 months. The BCR proportion was higher within non-SP than in SP (74 (16.8%) vs 17 (3.5%) pts) (p=&amp;lt;0.05). Median age at diagnosis was higher in non-SP (p=0.028). Distant relapses were higher in non-SP than in SP (44 (59.4%) vs 8 (47%) pts). St Gallen 2017 Luminal A/B subtypes were most common in non-SP compared to SP where Basal-like subtype was higher (p=0.048). Luminal-A subtype had the best survival among non-SP compared to SP in which HER2 non-luminal had the higher survival (p&amp;lt;0.001). Conclusions. Experience with SP at our center shows promising results in the improvement of BCR. Access to adequate systemic management (hormone-blocking and HER2 targeted therapy) has a positive impact on recurrence, disease-free survival, and cancer-specific global survival. A longer follow-up time is required in the SP group (prospective cohort) to confirm these findings, especially in luminal tumors with late recurrence risk. Efforts should be made in the Mexican public health system to secure basic and continuous access to BCT. Citation Format: Mejía-Fernández L, Medina-Franco H, Armengol-Alonso A. Impact of public health insurance “Seguro Popular” on breast cancer recurrence at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City [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 P5-13-11.
Abstract OT3-02-05: CORALLEEN: A phase 2 clinical trial of chemotherapy or letrozole plus ribociclib as neoadjuvant treatment for postmenopausal patients with luminal B/HER2-negative breast cancer
Authors: J Gavila, C Saura, M Oliveira, E Ciruelos, X Gonzalez, L de la Peña, B Bermejo de las Heras, M Muñoz, P Fernandez, P Villagrasa, V Ortega, R Lopez, P Celiz, T Pascual, A Prat
Journal: Cancer Research (2019)

Abstract Background: Dysregulation of cyclin D-CDK4/6-Rb pathway is associated with endocrine resistance in hormone receptor–positive (HR+) breast cancer. Recently, a CDK4/6 inhibitor has shown unprecedented efficacy in metastatic disease, leading to its regulatory approval. Several others are currently in clinical development for the management of HR+ breast cancer in the early and advanced settings. However, it is vital to gain insights into the molecular and biological effects of this class of agents and could identify patients who can benefit the most, delaying or avoiding the use of chemotherapy.The neoadjuvant setting provides an ideal scenario to carry out these investigations. Hence, we propose to conduct an exploratory study to evaluate the biological effects and the efficacy of ribociclib in patients with primary luminal B tumors. We hypothesize that the combination of ribociclib plus letrozole may offer clinical benefit in the preoperative setting. Methods: This is a parallel, multicenter, two-arm, randomized exploratory study in postmenopausal women with primary operable HR+/HER2-negative Luminal B breast cancer designed to evaluate the clinical benefit of ribociclib plus letrozole. Eligibility includes stage I-III operable breast cancer, Luminal B by PAM50, ECOG 0-1. They will be randomized 1:1 to receive either six 28-days cycles of ribociclib (600mg; 3-weeks-on/1-week-off) plus daily letrozole (2.5mg) or chemotherapy: four cycles of AC (doxorubicin 60 mg/m2, cyclophosphamide 600 mg/m2 every 21 days) followed by weekly paclitaxel during 12 weeks. Baseline, Day 15 on-treatment, and surgical specimens will be collected for molecular characterization and evaluation of response (decrease in Ki67, change to ROR low disease) The primary endpoint is the rate of Residual Cancer Burden (RCB) per MD Anderson Cancer Center procedures. A rate of RCB 0 and 1 score at surgery, with a rank between 20% to 25% with 47 evaluable patients by group of treatment will offer a precision between 11.5% and 12.4%, respectively (95%CI). Ninety-four patients will be enrolled in 21 sites across Spain. The trial was activated in July 2017. As of June 2018, 78 patients have been recruited. Citation Format: Gavila J, Saura C, Oliveira M, Ciruelos E, Gonzalez X, de la Peña L, Bermejo de las Heras B, Muñoz M, Fernandez P, Villagrasa P, Ortega V, Lopez R, Celiz P, Pascual T, Prat A. CORALLEEN: A phase 2 clinical trial of chemotherapy or letrozole plus ribociclib as neoadjuvant treatment for postmenopausal patients with luminal B/HER2-negative breast cancer [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 OT3-02-05.
If I should practise . . .
Authors: Sameera Rashid
Journal: BMJ (2012)

I live in Pakistan where 70% of the women choose not to work outside the home. Most of them become housewives. It might seem more desirable to stay at home, raise a family, and adopt a traditional lifestyle.

In my country the value of a housewife is never underestimated. Women are seen as devoted mothers, wives, and as the powerhouses behind men’s success. Working women can be gossiped about and labelled as “busy, selfish, and inattentive to their children.”

Women make up only 14% of those …
Abstract P5-09-16: Multiple mutations in a single lineage: is it time for a shift in predictive testing?
Authors: J Scalia Wilbur, J Laprise, M Beaston, RD Legare
Journal: Cancer Research (2019)

Abstract Germline cancer genetic testing is a critical part of patient care influencing cancer risk reduction, prevention and now treatment decision-making. Single syndrome and mutation testing has been available for twenty years, however massively parallel sequencing technology has made multigene panel tests more readily available and at lower costs. Currently, it remains unclear if there is benefit related to panel testing in cancer families and patients already harboring a pathogenic mutation. We report 5 families found to harbor additional pathogenic mutations identified with multigene panel testing. One Ashkenazi family was found to harbor both a founder and non-founder BRCA mutation in a single lineage. Four additional families were found to harbor a second mutation in either a novel breast/ovary cancer gene or in a gene related to an established cancer syndrome. All patients were either initially BRCA2 or PALB2 positive and were subsequently found to have a second mutation in either CHEK2, RAD51D, ATM, MUTYH or PMS2. In 2 cases, the secondary mutation either increased frequency and/or decreased start age of colonoscopy screening. Interestingly, 2 of the additional mutations were first reported as variants of uncertain significance later reclassified as likely pathogenic. In all cases the traditional approach of single site/syndrome analysis for predictive testing would have failed to identify the second pathogenic mutation resulting in an underestimate of cancer risk in negative family members. Notably, the majority of secondary mutations were present within the same lineage as the known familial mutation. In 3 of 5 cases, the finding of a second mutation in already identified mutation carriers led to additional changes in medical management. As multigene panel testing becomes more accessible in both cost and provider acceptance, this case series illustrates the need to strongly consider use of multigene panel testing for relatives undergoing testing for known familial mutations regardless of family history, and ultimately indicating a role for re-testing established mutation carriers. Citation Format: Scalia Wilbur J, Laprise J, Beaston M, Legare RD. Multiple mutations in a single lineage: is it time for a shift in predictive testing? [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 P5-09-16.
Cancer Immunotherapy: Simultaneous T Cell Activation and Macrophage Polarization to Promote Potent Tumor Suppression by Iron Oxide‐Embedded Large‐Pore Mesoporous Organosilica Core–Shell Nanospheres (Adv. Healthcare Mater. 9/2019)
Authors: Lin Chen, Xiaobo Ma, Meng Dang, Heng Dong, Hongming Hu, Xiaodan Su, Wenfei Liu, Qing Wang, Yongbin Mou, Zhaogang Teng
Journal: Advanced Healthcare Materials (2019)

In article number 1900039, Yongbin Mou, Zhaogang Teng, and co-workers show that iron oxide-embedded large-pore mesoporous organosilica nanospheres (IO-LPMONs) with core-shell structure, high surface area, large mesopores and huge pore volume can initiate DC-based T cell activation and tumor-associated macrophage (TAM) polarization simultaneously. The combined T cell activation and macrophage polarization strategy based on the IO-LPMONs elicits remarkable combined antitumor effects. This study demonstrates that the new-synthesized IO-LPMONs hold excellent potential as an immune modulator for cancer immunotherapy.
The “bubble sign”: a novel way to detect a perforation after cold snare polypectomy
Authors: Joaquín Rodríguez Sánchez, Mónica Sánchez Alonso, María Pellisé Urquiza
Journal: Endoscopy (2019)

To date, there have been no reported perforations with cold snare polypectomy (CSP). Therefore, possible signs of damage in the muscular layer remain unknown. We report the first cases of perforation using cold snare polypectomy, when two polyps < 20 mm in size were removed. Thus we are able to describe a new sign, the "bubble sign," for checking the integrity of the submucosal and muscular layer, that can help to detect potential injury in the colonic wall when cold snare polypectomy is performed.
Abstract 16063: Comparison of Lipid Plaque Composition and Reduction During Percutaneous Coronary Intervention Between Patients With Acute Coronary Syndrome and Stable Angina: A Near-Infrared Spectroscopy Analysis
Authors: Hideaki Ota, Toru Tanigaki, Shuichi Okamoto, Hiroyuki Omori, Tetsuo Hirata, Jun Kikuchi, Yoshiaki Kawase, Munenori Okubo, Hiroki Kamiya, Hitoshi Matsuo
Journal: Circulation (2018)

Background: Most acute coronary syndrome (ACS) patients are caused by rupture of preexisting lipid core plaque (LCP). Furthermore, such LCP may be prone to distal embolization which is associated w...
Doctors need to establish general skills before specialist training, says report
Authors: Kelly Brendel
Journal: BMJ (2012)

Doctors should establish more generalist skills before specialist training to cope with increasing rates of chronic disease, says a report by the Centre for Workforce Intelligence (CfWI).

The report, Informing medical and dental student intakes, is part of an ongoing project to review the future healthcare workforce, and it outlines the long term factors that are anticipated to affect future medical and dental school intakes. One of the factors cited most often was that of rising rates of …
Declining hepatitis C virus-related liver disease burden in the direct-acting antiviral therapy era in New South Wales, Australia
Authors: Maryam Alavi, Matthew G. Law, Heather Valerio, Jason Grebely, Janaki Amin, Behzad Hajarizadeh, Christine Selvey, Jacob George, Gregory J. Dore
Journal: Journal of Hepatology (2019)
Abstract P5-05-14: Withdrawn
Authors: AM Elia, P Rojas, M Liguori, P Gonzalez, I Caillet, P Martínez Vazquez, J Burruchaga, H Gass, C Lanari
Journal: Cancer Research (2019)

Abstract This abstract was withdrawn by the authors. Citation Format: Elia AM, Rojas P, Liguori M, Gonzalez P, Caillet I, Martínez Vazquez P, Burruchaga J, Gass H, Lanari C. 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 P5-05-14.
Abstract P5-03-16: KCNN4 confers multiple chemoresistance in breast cancer
Authors: X Hu, C-G Song
Journal: Cancer Research (2019)

Abstract Multiple chemoresistance is a major unmet clinical obstacle in breast cancer treatment. Here, we uncovered that calcium-activated channel subfamily N member 4 (KCNN4) was an important modulator that limit the cytotoxicity of gemcitabine via a pooled ORF library screen. Importantly, elevating KCNN4 expression enhances the multiple resistance to anti-metabolism chemotherapy drugs, and accelerates cell proliferation. Conversely, silencing or using specific inhibitor, TRAM-34, can counteract its multiple chemoresistance and cell proliferative effects. Mechanically, we found that KCNN4 up-regulated BCL2A1 to suppress cell apoptosis progression via activating RAS-MAPK and PI3K-AKT signaling. In clinical specimens of breast cancer, KCNN4 expression was frequently upregulated and positively correlated with BCL2A1 expression. Moreover, high expression of KCNN4 and BCL2A1 was associated with shorten disease-free survival in studied cohorts. Collectively, our findings showed that KCNN4 was a key modulator in breast tumor progression, implicating that targeting the KCNN4 may serve as a promising therapeutic strategy to overcome multiple chemoresistance in breast cancer. Citation Format: Hu X, Song C-G. KCNN4 confers multiple chemoresistance in breast cancer [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 P5-03-16.
A man with a human bite to the finger
Authors: Kartika Selvam, Kuen Chin, Alok Misra
Journal: BMJ (2013)

A 29 year old man presented to the emergency department with increasing pain, redness, and swelling of his right middle finger. Two weeks previously he had been bitten during an alleged assault, but had not sought medical attention.

Examination of the digit showed a discharging sinus at the distal inter-phalangeal joint level on the dorsal surface, with swelling, localised erythema, tenderness, and reduced active and passive motion (30 degrees active and passive flexion compared with 45 degrees on the opposite side).⇑⇑

Systemically, the patient was apyrexial and had normal vital signs. Routine investigations showed a normal white cell count, a C reactive protein of 52 (normal range: < 5 mg/L). He had two radiographs taken—anteroposterior and lateral. The lateral radiograph is shown.

(1) What does the radiograph show?

(2) Based on the case history and radiograph, what diagnosis does this patient have?

(3) What other investigations may be helpful?

(4) How might this patient be managed?

(5) What are the possible complications of this presentation?

(6) What are the micro-organisms typically isolated in a bite injury?

(1) This is a lateral radiograph of a right index finger, showing soft tissue swelling, …
Work experience—what you should know before you start
Authors: Matthew Billingsley
Journal: BMJ (2015)

One of the major sources of confusion for medical school applicants is work experience: how much to do, where to find opportunities, and what you should be getting out of it. In this article I offer advice on what you should be thinking about before you start work experience placements so you can maximise the time you have to your advantage.

In your personal statement, and later at the interview stage, medical schools are looking for evidence that you have worked with other people either in a caring or service based role and have directly observed some form of healthcare. Guidelines from the Medical Schools Council (MSC) strongly recommend that applicants aim to acquire experience with people who are ill, disabled, or disadvantaged because these are the types of people you are most likely to care for as a doctor.1 However, the guidance places greater emphasis on applicants having experience of helping people than on observing healthcare. The guidance also gives ideas of what you can do if you cannot get experience in a healthcare setting because this shouldn’t put you off applying to medicine.

But what you do is only half the story. I have met students who have proudly told me that they have obtained four hospital placements, but this doesn’t mean a thing if all they can do is repeat what they saw. The MSC states your primary aim in gaining work experience should be to “learn about yourself, about other …
Update on Clinical Trials of Losartan With and Without β-Blockers to Block Aneurysm Growth in Patients With Marfan Syndrome
Authors: Marion A. Hofmann Bowman, Kim A. Eagle, Dianna M. Milewicz
Journal: JAMA Cardiology (2019)

<h3>Importance</h3> Thoracic aortic aneurysms leading to acute aortic dissections are a major cause of morbidity and mortality despite significant advances in surgical treatment, which remains the main intervention to prevent type A dissections. In the past 2 decades progress has been made toward a better understanding of molecular mechanisms that lead to aneurysm formation and dissections of the thoracic aorta. This focused review emphasizes the results of clinical trials using β-blocker, losartan potassium, and irbesartan in patients with Marfan syndrome and comments briefly on mechanisms of aortic remodeling, including fibrosis and transforming growth factor β signaling. <h3>Observation</h3> The major risk factors for the disease are increased hemodynamic forces, typically owing to poorly controlled hypertension, and heritable genetic variants. The altered genes predisposing to thoracic aortic disease have been shown or are predicted to decrease vascular smooth muscle cell contraction, decrease transforming growth factor β signaling, or alter the extracellular matrix. Preclinical models of Marfan syndrome showed promising results for losartan as a potential therapy to attenuate aortic dilation in mice. However, several clinical trials did not conclusively confirm that losartan attenuated aortic aneurysm expansion better than β-blockers. Most importantly, clinical trials assessing whether losartan therapy not only reduces aortic growth but also improves adverse aortic outcomes, including dissection, need for surgery, and death, have not been conducted. The largest trial to date to our knowledge, the Pediatric Heart Network trial, sponsored by the National Heart, Lung, and Blood Institute, showed a nonsignificant increase in adverse aortic outcomes, with almost a doubling of adverse events in patients randomized to losartan treatment compared with β-blockers, suggesting that this study was underpowered to assess adverse aortic outcomes. On the other hand, the evidence for β-blocker therapy to reduce morbidity and mortality in Marfan syndrome is limited to a single small, prospective randomized and nonblinded clinical trial. <h3>Conclusions and Relevance</h3> Taken together, these data emphasize the need for clinical trials adequately powered to assess both aortic aneurysm growth and adverse aortic outcomes to identify effective medical therapies for Marfan syndrome and other aortopathies.
Abstract 14837: Role of Coronary Computed Tomography Angiography in Patients Scheduled for Carotid Artery Revascularization: Preoperative Assessment of Coronary Stenotic Severity and Plaque Characteristics Change Treatment Strategies
Authors: Meiko Miyagi, Hideki Kawai, Masayoshi Sarai, Sadako Motoyama, Yasuomi Nagahara, Keiichi Miyajima, Hiroshi Takahashi, Junnichi Ishii, Yukio Ozaki
Journal: Circulation (2017)

Introduction: Coronary artery atherosclerosis in patients scheduled for carotid artery revascularization has not been fully clarified. We aimed to evaluate the stenotic severity and plaque characte...
Abstract P2-08-08: Isolated ipsilateral local recurrence of breast cancer: Predictive factors and prognostic impact
Authors: G Houvenaeghel, A de Nonneville, M Cohen, J-M Classe, F Reyal, C Mazouni, N Chopin, A Martinez, E Daraï, C Coutant, P-E Colombo, P Gimbergues, M-P Chauvet, A-S Azuar, R Rouzier, C Tunon de Lara, X Murraciole, A Agostini, A Gonçalves, E Lambaudie
Journal: Cancer Research (2019)

Abstract Background Tumour features associated with isolated invasive breast cancer ipsilateral local recurrence (ILR) after breast conservative treatment (BCT) and consequences on overall survival (OS) are still debated. The aim of our study was to examine predictive factors of isolated ILR after BCT with in sano resection and whole breast irradiation as well as the impact of such an ILR on overall survival in a large multi-institutional cohort. Methods Patients were retrospectively identified from a large cohort of 23,375 consecutive patients who underwent BCT for invasive breast cancer in 16 cancer centres. End-points were ILR rate and OS. The impact of ILR on OS was assessed through multivariate analysis by logistic regression and Cox model, adjusted on ERs/Grade status (ERs+/Grade 1, ERs+/Grade 2, ERs+/Grade 3 and ERs-) and then on tumour subtypes. Results Of 15,570 patients, ILR rate was 3.1%. Cumulative ILR rates differed according to ERs/grade (ERs+/Grade2: HR=1.42, p=0.010; ERs+/Grade3: HR=1.41, p=0.067; ERs-: HR=2.14, p&amp;lt;0.0001), endocrine therapy (HR=2.05, p&amp;lt;0.0001) and age&amp;lt;40-years old (HR=2.28, p=0.005) in multivariate analysis. When multivariate analysis was adjusted on tumour subtype, the latter was the only independent factor. OS-after-ILR was significantly different according to ILR-free intervals (HR=4.96 for ILR-free interval between 2-5-years and HR=9.00 when &amp;lt;2-years, in comparison with ≥5-years). Impact of free interval time on OS among patients with ILR and among all patients p-valueHRInfSupILRno ILR 1 &amp;lt;2 years0.0172.2551.1594.388 2-5 years0.0012.451.423.89 ≥5 years0.1030.5550.2741.126Tumor subtypesLuminal A G1 1 Luminal A G20.0031.4311.1321.810 Triple negative&amp;lt;0.00012.6992.0553.544 Luminal B ER-&amp;lt;0.00013.1952.4144.229 Luminal B ER+0.021.6081.0762.401 HER2+&amp;lt;0.00012.2791.4523.579 Conclusion ERs/Grade status, lack of endocrine therapy and tumour subtypes predict isolated ILR risk in patients treated with BCT. Short ILR-free-intervals represent a strong pejorative factor for OS. These results may help selecting initial treatment as well as tailoring ILR systemic chemotherapy. Citation Format: Houvenaeghel G, de Nonneville A, Cohen M, Classe J-M, Reyal F, Mazouni C, Chopin N, Martinez A, Daraï E, Coutant C, Colombo P-E, Gimbergues P, Chauvet M-P, Azuar A-S, Rouzier R, Tunon de Lara C, Murraciole X, Agostini A, Gonçalves A, Lambaudie E. Isolated ipsilateral local recurrence of breast cancer: Predictive factors and prognostic impact [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 P2-08-08.