Effect of orbital wall resection areas in the treatment of patients with endocrine orbitopathy

In patients treated by orbital wall decompression for endocrine orbitopathy (EO) there is limited evidence on the effect of orbital wall resections. Thus, the aim of this study was to evaluate the effect of one, two, and three-wall resections on orbital parameters to determine if any such correlations exist. Preoperative and postoperative data from all patients at a tertiary care centre who underwent decompression surgery from 2010 - 2020 were digitally analysed. The effect of the number and area of resected walls on orbital area, orbital volume, and Hertel value, and the effect of lateral rim advancement (LARA) were determined. A total of 131 orbital areas showed an increase from a mean (SD) preoperative area of 42.0 (4.6) cm² to 47.3 (6.1) cm² postoperatively (p<0.001). In total, the mean (SD) area of osseous wall removed in all patients was 6.2 (1.7) cm² at the lateral orbit (n = 129), 6.7 (2.3) cm² at the orbital floor (n = 123), and 5.8 (1.8) cm² at the medial orbital wall (n =30). The mean (SD) orbital volume increased by 6.0 (3.0) cm³ after decompression. There was also a significant reduction in exophthalmos of 7.3 (3.2) mm (from 25.2 (3.9) to 17.9 (3.5), p<0.001). LARA was performed in 50 patients. Changes in volume and area, and reduction in exophthalmos were not significantly different with or without LARA. The postoperative effects of orbital wall resection are predictable and exhibit a relation with six units of change. Two-wall resection is the most common intervention.     

激素受体阳性乳腺癌患者在不同内分泌治疗用药时间的类更年期症状及生命质量

目的探讨激素受体阳性(HR+)乳腺癌患者在不同内分泌治疗时间的类更年期症状和生命质量状况。方法采用横断面研究设计,收集2011—2017年就诊于四川省肿瘤医院经病理确诊的167例HR+乳腺癌患者,按内分泌治疗时间分为<12个月组、12~36个月组、>36个月组。应用改良Kupperman量表和乳腺癌生命质量测定量表(FACT-B)测量类更年期症状和生命质量。采用方差分析及χ2检验比较不同用药时间及用药类型患者的类更年期症状差异,采用协方差分析和多重线性回归分析不同用药时间患者的生命质量得分差异和类更年期症状对生命质量的影响。结果167例乳腺癌患者的类更年期症状得分为(14.5±7.6)分,现患率为87.4%(146/167),以失眠率最高(73.7%,123/167)。除失眠易激动外,选择性雌激素受体调节剂(SERM)使用者以潮热症状最多(64.8%,79/122),芳香化酶抑制剂使用者以骨关节痛症状最多(62.2%,28/45)。患者的FACT-B总得分为(104.5±15.5)分,达标率高达89.8%(150/167),但各维度状况参差不齐,以社会家庭及功能维度达标率最低,分别为73.0%(122/167)和50.9%(85/167)。<12个月组、12~36个月组和>36个月组患者的Kupperman总分分别为(15.0±1.3)分、(14.0±6.9)分和(14.5±7.4)分;FACT-B总得分分别为(102.7±17.8)分、(105.0±12.9)分和(105.6±16.7)分,差异均无统计学意义(均P>0.05)。多重线性回归分析结果显示,患者服用SERM类药物期间类更年期症状对生命质量存在负向影响,<12个月组、12~36个月组和>36个月组患者的标准偏回归系数分别为-0.67、-0.30和-0.50,影响程度在12~36个月组中最小。结论HR+乳腺癌患者回归社会、家庭和功能恢复情况较差,应重点关注。类更年期症状在内分泌治疗期间普遍存在,应积极处理以改善生命质量。     

复发性流产患者病因构成分析

背景　复发性流产（RSA）发病率呈逐年上升趋势，严重影响妇女身心健康，目前现代医学对RSA的病因和发病机制尚未完全明确。目的　了解RSA病因的分布情况，以及流产孕周与流产次数和RSA病因之间的关系。方法　选取2018年在新疆医科大学第二附属医院确诊为RSA的患者198例，收集患者的一般资料包括年龄、自然流产次数、流产孕周，并筛查患者的病因：染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常等，并对这些资料进行回顾性分析。根据患者的流产孕周，分为早期RSA组（<12周）（155例）和晚期RSA组（≥12周）（43例）；根据流产次数分为2次组（123例）和≥3次组（75例）。分析RSA患者各病因所占比例，以及RSA病因在不同流产孕周组和不同流产次数组间的差异。结果　198例RSA患者，染色体异常9例（4.55%），生殖道解剖结构异常11例（5.56%），内分泌系统异常36例（18.18%），生殖道感染14例（7.07%），自身免疫异常30例（15.15%），不明病因98例（49.49%）。晚期RSA组患者生殖道解剖结构异常发生率大于早期RSA组，不明病因发生率低于早期RSA组（P<0.05）；早期RSA组与晚期RSA组患者染色体异常、内分泌系统异常、生殖道感染、自身免疫异常发生率比较，差异均无统计学意义（P>0.05）。流产次数2次组和流产次数≥3次组患者染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常、不明病因发生率比较，差异均无统计学意义（P>0.05）。结论　导致RSA的病因有多种，包括染色体异常、生殖道解剖结构异常、内分泌系统异常、生殖道感染、自身免疫异常及不明病因等多种因素，其中不明病因的RSA占多数；生殖道解剖结构异常对妊娠晚期的影响大于妊娠早期。     

乳腺癌内分泌治疗患者症状评估量表的编制和信效度检验

目的 根据乳腺癌内分泌治疗患者的症状特征,编制适用于我国乳腺癌内分泌治疗患者的症状评估量表,并检验其信效度。方法 在文献回顾及参照现有症状评估量表的基础上编制量表初始条目池;通过2轮德尔菲专家函询,形成初始版量表;通过对11例患者的认知性访谈,对量表条目进一步修订,形成临床测试版量表。便利选取2020年7月—9月在浙江省某三级甲等肿瘤医院门诊或住院的325例乳腺癌内分泌治疗患者进行问卷调查,检验量表信效度。 结果 形成的最终版乳腺癌内分泌治疗患者症状评估量表包括33个条目,探索性因子分析提取7个公因子,累计方差贡献率为68.76%;各条目内容效度指数为0.78~1.00,量表内容效度指数为0.91;内在相关性检验结果显示,量表各维度与总量表相关系数为0.58~0.79（P<0.05）;维度间相关系数为0.26~0.52（P<0.05）;总量表Cronbach’s α系数为0.94,重测信度为0.95,折半信度为0.84。结论 编制的乳腺癌内分泌治疗患者症状评估量表具有良好的信效度,适用于相关人群的症状测评。     

Bone mineral density changes after parathyroidectomy are dependent on biochemical profile

Background

Bone mineral density (BMD) has been found to improve after parathyroidectomy (PTX) in patients with primary hyperparathyroidism. There are few data on the effect of PTX on BMD in normocalcemic and normohormonal primary hyperparathyroidism.

The association between endocrine therapy use and osteoporotic fracture among post-menopausal women treated for early-stage breast cancer in Ontario,Canada

BackgroundThe use of endocrine therapy for early-stage breast cancer, particularly aromatase inhibitor therapy has been associated with an increased risk of osteoporosis and fracture in clinical trials. We sought to validate this observation in real-world practice.MethodsWe used health administrative data collected from post-menopausal women (aged ≥66 years) who were diagnosed with breast cancer and started on adjuvant endocrine therapy from 2005 to 2012. Patients were classified by use of either an aromatase inhibitor or tamoxifen and followed until 2017 for a new diagnosis of an osteoporotic fracture. A multivariable analysis using a Cox proportional hazards model was adjusting for age, medical co-morbidities, medication use and duration of endocrine therapy.ResultsWe identified 12,077 patients of whom 73% were treated with an aromatase inhibitor as compared to 27% with tamoxifen. Our multivariable analysis did not demonstrate any significant difference in the rate of osteoporotic fracture between patients treated with an aromatase inhibitor when compared with tamoxifen [Hazard ratio (HR) = 1.09; 95% confidence interval (CI) = 0.96–1.23, p-value = 0.18]. The 5-year rate of osteoporotic fracture for patients treated with either an aromatase inhibitor or tamoxifen was 7.5% and 6.9%, respectively. A completed sensitivity analysis did observe a decreased risk of fracture associated with tamoxifen usage over time.ConclusionWe could not detect a significant difference in the rate of osteoporotic fracture among patients treated with an aromatase inhibitor versus tamoxifen. Nonetheless, the risk with tamoxifen was numerically lower and significantly decreased when accounting for total duration of endocrine therapy.     

A Phase II Open Label Study of Everolimus in Combination With Endocrine Therapy in Resistant Hormone Receptor-Positive HER2-Negative Advanced Breast Cancer

BackgroundTherapies targeting estrogen receptor signaling are standard for patients with hormone receptor (HR)-positive (HR⁺) metastatic breast cancer (MBC). Dysregulation of the phosphoinositol 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) pathway is associated with treatment resistance. Addition of the mTOR inhibitor, everolimus, to exemestane doubled progression-free survival (PFS) in HR⁺/HER2⁻ MBC patients whose disease had previously progressed during endocrine therapy. In this phase II study, we used everolimus in addition to the most recent endocrine therapy during which a patient's disease progressed, in an attempt to restore and extend the benefit of the antiestrogen therapy in patients with HR⁺/HER2⁻ MBC.Patients and MethodsPatients with HR⁺ MBC who progressed on antiestrogen therapy received everolimus (10 mg orally daily) in combination with the antiestrogen therapy most recently administered. Treatment was administered in 4-week cycles and continued until disease progression or unacceptable toxicity. Blood and archival tumor specimens were collected for VeriStrat (Biodesix, Inc) and Foundation One (Foundation Medicine) assays, respectively. Accrual of 42 evaluable patients allowed detection of improvement in median PFS from 2.8 months (expected with hormonal treatment alone) to 5 months (power 80%, α = 5%).ResultsForty-seven patients were enrolled and treated. After a median follow-up of 22.2 months, median PFS was 6.6 months. Secondary efficacy end points included: overall response rate, 6%; clinical benefit rate, 40%; and median overall survival, 21.1 months. No unexpected toxicity was observed. Efficacy could not be correlated with PI3K/AKT/mTOR alterations or VeriStrat (Biodesix, Inc) prognostic signatures.ConclusionAfter progression during antiestrogen therapy, the addition of everolimus, without changing the hormonal therapy, resulted in a median PFS of 6.6 months, suggesting efficacy in patients with HR⁺/HER2⁻ MBC.     

Prenatal exposure to phthalates and male reproductive system development: Results from a Canadian pregnancy cohort study

Our objective was to determine if maternal first trimester urinary phthalate concentrations are associated with reduced penile length (PL) or width (PW) at birth in full term singletons.First trimester phthalate metabolite urinary concentrations were obtained from mothers participating in a Canadian pregnancy cohort study (MIREC). PL and PW were measured shortly after birth in the male offspring. Univariate and multivariable linear regressions were performed to study associations between maternal phthalate exposure and penile measurements, adjusting for confounders.On univariate analysis of 170 mother-infant pairs, PW showed an inverse relationship with the concentration of mono-3-carboxypropyl phthalate (MCPP-p = 0.016), which was not confirmed on multivariable analysis. On multivariable analysis controlling for infant’s size and other confounders, no statistically signficant associations between phthalate metabolite concentrations and PL or PW were identified.In this population of Canadian women, there was no strong evidence to suggest an association between maternal first trimester urinary phthalates with PL or PW in term singletons.