Underuse of adjuvant therapy is a potentially important and remediable explanation for the inferior survival of minority women with breast cancer. We sought to measure a racial disparity in the ...underuse of adjuvant treatments for early-stage breast cancer and to identify associated factors.
Cross-sectional study with review of all inpatient and outpatient medical records of 677 women treated surgically for a primary American Joint Committee on Cancer stage I or II breast cancer in 1999 to 2000. Underuse was defined as omissions of radiation therapy after breast-conserving surgery, adjuvant chemotherapy after resection of hormone-receptor-negative tumors > or = 1 cm, or hormonal therapy for receptor-positive tumors > or = 1 cm.
One hundred forty-five (21%) of 677 women experienced underuse of appropriate adjuvant therapy: 16% in whites, 34% in blacks, and 23% in Hispanics (P < .001). Women referred to medical oncologists were less likely to experience underuse of necessary adjuvant treatments (relative risk RR for underuse = 0.2; 95% CI, 0.1 to 0.3). Women who were minorities (RR = 2.0; 95% CI, 1.3 to 3.1), had higher levels of comorbidity (RR = 1.4; 95% CI, 1.1 to 1.8) and lacked insurance (RR = 1.9; 95% CI, 0.9 to 4.0) were at greater risk for underuse.
Minority women with early-stage breast cancer have double the risk of white women for failing to receive necessary adjuvant treatments despite rates of oncologic consultation similar to those for white women. Oncology referrals are necessary to reduce treatment disparities but are not sufficient to ensure patients' receipt of efficacious adjuvant treatment.
The co‐inhibitory checkpoint molecule programmed death receptor 1 (PD‐1) can trigger T cell functional exhaustion upon binding to its ligand PD‐L1 expressed on tumour cells or macrophages. PD‐1 ...blocking antibodies have generated remarkable results in human cancer patients, including inducing durable responses in a number of advanced cancers. Therefore, monoclonal antibodies specific for canine PD‐1 were assessed for T cell binding and induction of functional activation. A total of 5–10% of CD4 T cells and 20–25% of CD8 T cells from healthy dogs expressed PD‐1, and PD‐1 expression was upregulated on T cells from dogs with cancer. Functionally, PD‐1 antibodies significantly enhanced T‐cell activation, as assessed by proliferation and interferon‐gamma (IFN‐γ) production. PD‐1 antibodies also reversed T‐cell suppression induced by canine soluble PD‐L1 and by tumour cells and tumour explant fragments. These findings indicate that PD‐1 antibodies have potential for use in cancer immunotherapy in dogs.
Immunotherapies targeting checkpoint molecule programmed cell death 1 (PD‐1) protein were shown to be effective for treatment of non‐Hodgkin lymphoma in people, but little is known about the ...expression of PD‐1 or its ligand PD‐L1 by canine lymphoma. Therefore, flow cytometry was used to analyse expression of PD‐1 and PD‐L1 in canine lymphoma, using fine‐needle aspirates of lymph nodes from 34 dogs with B cell lymphoma (BCL), 6 dogs with T cell lymphoma (TCL) and 11 dogs that had relapsed. Furthermore, fine‐needle aspirates were obtained from 17 healthy dogs for comparison. Lastly, the impact of chemotherapy resistance on expression of PD‐1 and PD‐L1 was assessed in vitro. These studies revealed increased expression of PD‐L1 by malignant B cells compared to normal B cells. In the case of TCL, tumour cells and normal T cells both showed low to negative expression of PD‐1 and PD‐L1. In addition, tumour infiltrating lymphocytes from both BCL and TCL had increased expression of both PD‐1 and PD‐L1 expression compared to B and T cells from lymph nodes of healthy animals. In vitro, chemotherapy‐resistant BCL and TCL cell lines exhibited increases in both PD‐1 and PD‐L1 expression, compared to non‐chemotherapy selected tumour cells. These findings indicate that canine lymphomas exhibit upregulated checkpoint molecule expression, though the impact of checkpoint molecule expression on tumour biological behaviour remains unclear.
Advances in bioelectrical impedance analysis (BIA) permit the assessment of lymphedema by directly measuring lymph fluid changes. The objective of the study was to examine the reliability, ...sensitivity, and specificity of cross-sectional assessment of BIA in detecting lymphedema in a large metropolitan clinical setting. BIA was used to measure lymph fluid changes. Limb volume by sequential circumferential tape measurement was used to validate the presence of lymphedema. Data were collected from 250 women, including healthy female adults, breast cancer survivors with lymphedema, and those at risk for lymphedema. Reliability, sensitivity, specificity and area under the ROC curve were estimated. BIA ratio, as indicated by L-Dex ratio, was highly reliable among healthy women (ICC=0.99; 95% CI = 0.99 - 0.99), survivors at-risk for lymphedema (ICC=0.99; 95% CI = 0.99 - 0.99), and all women (ICC=0.85; 95% CI = 0.81 - 0.87); reliability was acceptable for survivors with lymphedema (ICC=0.69; 95% CI = 0.54 to 0.80). The L-Dex ratio with a diagnostic cutoff of >+7.1 discriminated between at-risk breast cancer survivors and those with lymphedema with 80% sensitivity and 90% specificity (AUC=0.86). BIA ratio was significantly correlated with limb volume by sequential circumferential tape measurement. Cross-sectional assessment of BIA may have a role in clinical practice by adding confidence in detecting lymphedema. It is important to note that using a cutoff of L-Dex ratio >+7.1 still misses 20% of true lymphedema cases, it is important for clinicians to integrate other assessment methods (such as self-report, clinical observation, or perometry) to ensure the accurate detection of lymphedema.
Many species of reef-building corals are mixotrophic, relying on both photoautotrophy performed by their dinoflagellate symbionts and heterotrophy from consumption of zooplankton. Autotrophy and ...heterotrophy supply corals with specific
ω
3 fatty acids, which can be used as trophic markers and record the contribution of each feeding strategy. This study investigated whether the reef-building coral
Mussismilia hispida
, endemic to Brazil, is able to shift between predominantly autotrophic and predominantly heterotrophic by monitoring the concentration of fatty acids in the host tissue. We then examined whether shifts are related to changes in temperature and wind stress. For that purpose,
M. hispida
colonies were monitored for a year with monthly tissue sampling. Symbiont concentration was determined and lipid extraction performed. Four fatty acids were quantitatively analyzed by gas chromatography with flame ionization detector: the autotrophy markers: stearidonic acid (SDA), docosapentaenoic acid (DPA), docosahexaenoic acid (DHA), and a heterotrophy marker: cis-gondoic acid (CGA). Three preliminary experiments confirmed the specificity of SDA, DPA and CGA, but not of DHA. Shifts of predominance occurred multiple times during the year and were associated with minimal temperatures and wind stress. Colonies underwent mild bleaching during summer months, which they seemed to compensate with heterotrophic feeding. Our major findings include the validation of three FATM and a trophic index for coral reef ecology studies and also describing the in situ occurrences of shifts between feeding modes, while highlighting the role of temperature and meteorological events.
Within two months, the World Health Organization (WHO)Advisory Committee on Medical Research met and discussed the need to "coordinate and stimulate biomedical research through bilateral and ...multinational arrangements," and to apply "advances in knowledge in basic biology to urgent medical and public health problems." TDR principles: * Research carried out in the countries where the diseases occur and by scientists from those countries. * Long-term commitment to strengthening research capacity. * Partnership model--for identifying research priorities, setting up multidisciplinary projects, and managing these projects. * Organizational sponsorship and structure within the UN system, and a governance model that provides equitable input from low-, middle-, and high-income countries. * Continual assessment of progress and flexibility in changing the strategy and priorities.
The SARS-CoV-2 (COVID-19) pandemic is a global event with unprecedented impact on individuals and communities around the world. The purpose of this study is to use a modified photo-elicitation ...methodology to examine the impact of the COVID-19 pandemic on the lives of medical students and their communities around the world.
Participating medical students were asked to take photographs for 14 days. In lieu of an interview, which is customary for photo-elicitation projects, participants were asked to share a reflection (a paragraph or two) for each photograph they contributed to the study.
Between April 27th, 2020 and May 11th, 2020 26 students from 19 medical schools across 13 countries shared photographs and reflections. Qualitative analysis of written reflections revealed that medical students felt the impact of the pandemic on several levels 1) individual, 2) interpersonal, 3) educational, and 4) societal.
The COVID-19 pandemic has impacted the lives of medical students on multiple levels. As individuals, students felt emotional distress but found resilience through physical activity and the establishment of new routines. Many students felt isolated as their interpersonal relationships were confined due to social distancing measures. These feelings could be combated with new educational initiatives focused on group collaboration. Lastly, students reflecting on the larger societal implications were concerned with the economic ramifications of the virus and its impact on their future. This study brought together students from several different countries to engage in an applied learning program as a model for equitable global health research.
Coral reefs are diverse ecosystems relying on the presence of dinoflagellates (genus
Symbiodinium
), that are found in symbiotic association with multiple phyla and performing the majority of primary ...production. However, coral reefs are currently threatened by climate change and the increase in seawater temperature, which causes the bleaching phenomenon. While bleaching has been well documented for adult host organisms, it is still poorly understood in larval stages. We offered
Symbiodinium
types within clades A–F to the larvae of
Mussismilia hispida
(scleractinian coral),
Berghia stephanieae
(nudibranch) and
Tridacna crocea
(giant clam) and manipulated the temperature to 26, 29 or 32 °C. Samples were taken at 0, 12, 24, 48 and 72 h post-temperature increase, chlorophyll-
a
(chl-
a
) was extracted and its content measured in a fluorometer.
Symbiodinium
type, temperature and time all influenced chl-
a
content.
M. hispida
larvae displayed a bleaching threshold at 29 °C; larvae containing
Symbiodinium
A–F all bleached at 32 °C, but with significantly lower bleaching in larvae associated with type A1.
B. stephanieae
digested the symbionts; while chl-
a
content decreased over time equally for all clades, it is not possible to determine if it is related to bleaching.
T. crocea
larvae at 29 °C bleached for all symbiont types, except for A1. At 32 °C, all types were bleached, but type A1 bleached significantly less. These findings show that type A1 seems to be more thermo-tolerant in larvae of the tested species. This may be related to the fact that strains within this clade are homologous to both
M. hispida
and
T. crocea
, as they are found within these adult host’ tissues. Therefore, symbiont type may have an important role in invertebrate larvae development and present relevant implications for recruitment.
Background
Despite recent advances in breast cancer treatment, breast cancer related lymphedema (BCRL) continues to be a significant problem for many survivors. Some BCRL risk factors may be largely ...unavoidable, such as mastectomy, axillary lymph node dissection (ALND), or radiation therapy. Potentially avoidable risk factors unrelated to breast cancer treatment include minor upper extremity infections, injury or trauma to the arm, overuse of the limb, and air travel. This study investigates how providing information about BCRL affects the cognitive and symptomatic outcome of breast cancer survivors.
Methods
Data were collected from 136 breast cancer survivors using a Demographic and Medical Information interview instrument, a Lymphedema Education Status interview instrument, a Knowledge Test for cognitive outcome
,
and the Lymphedema and Breast Cancer Questionnaire for symptom outcome
.
Data analysis included descriptive statistics,
t
tests, chi-square (χ
2
) tests, and regression.
Results
BCRL information was given to 57% of subjects during treatment. The mean number of lymphedema-related symptoms was 3 symptoms. Patients who received information reported significantly fewer symptoms and scored significantly higher in the knowledge test. After controlling for confounding factors, patient education remains an additional predictor of BCRL outcome. Significantly fewer women who received information about BCRL reported swelling, heaviness, impaired shoulder mobility, seroma formation, and breast swelling.
Conclusions
Breast cancer survivors who received information about BCRL had significantly reduced symptoms and increased knowledge about BCRL. In clinical practice, breast cancer survivors should be engaged in supportive dialogues so they can be educated about ways to reduce their risk of developing BCRL.
The coronavirus disease 2019 (COVID-19) pandemic has substantially changed life worldwide in 2020. This also influences the psychological treatment options of patients with headache.
The present ...article intends to illustrate the different psychological forms of treatment for headache patients and their implementation during the COVID-19 pandemic.
Literature review and case reports.
Even during the COVID-19 pandemic, psychological treatment enables the increased stress level in headache patients to be counteracted by using cognitive behavioral therapy and relaxation techniques. The changed living conditions are often unfavorable but sometimes also favorable in the course of disease. It can be shown that even during the pandemic, such favorable changes can be used to support patients to cope with their headache.
The digital implementation of psychological approaches makes a major contribution to maintaining psychological treatment of headache patients, so that the individually changed needs can be addressed. With respect to content, stress regulation techniques and increased acceptance gain in importance. Regarding biofeedback there are limitations, which may be overcome by improved technical devices.
PDF
