Nationwide Survival Benefit after Implementation of First-Line Immunotherapy for Patients with Advanced NSCLC-Real World Efficacy.

Background The selection of patients with non-small cell lung cancer (NSCLC) for immune checkpoint inhibitor (ICI) treatment remains challenging. This real-world study aimed to compare the overall survival (OS) before and after the implementation of ICIs, to identify OS prognostic factors, and to assess treatment data in first-line (1L) ICI-treated patients without epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Methods Data from the Danish NSCLC population initiated with 1L palliative antineoplastic treatment from 1 January 2013 to 1 October 2018, were extracted from the Danish Lung Cancer Registry (DLCR). Long-term survival and median OS pre- and post-approval of 1L ICI were compared. From electronic health records, additional clinical and treatment data were obtained for ICI-treated patients from 1 March 2017 to 1 October 2018. Results The OS was significantly improved in the DLCR post-approval cohort (n = 2055) compared to the pre-approval cohort (n = 1658). The 3-year OS rates were 18% (95% CI 15.6-20.0) and 6% (95% CI 5.1-7.4), respectively. On multivariable Cox regression, bone (HR = 1.63) and liver metastases (HR = 1.47), performance status (PS) 1 (HR = 1.86), and PS ≥ 2 (HR = 2.19) were significantly associated with poor OS in ICI-treated patients. Conclusion OS significantly improved in patients with advanced NSCLC after ICI implementation in Denmark. In ICI-treated patients, PS ≥ 1, and bone and liver metastases were associated with a worse prognosis.

Hutchinson's sign of ophthalmic zoster.

A 77-year-old woman presented with ophthalmic zoster and nasal tip involvement, consistent with Hutchinson's sign. Ocular examination disclosed a swollen upper eyelid, chemosis, conjunctival injection, pus, and mild corneal endothelial decompensation. The presence of Hutchinson's sign requires urgent consultation with an ophthalmologist due to the high risk of ocular complications.

[Christmas article: Consumption of chocolate vs candy in a Danish emergency department].

INTRODUCTION: The main objective of this single-centre, prospective, observational study was to compare the survival rate of chocolate with that of candy among healthcare professionals working in an emergency department. Secondary objectives included comparisons of cumulative weight, calorie count, and cost of consumed chocolate vs candy. METHODS: On five separate occasions, an observer with recurring duty in the emergency department placed 56 pieces of milk chocolate (30% cocoa) and 56 pieces of candy (wine gum and liquorice) next to each other in standard, disposable bowls, in one of two prespecified locations. These bowls were continuously monitored for two hours. The primary outcome, i.e., the survival of chocolate vs candy, was evaluated using Kaplan-Meier analysis with the log-rank test and Cox proportional hazards regression. Secondary outcomes were compared using unpaired t-test. RESULTS: Of the 560 pieces of sweets distributed 257 were consumed, 108 pieces of chocolate and 149 pieces of candy. The survival of chocolate was significantly longer than that of candy, hazard ratio for chocolate vs candy was 0.66 (95% confidence interval: 0.52-0.85), p = 0.001. Chocolate was responsible for significantly more weight eaten (771 g vs 497 g), calories consumed (4,243 kcal vs 1,723 kcal), and cost (81 SEK vs 38 SEK), p < 0.001 for all. CONCLUSION: Pieces of chocolate survived significantly longer than pieces of candy. FUNDING: none. TRIAL REGISTRATION: not relevant.

The effect of dietary carbohydrates in women with polycystic ovary syndrome: a systematic review.

Weight loss improves ovulation, testosterone levels and insulin resistance in women with polycystic ovarian syndrome (PCOS), but the optimal diet composition is disputed. A diet low in carbohydrates (LCD) may be superior to a standard diet in terms of improving fertility, endocrine/metabolic parameters, weight loss and satiety in women with PCOS. The aim of the present study was to review the literature on the effects of LCD in PCOS, and to summarize the findings into evidence-based guidelines. A literature review based on publications in PubMed and Cochrane was carried out. The outcomes during LCD were compared to other types of diet interventions and exercise. Studies including insulin-sensitizing agents, such as metformin, were excluded. The outcomes were fertility, endocrine/metabolic parameters, weight loss and satiety. The review resulted in fifteen articles. Fertility parameters, endocrine hormones, metabolic outcomes and satiety hormones were not further improved during LCD compared to a standard diet. LCD had a 1-5% significant additional effect on weight loss compared to a standard diet. Energy restriction and weight loss in PCOS improve ovulation rates, conception, hyperandrogenemia, glucose- and insulin levels, insulin resistance and satiety hormones, whereas diet composition is of less importance. A LCD has an additional effect to caloric restriction in terms of weight loss. Conclusions are summarized as evidence-based recommendations.