Development of metastasis in peripheral tissues is a major problem in the fight to cure breast cancer. Although it is becoming evident that chronic inflammation can contribute to tumor progression and metastasis, the effect of acute inflammation in primary tumor is less known. Using mouse models for breast cancer here we show that biopsy of mammary tumors increases the frequency of lung metastases. This effect is associated with the recruitment of inflammatory cells to the lung and elevated levels of certain cytokines such as IL-6 in the lung airways. Antiinflammatory treatment prior to and after the biopsy reduces the development of metastases triggered by the biopsy. In addition, while lack of IL-6 does not affect primary tumor development, it protects from increasing number of metastases upon biopsy. Thus, our studies show that in addition to chronic inflammation, acute immune response caused by invasive procedures in the primary tumor may cause an increased risk on peripheral metastases, but the risk could be decreased by anti-inflammatory treatments.
A high proportion of triatomine insects, vectors for Trypanosoma cruzi trypanosomes, collected in Arizona and California and examined using a novel assay had fed on humans. Other triatomine insects were positive for T. cruzi parasite infection, which indicates that the potential exists for vector transmission of Chagas disease in the United States.
as "other" race (4.17 [1.17]), African Americans (3.96 [1.16]), Hispanic/Spanish/Latinos (4.00 [1.08]), and those with household incomes between $20 000 and $40 0000 (4.19 [1.17]). Racial minorities and low-income students were more likely to cite socioeconomic barriers, such as lack of loan forgiveness. The highest values were reported by those identifying as other races (4.50 [0.84]) and those with household incomes less than $20 000 (4.78 [0.44]). Hispanic/Spanish/ Latino students (4.79 [0.43]) and those with household incomes less than $20 000 (4.89 [0.33]) reported the highest scores for poor accessibility to mentors, especially with which students can identify.Study limitations included calculating accurate response rates (medical student respondents/number of medical students who received survey); participants may not represent all US medical students; and not all minority groups are underrepresented in medicine. Asians were included as minorities because 50.0% of respondents were born outside of the United States (n = 21), and 37.5% (n = 15) had a first language other than English. These participants are likely to have an "additional distance traveled," a higher likelihood of addressing health care disparities, and may demonstrate "grit" compared with their peers. 6 Study strengths include a diverse cohort representing many medical schools.
Discussion | Overall, participants cited US Medical Licensing ExaminationStep 1, clinical grades, and the risk of not matching as the most important barriers to applying for a dermatology residency. However, minority students reported the lack of diversity, perceived negative perceptions of minority students by residencies, socioeconomic factors, and lack of mentors as major barriers. The perceived barriers differ by the racial, ethnic, and socioeconomic backgrounds of students and highlight the need to actively recruit and mentor students of all backgrounds. Furthermore, efforts should be made to increase minority students' exposure to dermatology by incorporating it into the curriculum, providing research opportunities, and reducing the cost of "visiting electives" by providing stipends.
Patients who attended OH consultations with a companion felt the companion was beneficial to the consultation and did not have concerns about personal issues. OH physicians felt that further guidance and training on accompanied consultations would be useful. Written information could usefully be provided to patients attending an OH consultation with a companion.
Despite the low return rate for questionnaires, this survey has helped identify themes which are important to physicians practising occupational medicine and has also highlighted those which are less important for inclusion in a CPD programme. Some differences in responses were identified between accredited specialists, specialist registrars and non-specialist practitioners of occupational medicine. The findings from this survey should be useful to providers of continuing medical education in planning courses, study days and electronic or distance learning educational packages.
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